Category: Pain Management

Categories : COVID Pain ManagementTags :

Treatment of Lingering COVID Pain is Challenging

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The treatment of pain in recovered COVID patients poses unique challenges, said a pain expert presenting at the American Academy of Pain Medicine virtual meeting.

“A lot of these patients are going to need rehabilitation” or physical therapy, noted Natalie Strand, MD, of the Mayo Clinic in Scottsdale, Arizona, at the meeting. “There can be quite a bit of deconditioning that occurs, especially after a prolonged ICU stay. Neuropathic pain is also quite common.”

Post-COVID neuropathy may be viral or else possibly related to patient positioning, including prone positioning. Some patients “may need short-term opioids or gabapentinoids and they may experience aggravation of prior underlying pain, either due to direct physical causes or to the increase in anxiety and depression that can accompany a COVID infection,” Dr Strand said.

A study that followed 143 patients two months after acute COVID showed a high proportion reported persistent symptoms — including fatigue (53%), joint pain, (27%) and chest pain (22%) — that often results in patients going to a pain clinic for care, she noted.

Persistent pain remains prevalent, following any ICU admission, ranging from 28% to 77%, according to Dr Strand.

Chronic neuropathic pain after a COVID patient’s ICU stay can include muscle pain related to joint contractures or muscle atrophy, and pain due to critical illness myopathy or polyneuropathy. In addition, peripheral nerve injuries have been associated with prone positioning for COVID–related acute respiratory distress syndrome, Dr Strand added. Complications from traumatic procedures like placement of chest tubes or tracheotomy can also cause chronic neuropathic pain.

Dr Strand noted that pain can persist after discharge of COVID patients, as indicated by follow-ups. In China, three-quarters of patients previously hospitalised with COVID continued to report at least one symptom 6 months later, with fatigue or muscle weakness by far the most common symptoms (63%). “Compared with 2-month follow up, 6 months later we see the same trends,” she pointed out.

In that study, “13% of the patients who did not develop an acute renal injury during their hospital stay and presented with normal renal function exhibited a decline in GFR at follow up,” Dr Strand noted. This may signal caution about using NSAIDS to manage pain in some patients, she said: “Normal renal function at discharge does not necessarily mean it will remain this way 6 months afterwards.”

There may be a relationship with the SARS-CoV-2 virus and chronic neuropathic pain, Strand observed. In a recent article in Pain Reports, “the authors concluded it could be direct or indirect effects of the virus on the nervous system that can cause neuropathic pain,” she noted. “We know that there are neuropathic symptoms involved with the famous loss of taste and loss of smell with presentation,” she continued. “But also in the acute phase, we commonly see headache, dizziness, muscle pain, ataxia, and in hospitalized patients we see stroke, meningitis, encephalitis, and autoimmune disorders like Guillain-Barré syndrome and acute disseminated encephalomyelitis.”

Psychological stressors can also be related to the emergence of chronic pain, added Dr Strand. “Anxiety and depression often follows COVID-19 infection,” she said. “It may be wise to screen our patients for anxiety and depression after infection to see if we can further control these components to help manage their pain overall.”

Source: MedPage Today

Presentation information: Strand NH “Treating the COVID-Recovered Patient: An Evolving Understanding” AAPM 2021.

Categories : Obstetrics & Gynaecology Pain ManagementTags :

Epidurals Do Not Increase Autism Risk for Babies

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A Canadian study showed that children born to mothers who used epidural analgesia during labour were not at increased risk of developing autism spectrum disorder (ASD).

Epidural analgesia is administered into the epidural space around the spinal cord, typically during labour. Besides easing pain and reducing the use of other analgesics, it has also been shown to lower cortisol levels, expedite the return of bowel function, decrease the incidence of PE and DVT in the postoperative period, and reduce hospital stays.

Epidural analgesia is used by 73% of pregnant women in the U.S. for pain during labour. Since the US incidence of ASD increased from 0.66% in 2002 to 1.85% in 2016, there have been more efforts to identify environmental factors that put children at risk, the researchers said.

