Benefits and adverse effects of cannabis use among adults with persistent pain
Teresa Bigand, Cristina Lee Anderson, Mary Lee Roberts, Michele Rose Shaw, Marian Wilson
Nursing Outlook, 2 0 1 9 , 67, 2 2 3 -2 3 1
doi : 10.1016/j.outlook.2018.12.014.
A B S T R A C T
Background : Increasingly, states are legalizing cannabis for recreational use. Improved accessibility may allow adults with pain to use cannabis more liberally. Greater understanding is needed about how adults with pain perceive the effects of cannabis, particularly those who also use opioid analgesics.
Purpose : To examine the perceived effects of cannabis among adults who have been prescribed opioids for persistent pain.
Methods : A survey-based study was conducted on 150 adults with persistent pain. Data from two open-ended questions were analyzed using a qualitative descriptive approach and content analysis.
Findings : Data analysis led to identification of two main categories and five subcategories: (a) cannabis benefits with two subcategories of “physiological” and “mental health”; (b) adverse effects with three subcategories of “physiological,” “mental health,” and “social and economic concerns.”
Discussion : Both positive and negative effects of cannabis were described. Nursing practice, including open communication with patients, can be guided by patient perspectives surrounding benefits and adverse effects of cannabis use.
Keywords : Cannabis use, Nursing care, Opioid use, Pain management, Persistent pain
In the United States today, the prevalence of pain conditions is high, with an estimated 25 million adults experiencing pain lasting 3 months or more (Nahin, 2015). Among adults with persistent pain, co-occurring, complex symptoms such as anxiety (de Heer et al., 2014), depression (Hooten, 2016; Rayner et al., 2016), and poor-quality sleep (Finan, Goodin, & Smith, 2013) can exacerbate the pain experience and negatively impact quality of life (Kroenke et al., 2013). Many adults with persistent pain who use opioid medications for pain management also report using cannabis to treat pain and related symptoms (Sexton, Cuttler, Finnell, & Mischley, 2016; Wilson et al., 2018). While clinical trials have found modest evidence for the effectiveness of cannabis as a pharmacotherapy for pain (Whiting et al., 2015), the experience of pain and the efficacy of marijuana for treating pain can be subjective, involving sensory, emotional, social, and genetic parameters (Hill, Palastro, Johnson, & Ditre, 2017).
Pain management is an issue of public interest in the United States, given that poorly treated pain is referenced as the most common reason for opioid misuse (Weiss et al., 2014). “Misuse,” or taking a drug in a manner or dose other than how it was prescribed, can result in serious medical consequences (National Institute on Drug Abuse, 2018). Consequently, an opioid epidemic has been declared in the United States, resulting from increases in opioid overdose and death (Kolodny et al., 2015). In 2016 alone, over 11 million Americans reported misuse of opioid pain relievers (Substance Abuse and Mental Health Services Administration, 2017), while >40,000 people died of a drug overdose involving opioids (Centers for Disease Control, 2017). A recent study found rates of self-reported opioid misuse in adults with persistent pain to be 35%, similar to estimates of opioid misuse in the general population (Chang, 2018). However, some research suggests that the increased accessibility to cannabis will reduce opioid use (Bradford & Bradford, 2016) as cannabis may offer an alternative to opioids for pain treatment (Corroon, Mischley, & Sexton, 2017; Vyas, LeBaron, & Gilson, 2018).
The accessibility of cannabis has greatly expanded in recent years, due in large part to an increasing number of states legalizing cannabis for medical and recreational use (National Conference of State Legislatures, 2018). In contrast, the U.S. Drug Enforcement Administration classifies cannabis as a schedule 1 controlled drug, on par with heroin and cocaine (U.S. Department of Justice, 2017). As a result, some pain specialists have reported that they will not accept nor treat patients in their practice who use cannabis, even in states where cannabis is legal (Lucas and Walsh, 2017; Walsh et al., 2013). However, the increase in accessibility to cannabis may allow patients to use the drug more freely and
to self-treat pain or other symptoms without the guidance of a licensed health care professional. Such medically unmonitored use may have negative side effects and can facilitate a cannabis use disorder (American Psychiatric Association, 2013; Lev-Ran et al., 2014; NAS, 2017). Nurses may play an important role in identifying cannabis use in this population by utilizing open communication, a nonjudgmental approach, and offering current research findings on the impact of cannabis use on pain and related complex symptoms as outlined by National Council on State Board of Nursing in a 2018 publication of nursing care guidelines.
In the context of the limited legal status of cannabis in selected U.S. states, there is little knowledge about how people with persistent pain perceive the benefits or adverse effects of cannabis use. Research on actual benefits and harms is also lacking due to constraints on conducting cannabis research (National Academies of Sciences, 2017; Nugent et al., 2017). The purpose of this study was to describe the perceived effects of cannabis use among people with persistent pain who are prescribed opioids in a state where it has been legalized for medical and recreational reasons. We are guided by Individual and Family Self-Management Theory (IFSMT) that incorporates holistic patientprovider communication into care of the client with a chronic condition to empower the individual to self-manage symptoms with the help of an appropriate social network (Ryan & Sawin, 2009). Therefore, we focus on patient perceptions in this study to best understand how patients self-manage symptoms related to persistent pain using cannabis. Findings from this study may facilitate open nurse-patient communication on the perceived advantages and disadvantages of cannabis use among adults with persistent pain regarding cannabis as a pain management option.