Association between cannabis and pain outcomes in a Tribally operated clinic

部落经营的诊所中大麻与疼痛结果之间的关联

• 批准号: 10460837
• 负责人: STACY M RASMUS
• 金额: $ 40万
• 依托单位: NORTHWEST INDIAN COLLEGE
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-24 至 2025-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10460837
• 关键词: Adult; Affect; Age; Alaska Native; American Indians; Analgesics; Anti-Anxiety Agents; Anxiety; Arthritis; Cannabidiol; Cannabis; Caring; Clinic; Communities; Consultations; Data; Data Analyses; Data Collection; Diabetic Neuropathies; Discipline of Nursing; District of Columbia; Economic Factors; Elderly; Enrollment; Event; Female; Fibrinogen; Grant; Hemp; Individual; Industry; Institutional Review Boards; Interview; Legal; Life; Low Back Pain; Marijuana; Measures; Mediating; Medical; Medical Marijuana; Medicine; Mental Depression; Mental Health; Mentorship; Methods; Native American Research Center for Health; Native-Born; Pain; Pain Research; Pain intensity; Pain interference; Pain management; Participant; Patients; Pattern; Pharmacy facility; Pilot Projects; Post-Traumatic Stress Disorders; Poverty; Prevention; Procedures; Provider; Puyallup; Qualitative Methods; Race; Reporting; Research; Sampling; Science; Self Efficacy; Sleep; Sleep Disorders; Sleeplessness; Students; Tetrahydrocannabinol; Time; Training; Tribes; Universities; Washington; care seeking; chronic pain; chronic painful condition; clinical care; college; comorbidity; data infrastructure; data repository; demographics; experience; graduate student; healing; health care availability; improved; marijuana decriminalization; marijuana legalization; marijuana use; marijuana user; negative affect; nonmedical use; opioid misuse; opioid mortality; pain outcome; pain reduction; pain relief; prescription opioid; programs; sex; social factors; undergraduate student; vehicular accident

ABSTRACT American Indians and Alaska Native (AIAN) people are disproportionately affected by chronic pain conditions, including arthritis, diabetic neuropathy, and lower back pain. AIAN communities have also experienced harm as a result of pain solutions offered by Western medicine, such as prescription opioids, which have contributed to increased opioid misuse and mortality in AIAN people. Many AIAN people have turned to Native medicine and other non-Western approaches to pain management. Thirty-four states have legalized marijuana for medical use, while 12 states, and the District of Columbia, have legalized non-medical use, and cannabidiol (CBD) derived from hemp is no longer a controlled substance. Therefore, cannabis products are available to the majority of U.S. adults. 66% of adults think that cannabis provides pain relief, and 42% of medicinal marijuana users report using it to relieve pain. While initial evidence indicates that cannabis tetrahydrocannabinol [THC] has analgesic effects, the evidence for cannabis-associated reductions in pain intensity and interference (i.e., the extent to which pain interferes with functioning) is limited. There is very limited data about the effects of how a variety of cannabis products available on the legal market (e.g., different strains, methods of delivery) and patterns of use impact pain outcomes and the comorbidities (e.g., mental health, sleep) that are associated with pain. As a sovereign nation in Washington State, our Tribal partners developed the Qwibil Clinic, which advises patients on the use of cannabis for the management of pain and other medical problems. The Qwibil Clinic provides a unique opportunity to investigate the relationship between cannabis use, pain, and pain-related factors in an AIAN owned and operated clinic. We propose a mixed-methods embedded (QUANT+Qual) study to assess how cannabis impacts pain intensity and interference in a sample of n=350 patients seeking chronic pain treatment at the Qwibil Clinic. We will identify types and patterns of cannabis use that are associated with pain outcomes over 12-months of care. We will also determine whether the effect of cannabis on pain outcomes is mediated through known pain-related factors (i.e., negative affect, sleep problems, self-efficacy) over time. To supplement our quantitative methods, we will use qualitative interviews to explore how patients seeking care for pain experience cannabis and its impact on pain, including participants who differ by sex, race (AIAN, Non-AIAN), and type of cannabis used. Finally, we will provide opportunities for AIAN students enrolled in Washington State University medical, nursing, pharmacy, and prevention science graduate programs and Northwest Indian College undergraduate programs to receive training and mentorship in cannabis and pain research at the Qwibil Clinic, including training in qualitative and quantitative data collection and analysis and dissemination of research results. Results will provide important information about the impact of legal cannabis products on chronic pain in a mostly AIAN sample, providing important information to people with pain, providers, and Tribal policymakers.

抽象的 美洲印第安人和阿拉斯加原住民 (AIAN) 受慢性疼痛的影响尤为严重 疾病，包括关节炎、糖尿病神经病变和腰痛。 AIAN 社区还 因西药提供的疼痛解决方案（例如处方阿片类药物）而遭受伤害， 导致 AIAN 人群阿片类药物滥用和死亡率增加。很多AIAN人都转向了 本土医学和其他非西方的疼痛治疗方法。 34个州已将其合法化 大麻用于医疗用途，而 12 个州和哥伦比亚特区已将非医疗用途合法化，并且 从大麻中提取的大麻二酚（CBD）不再是受管制物质。因此，大麻产品 大多数美国成年人都可以使用。 66% 的成年人认为大麻可以缓解疼痛，42% 的人认为大麻可以缓解疼痛。 药用大麻使用者报告使用它来缓解疼痛。虽然初步证据表明大麻 四氢大麻酚 [THC] 具有镇痛作用，这是大麻相关减轻疼痛的证据 强度和干扰（即疼痛干扰功能的程度）是有限的。数量非常有限 有关合法市场上提供的各种大麻产品的影响的数据（例如，不同的菌株、 分娩方法）和使用模式影响疼痛结果和合并症（例如心理健康、睡眠） 与疼痛有关的。作为华盛顿州的一个主权国家，我们的部落合作伙伴制定了 Qwibil Clinic，为患者提供有关使用大麻治疗疼痛和其他医疗问题的建议 问题。 Qwibil 诊所提供了一个独特的机会来调查大麻使用之间的关系， AIAN 拥有和经营的诊所中的疼痛以及疼痛相关因素。我们提出了一种嵌入的混合方法 (QUANT+Qual) 研究评估大麻如何影响 n=350 样本中的疼痛强度和干扰 在 Qwibil 诊所寻求慢性疼痛治疗的患者。我们将确定大麻使用的类型和模式 与 12 个月护理期间的疼痛结果相关。我们还将确定是否有效果 大麻对疼痛结果的影响是通过已知的疼痛相关因素（即负面影响、睡眠问题、 自我效能感）随着时间的推移。为了补充我们的定量方法，我们将使用定性访谈来探索 寻求疼痛护理的患者如何体验大麻及其对疼痛的影响，包括不同的参与者 按性别、种族（AIAN、非 AIAN）和使用的大麻类型。最后，我们将为AIAN提供机会 就读于华盛顿州立大学医学、护理、药学和预防科学研究生的学生 项目和西北印度学院本科项目接受大麻培训和指导 Qwibil 诊所的疼痛研究，包括定性和定量数据收集和培训 分析和传播研究成果。结果将提供有关影响的重要信息 合法大麻产品在大部分 AIAN 样本中治疗慢性疼痛，为患有慢性疼痛的人提供重要信息 痛苦、提供者和部落决策者。