Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: A longitudinal analysis

English version

Autoři: Stephanie Lake ^aff001; Zach Walsh ^aff003; Thomas Kerr ^aff001; Ziva D. Cooper ^aff005; Jane Buxton ^aff002; Evan Wood ^aff001; Mark A. Ware ^aff007; M. J. Milloy ^aff001
Působiště autorů: British Columbia Centre on Substance Use, Vancouver, British Columbia, Canada ^aff001; School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada ^aff002; Department of Psychology, University of British Columbia, Kelowna, British Columbia, Canada ^aff003; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada ^aff004; Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, California, United States of America ^aff005; British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada ^aff006; Department of Family Medicine, McGill University, Montreal, Québec, Canada ^aff007; Department of Anesthesia, McGill University, Montreal, Québec, Canada ^aff008
Vyšlo v časopise: Frequency of cannabis and illicit opioid use among people who use drugs and report chronic pain: A longitudinal analysis. PLoS Med 16(11): e1002967. doi:10.1371/journal.pmed.1002967
Kategorie: Research Article
doi: https://doi.org/10.1371/journal.pmed.1002967

Souhrn

Background

Ecological research suggests that increased access to cannabis may facilitate reductions in opioid use and harms, and medical cannabis patients describe the substitution of opioids with cannabis for pain management. However, there is a lack of research using individual-level data to explore this question. We aimed to investigate the longitudinal association between frequency of cannabis use and illicit opioid use among people who use drugs (PWUD) experiencing chronic pain.

Methods and findings

This study included data from people in 2 prospective cohorts of PWUD in Vancouver, Canada, who reported major or persistent pain from June 1, 2014, to December 1, 2017 (n = 1,152). We used descriptive statistics to examine reasons for cannabis use and a multivariable generalized linear mixed-effects model to estimate the relationship between daily (once or more per day) cannabis use and daily illicit opioid use. There were 424 (36.8%) women in the study, and the median age at baseline was 49.3 years (IQR 42.3–54.9). In total, 455 (40%) reported daily illicit opioid use, and 410 (36%) reported daily cannabis use during at least one 6-month follow-up period. The most commonly reported therapeutic reasons for cannabis use were pain (36%), sleep (35%), stress (31%), and nausea (30%). After adjusting for demographic characteristics, substance use, and health-related factors, daily cannabis use was associated with significantly lower odds of daily illicit opioid use (adjusted odds ratio 0.50, 95% CI 0.34–0.74, p < 0.001). Limitations of the study included self-reported measures of substance use and chronic pain, and a lack of data for cannabis preparations, dosages, and modes of administration.

Conclusions

We observed an independent negative association between frequent cannabis use and frequent illicit opioid use among PWUD with chronic pain. These findings provide longitudinal observational evidence that cannabis may serve as an adjunct to or substitute for illicit opioid use among PWUD with chronic pain.

Klíčová slova:

Cannabis – Drug users – Heroin – Neuropathic pain – Opioids – Pain management – Recreational drug use

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