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Bergmans RS, Yu C, Yalavarthi B, Xiao LZ, Wegryn-Jones R, Summerville J, Rajgarhia S, Kurtz V, Dell'Imperio S, Bohnert ASB, Boehnke KF. How Veterans with Chronic Pain Approach Using Cannabis for Symptom Management: Results from a Qualitative Interpretive Description Study. Cannabis Cannabinoid Res 2024. [PMID: 39582441 DOI: 10.1089/can.2024.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2024] Open
Abstract
Introduction: Veterans use cannabis as a chronic pain treatment due to a combination of the easing of restrictions and dissatisfaction with care standards. The segregation of medical cannabis from conventional health systems may translate to opportunities and disadvantages that are not well defined. Our study aimed to characterize how Veterans with chronic pain approach using cannabis for symptom management, including product access, developing a treatment plan, and its integration into daily life. Materials and Methods: We used an interpretive description design and conducted semi-structured interviews with U.S. Veterans in Michigan who had chronic pain; were aged 21 years or older; and (a) used cannabis, (b) were planning to use cannabis, or (c) interested in learning about how cannabis could help with pain. We analyzed deidentified interview transcripts to develop themes that focused on how Veterans approached new and continued use of cannabis for chronic pain management. Results: Participants were Veterans with chronic pain, median age = 50 years (n = 32). Participants described how factors at the individual, relationship, community, and societal levels influenced their interest in and use of cannabis for chronic pain. We identified five main themes: (1) cannabis supports holistic wellness, but there are also undesired effects; (2) medical cannabis requires a personalized treatment approach; (3) Veterans seek expanded access to medical cannabis and more assurance regarding product safety and efficacy; (4) sociopolitical attitudes and advocacy shape medical cannabis acceptability; and (5) the interest in research to inform treatment approaches and facilitate access. Discussion: This article illustrates how Veterans approached using cannabis for chronic pain management. Findings illuminate the potential value of cannabis for Veterans with chronic pain while also highlighting numerous obstacles and limitations related to its use. There are opportunities for health care providers to support Veterans who are interested in cannabis while research regarding efficacy and safety continues. Future efforts should engage Veterans to collectively work toward a better understanding of cannabis as a pain treatment option.
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Affiliation(s)
- Rachel S Bergmans
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Christine Yu
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Bhaavna Yalavarthi
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Lillian Z Xiao
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Riley Wegryn-Jones
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Johari Summerville
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Sia Rajgarhia
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Vivian Kurtz
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Samantha Dell'Imperio
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, Medical School, University of Michigan, Ann Arbor, Michigan, USA
| | - Amy S B Bohnert
- Department of Anesthesiology, Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Department of Veterans Affairs, Health Services Research & Development (HSR&D) Center for Clinical Management Research, Ann Arbor, Michigan, USA
| | - Kevin F Boehnke
- Department of Anesthesiology, Chronic Pain and Fatigue Research Center, Medical School, University of Michigan, Ann Arbor, Michigan, USA
- Department of Anesthesiology, Michigan Psychedelic Center, Medical School, University of Michigan, Ann Arbor, Michigan, USA
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Warner E, Azizoddin D, Frank-Pearce SG, Ford L, Bradley D, Cohn AM, Businelle M, Spicer P, Appleseth H, McQuoid J. "It frees your body from that pain thought": A mixed-methods exploration of patterns, contexts, and experiences of cannabis use for pain in rural communities. THE JOURNAL OF PAIN 2024; 25:104636. [PMID: 39025284 PMCID: PMC11486579 DOI: 10.1016/j.jpain.2024.104636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/02/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024]
Abstract
U.S. adults increasingly report using cannabis to manage chronic pain and rural areas have inadequate comprehensive pain management. Using mixed methods, we aimed to understand how and why some rural adults use cannabis for pain, including within the context of co-use with opioids. Participants (N = 14, Oklahoma) were rural-dwelling adults who used tobacco and ≥1 other substance, including cannabis and opioids, ≥3 days per week. Participants completed 14 days of ecological momentary assessment (EMA) regarding substance use and subsequent in-depth interviews discussing maps of their substance use reports. Half (7/14) described cannabis use for chronic pain, and most of these (85%) reported use on ≥75% of EMA days. The most frequently reported cannabis use motive was therapeutic/medicinal (90% of use reports). Most reports were of combusted cannabis (88% of use reports) at home (99% of use reports). Same-day use of cannabis and opioids was relatively common (45% of daily surveys), but seemingly not within close temporal proximity. Interview narratives characterized cannabis as modifying pain-adjacent factors (eg, thoughts), not eliminating pain itself. They recounted using a repertoire of substances to manage different pain dimensions (eg, intensity, quality) and balance perceived trade-offs of different substances. Participants described high medical cannabis access, low pain specialist access, and most physicians as unwilling to discuss cannabis for pain. The findings suggest that rural-dwelling patients could benefit from increased access to comprehensive pain management, having cannabis addressed within pain management provider discussions, and that risks and benefits of cannabis use for pain must be better established. PERSPECTIVE: This study used a geographically explicit EMA mixed method to gather rich, intensive pilot data on cannabis use and co-use for chronic pain in rural Oklahoma. It provides unique insights to inform future research on cannabis use among a vulnerable and understudied subgroup of adults with pain-rural residents.
