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J Acquir Immune Defic Syndr. 2019 Jun 1;81(2):231-237. doi: 10.1097/QAI.0000000000001998.

Marijuana Use Is Not Associated With Changes in Opioid Prescriptions or Pain Severity Among People Living With HIV and Chronic Pain.

Author information

1
Divisions of General Internal Medicine and Infectious Diseases, Center for Research on Healthcare, University of Pittsburgh School of Medicine, Pittsburgh, PA.
2
Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
3
Section of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT.
4
VA Connecticut Healthcare System, West Haven, CT.
5
Division of Infectious Diseases, Department of Medicine, Owen Clinic, University of California at San Diego, San Diego, CA.
6
Division of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA.
7
Department of Psychiatry, University of Texas at Austin Dell Medical School, Austin, TX.
8
Division of Infectious Disease, Department of Medicine, University of Washington, Seattle, WA.
9
Yale Schools of Medicine and Public Health, New Haven, CT.
10
Department of Psychiatry, Oregon Health & Science University, Portland, OR.
11
Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR.
12
Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
13
Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, The Fenway Institute, Boston, MA.
14
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL.
15
Division of General Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY.
16
Division of Infectious Diseases, Department of Medicine, and Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

Abstract

BACKGROUND:

People living with HIV (PLWH) commonly report marijuana use for chronic pain, although there is limited empirical evidence to support its use. There is hope that marijuana may reduce prescription opioid use. Our objective was to investigate whether marijuana use among PLWH who have chronic pain is associated with changes in pain severity and prescribed opioid use (prescribed opioid initiation and discontinuation).

METHODS:

Participants completed self-report measures of chronic pain and marijuana use at an index visit and were followed up for 1 year in the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). Self-reported marijuana use was the exposure variable. Outcome variables were changes in pain and initiation or discontinuation of opioids during the study period. The relationship between exposure and outcomes was assessed using generalized linear models for pain and multivariable binary logistic regression models for opioid initiation/discontinuation.

RESULTS:

Of 433 PLWH and chronic pain, 28% reported marijuana use in the past 3 months. Median pain severity at the index visit was 6.3/10 (interquartile range 4.7-8.0). Neither increases nor decreases in marijuana use were associated with changes in pain severity, and marijuana use was not associated with either lower odds of opioid initiation or higher odds of opioid discontinuation.

CONCLUSIONS:

We did not find evidence that marijuana use in PLWH is associated with improved pain outcomes or reduced opioid prescribing. This suggests that caution is warranted when counseling PLWH about potential benefits of recreational or medical marijuana.

PMID:
30865181
PMCID:
PMC6522289
[Available on 2020-06-01]
DOI:
10.1097/QAI.0000000000001998

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