醫用大麻是阿片類藥物危機的答案嗎？

梅根.布魯克斯 / 2022 年 10 月 3 日 / Medscape 醫學新聞 /財團法人台灣紅絲帶基金會編譯

 

新的研究顯示，醫用大麻可能是阿片類藥物治療疼痛的重要替代品。

在一項大型調查中，患有各種疾病（包括疼痛和心理健康問題）的患者在使用醫用大麻後報告說疼痛減輕且功能更好——而且大多數人能夠停止或減少阿片類藥物的使用。

「一些患者希望擺脫基於阿片類藥物的止痛藥，並可能選擇醫用大麻來控制慢性疼痛」，研究調查員 Carolyn Pritchett 博士告訴 Medscape 醫學新聞。

「我們的數據顯示，使用醫用大麻緩解疼痛可能對某些患者有幫助和有效，尤其是那些因使用阿片類藥物而難以獲得健康功能結果和生活質量的患者」，佛羅里達州塔拉哈西翡翠海岸研究中心研究主任 Pritchett 說。

她指出，調查結果「與各種臨床報告一致，即一些患有慢性疼痛問題的患者發現醫用大麻足以控制疼痛並有益於他們的生活質量」。

該研究於 9 月 27 日線上發表在《物質使用和濫用》上。

患者體驗

普里切特說，許多研究報告了患者如何使用醫用大麻，但沒有報告這種使用如何影響患者日常生活的功能或藥物使用的變化。

「我們的研究是第一個透過測量日常生活中的一般健康功能，以及生活質量以及醫用大麻和基於阿片類藥物的止痛藥的使用來解決醫用大麻患者體驗的研究之一」，她說。

研究人員讓佛羅里達州的 2,183 名醫用大麻使用者完成了一項 66 項橫斷面調查，其中包括人口統計、健康和藥物使用項目，以及開始使用醫用大麻前後的健康功能。

大多數醫用大麻使用者年齡在 20 至 70 歲之間，54% 是女性，大約一半已婚，47% 有工作，大多數是白人。

「疼痛+心理健康」的組合是醫用大麻使用者報告的最常見問題（48%），其次是心理健康（29%）、疼痛（9%）和「其他 」（不是疼痛，癌症，或心理健康）。

大多數參與者報告了有 1 到 5 種不同的疾病； 23% 報告了 1 到 2 種疾病，44% 報告了 3 到 5 種疾病，33% 報告了 6 種或更多疾病。

超過一半的人報告說每天使用醫用大麻，例如全天定期（55%）、偶爾全天（25%）、每天 1 至 2 次（10%）或僅在晚上（9%）。

儘管大多數 (69%) 報告至少有一種副作用，但患者對醫用大麻作為一種治療的看法基本上是積極的。

絕大多數 (91%) 報告說，醫用大麻在處理他們的醫療狀況時非常或非常有幫助；不到 2% 的人報告說它有一點幫助或根本沒有幫助； 89% 的人表示醫用大麻產品對他們的生活質量非常重要或極其重要。

開始使用醫用大麻後，身體疼痛、身體機能和社會機能等健康領域得到改善，而由於身體和情緒問題造成的限制沒有改變。

阿片類藥物保留策略？

大多數患者報告使用 (hydrocodone-acetaminophen) 氫可酮-對乙酰氨基酚 (37%) 或 (oxycodone-acetaminophen) 羥考酮-對乙酰氨基酚 (27%)，而據報導 10% 至 20% 的參與者單獨使用 (oxycodone)  羥考酮、 (hydrocodone) 氫可酮和 (codeine) 可待因。

超過四分之三 (79%) 的參與者報告說在開始使用醫用大麻後停止或減少了阿片類止痛藥的使用。

「應監測醫用大麻患者的有效性、不良事件和濫用障礙。然而，有些患者在使用醫用大麻時可能會比使用阿片類藥物更好，同時仍能減輕疼痛和提高生活質量」，普里切特告訴 Medscape 醫學新聞。

普里切特說：「因此，對於醫生來說，與患者進行討論以確保誠實並能夠監測戒斷症狀或濫用障礙是很重要的」。

「我們希望我們的發現將啟動進一步的調查，包括未來的臨床研究，對醫用大麻和健康功能結果進行更全面的了解，以更全面地了解醫用大麻如何影響患者的生活」，普里切特補充說。

需要更多研究

加拿大安大略省漢密爾頓市麥克馬斯特大學藥用大麻研究中心副主任 Jason W. Busse 博士表示，該調查的一個關鍵限制是在某個時間點收集數據，該時間點有回憶偏差的風險，並且透過審查處方記錄，在開始使用大麻之前和之後沒有對藥物使用進行外部驗證。

「許多研究提出了使用大麻來減少阿片類藥物用於慢性疼痛的概念。但是，也有研究發現沒有關聯，因此這個問題是有爭議的」，布塞告訴 Medscape 醫學新聞。

Busse 指出，2019 年英國 NICE 慢性疼痛大麻指南探討了這個問題，並發現令「令人信服」的證據顯示，向慢性疼痛患者提供醫用大麻並沒有減少阿片類藥物的使用。

「然而，他們基於四項並非旨在解決這個問題的隨機試驗得出這一結論」，布塞指出。

Busse 及其同事最近審查了醫用大麻對慢性疼痛的阿片類藥物節約作用，並得出結論認為，由於證據質量非常低，陪審團仍未做出定局。

「大麻可能有阿片類藥物替代作用，但在我們嚴格設計隨機試驗之前——理想情況下，將大麻作為減少阿片類藥物使用的協調戰略的一部分——我們不能確定」，他說。

 

這項研究的一部分得到了 Trulieve Cannabis Corp 的部分支持，特別是5 美元參與和基礎研究的費用。 Trulieve 不參與研究開發、設計、數據收集或處理、分析、解釋、寫作或手稿審查。 Pritchett 和一位合著者報告了與醫用大麻公司的財務關係。 Busse 報告沒有相關的財務關係。

Subst Use Misuse《物質使用和濫用》. Published online September 27, 2022. Full text

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is Medical Cannabis the Answer to the Opioid Crisis?