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Affiliation(s)
- Emily Warner
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma; TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Desiree Azizoddin
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Summer G Frank-Pearce
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Lance Ford
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - David Bradley
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Amy M Cohn
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Michael Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Paul Spicer
- Department of Anthropology, University of Oklahoma, Norman, Oklahoma
| | - Hannah Appleseth
- Department of Psychology, Oklahoma State University, Stillwater, Oklahoma; TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Julia McQuoid
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma; Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
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Ramírez-Méndez JF, Wong-Salgado P, Gámez P, Solis P, Moya-Salazar J. Patients' knowledge about the uses, risks, and beliefs surrounding the regulation and safety of Cannabis sativa L. in Peru. Heliyon 2024; 10:e27068. [PMID: 38689986 PMCID: PMC11059411 DOI: 10.1016/j.heliyon.2024.e27068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 05/02/2024] Open
Abstract
In recent decades, there has been a significant rise in the utilization of medical cannabis. Understanding the various facets surrounding its usage and regulation is paramount for patients, health professionals, and policymakers. This cross-sectional study conducted at the CANNAVITAL clinic in Lima, Peru aimed to assess the basic knowledge, attitudes towards use, and beliefs regarding regulation and safety of Cannabis sativa L. Among 86 patients (mean age: 41 ± 7.8 years; 53.4% women) actively receiving medical cannabis treatment for at least one year, we utilized the 22-item KUC-22 questionnaire to evaluate their understanding of cannabis, risk factors, legislation, medical and recreational use. The average duration of medical cannabis use was 3 ± 1.2 years. Results showed that 60.2% of patients were familiar with different forms of cannabis consumption, while 77.3% recognized the importance of product quality. Chronic pain, nausea and vomiting (each 23.9%) were the primary conditions treated with cannabis, followed by cancer and epilepsy (both 21.6%). A significant correlation was found between knowledge and cannabis use (p < 0.001). Furthermore, 92% of patients believed that a medical prescription was necessary, while 84.1% engaged in self-medication practices. Concerning perceptions, 69.3% of participants perceived psychological dependence from long-term cannabis use, and 65.9% believed it could cause health damage. Significant correlations were observed between the perception of risk factors, knowledge of legislation, and cannabis use (p < 0.001). In conclusion, Peruvian patients exhibited a high level of knowledge regarding the risks, uses, and regulatory framework surrounding Cannabis sativa L. These findings provide valuable insights into patients' perspectives on medical cannabis, offering important information for medical providers and researchers aiming to enhance cannabinoid-based therapies.
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Affiliation(s)
| | - Pedro Wong-Salgado
- CANNAVITAL Clínica Especializada en Terapias con Cannabinoides, Lima, Peru
- Centro de Estudios del Cannabis, Lima, Peru
| | - Peter Gámez
- CANNAVITAL Clínica Especializada en Terapias con Cannabinoides, Lima, Peru
- Department of Medicine, Essalud Hospital Jorge Voto Bernales Corpancho, Lima, Peru
| | - Pedro Solis
- Graduate School, Universidad Alas Peruanas, Lima, Peru
| | - Jeel Moya-Salazar
- Digital Transformation Center, Universidad Norbert Wiener, Lima, Peru
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Kitchen C, Kabba JA, Nelson EU, Adu-Gyamfi S, Ssekamatte T, Mametja M, Yang C, Chang J, Fang Y. Medicinal use of cannabis: A qualitative study of the perspectives of doctors and pharmacists from six African countries. J Ethn Subst Abuse 2023:1-25. [PMID: 37791493 DOI: 10.1080/15332640.2023.2259830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
We conducted a qualitative study to examine the enablers and barriers influencing the implementation of medical cannabis from the perspectives of practicing doctors and pharmacists within the African context. Interviews were conducted to investigate medical professionals' perceptions and concerns regarding medicinal cannabis. Three major themes were identified: beliefs about consequences, optimism, and environmental resources and context. Depending on the context of use, medical professionals described cannabis as potentially useful as an adjunct medicine and yet problematic owing to knowledge and social barriers, particularly religion. Implementation strategies tailored to address structural and social concerns to providing optimal care are needed to ensure that medical professionals are well versed in policy and clinical aspects.
