Zie ook in gerelateerde artikelen.

9 december 2022: Bron: JAMA 6 december 2022

Legalisatie van medische marihuana - cannabis blijkt een gunstige invloed te hebben bij volwassenen tot 65 jaar die worden behandeld voor nieuw gediagnosticeerde vormen van kanker. Uit een studie uitgevoerd bij gegevens van 38.189 patiënten met nieuw gediagnosticeerde borstkanker (100 procent vrouwen); 12.816 met darmkanker (55,4 procent mannen); en 7.190 met longkanker (51,1 procent vrouwen) bleek minder morfine nodig als pijnstilling (5 tot 20 procent minder) en werden er minder ziekenhuisopnames die aan pijn gerelateerd waren gezien bij de marihuana - cannabis gebruikers. Deze zogeheten cross-sectionele studie is op 1 december online gepubliceerd in JAMA Oncology.

De onderzoekers ontdekten dat legalisatie van medicinale marihuana geassocieerd was met een vermindering van het aantal opioïdendagen bij patiënten met borstkanker met recente opioïden, met darmkanker met recente opioïden en met longkanker zonder recente opioïden (verschil, 5,6 en 4,9 en respectievelijk 6,5 procentpunt). Onder patiënten met longkanker met recente opioïden ging legalisatie van medicinale marihuana gepaard met een vermindering van het aantal pijngerelateerde ziekenhuisgebeurtenissen (verschil, 6,3 procentpunten).
"De bevindingen suggereren dat medische marihuana tot op zekere hoogte zou kunnen dienen als vervanging voor opioïden", schrijven de auteurs.

Conclusie van de studie:

Uit deze cross-sectionele studie bleek dat de legalisatie van medicinale marihuana tussen 2012 en 2017 in verband werd gebracht met een afname van de verstrekking van opioïden en pijn gerelateerde ziekenhuisgebeurtenissen bij sommige particulier verzekerde patiënten van 18 tot 64 jaar die een behandeling tegen kanker kregen. De bevindingen suggereren dat medicinale marihuana tot op zekere hoogte zou kunnen dienen als vervanging voor opioïden. Toekomstige studies moeten de aard van de associaties en hun implicaties voor patiëntuitkomsten ophelderen.

Het volledige studierapport is gratis in te zien of te downloaden. Klik op de titel van het abstract:

December 1, 2022

Medical Marijuana Legalization and Opioid- and Pain-Related Outcomes Among Patients Newly Diagnosed With Cancer Receiving Anticancer Treatment

Yuhua Bao, PhD1,2; Hao Zhang, PhD1; Eduardo Bruera, MD3; et alRussell Portenoy, MD4,5,6; William E. Rosa, PhD, MBE, APRN7; M. Carrington Reid, MD, PhD8; Hefei Wen, PhD9
Author Affiliations Article Information
JAMA Oncol. Published online December 1, 2022. doi:10.1001/jamaoncol.2022.5623
Key Points

Question  Is medical marijuana legalization associated with opioid-related and pain-related outcomes for adult patients newly diagnosed with cancer and receiving anticancer treatment?

Findings  This cross-sectional study of 38 189 patients with newly diagnosed breast cancer, 12 816 with colorectal cancer, and 7190 with lung cancer found that medical marijuana legalization implemented between 2012 and 2017 was associated with a 5.5% to 19.2% relative reduction in the rate of opioid dispensing.

Meaning  Medical marijuana could be serving as a substitute for opioid therapies among some adult patients receiving cancer treatment; future studies need to elucidate the nature of the associations and implications for patient outcomes.

Abstract

Importance  The past decade saw rapid declines in opioids dispensed to patients with active cancer, with a concurrent increase in marijuana use among cancer survivors possibly associated with state medical marijuana legalization.

Objective  To assess the associations between medical marijuana legalization and opioid-related and pain-related outcomes for adult patients receiving cancer treatment.

Design, Setting, and Participants  This cross-sectional study used 2012 to 2017 national commercial claims data and a difference-in-differences design to estimate the associations of interest for patients residing in 34 states without medical marijuana legalization by January 1, 2012. Secondary analysis differentiated between medical marijuana legalization with and without legal allowances for retail dispensaries. Data analysis was conducted between December 2021 and August 2022. Study samples included privately insured patients aged 18 to 64 years who received anticancer treatment during the 6 months after a new breast (in women), colorectal, or lung cancer diagnosis.

