Boehnke Kevin F, Yakas Laura, Scott J Ryan, DeJonckheere Melissa, Litinas Evangelos, Sisley Suzanne, Clauw Daniel J, Williams David A, McAfee Jenna
Anesthesiology Department, University of Michigan Medical School, Ann Arbor, MI, USA.
Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
J Cannabis Res. 2022 Jan 11;4(1):7. doi: 10.1186/s42238-021-00116-7.
The wide heterogeneity of available cannabis products makes it difficult for physicians to appropriately guide patients. In the current study, our objective was to characterize naturalistic cannabis use routines and explore associations between routines and reported benefits from consuming cannabis.
We performed a mixed methods analysis of n=1087 cross-sectional survey responses from adults with self-reported chronic pain using cannabis for symptom management in the USA and Canada. First, we qualitatively analyzed responses to an open-ended question that assessed typical cannabis use routines, including administration routes, cannabinoid content, and timing. We then sub-grouped responses into categories based on inhalation (smoking, vaporizing) vs. non-inhalation (e.g., edibles). Finally, we investigated subgroups perceptions of how cannabis affected pain, overall health, and use of medications (e.g., substituting for opioids, benzodiazepines). Substitutions were treated as a count of medication classes, while responses for both pain and health were analyzed continuously, with - 2 indicating health declining a lot or pain increasing a lot and 2 indicating that health improved a lot or pain decreased a lot.
Routines varied widely in terms of administration routes, cannabinoid content, and use timing. Overall, 18.8%, 36.2%, and 45% used non-inhalation, inhalation, and non-inhalation + inhalation routes, respectively. Those who used inhalation routes were younger (mean age 46.5 [inhalation] and 49.2 [non-inhalation + inhalation] vs. 56.3 [inhalation], F=36.1, p<0.001), while a higher proportion of those who used non-inhalation routes were female (72.5% non-inhalation vs. 48.3% inhalation and 65.3% non-inhalation + inhalation, X=59.6, p<0.001). THC-rich products were typically used at night, while CBD-rich products were more often used during the day. While all participants reported similarly decreased pain, participants using non-inhalation + inhalation administration routes reported larger improvements in health than the non-inhalation (mean difference = 0.32, 95% CI: 0.07-0.37, p<0.001) and inhalation subgroups (mean difference = 0.22, 95% CI: 0.07-0.37, p=0.001). Similarly, the non-inhalation + inhalation group had significantly more medication substitutions than those using non-inhalation (mean difference = 0.62, 95% CI: 0.33-0.90, p<0.001) and inhalation administration routes (mean difference = 0.45, 95% CI: 0.22-0.69, p<0.001), respectively.
Subgrouping medical cannabis patients based on administration route profile may provide useful categories for future studies examining the risks and benefits of medical cannabis.
现有大麻产品种类繁多，差异巨大，这使得医生难以对患者进行恰当的指导。在本研究中，我们的目标是描述实际的大麻使用习惯，并探讨这些习惯与报告的大麻消费益处之间的关联。
我们对来自美国和加拿大1087名自我报告患有慢性疼痛且使用大麻进行症状管理的成年人的横断面调查回复进行了混合方法分析。首先，我们对一个开放式问题的回复进行了定性分析，该问题评估了典型的大麻使用习惯，包括给药途径、大麻素含量和使用时间。然后，我们根据吸入（吸烟、汽化）与非吸入（如 edibles）将回复分为不同类别。最后，我们调查了各亚组对大麻如何影响疼痛、整体健康和药物使用（如替代阿片类药物、苯二氮卓类药物）的看法。替代情况被视为药物类别计数，而对疼痛和健康的回复则进行连续分析，-2表示健康大幅下降或疼痛大幅增加，2表示健康大幅改善或疼痛大幅减轻。
在给药途径、大麻素含量和使用时间方面，使用习惯差异很大。总体而言，分别有18.8%、36.2%和45%的人使用非吸入、吸入和非吸入+吸入途径。使用吸入途径的人更年轻（平均年龄46.5岁[吸入]和49.2岁[非吸入+吸入]，而使用非吸入途径的人为56.3岁，F = 36.1，p < 0.001），而使用非吸入途径的女性比例更高（非吸入组为72.5%，吸入组为48.3%，非吸入+吸入组为65.3%，X = 59.6，p < 0.001）。富含四氢大麻酚（THC）的产品通常在夜间使用，而富含大麻二酚（CBD）的产品则更常在白天使用。虽然所有参与者报告的疼痛均有类似程度的减轻，但使用非吸入+吸入给药途径的参与者报告的健康改善程度大于非吸入组（平均差异 = 0.32，95%置信区间：0.07 - 0.37，p < 0.001）和吸入亚组（平均差异 = 0.22，95%置信区间：0.07 - 0.37，p = 0.001）。同样，非吸入+吸入组的药物替代情况明显多于使用非吸入（平均差异 = 0.62，95%置信区间：0.33 - 0.90，p < 0.001）和吸入给药途径（平均差异 = 0.45，95%置信区间：0.22 - 0.69，p < 0.001）的组。
根据给药途径特征对医用大麻患者进行亚组划分，可能为未来研究医用大麻的风险和益处提供有用的类别。
