Medical Marijuana and Opioids (MEMO) Study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic pain
Introduction In 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...
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doaj-1b2db97220654102a990d92b12bc74b72021-09-16T23:00:04ZengBMJ Publishing GroupBMJ Open2044-60552020-12-01101210.1136/bmjopen-2020-043400Medical Marijuana and Opioids (MEMO) Study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic painChinazo O Cunningham0Joanna L Starrels1Chenshu Zhang2Marcus A Bachhuber3Nancy L Sohler4Frances R Levin5Haruka Minami6Deepika E Slawek7Julia H Arnsten8Division of General Internal Medicine, Montefiore Health System, Bronx, New York, USADivision of General Internal Medicine, Montefiore Health System, Bronx, New York, USADivision of General Internal Medicine, Montefiore Health System, Bronx, New York, USASection of Community and Population Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana, USASchool of Medicine, City University of New York, New York, New York, USADepartment of Psychiatry, Columbia University Irving Medical Center, New York, New York, USAPsychology Department, Fordham University, Bronx, New York, USADivision of General Internal Medicine, Montefiore Health System, Bronx, New York, USADivision of General Internal Medicine, Montefiore Health System, Bronx, New York, USAIntroduction In 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 analyses We 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 dissemination This 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 number ClinicalTrials.gov Registry (NCT03268551); Pre-results.https://bmjopen.bmj.com/content/10/12/e043400.full |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Chinazo O Cunningham Joanna L Starrels Chenshu Zhang Marcus A Bachhuber Nancy L Sohler Frances R Levin Haruka Minami Deepika E Slawek Julia H Arnsten |
spellingShingle |
Chinazo O Cunningham Joanna L Starrels Chenshu Zhang Marcus A Bachhuber Nancy L Sohler Frances R Levin Haruka Minami Deepika E Slawek Julia H Arnsten Medical Marijuana and Opioids (MEMO) Study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic pain BMJ Open |
author_facet |
Chinazo O Cunningham Joanna L Starrels Chenshu Zhang Marcus A Bachhuber Nancy L Sohler Frances R Levin Haruka Minami Deepika E Slawek Julia H Arnsten |
author_sort |
Chinazo O Cunningham |
title |
Medical Marijuana and Opioids (MEMO) Study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic pain |
title_short |
Medical Marijuana and Opioids (MEMO) Study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic pain |
title_full |
Medical Marijuana and Opioids (MEMO) Study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic pain |
title_fullStr |
Medical Marijuana and Opioids (MEMO) Study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic pain |
title_full_unstemmed |
Medical Marijuana and Opioids (MEMO) Study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic pain |
title_sort |
medical marijuana and opioids (memo) study: protocol of a longitudinal cohort study to examine if medical cannabis reduces opioid use among adults with chronic pain |
publisher |
BMJ Publishing Group |
series |
BMJ Open |
issn |
2044-6055 |
publishDate |
2020-12-01 |
description |
Introduction In 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 analyses We 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 dissemination This 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 number ClinicalTrials.gov Registry (NCT03268551); Pre-results. |
url |
https://bmjopen.bmj.com/content/10/12/e043400.full |
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