Elizabeth Wall-Wieler, PhD, of the University of Manitoba in Winnipeg, and colleagues drew from population datasets and included vaginal deliveries of singleton babies born in Canada from 2005 to 2016, following children from birth up until 2019.

Of the more than 123 000 infants included in the study, approximately 38% were exposed to epidural analgesia during delivery, and about 80 000 had a sibling in the study cohort. The mean age of mothers was 28 years. The children’s median age at their first diagnosis of ASD was 4 years. Births with epidural analgesia were more likely to be nulliparous or involve other factors such as foetal distress.
About 2.1% of children exposed to epidural labour analgesia (ELA) later developed ASD, compared with 1.7% who were not exposed, the team reported. But after factor adjustments, the researchers found no association between epidural analgesia and childhood ASD risk, they wrote in JAMA Pediatrics.

“This finding is of clinical importance in the context of pregnant women and their obstetric and anesthesia care professionals who are considering ELA during labor,” Dr Wall-Wieler and colleagues noted.

The group’s results contrast with Qiu et al.’s recent study that found a 37% increased risk of autism in children whose mothers used epidural analgesia during their delivery. Their study did not account for key perinatal factors, such as induction of labor, labor dystocia, and foetal distress, and drew criticism from five medical societies for possible residual confounding.

Dr Wall-Wieler and colleagues said that ELA is “recognized as the most effective method of providing labor analgesia,” adding that future qualitative research should assess how their findings — as well as the prior ones — have altered the perceptions about the perceived risk of ASD in offspring among both pregnant women and healthcare providers.

In an accompanying editorial, Gillian Hanley, PhD, of the University of British Columbia in Vancouver, and colleagues said that given the concerns stemming from previous findings, “it thus comes with some relief that Wall-Wieler et al found no association when controlling for key maternal sociodemographic and perinatal factors.”

“Epidural labor analgesia is an extremely effective approach to obstetric analgesia,” Dr Hanley’s group noted. “We have a collective responsibility to understand whether it is a safe option that sets a healthy developmental pathway well into childhood.”

The researchers observed an association between ELA and autism risk before accounting for confounders; but after controlling for all maternal sociodemographic, pre-pregnancy, pregnancy and perinatal factors, there was no longer a correlation.

In an analysis of siblings, researchers again observed a null association after controlling for all confounders and family fixed effects. Siblings who were exposed to epidural analgesia had a 2% cumulative risk of developing autism, and unexposed siblings had a risk of 1.6%.

The accuracy of inpatient and outpatient diagnostic codes for ASD, as well as coding for ELA was acknowledged as a study limitation by the researchers, as well as a lack of data describing epidural analgesia drug doses.

Source: MedPage Today

Journal information: Wall-Wieler E, et al “Association of epidural labor analgesia with offspring risk of autism spectrum disorders” JAMA Pediatr 2021; DOI: 10.1001/jamapediatrics.2021.0376.

Categories : Gender Pain ManagementTags :

Unique Genetic Basis for Chronic Pain in Women Discovered

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A meta-analysis of UK genetic data has found a different genetic basis for chronic pain in women compared to men.

While the results are still preliminary, this is one of the largest genetic studies on chronic pain analysing by sexes.

“Our study highlights the importance of considering sex as a biological variable and showed subtle but interesting sex differences in the genetics of chronic pain,” said population geneticist Keira Johnston of the University of Glasgow in Scotland.

Chronic pain conditions are among the most prevalent, disabling, and expensive conditions in public health, and are frequently overlooked for research funding. With 100 million people in chronic pain in the US in 2016, overprescription of opioids for chronic pain has resulted in an epidemic of opioid misuse, with 66% of overdose cases being for opioids. Even very moderate opioid use carries the risk of addiction and abuse.

Even when studies are done, they often overlook underlying sex differences, and that’s a huge and detrimental oversight. Compared to men, women are far more likely to develop multiple chronic pain disorders, and yet historically, 80 percent of all pain studies have been conducted on male mice or male humans. This means we know very little about how and why females are suffering more and what treatments can help them best.

