Cannabis Use is Associated with Lower Odds of Prescription Opioid Analgesic Use Among HIV-Infected Individuals with Chronic Pain

IntroductionIn the USA, opioid analgesic use and overdoses have increased dramatically. One rapidly expanding strategy to manage chronic pain in the context of this epidemic is medical cannabis. Cannabis has analgesic effects, but it also has potential adverse effects. Further, its impact on opioid analgesic use is not well studied. Managing pain in people living with HIV is particularly challenging, given the high prevalence of opioid analgesic and cannabis use. This study’s overarching goal is to understand how medical cannabis use affects opioid analgesic use, with attention to Δ9-tetrahydrocannabinol and cannabidiol content, HIV outcomes and adverse events.Methods and analysesWe are conducting a cohort study of 250 adults with and without HIV infection with (a) severe or chronic pain, (b) current opioid use and (c) who are newly certified for medical cannabis in New York. Over 18 months, we collect data via in-person visits every 3 months and web-based questionnaires every 2 weeks. Data sources include: questionnaires; medical, pharmacy and Prescription Monitoring Program records; urine and blood samples; and physical function tests. Using marginal structural models and comparisons within participants’ 2-week time periods (unit of analysis), we will examine how medical cannabis use (primary exposure) affects (1) opioid analgesic use (primary outcome), (2) HIV outcomes (HIV viral load, CD4 count, antiretroviral adherence, HIV risk behaviours) and (3) adverse events (cannabis use disorder, illicit drug use, diversion, overdose/deaths, accidents/injuries, acute care utilisation).Ethics and disseminationThis study is approved by the Montefiore Medical Center/Albert Einstein College of Medicine institutional review board. Findings will be disseminated through conferences, peer-reviewed publications and meetings with medical cannabis stakeholders.Trial registration numberClinicalTrials.gov Registry (NCT03268551); Pre-results.

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Prescription opioid analgesic use in France: Trends and impact on morbidity-mortality

European Journal of Pain ◽

10.1002/ejp.1291 ◽

2018 ◽

Vol 23 (1) ◽

pp. 124-134 ◽

Cited By ~ 42

Author(s):

C. Chenaf ◽

J.-L. Kaboré ◽

J. Delorme ◽

B. Pereira ◽

A. Mulliez ◽

...

Keyword(s):

Opioid Analgesic ◽

Prescription Opioid ◽

Analgesic Use

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Use of electroanalgesia and laser therapies as alternatives to opioids for acute and chronic pain management

F1000Research ◽

10.12688/f1000research.12324.1 ◽

2017 ◽

Vol 6 ◽

pp. 2161 ◽

Cited By ~ 6

Author(s):

Paul F. White ◽

Ofelia Loani Elvir Lazo ◽

Lidia Galeas ◽

Xuezhao Cao

Keyword(s):

Chronic Pain ◽

Back Pain ◽

Pain Management ◽

Abdominal Surgery ◽

Myofascial Pain ◽

Elective Surgery ◽

Opioid Analgesic ◽

Joint Disease ◽

Prescription Opioid ◽

Joint Replacement Surgery

The use of opioid analgesics for postoperative pain management has contributed to the global opioid epidemic. It was recently reported that prescription opioid analgesic use often continued after major joint replacement surgery even though patients were no longer experiencing joint pain. The use of epidural local analgesia for perioperative pain management was not found to be protective against persistent opioid use in a large cohort of opioid-naïve patients undergoing abdominal surgery. In a retrospective study involving over 390,000 outpatients more than 66 years of age who underwent minor ambulatory surgery procedures, patients receiving a prescription opioid analgesic within 7 days of discharge were 44% more likely to continue using opioids 1 year after surgery. In a review of 11 million patients undergoing elective surgery from 2002 to 2011, both opioid overdoses and opioid dependence were found to be increasing over time. Opioid-dependent surgical patients were more likely to experience postoperative pulmonary complications, require longer hospital stays, and increase costs to the health-care system. The Centers for Disease Control and Prevention emphasized the importance of finding alternatives to opioid medication for treating pain. In the new clinical practice guidelines for back pain, the authors endorsed the use of non-pharmacologic therapies. However, one of the more widely used non-pharmacologic treatments for chronic pain (namely radiofrequency ablation therapy) was recently reported to have no clinical benefit. Therefore, this clinical commentary will review evidence in the peer-reviewed literature supporting the use of electroanalgesia and laser therapies for treating acute pain, cervical (neck) pain, low back pain, persistent post-surgical pain after spine surgery (“failed back syndrome”), major joint replacements, and abdominal surgery as well as other common chronic pain syndromes (for example, myofascial pain, peripheral neuropathic pain, fibromyalgia, degenerative joint disease/osteoarthritis, and migraine headaches).

