Risks of Cannabis Use Among Veterans on Long-term Opioid Therapy

长期接受阿片类药物治疗的退伍军人吸食大麻的风险

• 批准号: 10817659
• 负责人: Salomeh Keyhani
• 金额: --
• 依托单位: VETERANS AFFAIRS MED CTR SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-12-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10817659
• 关键词: 18 year old; Address; Adverse effects; Adverse event; Aging; Algorithms; Area; Behavior; Benzodiazepines; Cannabis; Cardiac; Categories; Chronic Obstructive Pulmonary Disease; Classification; Clinical; Cognition; Cohort Studies; Confusion; Congestive Heart Failure; Constipation; Data; Data Sources; District of Columbia; Dizziness; Drug Screening; Equilibrium; Frequencies; General Population; Guidelines; Hallucinations; Health; Heart Diseases; Hospitalization; Individual; Injury; Legal; Legal Medicine; Literature; Medicare; Memory impairment; Mental Health; Methodology; Mood Disorders; Nausea; Opioid; Outcome; Pain management; Patient Care; Patient-Focused Outcomes; Patients; Pharmaceutical Preparations; Pharmacologic Substance; Policies; Policy Maker; Population; Post-Traumatic Stress Disorders; Practice Guidelines; Prevalence; Randomized, Controlled Trials; Recreation; Reporting; Research; Research Personnel; Respiration Disorders; Risk; Scoring Method; Sedation procedure; Series; Sleep Apnea Syndromes; Subgroup; Substance abuse problem; Suicide; Tetrahydrocannabinol; Text; Toxicology; Urine; Ventilatory Depression; Veterans; Vomiting; Woman; chronic pain; chronic pain patient; clinical practice; clinically relevant; cocaine use; cohort; data mining; dosage; epidemiology study; evidence base; fall injury; high risk; human old age (65+); individual patient; innovation; marijuana use; marijuana user; military veteran; mortality; opioid mortality; opioid therapy; opioid use; overdose death; overdose risk; patient screening; prescription opioid; primary outcome; respiratory; safety study; secondary outcome; side effect

Background: Despite increasing cannabis use among the general population, very little data exists on potential harms associated with use. In randomized controlled trials examining the effect of THC-based pharmaceuticals on the management of pain, adverse events included dizziness, sedation, confusion, loss of balance, nausea, vomiting, and hallucination. These side effects suggest that cannabis used in combination with opioids—which also cause, dizziness, sedation, confusion, respiratory depression, nausea, vomiting and constipation—may be particularly harmful. Older Veterans, and those with underlying respiratory and cardiac conditions, may be at higher risk of adverse effects from combined opioid and cannabis use. On the other hand, several ecological studies suggest that state-based recreational legalization may be associated with a decrease in opioid related deaths. Thus, it is plausible that cannabis use, by reducing the use of opioids, reduces respiratory depression and the risk of overdose. However, ecological studies examining the effect of legalization on opioid related deaths do not inform our understanding of the effects of combined use of cannabis and opioids on individual health. Understanding the effects of the combined use of cannabis and opioids on individual patient outcomes is critically important. No evidence base is currently available to inform VA guidelines on cannabis use among chronic pain patients who receive opiates. Significance: Although cannabis use is common among Veterans with chronic pain, the risk or benefits of cannabis use among Veterans on long-term opioid therapy (LTOT) is unknown. This proposal is directly responsive to research gaps identified by VA practice guidelines and the HSR&D priority area focused on “Studying safety and efficacy issues related to long-term opioid therapy among aging Veterans and Veterans with mental health (non-pain) conditions”. Our proposal is also responsive to the HSR&D priority area: “Assessing the feasibility of LTOT cohort studies using data-mining strategies.” Innovation: To address the gaps in the literature on the potential harms (or benefits) of cannabis use among patients on long-term opioid therapy, we propose an innovative approach to cohort construction using a combination of urine drug screen data, text processing algorithms (developed by our team), and national VA and Medicare data to categorize exposure status (concomitant cannabis plus opioid vs. opioid without cannabis) to address the following aims: Specific Aims: Aim 1: To examine the association of cannabis use on the outcome of all-cause mortality among Veterans ≥18 years-old who use long-term opioids. Aim 2: To examine the association of cannabis use on the primary outcome of all-cause mortality and the secondary outcomes of hospitalization among Veterans ≥65 years-old on LTOT with chronic obstructive lung disease, congestive heart failure or sleep apnea. Aim 3: To examine the association of cannabis on the primary outcome of all-cause mortality and the secondary outcomes of any hospitalization, fall-related injury, any injury, and hospitalization for mood disorders among Veterans ≥65 years-old on LTOT. Methodology: We will leverage VA data sources and use data extracted from progress notes, urine toxicology data, and national VA and Medicare administrative data to answer a clinically relevant question. We will use propensity score methods to compare one-year outcomes among cannabis users and non-users. Next Steps: Next steps include dissemination of the findings to VA researchers and clinical and operational leaders. Study findings will be informative to VA guidelines and clinical practice.