Megan Brooks / October 03, 2022 / Medscape Medical News

 

Medical cannabis may be an important alternative to opioids for pain management, new research suggests.

In a large survey, patients with a variety of ailments, including pain and mental health problems, reported less pain and better functioning, after using medical cannabis — and most were able to stop or cut back on their opioid use.

“Some patients wish to move away from opioid-based pain medications and may choose medical cannabis to control chronic pain,” study investigator Carolyn Pritchett, PhD, told Medscape Medical News.

“Our data indicate that using medical cannabis to moderate pain may be helpful and effective for certain patients, especially those struggling with health functioning outcomes and quality of life with opioid use,” said Pritchett, director of research, Emerald Coast Research, Tallahassee, Florida.

She noted that the survey results “align with various clinical reports that some patients with chronic pain issues find medical cannabis sufficient for pain control and beneficial to their quality of life.”

The study was published online September 27 in Substance Use and Misuse.

The Patient’s Experience

Many studies have reported on how patients use medical cannabis, but not how this use affects functioning in patients’ daily lives or changes in medication use, said Pritchett.

“Our study is one of the first to address the medical cannabis patient experience by measuring general health functioning in daily life, along with quality of life and use of both medical cannabis and opioid-based pain medications,” she said.

The researchers had 2183 medical cannabis users in Florida complete a 66-item cross-sectional survey that included demographic, health, and medication usage items, along with health functioning before and after starting medical cannabis.

Most medical cannabis users were between 20 and 70 years old, 54% were women, about half were married, 47% were employed, and most were White.

The combination of “pain + mental health” was the most common problem reported by medical cannabis users (48%), followed by just mental health (29%), just pain (9%), and “other” (not pain, cancer, or mental health).

Most participants reported between 1 and 5 different ailments; 23% reported 1 to 2 ailments, 44% reported 3 to 5 ailments, and 33% reported 6 or more.

More than half reported using medical cannabis daily, such as regularly throughout the day (55%), occasionally throughout the day (25%), 1 to 2 times per day (10%), or evenings only (9%).

Patient perceptions regarding medical cannabis as a treatment were largely positive, despite the majority (69%) reporting at least one side effect.

The vast majority (91%) reported that medical cannabis was very or extremely helpful when dealing with their medical condition; fewer than 2% reported it as slightly or not helpful at all; 89% said medical cannabis products were very or extremely important to their quality of life.

The health domains of bodily pain, physical functioning, and social functioning improved after starting medical cannabis while limitations due to physical and emotional problems were unchanged.

Opioid-Sparing Strategy?

Most patients reported using hydrocodone-acetaminophen (37%) or oxycodone-acetaminophen (27%) while oxycodone, hydrocodone, and codeine alone were reportedly used by 10% to 20% of participants.

More than three quarters (79%) of participants reported either stopping or reducing their opioid pain medication use after starting medical cannabis.

“Medical cannabis patients should be monitored for effectiveness, adverse events, and abuse disorder. However, it is possible some patients will function better on medical cannabis than on opioids while still experiencing reduced pain and a good quality of life,” Pritchett told Medscape Medical News.

“Thus, it is important for doctors to be open to discussion with patients to ensure honesty and be able to monitor for withdrawal symptoms or abuse disorder,” Pritchett said.

“We hope our findings will initiate further investigations, including future clinical studies, on medical cannabis and health functioning outcomes to gain a more complete picture of how medical cannabis might impact a patient’s life,” Pritchett added.

More Research Needed

Reached for comment, Jason W. Busse, PhD, associate director of the Centre for Medicinal Cannabis Research at McMaster University in Hamilton, Ontario, Canada, said a key limitation of the survey is the collection of data at one point in time, which runs the risk of recall bias, and no external validation of medication use before and after initiation of cannabis use through a review of prescriber records.

“The notion of using cannabis to reduce opioid use for chronic pain has been suggested by a number of studies. However, there are also studies that have found no association, and so the issue is controversial,” Busse told Medscape Medical News.

Busse noted that the 2019 UK NICE guideline on cannabis for chronic pain explored this issue and found “compelling” evidence that providing medical cannabis to patients with chronic pain did not reduce opioid use.

“However, they made this conclusion based on four randomized trials that were not designed to address this issue,” Busse noted.

Busse and colleagues recently reviewed the opioid-sparing effects of medical cannabis for chronic pain and concluded that the jury remains out due to very low certainty evidence.

“There may be an opioid substitution effect of cannabis, but until we have rigorously designed randomized trials — ideally that administer cannabis as part of a coordinated strategy to reduce opioid use — we can’t be certain,” he said.

 

Portions of this research were partially supported by Trulieve Cannabis Corp, specifically a $5 credit for participation and basic research costs. Trulieve was not involved with study development, design, data collection or handling, analyses, interpretation, writing, or manuscript review. Pritchett and a co-author have reported financial relationships with medical cannabis companies. Busse has reported no relevant financial relationships.

Subst Use Misuse. Published online September 27, 2022. Full text