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Mark A Ilgen - One of the best experts on this subject based on the ideXlab platform.

  • driving under the influence of Cannabis among Medical Cannabis patients with chronic pain
    Drug and Alcohol Dependence, 2019
    Co-Authors: Erin E Bonar, Kipling M Bohnert, Maureen A Walton, James A Cranford, Brooke J Arterberry, Mark A Ilgen
    Abstract:

    Abstract Background Driving under the influence of Cannabis (DUIC) is a public health concern among those using Medical Cannabis. Understanding behaviors contributing to DUIC can inform prevention efforts. We evaluated three past 6-month DUIC behaviors among Medical Cannabis users with chronic pain. Methods Adults (N = 790) seeking Medical Cannabis certification or recertification for moderate/severe pain were recruited from February 2014 through June 2015 at Michigan Medical Cannabis clinics. About half of participants were male (52%) and 81% were White; their Mean age was 45.8 years. Participants completed survey measures of DUIC (driving within 2 h of use, driving while “a little high,” and driving while “very high”) and background factors (demographics, alcohol use, etc.). Unadjusted and adjusted logistic regressions were used to examine correlates of DUIC. Results For the past 6 months, DUIC within 2 h of use was reported by 56.4% of the sample, DUIC while a “little high” was reported by 50.5%, and “very high” was reported by 21.1%. Greater Cannabis quantity consumed and binge drinking were generally associated with DUIC behaviors. Higher pain was associated with lower likelihood of DUIC. Findings vary somewhat across DUIC measures. Conclusions The prevalence of DUIC is concerning, with more research needed on how to best measure DUIC. Prevention messaging for DUIC may be enhanced by addressing alcohol co-consumption.

  • factors associated with alcohol consumption among Medical Cannabis patients with chronic pain
    Addictive Behaviors, 2018
    Co-Authors: Kipling M Bohnert, Alan K Davis, Maureen A Walton, Carrie Bourque, Mark A Ilgen
    Abstract:

    Abstract Introduction Chronic pain is the most common reason for Medical Cannabis certification. Data regarding alcohol use and risky drinking among Medical Cannabis patients with pain is largely unknown. Therefore, we examined the prevalence and correlates of alcohol use and risky drinking in this population. Methods Participants completed surveys regarding demographics, pain-related variables, anxiety, Cannabis use, and past six-month alcohol consumption. Alcohol use groups were defined using the AUDIT-C [i.e., non-drinkers, low-risk drinkers, and high-risk drinkers (≥ 4 for men and ≥ 3 for women)] and compared on demographic characteristics, pain measures, anxiety, and Cannabis use. Results Overall, 42% (n = 330/780) were non-drinkers, 32% (n = 251/780) were low-risk drinkers, and 26% (n = 199/780) were high-risk drinkers. Compared to non-drinkers, low- and high-risk drinkers were significantly younger whereas a larger proportion of low-risk drinkers reported being African-American compared to non- or high-risk drinkers. High-risk drinkers reported significantly lower pain severity/interference compared to the other groups; high-risk drinkers were also less likely to be on disability compared to other groups. A multinomial logistic regression showed that patients reporting lower pain severity and less disability had greater odds of being classified a high-risk drinker. Conclusions High-risk drinking appears common among Medical Cannabis patients. Future research should examine whether such use is concurrent or consecutive, and the relationship of such co-use patterns to consequences. Nevertheless, individuals treating patients reporting Medical Cannabis use for pain should consider alcohol consumption, with data needed regarding the efficacy of brief alcohol interventions among Medical Cannabis patients.

