ArticlePain medicine (Malden, Mass.)2020
Disagreement and Uncertainty Among Experts About how to Respond to Marijuana Use in Patients on Long-term Opioids for Chronic Pain: Results of a Delphi Study.
Article in Pain medicine (Malden, Mass.), 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Healthcare professionals' perspectives on the use of medicinal cannabis to manage chronic pain: A systematic search and narrative review.Pain practice : the official journal of World Institute of Pain · 2022Review
- Consensus-based recommendations for titrating cannabinoids and tapering opioids for chronic pain control.International journal of clinical practice · 2021Article
- Article
- Physicians' Knowledge, Attitudes, and Perceptions about Medical Cannabis in the United States: A Scoping Review.Medical cannabis and cannabinoidsArticle
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Authors and funding
10 authors.
Funding
Abstract
backgroundMarijuana use is common among patients on long-term opioid therapy (LTOT) for chronic pain, but there is a lack of evidence to guide clinicians' response.
objectiveTo generate expert consensus about responding to marijuana use among patients on LTOT.
designAnalysis from an online Delphi study. SETTING/SUBJECTS: Clinician experts in pain and opioid management across the United States.
methodsParticipants generated management strategies in response to marijuana use without distinction between medical and nonmedical use, then rated the importance of each management strategy from 1 (not at all important) to 9 (extremely important). A priori rules for consensus were established, and disagreement was explored using cases. Thematic analysis of free-text responses examined factors that influenced participants' decision-making.
resultsOf 42 participants, 64% were internal medicine physicians. There was consensus that it is not important to taper opioids as an initial response to marijuana use. There was disagreement about the importance of tapering opioids if there is a pattern of repeated marijuana use without clinical suspicion for a cannabis use disorder (CUD) and consensus that tapering is of uncertain importance if there is suspicion for CUD. Three themes influenced experts' perceptions of the importance of tapering: 1) benefits and harms of marijuana for the individual patient, 2) a spectrum of belief about the overall riskiness of marijuana use, and 3) variable state laws or practice policies.
conclusionsExperts disagree and are uncertain about the importance of opioid tapering for patients with marijuana use. Experts were influenced by patient factors, provider beliefs, and marijuana policy, highlighting the need for further research.
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