New York State Department of Health, Albany.
Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, New York.
JAMA Netw Open. 2023 Jan 3;6(1):e2254573. doi: 10.1001/jamanetworkopen.2022.54573.
Patients with chronic pain often receive long-term opioid therapy (LOT), which places them at risk of opioid use disorder and overdose. This presents the need for alternative or companion treatments; however, few studies on the association of medical cannabis (MC) with reducing opioid dosages exist.
To assess changes in opioid dosages among patients receiving MC for longer duration compared with shorter duration.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study of New York State Prescription Monitoring Program data from 2017 to 2019 included patients receiving MC for chronic pain while also receiving opioid treatment. Of these, patients receiving LOT prior to receiving MC were selected. Individuals were studied for 8 months after starting MC. Data were analyzed from November 2021 to February 2022.
Selected patients were divided into 2 groups based on the duration of receiving MC: the nonexposure group received MC for 30 days or fewer, and the exposure group received MC for more than 30 days.
The main outcome was opioid dosage, measured by mean daily morphine milligram equivalent (MME). Analyses were conducted for 3 strata by opioid dosage prior to receiving MC: MME less than 50, MME of 50 to less than 90, and MME of 90 or greater.
A total of 8165 patients were included, with 4041 (median [IQR] age, 57 [47-65] years; 2376 [58.8%] female) in the exposure group and 4124 (median [IQR] age, 54 (44-62) years; 2370 [57.5%] female) in the nonexposure group. Median (IQR) baseline MMEs for the exposure vs nonexposure groups were 30.0 (20.0-40.0) vs 30.0 (20.0-40.0) in the lowest stratum, 60.0 (60.0-70.0) vs 60.0 (60.0-90.0) in the middle stratum, and 150.0 (100.0-216.2) vs 135.0 (100.0-218.0) in the highest stratum. During follow-up, significantly greater reductions in opioid dosage were observed among the exposure group. A dose-response association of patients' opioid dosage at baseline was observed with the differences in the monthly MME reductions between exposure and nonexposure groups, with a difference of -1.52 (95% CI, -1.67 to -1.37) MME for the lowest stratum, -3.24 (95% CI, -3.61 to -2.87) MME for the middle stratum, and -9.33 (95% CI, -9.89 to -8.77) MME for the highest stratum. The daily MME for the last month of the follow-up period among patients receiving longer MC was reduced by 48% in the lowest stratum, 47% in the middle stratum, and 51% in the highest stratum compared with the baseline dosages. Among individuals in the nonexposure group, daily MME was reduced by only 4% in the lowest stratum, 9% in the middle stratum, and 14% in the highest stratum.
In this cohort study of patients receiving LOT, receiving MC for a longer duration was associated with reductions in opioid dosages, which may lower their risk of opioid-related morbidity and mortality.
重要性：慢性疼痛患者常接受长期阿片类药物治疗（LOT），这使他们面临阿片类药物使用障碍和过量的风险。这就需要替代或辅助治疗；然而，关于医用大麻（MC）与减少阿片类药物剂量之间关联的研究很少。
目的：评估与较短时间相比，接受 MC 治疗时间较长的患者的阿片类药物剂量变化。
设计、地点和参与者：这项纽约州处方监测计划 2017 年至 2019 年的队列研究纳入了同时接受慢性疼痛 MC 治疗和阿片类药物治疗的患者。其中，选择了 LOT 治疗前接受 MC 治疗的患者。从开始使用 MC 后 8 个月对个人进行了研究。数据于 2021 年 11 月至 2022 年 2 月进行了分析。
暴露：根据接受 MC 的时间长短，将选定的患者分为两组：非暴露组接受 MC 治疗 30 天或更短时间，暴露组接受 MC 治疗超过 30 天。
主要结果和测量：主要结果是通过平均每日吗啡毫克当量（MME）来衡量的阿片类药物剂量。对接受 MC 前的阿片类药物剂量进行了 3 个分层分析：MME 小于 50、MME 为 50 至小于 90 和 MME 为 90 或更高。
结果：共纳入 8165 名患者，其中暴露组 4041 名（中位数[IQR]年龄 57[47-65]岁；2376[58.8%]女性），非暴露组 4124 名（中位数[IQR]年龄 54[44-62]岁；2370[57.5%]女性）。暴露组与非暴露组的基线 MME 中位数分别为最低分层的 30.0（20.0-40.0）与 30.0（20.0-40.0），中间分层的 60.0（60.0-70.0）与 60.0（60.0-90.0），最高分层的 150.0（100.0-216.2）与 135.0（100.0-218.0）。在随访期间，暴露组的阿片类药物剂量显著降低。在基线时观察到患者阿片类药物剂量的剂量反应关联，与暴露组和非暴露组之间每月 MME 减少量的差异相关，最低分层的差异为-1.52（95%CI，-1.67 至-1.37）MME，中间分层的差异为-3.24（95%CI，-3.61 至-2.87）MME，最高分层的差异为-9.33（95%CI，-9.89 至-8.77）MME。在随访期的最后一个月，接受较长 MC 治疗的患者的每日 MME 减少量在最低分层中为 48%，在中间分层中为 47%，在最高分层中为 51%，与基线剂量相比。在非暴露组中，每日 MME 仅减少了 4%，在中间分层中减少了 9%，在最高分层中减少了 14%。
结论和相关性：在这项 LOT 患者的队列研究中，接受 MC 治疗时间较长与阿片类药物剂量减少相关，这可能降低他们与阿片类药物相关发病率和死亡率的风险。
