番茄社区

ANAHEIM, Calif. -- Users of opioids for pain may not find added relief with cannabis, researchers reported here.

In a study led by Teresa Bigand, RN-BC, MSN, CNL, of Washington State University (WSU) in Spokane, use of cannabis within the month prior was not found to be predictive of sleep quality, intensity in pain, or confidence in controlling symptoms.

However, cannabis use was predictive of self-efficacy in emotion management -- specifically tied to a lower confidence in ability to manage negative emotions.

"We were especially surprised to find that cannabis interferes with sleep -- particularly at a higher frequency and quantity -- because that's not what patients tell us," study co-author Mary Lee Roberts, PhD, RN, also of WSU, told 番茄社区 during a poster session at the . "They tell us that 'I do it so I can sleep,' but our findings indicate something other than that."

The analysis looked at adults who were prescribed opioids for persistent pain (n=150), as well as those who were involved in a medication-assisted treatment for opioid use disorder (n=150). Between the groups, adults with persistent pain were more likely to be older and have a higher level of education, while those with opioid use disorder were more likely to self-report a history of ever-using cannabis (92.7% versus 69.8%).

"Cannabis use is frequently reported within both populations to manage pain and sleep problems, although how cannabis influences co-occurring symptoms is uncertain," the researchers explained.

Participants' sleep was assessed using the Pittsburgh Sleep Quality Index (PSQI), while pain intensity and self-efficacy of symptom managment were measured via the Patient-Reported Outcomes Measurement Information System. Among both groups, 87% of adult opioid users had clinically poor sleep quality (PSQI >5).

When comparing the two groups, those with persistent pain tended to have poorer quality of sleep (average PSQI 11.82 versus 9.96, P=0.001), as well as a higher level of pain intensity (58.64 versus 53.6, P<0.001), compared with those with opioid use disorder.

"This is just self-report -- one snapshot in time -- and we really need to see what happens when people use cannabis in relation to their symptoms," the study's senior author, Marian Wilson, PhD, MPH, RN-BC, also of WSU, told 番茄社区. "There's obviously a perception that it's helpful, and there's also some evidence that shows it may not be helpful for specific people with depression and anxiety, in particular."

She highlighted the need for well-powered clinical trials that would closely look at the specific strain, amount, and type of cannabis and the impact on pain symptoms and potential for reducing opioid use. "Right now there's a conundrum where if a prescriber wants patients to have opioids, they have to be tested for cannabis use, and a lot of them can't have both together in the medical population of people with chronic pain," Wilson said. "Now in the opioid-using medication-assisted treatment program folks -- i.e., people with addiction -- we don't have that same scrutiny of marijuana use. So there's a discrepancy in how they're being treated in clinical practice."

One major barrier to looking at the real impacts of cannabis in a research setting is the availability of the type of cannabis, which may have a very different tetrahydrocannabinol content compared with what a lot of others typically would use, Wilson noted.

"There's a real problem in understanding the truth of the matter of how much cannabis may or may not help people, and I'm particularly interested in how we can help them transition away from high-dose opioids, which can lead to respiratory depression and death. So if a little bit of cannabis could help patients reduce their opioids, that could be a really positive thing to know, but we also want to know if using the cannabis and the opioids -- particularly for some vulnerable people -- makes them worse, makes them not really have the kind of symptom control that they are trying to find."

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