  • prevalence and correlates of vaping as a route of Cannabis administration in Medical Cannabis patients
    Drug and Alcohol Dependence, 2016
    Co-Authors: James A Cranford, Kipling M Bohnert, Mark A Ilgen, Carrie Bourque, Brian E Perron
    Abstract:

    Abstract Purpose To examine the prevalence and correlates of vaporization (i.e., “vaping”) as a route of Cannabis administration in a sample of Medical Cannabis patients. Procedures Adults ages 21 and older ( N  = 1485  M age = 45.1) who were seeking Medical Cannabis certification (either for the first time or as a renewal) at Medical Cannabis clinics in southern Michigan completed a screening assessment. Participants completed measures of route of Cannabis administration, Cannabis use, alcohol and other substance use. Findings An estimated 39% (n = 511) of the sample reported past-month Cannabis vaping, but vaping as the sole route of Cannabis administration was rare. Specifically, only 30 participants (2.3% of the full sample and 5.9% of those who reported any vaping) indicated vaping as the sole route of Cannabis administration. The majority (87.3%) of those who reported vaping also reported smoking (combustion) as a route of Cannabis administration. Being younger than age 44, having more than a high school education, engaging in nonMedical stimulant use, being a returning Medical Cannabis patient, and greater frequency of Cannabis use were associated with higher odds of vaping at the bivariate level and with all variables considered simultaneously. Conclusions Vaping appears to be relatively common among Medical Cannabis patients, but is seldom used as the sole route of Cannabis administration. Results highlight the importance of monitoring trends in vaping and other substance use behaviors in this population and underscore the need for longitudinal research into the motives, correlates, and consequences of Cannabis vaping in Medical Cannabis patients.

  • characteristics of substance use disorder treatment patients using Medical Cannabis for pain
    Addictive Behaviors, 2015
    Co-Authors: Lisham Ashrafioun, Kipling M Bohnert, Mary Jannausch, Mark A Ilgen
    Abstract:

    Abstract Background This study was designed to assess the prevalence and correlates of self-reported Medical Cannabis use for pain in a substance use disorder (SUD) treatment program. Method Participants ( n  = 433) aged 18 years and older were recruited from February 2012 to July 2014 at a large residential SUD treatment program. They completed a battery of questionnaires to assess demographics, usual pain level in the past three months (using the 11-point Numeric Rating Scale for pain), depression (using the Beck Depression Inventory), previous types of pain treatments, and lifetime and past-year use of substances (using the Addiction Severity Index). Using both adjusted and unadjusted logistic regression models, we compared those who reported Medical Cannabis use for pain with those who did not report it. Results Overall, 15% of the sample ( n  = 63) reported using Medical Cannabis for pain in the past year. After adjusting for age, Medical Cannabis use for pain was significantly associated with past-year use of alcohol, cocaine, heroin, other opioids, and sedatives, but was not associated with usual pain level or depression. It was also associated with past year treatment of pain using prescription pain relievers without prescriptions. Conclusions These results indicate that Medical Cannabis use for pain is relatively common and is associated with more extensive substance use among SUD patients. Future work is needed to develop and evaluate strategies to assess and treat individuals who report Medical Cannabis for pain in SUD treatment settings.

Colleen L Barry - One of the best experts on this subject based on the ideXlab platform.

  • Medical Cannabis laws and opioid analgesic overdose mortality in the united states 1999 2010
    JAMA Internal Medicine, 2014
    Co-Authors: Marcus A Bachhuber, Brendan Saloner, Chinazo O Cunningham, Colleen L Barry
    Abstract:

    Importance Opioid analgesic overdose mortality continues to rise in the United States, driven by increases in prescribing for chronic pain. Because chronic pain is a major indication for Medical Cannabis, laws that establish access to Medical Cannabis may change overdose mortality related to opioid analgesics in states that have enacted them. Objective To determine the association between the presence of state Medical Cannabis laws and opioid analgesic overdose mortality. Design, Setting, and Participants A time-series analysis was conducted of Medical Cannabis laws and state-level death certificate data in the United States from 1999 to 2010; all 50 states were included. Exposures Presence of a law establishing a Medical Cannabis program in the state. Main Outcomes and Measures Age-adjusted opioid analgesic overdose death rate per 100 000 population in each state. Regression models were developed including state and year fixed effects, the presence of 3 different policies regarding opioid analgesics, and the state-specific unemployment rate. Results Three states (California, Oregon, and Washington) had Medical Cannabis laws effective prior to 1999. Ten states (Alaska, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Rhode Island, and Vermont) enacted Medical Cannabis laws between 1999 and 2010. States with Medical Cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate (95% CI, −37.5% to −9.5%; P  = .003) compared with states without Medical Cannabis laws. Examination of the association between Medical Cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time: year 1 (−19.9%; 95% CI, −30.6% to −7.7%; P  = .002), year 2 (−25.2%; 95% CI, −40.6% to −5.9%; P  = .01), year 3 (−23.6%; 95% CI, −41.1% to −1.0%; P  = .04), year 4 (−20.2%; 95% CI, −33.6% to −4.0%; P  = .02), year 5 (−33.7%; 95% CI, −50.9% to −10.4%; P  = .008), and year 6 (−33.3%; 95% CI, −44.7% to −19.6%; P Conclusions and Relevance Medical Cannabis laws are associated with significantly lower state-level opioid overdose mortality rates. Further investigation is required to determine how Medical Cannabis laws may interact with policies aimed at preventing opioid analgesic overdose.

