Importance: Cannabis has been proposed as a therapeutic with potential opioid-sparing properties in chronic pain, and its use could theoretically be associated with decreased amounts of opioids used and decreased risk of mortality among individuals prescribed opioids. Objective: To examine the risks associated with cannabis use among adults prescribed opioid analgesic medications. Design, Setting, and Participants: This cohort study was conducted among individuals aged 18 years and older who had urine drug screening in 2014 to 2019 and received any prescription opioid in the prior 90 days or long-term opioid therapy (LTOT), defined as more than 84 days of the prior 90 days, through the Veterans Affairs health system. Data were analyzed from November 2020 through March 2022. Exposures: Biologically verified cannabis use from a urine drug screen. Main Outcomes and Measures: The main outcomes were 90-day and 180-day all-cause mortality. A composite outcome of all-cause emergency department (ED) visits, all-cause hospitalization, or all-cause mortality was a secondary outcome. Weights based on the propensity score were used to reduce confounding, and hazard ratios [HRs] were estimated using Cox proportional hazards regression models. Analyses were conducted among the overall sample of patients who received any prescription opioid in the prior 90 days and were repeated among those who received LTOT. Analyses were repeated among adults aged 65 years and older. Results: Among 297620 adults treated with opioids, 30514 individuals used cannabis (mean [SE] age, 57.8 [10.5] years; 28784 [94.3%] men) and 267106 adults did not (mean [SE] age, 62.3 [12.3] years; P <.001; 247684 [92.7%] men; P <.001). Among all patients, cannabis use was not associated with increased all-cause mortality at 90 days (HR, 1.07; 95% CI, 0.92-1.22) or 180 days (HR, 1.00; 95% CI, 0.90-1.10) but was associated with an increased hazard of the composite outcome at 90 days (HR, 1.05; 95% CI, 1.01-1.07) and 180 days (HR, 1.04; 95% CI, 1.01-1.06). Among 181096 adults receiving LTOT, cannabis use was not associated with increased risk of all-cause mortality at 90 or 180 days but was associated with an increased hazard of the composite outcome at 90 days (HR, 1.05; 95% CI, 1.02-1.09) and 180 days (HR, 1.05; 95% CI, 1.02-1.09). Among 77791 adults aged 65 years and older receiving LTOT, cannabis use was associated with increased 90-day mortality (HR, 1.55; 95% CI, 1.17-2.04). Conclusions and Relevance: This study found that cannabis use among adults receiving opioid analgesic medications was not associated with any change in mortality risk but was associated with a small increased risk of adverse outcomes and that short-term risks were higher among older adults receiving LTOT.
|Original language||English (US)|
|Journal||JAMA Network Open|
|State||Published - Dec 16 2022|
Bibliographical noteFunding Information:
Conflict of Interest Disclosures: Dr Byers reported receiving a US Department of Veterans Affairs (VA) Research Career Scientist award outside the submitted work. Dr Krebs reported receiving grants from VA Health Services Research and Development during the conduct of the study; receiving grants from the VA Health Services Research and Development, National Institutes of Health, and the Patient-Centered Outcomes Research Institute; receiving travel expenses from the Australian Pain Society, Stanford University, Hennepin Healthcare Research Institute, American Society of Health-System Pharmacists, and National Academies of Medicine; and serving as associate editor for PCORI Research Reports outside the submitted work and serving as an unpaid member of the Foundation for Opioid Response Efforts Scientific Advisory Council. Dr Bravata reported receiving grants from the VA during the course of the study. No other disclosures were reported.
Funding/Support: This project was supported by VA Health Services Research and Development IIR grant 18-231-2 from the US Department of Veterans Affairs Health Services.
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PubMed: MeSH publication types
- Journal Article
- Research Support, U.S. Gov't, Non-P.H.S.