Allegheny Health Network/West Penn Hospital, Institute for Pain Medicine, Pittsburgh, Pennsylvania.
Pain Physician. 2022 Jan;25(1):E113-E119.
Chronic opioid therapy (COT) has been used to treat many chronic pain conditions even with poor evidence for its long-term effectiveness. Medical cannabis has emerged with certain pain-relieving properties, which has led to questions as to its' potential application, especially in relation to its effect on opioid use.
This study investigates a proposed clinical context in offering medical cannabis as a treatment for chronic pain for those already using chronic opioid therapy. It then details patients' daily morphine milligram equivalent (MME) usage.
This single-center prospective study follows a group of patients trialing medical cannabis treatment for chronic pain that is already using COT in order to determine individual efficacy. Continued medical cannabis treatment was a decision made by the patient, after trialing medical cannabis, to either continue medical cannabis along with COT at a reduced daily MME, or to revert back to their previous COT regimen.
This study was performed at the Allegheny Health Network Institute for Pain Medicine in Pittsburgh, Pennsylvania. The state of Pennsylvania legalized medical cannabis in April of 2016, and it became available to patients in February of 2018 through medical dispensaries.
One hundred and fifteen patients met the inclusion criteria, with the majority of those excluded due to not being treated with COT. Of the 115 who chose to undergo a medical cannabis trial in addition to their COT, 75 chose to remain certified for medical cannabis as they had significant pain relief and subsequently weaned down on opioids. Additionally, of the 115 choosing to undergo a medical cannabis trial, 30 chose to be decertified due to ineffectiveness or side effects, and those were placed back on their COT regimen. The other 10 were not included for other denoted reasons. Compliance was monitored through urine drug screens (UDS).
There was a 67.1% average decrease in daily MME/patient from 49.9 to 16.4 MME at the first follow-up. There was a 73.3% decrease in MME at second follow-up from 49.9 to 13.3 MME with an ANOVA analysis denoting a significant difference of P < 0.0001.
The period of follow-up presented at this point includes their first 6 months of treatment with medical cannabis and COT concomitantly.
Presenting medical cannabis to chronic pain patients on COT should be done in the context of a patient choice between medical cannabis WITH decrement of COT or continued current dose of COT in order to maximize effectiveness in opioid reduction as well as to limit polypharmacy concerns regarding medical cannabis. Allowing for a temporary short-term period where patients may trial medical cannabis, while concomitantly gradually weaning their COT, is also essential in determining medical cannabis' individual effectiveness for that patient's specific type of chronic pain, which should serve to maximize long-term opioid reduction results and hence decrease opioid-related overdose deaths.
慢性阿片类药物治疗（COT）已被用于治疗许多慢性疼痛病症，尽管其长期疗效的证据不足。医用大麻具有一定的止痛特性，这引发了人们对其潜在应用的质疑，特别是在其对阿片类药物使用的影响方面。
本研究调查了一种在为已经接受慢性阿片类药物治疗的慢性疼痛患者提供医用大麻治疗的情况下提出的临床方案，并详细介绍了患者的每日吗啡毫克当量（MME）使用情况。
这是一项单中心前瞻性研究，对一组接受医用大麻治疗慢性疼痛的患者进行了研究，这些患者已经在接受 COT 治疗，以确定个体疗效。继续使用医用大麻是患者在试用医用大麻后做出的决定，要么继续使用医用大麻和 COT，并减少每日 MME，要么恢复到以前的 COT 治疗方案。
这项研究在宾夕法尼亚州匹兹堡的阿勒格尼健康网络研究所疼痛医学中心进行。宾夕法尼亚州于 2016 年 4 月将医用大麻合法化，并于 2018 年 2 月通过医用药房向患者提供。
115 名患者符合纳入标准，大多数被排除在外的原因是未接受 COT 治疗。在选择接受 COT 加医用大麻治疗的 115 名患者中，75 名患者因疼痛缓解显著并随后减少阿片类药物用量而选择继续接受医用大麻治疗。此外，在选择接受医用大麻治疗的 115 名患者中，有 30 名因无效或副作用而选择取消医用大麻认证，并重新使用 COT 治疗方案。其他 10 人因其他指定原因未被包括在内。通过尿液药物筛查（UDS）监测依从性。
从第一次随访的 49.9 毫克当量/患者到 16.4 毫克当量/患者，平均每日 MME 减少了 67.1%。在第二次随访时，MME 减少了 73.3%，从 49.9 毫克当量降至 13.3 毫克当量，ANOVA 分析表明差异有统计学意义（P<0.0001）。
目前呈现的随访期包括他们接受 COT 联合医用大麻治疗的头 6 个月。
向接受 COT 治疗的慢性疼痛患者提供医用大麻治疗时，应根据患者在使用医用大麻减少 COT 剂量或继续使用当前 COT 剂量之间的选择来进行，以最大限度地减少阿片类药物的减少，并限制医用大麻的药物联合使用问题。允许患者在短期内试用医用大麻，同时逐渐减少 COT 的剂量，对于确定医用大麻对患者特定类型慢性疼痛的个体疗效也至关重要，这有助于最大限度地提高长期阿片类药物减少的效果，从而减少与阿片类药物相关的过量死亡。