Mark S Wallace - One of the best experts on this subject based on the ideXlab platform.

  • Medical Cannabis legalization and opioid prescriptions evidence on us medicaid enrollees during 1993 2014
    Addiction, 2018
    Co-Authors: Di Liang, Mark S Wallace, Igor Grant
    Abstract:

    BACKGROUND AND AIMS: While the United States has been experiencing an opioid epidemic, 29 states and Washington DC have legalized Cannabis for Medical use. This study examined whether state-wide Medical Cannabis legalization was associated with reduction in opioids received by Medicaid enrollees. DESIGN: Secondary data analysis of state-level opioid prescription records from 1993-2014 Medicaid State Drug Utilization Data. Linear time-series regressions assessed the associations between Medical Cannabis legalization and opioid prescriptions, controlling for state-level time-varying policy covariates (such as prescription drug monitoring programs) and socio-economic covariates (such as income). SETTING: United States. PARTICIPANTS: Drug prescription records for patients enrolled in fee-for-service Medicaid programs that primarily provide health-care coverage to low-income and disabled people. MEASUREMENTS: The primary outcomes were population-adjusted number, dosage and Medicaid spending on opioid prescriptions. Outcomes for Schedule II opioids (e.g. hydrocodone, oxycodone) and Schedule III opioids (e.g. codeine) were analyzed separately. The primary policy variable of interest was the implementation of state-wide Medical Cannabis legalization. FINDINGS: For Schedule III opioid prescriptions, Medical Cannabis legalization was associated with a 29.6% (P = 0.03) reduction in number of prescriptions, 29.9% (P = 0.02) reduction in dosage and 28.8% (P = 0.04) reduction in related Medicaid spending. No evidence was found to support the associations between Medical Cannabis legalization and Schedule II opioid prescriptions. Permitting Medical Cannabis dispensaries was not associated with Schedule II or Schedule III opioid prescriptions after controlling for Medical Cannabis legalization. It was estimated that, if all the states had legalized Medical Cannabis by 2014, Medicaid annual spending on opioid prescriptions would be reduced by 17.8 million dollars. CONCLUSION: State-wide Medical Cannabis legalization appears to have been associated with reductions in both prescriptions and dosages of Schedule III (but not Schedule II) opioids received by Medicaid enrollees in the United States.

  • Medical Cannabis for neuropathic pain
    Current Pain and Headache Reports, 2018
    Co-Authors: Brittany Grovey, Timothy Furnish, Mark S Wallace
    Abstract:

    Many cultures throughout history have used Cannabis to treat a variety of painful ailments. Neuropathic pain is a complicated condition that is challenging to treat with our current medications. Recent scientific discovery has elucidated the intricate role of the endocannabinoid system in the pathophysiology of neuropathic pain. As societal perceptions change, and legislation on Medical Cannabis relaxes, there is growing interest in the use of Medical Cannabis for neuropathic pain. We examined current basic scientific research and data from recent randomized controlled trials (RCTs) evaluating Medical Cannabis for the treatment of neuropathic pain. These studies involved patients with diverse etiologies of neuropathic pain and included Medical Cannabis with different THC concentrations and routes of administration. Multiple RCTs demonstrated efficacy of Medical Cannabis for treating neuropathic pain, with number needed to treat (NNT) values similar to current pharmacotherapies. Although limited by small sample sizes and short duration of study, the evidence appears to support the safety and efficacy of short-term, low-dose Cannabis vaporization and oral mucosal delivery for the treatment of neuropathic pain. The results suggest Medical Cannabis may be as tolerable and effective as current neuropathic agents; however, more studies are needed to determine the long-term effects of Medical Cannabis use. Furthermore, continued research to optimize dosing, cannabinoid ratios, and alternate routes of administration may help to refine the therapeutic role of Medical Cannabis for neuropathic pain.