While there are probably multiple biological and psychosocial processes in this sex discrepancy, the current genome-wide study suggests there’s a genetic factor in the mix, too.

The researchers compared gene variants associated with chronic pain in 209 093 women and 178 556 men from the UK Biobank, and found 31 genes associated with chronic pain in women and 37 genes associated with chronic pain in men with barely any overlap. This might be due to the slightly smaller sample size of men but the results are nonetheless intriguing, the researchers maintained.

The vast majority of these genes were active in a cluster of nerves within the spinal cord, known as the dorsal root ganglion, which transmits messages from the body to the brain.
While several genes in the male-only or female-only list were linked with psychiatric disorders or immune function, only one, called DCC, was found in both lists.
DCC encodes for a receptor that binds with a protein crucial for the development of the nervous system, especially the dopaminergic system. The dopaminergic system is the ‘reward centre’ but also has been linked to pain.

DCC is also linked to depression, and DCC mutations appear in those with congenital mirror movement disorder, which results in movements on one side of the body being replicated on the other side.

It’s not how DCC is linked to chronic pain, but the researchers believe their results support several theories “of strong nervous system and immune involvement in chronic pain in both sexes”, which will, they hope, result in the development of better treatments.

Should chronic pain be more closely linked to immune function in women, immune-targeting drugs may have very different side-effects than in men. Opioids negatively impact immune function, indicating that they could in fact worsen the situation for women suffering chronic pain. However, more research is needed to strengthen these findings and understand their impacts.

“All of these lines of evidence, together, suggest putative central and peripheral neuronal roles for some of these genes, many of which have not been historically well studied in the field of chronic pain,” the authors concluded.

Source: Science Alert

Journal information: Johnston KJA, Ward J, Ray PR, Adams MJ, McIntosh AM, Smith BH, et al. (2021) Sex-stratified genome-wide association study of multisite chronic pain in UK Biobank. PLoS Genet 17(3): e1009428. doi.org/10.1371/journal.pgen.1009428

Categories : Gender Pain ManagementTags :

Both Genders Rate Pain of Female Patients as Lower

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Woman clutching her belly in pain. Photo by Andrea Piacquadio from Pexels.

In a recent study, researchers found that a patient’s pain responses may be perceived differently by others based on their gender.

The study was published in The Journal of Pain, with the co-author being Elizabeth Losin, assistant professor of psychology and director of the Social and Cultural Neuroscience lab at the University of Miami. A previous study showed that men are seen as more stoic and women as more emotional in expression of pain.

In the first of two experiments in the study, 50 participants viewed videos of male and female patients complaining of shoulder pain as they performed a series of range of motion exercises using their injured and uninjured shoulders. These videos came from a database that contains videos of actual shoulder injury patients, each with a different level of pain, as well as the patients’ self-reported discomfort levels on shoulder movement.

According to Prof Losin, this study is more applicable to patients in a clinical setting.
“One of the advantages of using these videos of patients who are actually experiencing pain from an injury is that we have the patients’ ratings of their own pain,” she explained. “We had a ground truth to work with, which we can’t have if it’s a stimulus with an actor pretending to be in pain.”

The patients’ facial expressions were also analysed through the Facial Action Coding System (FACS)—a system for describing all visible facial movements. The researchers created an objective score of the intensity of the patients’ pain facial expressions derived from the FACS values, providing a second ground truth.

The study participants were asked to gauge the amount of pain they thought the patients in the videos experienced on a scale from zero, labeled as “absolutely no pain,” to 100, labeled as “worst pain possible.”

For the second experiment, the first experiment was replicated with 200 participants, who were asked to complete the Gender Role Expectation of Pain questionnaire, which measures gender-related stereotypes about pain sensitivity, the endurance of pain, and willingness to report pain.

The participants also reported the amount of medication and psychotherapy they would prescribe to each patient, and which of these they believed be a more effective treatment for that patient.

The researchers analysed the participants’ perceptions relative to the two ground truth pain measures, Prof Losin explained. That is because bias could be defined as different ratings for male and female patients despite the same level of responses.