背景：尽管大麻在一般人群中使用的使用量增加了，但很少有数据 与使用相关的潜在危害。在检查基于THC的效果的随机对照试验中 疼痛管理的药品，不良事件包括头晕，镇静，混乱，丧失 平衡，恶心，呕吐和幻觉。这些副作用表明将大麻用于组合 阿片类药物也会引起头晕，镇静，混乱，呼吸抑郁，恶心，呕吐和 便秘 - 可能特别有害。年长的退伍军人，以及那些具有潜在呼吸和心脏的老兵 综合使用阿片类药物和大麻的综合效应可能面临更高的不良影响风险。另一方面 手，一些生态学研究表明，基于州的娱乐合法化可能与 减少卵毒素相关的死亡。这是合理的，可以通过减少使用烯烃的使用来使用大麻 减少呼吸道抑郁症和过量的风险。但是，研究了研究的影响 关于阿片类药物相关死亡的合法化并不能使我们对合并使用的影响的理解 关于个人健康的大麻和阿片类药物。了解大麻的联合使用的影响和 对个别患者结局的阿片类药物至关重要。目前尚无证据基础来告知 在接受优化的慢性疼痛患者中使用大麻使用的VA指南。 意义：尽管使用大麻在慢性疼痛的退伍军人中很常见，但风险或益处很常见 退伍军人在长期阿片类药物治疗（LTOT）中使用大麻的使用是未知的。该提议直接 响应VA实践指南和HSR＆D优先领域确定的研究差距 “研究与老年退伍军人和退伍军人的长期阿片类药物治疗有关的安全和效率问题 在心理健康状况（非疼痛）条件下”。我们的建议也对HSR＆d优先领域做出了反应： “使用数据挖掘策略评估LTOT队列研究的可行性。” 创新：解决有关大麻使用的潜在危害（或益处）文献中的差距 在长期阿片类药物治疗的患者中，我们提出了一种创新的方法来使用 尿液药物筛查数据，文本处理算法（由我们的团队开发）和国家弗吉尼亚州的组合 和医疗保险数据以分类暴露状态（伴随大麻加阿片类药物与阿片类药物 大麻）解决以下目标： 具体目的：目的1：检查大麻使用在全因结果上的关联 ≥18岁的退伍军人使用长期阿片类药物的死亡率。目标2：检查关联 大麻在全因死亡率的主要结果和住院的次要结果上 在患有慢性阻塞性肺部疾病的LTOT上≥65岁的退伍军人中，充血性心力衰竭或 睡眠呼吸暂停。目标3：检查大麻在全因死亡率的主要结果和 任何住院，跌倒相关的伤害，任何伤害和心情的次要结果 LTOT≥65岁的退伍军人中的疾病。 方法论：我们将利用VA数据源并使用从进度注释，尿液中提取的数据 毒理学数据以及国家弗吉尼亚州和医疗保险行政数据，以回答与临床相关的问题。我们 将使用承诺得分方法比较大麻用户和非用户中的一年成绩。 下一步：下一步包括向VA研究人员和临床的发现以及 运营领导者。研究结果将为VA指南和临床实践提供信息。