Alexander J. Clark - One of the best experts on this subject based on the ideXlab platform.

  • Medical Cannabis: considerations for the anesthesiologist and pain physician
    Canadian Journal of Anesthesia Journal canadien d'anesthésie, 2016
    Co-Authors: Pierre Beaulieu, Aline Boulanger, Jean Desroches, Alexander J. Clark
    Abstract:

    PurposeNew regulations are in place at the federal and provincial levels in Canada regarding the way Medical Cannabis is to be controlled. We present them together with guidance for the safe use of Medical Cannabis and recent clinical trials on Cannabis and pain.SourceThe new Canadian regulations on the use of Medical Cannabis, the provincial regulations, and the various Cannabis products available from the Canadian Licensed Producers were reviewed from Health Canada, provincial licensing authorities, and the licensed producers website, respectively. Recent clinical trials on Cannabis and pain were reviewed from the existing literature.Principal findingsHealth Canada has approved a new regulation on Medical marijuana/Cannabis, the Marihuana for Medical Purposes Regulations: The production of Medical Cannabis by individuals is illegal. Health Canada, however, has licensed authorized producers across the country, limiting the production to specific licenses of certain Cannabis products. There are currently 26 authorized licensed producers from seven Canadian provinces offering more than 200 strains of marijuana. We provide guidance for the safe use of Medical Cannabis. The recent literature indicates that currently available cannabinoids are modestly effective analgesics that provide a safe, reasonable therapeutic option for managing chronic non-cancer-related pain.ConclusionThe science of Medical Cannabis and the need for education of healthcare professionals and patients require continued effort. Although cannabinoids work to decrease pain, there is still a need to confirm these beneficial effects clinically and to exploit them with acceptable benefit-to-risk ratios.RésuméObjectifDe nouvelles réglementations sont misent en place au Canada, à la fois au niveau fédéral et provincial, concernant le contrôle de la marijuana à des fins médicales. Nous les présentons conjointement avec un guide pour une utilisation sécuritaire de la marijuana à des fins médicales et des essais cliniques récents avec la marijuana dans le traitement de la douleur.SourceLes nouvelles réglementations canadienne sur l’utilisation de la marijuana à des fins médicales, les réglementations provinciales et les différents produits du Cannabis proposés par les producteurs canadiens autorisés ont été analysées à partir, respectivement, de Santé Canada, des services chargés d’accorder les licences et des sites Web des producteurs autorisés. Les essais cliniques récents sur le Cannabis et le traitement de la douleur ont été recherchés dans la littérature actuelle disponible.Constatations principalesSanté Canada a approuvé une nouvelle réglementation sur l’utilisation de la marijuana/Cannabis, le règlement sur la marijuana à des fins médicales (RMFM) : La production de marijuana à des fins médicales par des individus est illégale. Toutefois, Santé Canada a délivré des licences à des producteurs autorisés sur l’ensemble du pays en limitant l’autorisation à certains produits spécifiques du Cannabis. Il y a actuellement 26 fabricants autorisés détenteurs de licences dans sept provinces canadiennes offrant plus de 200 souches de marijuana. Nous fournissons un guide pour l’utilisation sécuritaire de la marijuana à des fins médicales. Les études récentes indiquent que les cannabinoïdes actuellement disponibles sont des analgésiques d’efficacité modeste qui procurent une option thérapeutique raisonnable et sécuritaire pour la gestion de la douleur chronique non liée au cancer.ConclusionLa recherche scientifique sur l’utilisation de la marijuana à des fins médicales et le besoin d’éducation des professionnels de la santé et des patients demandent des efforts continus. Même si les cannabinoïdes diminuent la douleur, il reste nécessaire de confirmer cliniquement ces effets bénéfiques et de les exploiter avec des rapports bénéfices-risques acceptables.

