MCP-Patienten zeigten signifikant höhere Chancen für Opioid-Absetzen (OR 17,27) und Dosisreduktion (OR 5,12) mit 47%-Punktreduzierung der täglichen Opioid-Dosierung sowie Verbesserungen in Schmerzreduktion und Lebensqualität.
Zusammenfassung
Historische Kohortenstudie zu Medical Cannabis Program (MCP)-Enrollment in New Mexico, n=37 chronische Schmerz-Patienten mit habituellem Opioid-Gebrauch (MCP-Gruppe) vs. n=29 Nicht-Enrolled (Kontrolle), Beobachtung über 21 Monate. MCP-Enrollment assoziiert mit 17,27-fach höherer adjustierter Odds für Opioid-Verschreibungs-Cessation (95%-CI 1,89–157,36, p=0,012), 5,12-fach höherer Odds für Dosis-Reduktion (95%-CI 1,56–16,88, p=0,007) und 47 Prozentpunkte niedrigere tägliche Opioid-Dosis vs. +10,4 Prozentpunkte Anstieg in Kontrolle (95%-CI -90,68 bis -3,59, p=0,034). Monatlicher Trend in MCP-Gruppe: -0,64mg IV-Morphin-Äquivalent (95%-CI -1,10 bis -0,18, p=0,008), Kontrolle: +0,18mg (95%-CI -0,02 bis +0,39, p=0,081). Patient-reported Outcomes nach 1 Jahr: Verbesserungen in Schmerzreduktion, Lebensqualität, sozialer Aktivität, Konzentration (alle p<0,001); wenige Nebenwirkungen.
P
PopulationChronische Schmerzpatienten mit habituellem Opioidgebrauch, n=66 (37 MCP-Einschreibung, 29 Kontrollen); Durchschnittsalter 54 vs. 60 Jahre; überwiegend chronischer Rückenschmerz
I
InterventionEinschreibung in das New Mexico Medical Cannabis Program (MCP); Cannabiskonsum ad libitum
C
KontrolleNicht im MCP eingeschriebene chronische Schmerzpatienten (n=29)
O
OutcomeMCP-Einschreibung assoziiert mit 17,27-fach höheren alters-/geschlechtsadjustierten Odds für Opioid-Abbruch (CI 1,89–157,36; p=0,012), 5,12-fach höheren Odds für Dosisreduktion (CI 1,56–16,88; p=0,007) und 47 Prozentpunkte Reduktion der täglichen Opioiddosis vs. +10,4 Prozentpunkte in der Vergleichsgruppe (p=0,034)
Vertrauen in die Evidenz
Sehr niedrigNiedrigModeratHoch
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Niedrigste GRADE-Stufe, die Effektschätzung bleibt unsicher.
Background: Current levels and dangers of opioid use in the U.S. warrant the investigation of harm-reducing treatment alternatives.
Purpose: A preliminary, historical, cohort study was used to examine the association between enrollment in the New Mexico Medical Cannabis Program (MCP) and opioid prescription use.
Methods: Thirty-seven habitual opioid using, chronic pain patients (mean age = 54 years; 54% male; 86% chronic back pain) enrolled in the MCP between 4/1/2010 and 10/3/2015 were compared to 29 non-enrolled patients (mean age = 60 years; 69% male; 100% chronic back pain). We used Prescription Monitoring Program opioid records over a 21 month period (first three months prior to enrollment for the MCP patients) to measure cessation (defined as the absence of opioid prescriptions activity during the last three months of observation) and reduction (calculated in average daily intravenous [IV] morphine dosages). MCP patient-reported benefits and side effects of using cannabis one year after enrollment were also collected.
Results: By the end of the 21 month observation period, MCP enrollment was associated with 17.27 higher age- and gender-adjusted odds of ceasing opioid prescriptions (CI 1.89 to 157.36, p = 0.012), 5.12 higher odds of reducing daily prescription opioid dosages (CI 1.56 to 16.88, p = 0.007), and a 47 percentage point reduction in daily opioid dosages relative to a mean change of positive 10.4 percentage points in the comparison group (CI -90.68 to -3.59, p = 0.034). The monthly trend in opioid prescriptions over time was negative among MCP patients (-0.64mg IV morphine, CI -1.10 to -0.18, p = 0.008), but not statistically different from zero in the comparison group (0.18mg IV morphine, CI -0.02 to 0.39, p = 0.081). Survey responses indicated improvements in pain reduction, quality of life, social life, activity levels, and concentration, and few side effects from using cannabis one year after enrollment in the MCP (ps<0.001).
Conclusions: The clinically and statistically significant evidence of an association between MCP enrollment and opioid prescription cessation and reductions and improved quality of life warrants further investigations on cannabis as a potential alternative to prescription opioids for treating chronic pain.