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

Jessica S. Merlin, Dustin Long, William C. Becker, Edward R. Cachay, Katerina A. Christopolous, Kasey R. Claborn, Heidi M. Crane, Eva Jennifer Edelman, Travis I. Lovejoy, William Christopher Mathews, Benjamin J. Morasco, Sonia Napravnik, Connall OʼCleirigh, Michael S. Saag, Joanna L. Starrels, Robert Gross, Jane M. Liebschutz

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)231-237
Number of pages7
JournalJournal of acquired immune deficiency syndromes (1999)
Volume81
Issue number2
DOIs
StatePublished - Jun 1 2019

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Cannabis
Chronic Pain
Opioid Analgesics
Prescriptions
HIV
Pain
Medical Marijuana
Logistic Models
Self Report
Counseling
Linear Models
Acquired Immunodeficiency Syndrome
Research

ASJC Scopus subject areas

  • Infectious Diseases
  • Pharmacology (medical)

Cite this

Marijuana Use Is Not Associated With Changes in Opioid Prescriptions or Pain Severity Among People Living With HIV and Chronic Pain. / Merlin, Jessica S.; Long, Dustin; Becker, William C.; Cachay, Edward R.; Christopolous, Katerina A.; Claborn, Kasey R.; Crane, Heidi M.; Edelman, Eva Jennifer; Lovejoy, Travis I.; Mathews, William Christopher; Morasco, Benjamin J.; Napravnik, Sonia; OʼCleirigh, Connall; Saag, Michael S.; Starrels, Joanna L.; Gross, Robert; Liebschutz, Jane M.

In: Journal of acquired immune deficiency syndromes (1999), Vol. 81, No. 2, 01.06.2019, p. 231-237.

Research output: Contribution to journalArticle

Merlin, JS, Long, D, Becker, WC, Cachay, ER, Christopolous, KA, Claborn, KR, Crane, HM, Edelman, EJ, Lovejoy, TI, Mathews, WC, Morasco, BJ, Napravnik, S, OʼCleirigh, C, Saag, MS, Starrels, JL, Gross, R & Liebschutz, JM 2019, 'Marijuana Use Is Not Associated With Changes in Opioid Prescriptions or Pain Severity Among People Living With HIV and Chronic Pain', Journal of acquired immune deficiency syndromes (1999), vol. 81, no. 2, pp. 231-237. https://doi.org/10.1097/QAI.0000000000001998
Merlin, Jessica S. ; Long, Dustin ; Becker, William C. ; Cachay, Edward R. ; Christopolous, Katerina A. ; Claborn, Kasey R. ; Crane, Heidi M. ; Edelman, Eva Jennifer ; Lovejoy, Travis I. ; Mathews, William Christopher ; Morasco, Benjamin J. ; Napravnik, Sonia ; OʼCleirigh, Connall ; Saag, Michael S. ; Starrels, Joanna L. ; Gross, Robert ; Liebschutz, Jane M. / Marijuana Use Is Not Associated With Changes in Opioid Prescriptions or Pain Severity Among People Living With HIV and Chronic Pain. In: Journal of acquired immune deficiency syndromes (1999). 2019 ; Vol. 81, No. 2. pp. 231-237.
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AU - Long, Dustin

AU - Becker, William C.

AU - Cachay, Edward R.

AU - Christopolous, Katerina A.

AU - Claborn, Kasey R.

AU - Crane, Heidi M.

AU - Edelman, Eva Jennifer

AU - Lovejoy, Travis I.

AU - Mathews, William Christopher

AU - Morasco, Benjamin J.

AU - Napravnik, Sonia

AU - OʼCleirigh, Connall

AU - Saag, Michael S.

AU - Starrels, Joanna L.

AU - Gross, Robert

AU - Liebschutz, Jane M.

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N2 - 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.

AB - 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.

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