Overall, the study found that female patients were perceived to be in less pain than the male patients who reported, and exhibited, the same intensity of pain. Additional analyses using participants’ responses to the questionnaire about gender-related pain stereotypes allowed researchers to conclude that these perceptions were partially explained by these stereotypes. 

“If the stereotype is to think women are more expressive than men, perhaps ‘overly’ expressive, then the tendency will be to discount women’s pain behaviors,” Prof Losin said. “The flip side of this stereotype is that men are perceived to be stoic, so when a man makes an intense pain facial expression, you think, ‘Oh my, he must be dying!’ The result of this gender stereotype about pain expression is that each unit of increased pain expression from a man is thought to represent a higher increase in his pain experience than that same increase in pain expression by a woman.”

Additionally, the researchers found that psychotherapy was also selected over medication for a higher proportion of female than male patients. The participants’ gender did not influence pain estimation, with both male and female participants perceiving women’s pain to be less intense.

Prof Losin said the study was motivated by literature showing that women received less treatment for pain and waited longer.

“There’s a pretty wide literature showing demographic differences in pain report, the prevalence of clinical pain conditions, and then also a demographic difference in pain treatments,” Losin pointed out. “These differences manifest as disparities because it seems that some people are getting undertreated for their pain based on their demographics.”

Moving forward, Prof Losin and her fellow researchers hope this study is a step in identifying and addressing gender disparities in health care.

Prof Losin said that even medically trained people are subject to such biases. “Critically, our results demonstrate that these gender biases are not necessarily accurate. Women are not necessarily more expressive than men, and thus their pain expression should not be discounted.”

Source: Medical Xpress

Journal information: Lanlan Zhang et al, Gender Biases in Estimation of Others’ Pain, The Journal of Pain (2021). DOI: 10.1016/j.jpain.2021.03.001

Categories : Pain ManagementTags :

Cannabinoid Effectiveness in Pain Management Questioned

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The effectiveness of cannabinoids as pain management has been brought into question by experts reviewing clinical evidence.

Researchers from the University of Bath’s Centre for Pain Research leading experts from around the world reviewed existing data into cannabinoids, including that on so-called ‘medicinal cannabis’ and ‘medicinal cannabis extracts’.

Their findings suggest that while preclinical data supports the hypothesis of cannabinoid analgesia, uncertainties especially in clinical evidence do not reach the certainty in efficacy and safety necessary for the IASP to endorse their general use for pain control.
 The studies and the statement from the IASP are limited to the use of cannabinoids to treat pain, and not for other conditions for which cannabinoids are used.

Dr Emma Fisher who led the review of the clinical evidence said: “Cannabis, cannabinoids, and cannabis-based medicines are becoming an increasingly popular alternative to manage pain. However, our review shows that there is limited evidence to support or refute their use for the management of any pain condition. The studies we found were poor quality (high risk of bias) and the evidence was of very low-certainty, meaning that we are very uncertain of the findings and more research is needed.”

Professor Christopher Eccleston, Director of the Centre for Pain Research / Department for Health, said: “Cannabis seems to attract strong opinions. If ever a field needed evidence and a rigorous scientific opinion it is this one. For many this will be an unpopular conclusion, but we need to face up to the fact that the evidence is simply lacking. Science is not about popularity but keeping people safe from false claims. The challenge in this field will be for governments to fund independent research, and to ensure balance and equipoise.

“Coming close on the heels of The Lancet Commission on children’s pain and the WHO guidelines on treating chronic pain, this further contribution also found no evidence to support the use of cannabis, cannabinoids, and cannabis-based medicines for children with chronic pain. We need to invest in real solutions to the very real problem of chronic pain in children.”

Source: Medical Xpress

Journal information: IASP Presidential Task Force on Cannabis and Cannabinoid Analgesia. Pain. journals.lww.com/pain/pages/co … picalCollectionId=23

Categories : Pain ManagementTags :

Dopamine Affects Pain Differently in Female and Male Mice

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Researchers have found that dopamine affects the neurons of male and female mice in different ways, a discovery which could have great potential in pain management for women, who suffer pain disproportionately throughout their lives.

