Lauff Sören, Petzke Frank, Brill Silviu, Schouten Leonie, Fitzcharles Mary-Ann, Pereira John X, Häuser Winfried
Pain Medicine, Department of Anesthesiology, University Medical Center Göttingen, Göttingen, Germany.
Pain Institute, Sourasky Medical Center, Tel Aviv, Israel.
Eur J Pain. 2023 May;27(5):588-601. doi: 10.1002/ejp.2082. Epub 2023 Feb 3.
A major concern with cannabis-based medicines (CbM) and medical cannabis (MC) is the risk of abuse and dependence. The face validity of the International Classification of Diseases (ICD-10) criteria for cannabis dependence in patients prescribed CbM for chronic pain has not been assessed.
Physicians from Canada, Germany and Israel were recruited via the mailing lists of national pain societies. To be eligible, physicians had to have prescribed CbM for chronic pain treatment in the past 12 months. Participants were asked to rate the appropriateness of items adapted from the substance use module of the Composite International Diagnostic Interview Version 3.0 to assess dependence in the context of chronic pain treatment with CbM and the appropriateness of two additional items. In case of disagreement, participants were asked to give reasons. Furthermore, they were asked to suggest potential additional criteria.
On average 69.0% of 178 participating physicians indicated agreement with the appropriateness of the ICD-10 criteria, while 20.6% indicated disagreement. The highest disagreement rate was observed for the item on repeated use despite legal problems (35.4% disagreement or strong disagreement). Reasons for disagreement were summarized into six content categories using qualitative methods of analysis. Additional criteria suggested by participants were summarized into 10 content categories.
A collaboration of psychiatrists and pain physicians is required to define criteria and develop instruments to capture abuse and dependence of CbM in chronic pain patients.
Sixty-nine per cent of 178 pain medicine physicians in Canada, Germany and Israel who participated in a survey on the appropriateness of the ICD-10 criteria for cannabis abuse and dependence for patients prescribed cannabis-derived products for chronic pain assessed the criteria as appropriate, whereas 20.6% deemed the criteria as not appropriate.
基于大麻的药物（CbM）和医用大麻（MC）的一个主要问题是滥用和成瘾风险。针对因慢性疼痛而开具CbM处方的患者，国际疾病分类（ICD - 10）中大麻成瘾标准的表面效度尚未得到评估。
通过各国疼痛协会的邮件列表招募了来自加拿大、德国和以色列的医生。符合条件的医生必须在过去12个月内为慢性疼痛治疗开具过CbM处方。参与者被要求对从综合国际诊断访谈第3.0版物质使用模块改编而来的项目进行评分，以评估在使用CbM进行慢性疼痛治疗背景下的成瘾情况，以及另外两个项目的适用性。如有分歧，要求参与者说明理由。此外，还要求他们提出潜在的附加标准。
178名参与调查的医生中，平均有69.0%表示同意ICD - 10标准的适用性，而20.6%表示不同意。在“尽管存在法律问题仍反复使用”这一项目上观察到的分歧率最高（35.4%不同意或强烈不同意）。使用定性分析方法将分歧原因归纳为六个内容类别。参与者提出的附加标准归纳为10个内容类别。
需要精神科医生和疼痛科医生合作来定义标准并开发工具，以捕捉慢性疼痛患者中CbM的滥用和成瘾情况。
参与关于ICD - 10标准对因慢性疼痛而开具大麻衍生产品处方的患者大麻滥用和成瘾适用性调查的178名加拿大、德国和以色列疼痛医学医生中，69%认为该标准合适，而20.6%认为该标准不合适。