  • Medical Cannabis considerations for the anesthesiologist and pain physician
    Canadian Journal of Anaesthesia-journal Canadien D Anesthesie, 2016
    Co-Authors: Pierre Beaulieu, Aline Boulanger, Jean Desroches, Alexander J. Clark
    Abstract:

    Purpose New regulations are in place at the federal and provincial levels in Canada regarding the way Medical Cannabis is to be controlled. We present them together with guidance for the safe use of Medical Cannabis and recent clinical trials on Cannabis and pain.

Sharon R Sznitman - One of the best experts on this subject based on the ideXlab platform.

  • Validation of Clinical Vignettes to Explore Medical Cannabis Practices.
    Israel Medical Association Journal, 2019
    Co-Authors: Yuval Zolotov, Sharon R Sznitman, Simon Vulfsons
    Abstract:

    The policies and practices related to Medical Cannabis are currently in flux. These changes have been associated with many controversies, and there is a lack of consensus within the Medical community regarding Medical Cannabis practices. To validate clinical vignettes that can be used to examine and improve Medical Cannabis practices. Ten physicians participated in a Delphi survey of two consequent rounds in which they quantified the eligibility of Medical Cannabis therapy for six clinical vignettes describing both chronic pain and cancer patients. Higher consensus was achieved for the vignettes of cancer patients, which were additionally rated as more eligible for Medical Cannabis therapy. The highest level of consent (4.3 out of 5) was achieved regarding a vignette of a metastatic cancer patient. While in some cases physicians consolidated their ratings toward the group's average, in other cases they remained stable in their responses. While controversies related to Medical Cannabis are expected to remain rampant, the validated vignettes may facilitate assessment of clinical practices, which is essential for a successful implementation of Medical Cannabis policies. These vignettes may additionally be used in Medical training for appropriate patient selection for Medical Cannabis authorization.

  • Long-term Medical Cannabis use and risk factors for diversion: Report on physician's guidance and patients' behaviour.
    Palliative & Supportive Care, 2019
    Co-Authors: Sharon R Sznitman, Yuval Zolotov, Victoria Goldberg, Hedva Sheinman-yuffe, Ezequiel Flechter, Gil Bar-sela
    Abstract:

    Objectives Various jurisdictions have legalized Cannabis for Medical purposes. As with all psychoactive medications, Medical Cannabis carries a risk of diversion and accidental ingestion. These risks may be particularly high among long-term Medical Cannabis patients as safety practices may become less salient to patients once the treatment becomes part of everyday life. The current study examines whether patients who have used Medical Cannabis for longer periods differ from those who have used for shorter periods in terms of sociodemographic background and other key aspects of Medical Cannabis use. Furthermore, the study examines the relationship between length of Medical Cannabis treatment and risk factors related to storage and diversion. Finally, the study examines the extent to which oncologists provide information to their patients about safe storage and disposal. Methods One hundred twenty-one Medical Cannabis oncology patients were interviewed face-to-face and 55 oncologists participated in a survey about safe storage and disposal practices related to Medical Cannabis. Results Length of Medical Cannabis treatment was related to administration by smoking and using higher monthly dosages. In terms of risk for unsafe storage and diversion, length of Medical Cannabis was positively associated with using Cannabis outside the home and having been asked to give away Medical Cannabis. Physicians did not report providing information to patients regarding safe storage and disposal practices in a regular manner. Significance of results Results suggest that there is an ongoing risk of unsafe storage and diversion over the course of Medical Cannabis treatment. Oncologists may need to give more consistent and continued training in safe storage and disposal practices, especially among long-term Medical Cannabis patients.