Dopamine, popularly known as the brain’s ‘pleasure chemical’, is implicated in many functions, including the reward pathways and also the pain-relieving pathways associated with heroin that the researchers were focussing on. Dopamine is also suggested to be involved in attention, suggesting a link between substance abuse, pain and attention.

“We focused on this neural pathway because our previous work and that of others show that specific neurons release dopamine to regulate pain responses,” explained Thomas Kash, PhD, the John R Andrews Distinguished Professor of Pharmacology, School of Medicine lab, University of North Carolina. “Unfortunately, that research was done only in male mice. So we decided to look at both male and female mice, and what we found was very surprising.”

Previous research from Dr Kash’s lab using male mice showed that dopaminergic neurons were key in how opiates dampen pain, likely through dopamine and glutamate release. The new experiments focussed on a neural pathway starting at the midbrain region called the periaqueductal grey, including part of the dorsal raphe.

This brain region is involved in behavioural adaptation, which is the way animals respond to their environment. The dopamine-producing neurons in this region form a neural pathway with a structure known as the bed nucleus of the stria terminalis (BNST). 

“We found that activating this pathway reduced pain sensitivity in male mice, but made female mice move more, especially in the presence of something capturing their attention,” said first author Waylin Yu, PhD, a former graduate student in the Kash lab and current postdoctoral researcher at UC San Francisco. “We think this is because of the different ways males and females respond to pain.”

This seems to indicate that dopamine helps male mice simply not feel as much pain, while female mice are able to focus their attention elsewhere while experiencing pain.

While further investigation is needed, the results appear to show that the activation of specific neural projections to the BNST reduces acute and persistent inflammatory pain. This adds to the evidence that dopamine signaling can enhance the blocking of pain stimuli, counteracting severe pain.

“We hope to investigate how this pathway can regulate more emotional behaviours associated with chronic pain, and then also look at the dynamics of the system, such as how this pathway works in real time during behaviour measurements,” Dr Kash said. “These neurons are also implicated in the actions of opioids such as morphine, so we plan to investigate that domain, as well.”

Source: News-Medical.Net

Categories : Pain ManagementTags :

Electroacupuncture Tops Standard Care for Cancer Pain

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Image by wei zhu from Pixabay

A study found that electroacupuncture was superior to both auricular acupuncture and standard care for skeletal muscle pain management in cancer survivors.

Electroacupuncture reduced pain by 1.9 points on the 0-10 scale of the Brief Pain Inventory (BPI), compared to standard care. Auricular acupuncture, which was developed by the US military, reduced pain by 1.6 points compared to standard care, and was associated with more adverse effects (AE). Standard care consisted of analgesics, physical therapy, and steroid injections.

“The magnitude of effect of electroacupuncture was clinically important and durable,” the authors wrote. “This finding is consistent with evidence from other large acupuncture trials for chronic pain in the general population. Electroacupuncture has been shown to influence endogenous opioid release, which provides a mechanistic basis for chronic pain management.”

“The present trial includes a large and diverse group of cancer survivors and provides evidence that electroacupuncture provides additional benefits beyond usual care, including not only reduction in pain severity, but also improvements in physical function and quality of life and reductions in analgesic use.”

The PEACE Study enrolled patients with a history of cancer who had experienced musculoskeletal pain for at least three months and at least 15 of the preceding 30 days, with a worst pain intensity within the past week of ≥ 4 (moderate or greater) on the BPI.

Patients were randomised 2:2:1 to receive either electroacupuncture, auricular acupuncture (which were both delivered by licensed, experienced practitioners) or standard care. 

In electroacupuncture procedure, needles were placed at four sites near the location of pain and four additional sites elsewhere on the body to address comorbid symptoms. The treatments consisted of 10 weekly 30-minute sessions.

The auricular acupuncture, also known as ‘battlefield acupuncture’ had a standardised procedure where a single needle was inserted into the cingulate gyrus of one ear. The patient then walked for one minute, and if pain remained ≥ 1 on the BPI, another needle was inserted into the other ear. The process was repeated for the four remaining ear acupuncture points.

