Davidson Whitney M, Mahavni Anika, Chrusciel Timothy, Salas Joanne, Miller-Matero Lisa R, Sullivan Mark D, Zabel Celeste, Lustman Patrick J, Ahmedani Brian K, Scherrer Jeffrey F
Department of Family and Community Medicine, Saint Louis University School of Medicine, 1008 S. Spring, SLUCare Academic Pavilion, 3rd Floor, St. Louis, MO, 63110, USA.
Advanced HEAlth Data (AHEAD) Research Institute, Saint Louis University School of Medicine, 3545 Lafayette Ave, 4th Floor, St. Louis, MO, 63104, USA.
J Cannabis Res. 2024 Feb 22;6(1):7. doi: 10.1186/s42238-024-00218-y.
Marijuana use is increasingly common among patients with chronic non-cancer pain (CNCP) and long-term opioid therapy (LTOT). We determined if lifetime recreational and medical marijuana use were associated with more frequent and higher dose prescription opioid use.
Cross-sectional SUBJECTS: Eligible patients (n=1,037), who had a new period of prescription opioid use lasting 30-90 days, were recruited from two midwestern health care systems to a study of long-term prescription opioid use and mental health outcomes. The present cross-sectional analyses uses baseline data from this on-going cohort study.
Primary exposures were participant reported lifetime recreational and medical marijuana use versus no lifetime marijuana use. Prescription opioid characteristics included daily versus non-daily opioid use and ≥50 morphine milligram equivalent (MME) dose per day vs. <50 MME. Multivariate, logistic regression models estimated the association between lifetime recreational and medical marijuana use vs. no use and odds of daily and higher dose prescription opioid use, before and after adjusting for confounding.
The sample was an average of 54.9 (SD±11.3) years of age, 57.3% identified as female gender, 75.2% identified as White, and 22.5% identified as Black race. Among all participants, 44.4% were never marijuana users, 21.3% were recreational only, 7.7% medical only and 26.6% were both recreational and medical marijuana users. After controlling for all confounders, lifetime recreational marijuana use, as compared to no use, was significantly associated with increased odds of daily prescription opioid use (OR=1.61; 95%CI:1.02-2.54). There was no association between lifetime recreational or medical marijuana use and daily opioid dose.
Lifetime medical marijuana use is not linked to current opioid dose, but lifetime recreational use is associated with more than a 60% odds of being a daily prescription opioid user. Screening for lifetime recreational marijuana use may identify patients with chronic pain who are vulnerable to daily opioid use which increases risk for adverse opioid outcomes. Prospective data is needed to determine how marijuana use influences the course of LTOT and vice versa.
大麻使用在慢性非癌性疼痛（CNCP）患者和长期阿片类药物治疗（LTOT）患者中越来越普遍。我们确定终生娱乐性和医用大麻使用是否与更频繁和更高剂量的处方阿片类药物使用有关。
横断面研究
从两个中西部医疗系统招募了符合条件的患者（n = 1,037），这些患者有一段持续30 - 90天的新处方阿片类药物使用期，参与一项关于长期处方阿片类药物使用和心理健康结果的研究。本横断面分析使用了这项正在进行的队列研究的基线数据。
主要暴露因素是参与者报告的终生娱乐性和医用大麻使用情况与无终生大麻使用情况。处方阿片类药物特征包括每日与非每日使用阿片类药物以及每天≥50毫克吗啡当量（MME）剂量与<50 MME。多变量逻辑回归模型估计了终生娱乐性和医用大麻使用与无使用情况之间的关联以及每日和更高剂量处方阿片类药物使用的几率，在调整混杂因素之前和之后。
样本的平均年龄为54.9岁（标准差±11.3），57.3%为女性，75.2%为白人，22.5%为黑人。在所有参与者中，44.4%从未使用过大麻，21.3%仅为娱乐性使用，7.7%仅为医用，26.6%为娱乐性和医用大麻使用者。在控制所有混杂因素后，与未使用相比，终生娱乐性大麻使用与每日处方阿片类药物使用几率增加显著相关（OR = 1.61；95%CI：1.02 - 2.54）。终生娱乐性或医用大麻使用与每日阿片类药物剂量之间无关联。
终生医用大麻使用与当前阿片类药物剂量无关，但终生娱乐性使用与成为每日处方阿片类药物使用者的几率增加超过60%相关。筛查终生娱乐性大麻使用情况可能识别出慢性疼痛患者中易出现每日阿片类药物使用的人群，这会增加阿片类药物不良后果的风险。需要前瞻性数据来确定大麻使用如何影响LTOT的进程，反之亦然。
