Cannabis Does Not Affect Nonmedical Opioid Use, Opioid Medication Dose, or Pain Outcomes Among People Living With HIV

Chronic pain is common among people living with HIV (PLWH). Both HIV and chronic pain are approved conditions for receipt of medical cannabis in many of the 29 states and District of Columbia that allow it. In a cohort of PLWH receiving opioid treatment of chronic pain, researchers investigated the prevalence of any cannabis use and assessed nonmedical opioid use using the Current Opioid Misuse Measure, and opioid dose using the morphine equivalent daily dose (MEDD). They also assessed HIV viral suppression and pain outcomes using the Brief Pain Inventory, which measures the severity of pain and its interference with daily functions on a scale of 0–10.

  • Of 166 participants, 65% were male, 72% were black, and the median age was 55 years. The median MEDD was 15 mg; pain severity and interference was a mean of 6/10 (SD 2); and 89% of participants had an undetectable viral load at baseline.
  • 85% of participants reported ever having used cannabis and 43% reported cannabis use in the past 12 months; 15% of the cohort reported daily use and 8% met criteria for a cannabis use disorder. Of the patients with cannabis use in the last 12 months, 66% used it for pain.
  • There was no association between past-year cannabis use and current nonmedical opioid use, MEDD, or pain severity and interference. In sensitivity analyses adjusting for depressive symptoms and substance use disorder (other than cannabis use disorder), past-year cannabis use was associated with 3-times increased odds of having a detectable viral load.

Comments: Among a cohort of PLWH prescribed opioid therapy, cannabis use was common and did not have an impact on nonmedical opioid use, opioid dose, or pain severity and interference, but it did have a negative impact on viral suppression. This study adds to the growing evidence that providers can draw from when counseling patients about the potential benefits and harms of cannabis use. Given that it did not improve pain and was associated with worse HIV outcomes, these results suggest that states should consider evidence when making decisions about medical cannabis laws.

Jeanette M. Tetrault, MD

Reference: Merlin JS, Samet JH, Cheng DM, et al. Marijuana use and its associations with pain, opioid dose, and HIV viral suppression among persons living with HIV on chronic opioid therapy. J Acquir Immune Defic Syndr. 2019;82(2):195–201.

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