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：尽管普通人群中大麻的使用有所增加，但关于大麻的数据却很少 在检验基于 THC 的效果的随机对照试验中。 治疗疼痛的药物，不良事件包括头晕、镇静、精神错乱、失去知觉 平衡、恶心、呕吐和幻觉这些副作用表明大麻联合使用。 阿片类药物——也会引起头晕、镇静、神志不清、呼吸抑制、恶心、呕吐和 便秘——可能对老年退伍军人以及患有潜在呼吸系统和心脏病的人特别有害。 另一方面，联合使用阿片类药物和大麻可能会面临更高的不良反应风险。 另一方面，一些生态研究表明，基于国家的娱乐合法化可能与 因此，通过减少阿片类药物的使用，大麻的使用似乎是合理的。 减少呼吸抑制和过量的风险然而，生态学研究检验了其效果。 阿片类药物相关死亡的合法化并不能帮助我们理解联合使用阿片类药物的影响 了解大麻和阿片类药物联合使用对个人健康的影响。 阿片类药物对个体患者的治疗效果至关重要，目前尚无证据基础。 退伍军人管理局关于接受阿片类药物治疗的慢性疼痛患者使用大麻的指南。 意义：虽然吸食大麻在患有慢性疼痛的退伍军人中很常见，但其风险或益处 退伍军人在长期阿片类药物治疗（LTOT）中使用大麻的情况尚不清楚。 响应 VA 实践指南和 HSR&D 优先领域确定的研究差距 “研究老年退伍军人和退伍军人长期阿片类药物治疗相关的安全性和有效性问题 我们的提案也响应了 HSR&D 优先领域： “使用数据挖掘策略评估 LTOT 队列研究的可行性。” 创新：弥补有关大麻使用潜在危害（或益处）的文献空白 在长期阿片类药物治疗的患者中，我们提出了一种创新的队列构建方法，使用 尿液药物筛查数据、文本处理算法（由我们团队开发）和国家 VA 的结合 和医疗保险数据对暴露状态进行分类（同时使用大麻加阿片类药物与不使用阿片类药物） 大麻）以实现以下目标： 具体目标： 目标 1：研究大麻使用与全因后果的关系 长期使用阿片类药物的 18 岁以上退伍军人的死亡率 目标 2：研究与以下因素之间的关联。 大麻使用对全因死亡率主要结局和住院次要结局的影响 年龄≥65 岁、患有慢性阻塞性肺病、充血性心力衰竭或接受 LTOT 的退伍军人 目标 3：研究大麻与全因死亡率和睡眠呼吸暂停主要结局的关系。 任何住院、跌倒相关伤害、任何伤害和情绪住院的次要结果 LTOT 年龄≥65 岁的退伍军人中的疾病。 方法：我们将利用 VA 数据源并使用从进度记录、尿液中提取的数据 毒理学数据以及国家 VA 和医疗保险行政数据来回答临床相关问题。 将使用倾向评分方法来比较大麻使用者和非使用者的一年结果。 后续步骤：后续步骤包括将研究结果传播给 VA 研究人员以及临床和 研究结果将为 VA 指南和临床实践提供信息。