Exposures  State medical marijuana legalization that took effect between 2012 and 2017.

Main Outcomes and Measures  Having 1 or more days of opioids, 1 or more days of long-acting opioids, total morphine milligram equivalents of any opioid dispensed to patients with 1 or more opioid days, and 1 or more pain-related emergency department visits or hospitalizations (hereafter, hospital events) during the 6 months after a new cancer diagnosis. Interaction terms were included between each policy indicator and an indicator of recent opioids, defined as having 1 or more opioid prescriptions during the 12 months before the new cancer diagnosis. Logistic models were estimated for dichotomous outcomes, and generalized linear models were estimated for morphine milligram equivalents.

Results  The analysis included 38 189 patients newly diagnosed with breast cancer (38 189 women [100%]), 12 816 with colorectal cancer (7100 men [55.4%]), and 7190 with lung cancer (3674 women [51.1%]). Medical marijuana legalization was associated with a reduction in the rate of 1 or more opioid days from 90.1% to 84.4% (difference, 5.6 [95% CI, 2.2-9.0] percentage points; P = .001) among patients with breast cancer with recent opioids, from 89.4% to 84.4% (difference, 4.9 [95% CI, 0.5-9.4] percentage points; P = .03) among patients with colorectal cancer with recent opioids, and from 33.8% to 27.2% (difference, 6.5 [95% CI, 1.2-11.9] percentage points; P = .02) among patients with lung cancer without recent opioids. Medical marijuana legalization was associated with a reduction in the rate of 1 or more pain-related hospital events from 19.3% to 13.0% (difference, 6.3 [95% CI, 0.7-12.0] percentage points; P = .03) among patients with lung cancer with recent opioids.

Conclusions and Relevance  Findings of this cross-sectional study suggest that medical marijuana legalization implemented from 2012 to 2017 was associated with a lower rate of opioid dispensing and pain-related hospital events among some adults receiving treatment for newly diagnosed cancer. The nature of these associations and their implications for patient safety and quality of life need to be further investigated.


Article Information

Accepted for Publication: September 12, 2022.

Published Online: December 1, 2022. doi:10.1001/jamaoncol.2022.5623

Corresponding Author: Yuhua Bao, PhD, Department of Population Health Sciences, Weill Cornell Medicine, 425 E 61st St, New York, NY 10065 (yub2003@med.cornell.edu).

Author Contributions: Dr Bao had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Bao, Wen.

Acquisition, analysis, or interpretation of data: Bao, Zhang, Bruera, Portenoy, Rosa, Reid, Wen.

Drafting of the manuscript: Bao.

Critical revision of the manuscript for important intellectual content: Bao, Zhang, Portenoy, Bruera, Portenoy, Rosa, Reid, Wen.

Statistical analysis: Bao, Zhang.

Obtained funding: Bao.

Administrative, technical, or material support: Bao.

Supervision: Bao.

Conflict of Interest Disclosures: Dr Bao reported receiving grants from Arnold Ventures and the National Institute on Drug Abuse during the conduct of the study. Dr Rosa reported receiving grants from the Cambia Health Foundation and the Robert Wood Johnson Foundation, consulting fees from Sunstone Therapies, and royalties from Springer Publishing outside the submitted work. No other disclosures were reported.

Funding/Support: This study was supported by grants from Arnold Ventures (Drs Bao and Zhang) and the National Institute on Drug Abuse (grant P30DA040500, Dr Bao).

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Meeting Presentation: Data in this article were presented as a poster at the 2022 ISPOR Europe Conference; November 6-9, 2022; Vienna, Austria.

Disclaimer: The views expressed in this article are those of the authors and do not necessarily reflect the opinions of the National Institute on Drug Abuse or the National Cancer Institute.

Additional Contributions: The authors acknowledge the assistance of the Health Care Cost Institute and its data contributors—Aetna, Humana, and UnitedHealthcare—in providing the claims data analyzed in this study. Philip J. Jeng, MS, conducted original legal research related to medical marijuana legalization and policies governing prescription drug monitoring programs. Kayla Hutchings, BA, provided editorial and administrative assistance. Both are from the Department of Population Health Sciences at Weill Cornell Medicine. Neither received compensation beyond their salaries.

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cannabis, chronische pijn, medicinale wietdruppels, Harvard studie, kankerpatienten, morfine, ziekenhuis opnames pijn gerelateerd, borstkanker, longkanker, darmkanker


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