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Affiliation(s)
- Chenai Kitchen
- Xi'an Jiaotong University, Xi'an, China
- Western Technological Innovation Harbour, Xi'an, China
| | - John Alimamy Kabba
- Xi'an Jiaotong University, Xi'an, China
- Western Technological Innovation Harbour, Xi'an, China
| | | | | | | | | | - Caijun Yang
- Xi'an Jiaotong University, Xi'an, China
- Western Technological Innovation Harbour, Xi'an, China
| | - Jie Chang
- Xi'an Jiaotong University, Xi'an, China
- Western Technological Innovation Harbour, Xi'an, China
| | - Yu Fang
- Xi'an Jiaotong University, Xi'an, China
- Western Technological Innovation Harbour, Xi'an, China
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Sedani AE, Campbell JE, Beebe LA. Cannabis use among cancer survivors in 22 states: Results from the Behavioral Risk Factor Surveillance System, 2020. Cancer 2023; 129:2499-2513. [PMID: 37029457 DOI: 10.1002/cncr.34793] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/07/2023] [Accepted: 03/22/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND This study identified factors associated with recent cannabis use and cannabis use for medical purposes among cancer survivors relative to individuals without a history of cancer. METHODS Data from the Behavioral Risk Factor Surveillance System were analyzed for the 22 states completing the optional cannabis module in 2020. Weighted multiple logistic regression was performed to explore variables associated with past 30-day cannabis use and cannabis use for medical purposes, stratified by history of cancer. Covariates included state-level cannabis policy, sociodemographic characteristics, health status indicators, and substance use. RESULTS Cannabis use was lower among cancer survivors compared to individuals with no history of cancer (7.57% vs. 10.83%). However, a higher proportion of cancer survivors reported use for medical purposes (82.23% vs. 62.58%). After adjusting for state-level policy, biological sex, age, educational attainment, self-reported race/ethnicity, home ownership, mental health status and physical health status, current smoking (odds ratio [OR], 5.14 vs. 3.74) and binge drinking (OR, 2.71 vs. 2.69) were associated with cannabis use in both groups. Characteristics associated with medical cannabis use varied for the two groups; however, daily use (20-30 days; OR, 1.72 vs. 2.43) was associated with cannabis use for medical purposes in both groups after adjusting for other variables in the model. CONCLUSIONS A high proportion of individuals report cannabis use for medical purposes with higher rates among cancer survivors. Findings support the urgent need for ongoing cannabis research to better understand and inform its use for medical purposes, as well as the development of high-quality standardized education materials and clinical practice guidelines.
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Affiliation(s)
- Ami E Sedani
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Laura A Beebe
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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Ng JY, Tahir U, Lum N. The quality of health information provided on web sites selling cannabis to consumers in Canada is poor. Harm Reduct J 2022; 19:138. [PMID: 36503517 PMCID: PMC9743698 DOI: 10.1186/s12954-022-00691-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 09/23/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Cannabis is used by millions of people for both medical and recreational purposes, and this use is even greater in jurisdictions where it is legalized, such as Canada. Online cannabis vendors have gained popularity for purchasing cannabis due to easy access and convenience to consumers. The objective of this study was to evaluate the quality of health information provided by web sites of cannabis vendors selling products to Canadian consumers and to further identify trends in the information provided. METHODS Six different searches were conducted on Google.ca, and the first 40 webpages of each search were screened for eligibility. A total of 33 unique web sites of cannabis vendors selling products to Canadian consumers were identified and included. The DISCERN instrument, which consists of 16 questions divided into three sections, was used to evaluate the quality of cannabis-related health information on these web sites. RESULTS Across the 33 web sites, the average of the summed DISCERN scores was 36.83 (SD = 9.73) out of 75, and the mean score for the overall quality of the publication (DISCERN question 16) was 2.41 (SD = 0.71) out of 5. Many of these web sites failed to discuss uncertainties in research evidence on cannabis, the impact of cannabis use on quality of life, alternatives to cannabis use, risks associated with cannabis use, and lacked references to support claims on effects and benefits of use. CONCLUSION Our findings indicate that the quality of cannabis-related health information provided by online vendors is poor. Healthcare providers should be aware that patients may use these web sites as primary sources of information and appropriately caution patients while directing them to high-quality sources. Future research should serve to replicate this study in other jurisdictions and assess the accuracy of information provided by online cannabis vendors, as this was outside the scope of the DISCERN instrument.
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Affiliation(s)
- Jeremy Y. Ng
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Michael G. DeGroote Centre for Learning and Discovery, McMaster University, Room 2112, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Umair Tahir
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Michael G. DeGroote Centre for Learning and Discovery, McMaster University, Room 2112, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
| | - Nicholas Lum
- grid.25073.330000 0004 1936 8227Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, Michael G. DeGroote Centre for Learning and Discovery, McMaster University, Room 2112, 1280 Main Street West, Hamilton, ON L8S 4K1 Canada
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