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Factors Associated with Prescription Opioid Analgesic Use in the US Population, 2011–2014

Pain Medicine ◽

10.1093/pm/pny158 ◽

2018 ◽

Vol 20 (7) ◽

pp. 1338-1346 ◽

Cited By ~ 3

Author(s):

Steven M Frenk ◽

Susan L Lukacs ◽

Qiuping Gu

Keyword(s):

Opioid Analgesic ◽

Opioid Analgesics ◽

Opioid Use Disorder ◽

Prescription Opioid ◽

Opioid Use ◽

Factors Associated ◽

The Past ◽

The Us ◽

Opioid Users ◽

Analgesic Use

Abstract Objective This study examined factors associated with prescription opioid analgesic use in the US population using data from a nationally representative sample. It focused on factors previously shown to be associated with opioid use disorder or overdose. Variations in the use of different strength opioid analgesics by demographic subgroup were also examined. Methods Data came from respondents aged 16 years and older who participated in the National Health and Nutrition Examination Survey (2011–2014). Respondents were classified as opioid users if they reported using one or more prescription opioid analgesics in the past 30 days. Results Opioid users reported poorer self-perceived health than those not currently using opioids. Compared with those not using opioids, opioid users were more likely to rate their health as being “fair” or “poor” (40.4% [95% confidence interval {CI} = 34.9%–46.2%] compared with 15.6% [95% CI = 14.3%–17.1%]), experienced more days of pain during the past 30 days (mean = 14.3 [95% CI = 12.9–15.8] days compared with 2.3 [95% CI = 2.0–2.7] days), and had depression (22.5% [95% CI = 17.3%–28.7%] compared with 7.1% [95% CI = 6.2%–8.0%]). Among those who reported using opioids during the past 30 days, 18.8% (95% CI = 14.4%–24.1%) reported using benzodiazepine medication during the same period and 5.2% (95% CI = 3.5%–7.7%) reported using an illicit drug during the past six months. When opioid strength was examined, a smaller percentage of adults aged 60 years and older used stronger-than-morphine opioids compared with adults aged 20–39 and 40–59 years. Conclusions Higher percentages of current opioid users than nonusers reported having many of the factors associated with opioid use disorder and overdose.

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Clinical Correlates of Prescription Opioid Analgesic Use in Pregnancy

Maternal and Child Health Journal ◽

10.1007/s10995-014-1536-6 ◽

2014 ◽

Vol 19 (3) ◽

pp. 548-556 ◽

Cited By ~ 19

Author(s):

Megan V. Smith ◽

Darce Costello ◽

Kimberly A. Yonkers

Keyword(s):

Opioid Analgesic ◽

Prescription Opioid ◽

Clinical Correlates ◽

Analgesic Use ◽

In Pregnancy

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Feasibility and acceptability of using smartphone-based EMA to assess patterns of prescription opioid and medical cannabis use among individuals with chronic pain

Internet Interventions ◽

10.1016/j.invent.2021.100460 ◽

2021 ◽

pp. 100460

Author(s):

Erin M. Anderson Goodell ◽

Courtney Nordeck ◽

Patrick H. Finan ◽

Ryan Vandrey ◽

Kelly E. Dunn ◽

...

Keyword(s):

Chronic Pain ◽

Cannabis Use ◽

Prescription Opioid ◽

Medical Cannabis

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Application of Hot Melt Extrusion Technology in the Development of Abuse Deterrent Formulations: An Overview

Current Drug Delivery ◽

10.2174/1567201817999200817151601 ◽

2020 ◽

Vol 17 ◽

Author(s):

Arun Butreddy ◽

Dinesh Nyavanandi ◽

Sagar Narala ◽

Fischer Austin ◽

Suresh Bandari

Keyword(s):

Chronic Pain ◽

Opioid Analgesic ◽

Hot Melt Extrusion ◽

Matrix Tablets ◽

Health Concern ◽

Prescription Opioid ◽

Pharmaceutical Companies ◽

Formulation Development ◽

Melt Extrusion ◽

Hot Melt

: The misuse, abuse, and illicit use of prescription opioid analgesics is a global public health concern. However, there are many viable therapeutic options for the treatment of patients with chronic pain. Both intact and manipulated opioid drug products are abused by various routes such as oral, nasal, and injection which may lead to overdose, drug addiction, and even death. To combat the abuse of these medications, regulatory agencies and pharmaceutical companies are switching their interest towards developing Abuse deterrent formulations (ADFs), with the intent to deter the abuse of opioid products to a maximum extent. Thereare several manufacturing strategies implemented in an attempt to develop ADFs. An example include matrix tablets of high molecular weight polymers such as polyethylene oxide. The scalable and continuous manufacturing techniques, such as hot melt extrusion (HME), is increasingly accepted by pharmaceutical companies to advance the development and manufacturing of ADFs. The application of the HME technique in the development of ADFs may overcome the challenges of opioid analgesic formulation development and provide improved protection against misuse and abuse, while also ensuring access to safe and effective use in patients with chronic pain. This review deals with a briefoverview of strategies, with emphasis on HME to deter opioid abuse, in vitrocharacterization methods, commonly used excipients in the development of ADFs, and regulatory standards to meet the requirements of ADFs.

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