  • Engagement with Medical Cannabis information from online and mass media sources: Is it related to Medical Cannabis attitudes and support for legalization?
    International Journal of Drug Policy, 2019
    Co-Authors: Nehama Lewis, Sharon R Sznitman
    Abstract:

    Abstract Background The legalization of Medical and recreational Cannabis is a topic of continued debate in countries around the world. It has been suggested that Medical Cannabis legalization influences Cannabis legalization for recreational purposes through increased media attention toward the positive health effects of Cannabis. However, the nature of media coverage is likely to vary across mass media and online sources (internet and social media). In addition, effects of information engagement on attitudes may vary depending on whether information was actively sought or obtained incidentally during patterns of regular media use (scanned). Methods This study uses data from an online survey of Israeli adults (N = 554) to test the association between information seeking and scanning about Medical Cannabis (from mass media and online sources) and attitudes toward Medical Cannabis. Furthermore, we test indirect effects of media engagement on attitudes toward Cannabis legalization through Medical Cannabis attitudes. Results Seeking and scanning for information about Medical Cannabis from online sources, but not from mass media sources, were associated with positive attitudes toward Medical Cannabis. Engagement with Medical Cannabis information from online sources was also indirectly associated with greater support for Cannabis legalization, through positive attitudes related to Medical Cannabis. Conclusion The results suggest that one mechanism through which Medical Cannabis legalization is associated with Cannabis legalization for all purposes is public engagement with information about Medical Cannabis in the media, particularly from the internet and social media channels. As increasingly more jurisdictions are expected to legalize Medical Cannabis, with resulting increase in media attention, support for recreational Cannabis legalization may be expected to grow.

  • Medical Cannabis: An oxymoron? Physicians’ perceptions of Medical Cannabis
    International Journal of Drug Policy, 2018
    Co-Authors: Yuval Zolotov, Simon Vulfsons, Dana Zarhin, Sharon R Sznitman
    Abstract:

    Abstract Background Medical Cannabis policies are changing in many places around the world, and physicians play a major role in the implementation of these policies. The aim of this study was to gain a deeper understanding of physicians’ views on Medical Cannabis and its possible integration into their clinic, as well as to identify potential underlying factors that influence these perceptions. Methods Qualitative narrative analysis of in-depth interviews with twenty-four Israeli physicians from three specialties (pain medicine, oncology and family medicine). Findings Physicians disclosed contrasting narratives of Cannabis, presenting it as both a medicine and a non-medicine. These divergent positions co-existed and were intertwined in physicians’ accounts. When presenting Cannabis as a non-medicine, physicians drew on conventional medicine and prohibition as narrative environments. They emphasized the incongruence of Cannabis with standards of biomedicine and presented Cannabis as an addictive drug of abuse. In contrast, physicians drew upon unconventional medicine and palliative care as narrative environments while presenting Cannabis as a medicine. In this narrative, physicians emphasized positive hands-on experiences with Cannabis, and pointed to the limits of conventional medicine. Conclusion Physicians did not have a consolidated perspective as to whether Cannabis is a medicine or not, but rather struggled with this question. The dualistic narratives of Cannabis reflect the lack of a dominant narrative environment that supports the integration of Cannabis into Medical practice. This may in turn indicate barriers to the implementation of Medical Cannabis policies. An awareness of physicians’ views and the different levels of their willingness to implement Medical Cannabis policies is essential for policy developments in this evolving field.

  • You Brought it on Yourself: The Joint Effects of Message Type, Stigma, and Responsibility Attribution on Attitudes Toward Medical Cannabis
    Journal of Communication, 2017
    Co-Authors: Nehama Lewis, Sharon R Sznitman
    Abstract:

    This study uses a web-based randomized experiment (N = 396) to test the effects of message type (narrative vs. expository), stigma (stigmatized vs. nonstigmatized illness), and attribution of responsibility for disease (internal vs. external) on attitudes toward Medical Cannabis. Narrative-formatted videos produced more favorable attitudes toward Medical Cannabis, compared with nonnarrative videos. Effects of narratives on attitudes were mediated through transportation and identification with the protagonist. Participants who viewed narratives in which the protagonist had a stigmatized illness and was responsible for contracting the disease expressed more negative attitudes toward Medical Cannabis. Effects of attribution were mediated through social distance toward Medical Cannabis users, and moderated by stigma. Implications for narrative persuasion and public opinion regarding Medical Cannabis are discussed.