Mean baseline BPI scores ranged from 5.0 to 5.6. At week 12, mean BPI score had declined by 0.48 in the standard care group, 2.39 in the electroacupuncture group (P < 0.001), and 2.03 in the auricular acupuncture group (P < 0.001). The 0.36 difference between the two acupuncture groups exceeded the prespecified noninferiority margin of 0.657 for auricular versus electroacupuncture.

Source: MedPage Today

Journal information: Mao JJ, et al “Effectiveness of electroacupuncture or auricular acupuncture vs usual care for chronic musculoskeletal pain among cancer survivors: the PEACE randomized clinical trial” JAMA Oncol 2021; DOI: 10.1001/jamaoncol.2021.0310.

Categories : Pain ManagementTags :

Review Finds Antidepressants Are Ineffective for Low Back Pain

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A systematic review of studies on antidepressants for low back pain has shown that they are no more effective than placebo, but still could have even more serious side effects. 

Explaining the study, lead author Michael Ferraro, doctoral candidate at University of New South Wales (UNSW) Medicine & Health and Neuroscience Research Australia (NeuRA), said:  “Antidepressants are commonly prescribed to treat the symptoms of low back pain. However, prescription rates for antidepressants to manage low back pain are increasing worldwide, despite unclear evidence to support their efficacy and safety and conflicting advice in clinical guidelines.”

Across 17 studies with over 2500 participants, the researchers looked at differences in outcomes for pain, safety, function and depressive symptoms between people taking antidepressants and placebos. 

“We found that treating low back pain with antidepressants failed to lead to reductions in what patients might consider important benefits for pain or function,” Mr Ferraro said.

“We also discovered that people taking antidepressants for low back pain are more likely to stop treatment and experience side effects and might even experience more serious side effects.
“If people are taking antidepressants for low back pain and have any concerns about their treatment, they should consult their medical physician for advice.”

These results bring into question no less than six international guidelines that recommend the use of antidepressants for low back pain. In particular, the US has a guideline for duloxetine, a serotonin and norepinephrine reuptake inhibitor, chronic low back pain treatment.
“We believe the US recommendation for duloxetine could be reconsidered in light of our findings,” he said. “Ongoing recommendations for the use of antidepressants to treat low back pain are concerning, particularly given the increased risk of side effects.”

The low quality of the studies in general limited their findings, but no clear benefits of using antidepressants for low back pain could be identified.
“It is difficult to estimate the true effects of such medicines being used to treat low back pain. The majority of the studies were considered to be at high risk of bias and interestingly, the studies which showed the most promise were industry-sponsored. We recommend future research focuses on other types of medicines that may provide benefit to adults with low back pain, as well as non-pharmacological treatments, such as physiotherapy and exercise,” said Mr Ferraro.

Source: News-Medical.Net

Journal information: Ferraro, M.C., et al. (2021) Efficacy, acceptability, and safety of antidepressants for low back pain: a systematic review and meta-analysis. Systematic Reviews. doi.org/10.1186/s13643-021-01599-4.

Categories : Injury & Trauma Neurology Pain ManagementTags :

New Surgery Improves Prosthetic Use and Reduces Pain

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A new type of surgery that links muscles together may improve the precision of prosthetic use and also relieve pain.

In typical amputations, the muscle pairs (such as triceps and biceps) that work together to control the joints are severed. However, an MIT team has discovered that reconnecting these muscles that are in an agonistic-antagonistic (‘push-pull’) relationship improves the sensory feedback and thus precision of the affected limb.

“When one muscle contracts, the other one doesn’t have its antagonist activity, so the brain gets confusing signals,” explained Srinivasan, a former member of the Biomechatronics group now working at MIT’s Koch Institute for Integrative Cancer Research. “Even with state-of-the-art prostheses, people are constantly visually following the prosthesis to try to calibrate their brains to where the device is moving.”

The 15 patients who received the AMI surgery were able to flex their prosthetic ankle joint with more precision than those without it, who were only able to fully extend or flex their joint.

“Through surgical and regenerative techniques that restore natural agonist-antagonist muscle movements, our study shows that persons with an AMI amputation experience a greater phantom joint range of motion, a reduced level of pain, and an increased fidelity of prosthetic limb controllability,” says Hugh Herr, a professor of media arts and sciences, head of the Biomechatronics group in the Media Lab, and the senior author of the paper.

The surgery also had a completely unexpected benefit: the reduction of pain in the amputated area, which can be from neuromas or phantom limb pain. Phantom limb pain can occur in 80% of amputess. Six of the 15 AMI patients reported zero pain. This may be significant as in the five centuries since phantom limb pain was first described, there has not been much advancement in the understanding of it.

“Our study wasn’t specifically designed to achieve this, but it was a sentiment our subjects expressed over and over again. They had a much greater sensation of what their foot actually felt like and how it was moving in space,” Srinivasan says. “It became increasingly apparent that restoring the muscles to their normal physiology had benefits not only for prosthetic control, but also for their day-to-day mental well-being.”

To treat patients who had received the traditional amputation surgery, the team is also working on using muscle grafts to create a ‘regenerative AMI’ procedure that restores the effect of agonist and antagonist muscles.

Source: Medical Xpress

Journal information: Shriya S. Srinivasan el al., “Neural interfacing architecture enables enhanced motor control and residual limb functionality postamputation,” PNAS (2021). www.pnas.org/cgi/doi/10.1073/pnas.2019555118

Categories : Addiction Pain ManagementTags :

Opioid Deaths Drop when Cannabis Stores are Near

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A new US study suggests that opioid-related mortality rates fall in counties where there are legal cannabis stores.

Cannabis was first legalised for medical use in the US in 1996; recreational legalisation began in 2012 with a number of states following suit. Previous research on the effect of legal access to cannabis on opioid overdose mortality had produced conflicting results, with a 2014 study showing a slow increase in deaths, but a subsequent study showing that it reversed over time.

Data on opioid mortality for adults 21 and over was drawn from 2014-2018 CDC data, and a website called Weedmaps for cannabis dispensary details in the 23 states plus the District of Columbia where cannabis dispensaries were allowed to operate as of 2017.

The number of cannabis dispensaries in a county was negatively related to log-transformed age-adjusted opioid mortality rate (β -0.17, 95% CI -0.23 to -0.11). An increase in the number of storefront dispensaries from one to two was linked to a 17% reduction in death rates of all opioid types, and an increase from two to three stores was associated with a further 8.5% drop in mortality.

Eight states plus the District of Columbia allowed recreational storefronts and 15 allowed only medical dispensaries. An increase in medical dispensaries from one to two resulted in a 15% drop in mortality rate; an increase in recreational dispensaries from one to two led to an 11% drop.

Co-author Balázs Kovács, PhD, of Yale University School of Management, said: “We find this relationship holds for both medical dispensaries, which serve only patients who have a state-approved medical card or doctor’s recommendation, as well as for recreational dispensaries, which sell to adults 21 years and older.”

An accompanying editorial pointed out that the relationship was not clear, noting that were was no evidence of substitution. Additionally, individual experiences of benefits and harms could not be inferred.

Although findings are suggestive of a possible link between the increased prevalence of cannabis dispensaries and reduced opioid-related mortality, they do not show causality, Kovács emphasised. “While we find a particularly strong association between the prevalence of storefront dispensaries and fentanyl-related opioid deaths, it is not clear whether cannabis use and fentanyl mortality rates are more specifically linked, or if the strength of the association is due to the rise in fentanyl use and mortality rates during the study period,” he said. 
He added that the potential harms of cannabis, including cognitive development of adolescents, schizophrenia and other medical conditions, and public safety risks, should not be ignored.
Source:MedPage TodayJournal information:  Hsu G and Kovács B “Association between county level cannabis dispensary counts and opioid related mortality rates in the United States: panel data study” BMJ 2021; DOI: 10.1136/bmj.m4957.