Matched pilot study examining cannabis-based dronabinol for acute pain following traumatic injury

Abstract

BackgroundTo determine whether adjunctive dronabinol, a licensed form of delta-9-tetrahydrocannabinol, reduces opioid consumption when used off-label for managing acute pain following traumatic injury.MethodsThis matched cohort study included patients who were admitted with a traumatic injury between 1 March 2017 and 30 October 2017. The hospital pharmacy database was used to identify patients who received dronabinol (cases), and they were matched 1:1 to patients who did not receive dronabinol (controls) using age, cause of injury and hospital length of stay. The primary outcome, change in opioid consumption, was calculated using morphine milligram equivalents (MME). The change in MME was calculated for cases as total MME over 48 hours with adjunctive dronabinol minus 48 hours prior to dronabinol, and for controls as total MME 48–96 hours from admission minus 0–48 hours from admission. Data are presented as mean and SE or median and IQR. Statistical analysis was performed using paired t-tests and McNemar’s tests.ResultsThere were 66 patients included: 33 cases and 33 matched controls. Dronabinol was initiated 55 (28–107) hours from admission. Cases and controls were well matched. Cases had a significant reduction in opioid consumption with adjunctive dronabinol (−79 (20) MME, p<0.001), while opioid consumption was unchanged for controls (−9 (20) MME, p=0.63). This resulted in a ninefold greater reduction in opioid consumption for cases versus controls that was statistically different between pairs (p=0.02). Nineteen (58%) cases reported using marijuana; in this subset, opioid consumption was reduced with adjunctive dronabinol (−97 (24) MME, p<0.001) versus a non-significant increase in opioid consumption in matched controls (11 (29) MME, p=0.70); difference between groups, p=0.01.ConclusionsThe results of this study suggest adjunctive dronabinol reduces opioid consumption following traumatic injury. The opioid-sparing effect of dronabinol may be greater in patients who are marijuana users.Level of evidenceIII.

ASRA Pain Medicine consensus guidelines on the management of the perioperative patient on cannabis and cannabinoids

“…The changes were not associated with changes in perioperative complications 117. Although some evidence suggests that cannabinoid use has improved opioid-related adverse events and reduced overall use,118–122 more substantial evidence demonstrates that cannabinoids can worsen pain and increase postoperative opioid use 73 123–126. There is evidence of biphasic effects of THC, with low doses reducing pain and high doses increasing pain, stressing the need for a better understanding of the relationship between THC consumption levels and pain 127 128…”

Adherence, Safety, and Effectiveness of Medical Cannabis and Epidemiological Characteristics of the Patient Population: A Prospective Study

“…Medical cannabis is now available in many countries, where it is primarily used for its analgesic effect ( 2 , 10 – 12 , 15 , 16 , 18 , 24 – 26 ). In 2007, the Israeli Ministry of Health (IMOH) began issuing licenses for the use of cannabis for patients with specific indications, including: nausea and vomiting due to chemotherapy treatment, cancer associated pain, inflammatory bowel disease (IBD), neuropathic pain, fibromyalgia, cachexia in AIDS (acquired immunodeficiency syndrome) patients, multiple sclerosis (MS), Parkinson's disease (PD), Tourette syndrome, epilepsy, autism, and post-traumatic stress disorder (PTSD).…”

Efficacy of Dronabinol for Acute Pain Management in Adults with Traumatic Injury: Study Protocol of A Randomized Controlled Trial

“…These results suggest that adjunctive dronabinol used as part of a multimodal analgesia regimen may result in a marked reduction in opioid consumption Two subset analyses of this matched cohort study provide mixed evidence that the opioid sparing effect of dronabinol may be greater in patients who are marijuana users. Among the subset of 19 cases who were marijuana users, opioid consumption was significantly reduced with adjunctive dronabinol (−97 mg, p < 0.001) versus no change in opioid consumption in 19 matched controls (1 mg, p = 0.70), with a difference between pairs that was significant: −108 mg, p = 0.01) [10]. However, when examining the subset of patients who received dronabinol, there were no differences in the change in opioid consumption for patients who were marijuana users (n = 21, −97 mg reduction with dronabinol) compared to non-marijuana users (n = 15, −64 mg reduction with dronabinol), p = 0.41 (unpublished).…”

“…Recently published preliminary clinical research from our group examined the effect of adjunctive dronabinol for acute pain management among 66 trauma patients [10]. Cases demonstrated a significant reduction in opioid consumption (morphine equivalents) from baseline with adjunctive dronabinol (−79 mg, p < 0.001), while the change in opioid consumption for matched controls was unchanged from baseline (−9 mg, p = 0.63), resulting in a nine-fold greater reduction in opioid consumption for cases versus controls that was significantly different between pairs (difference: −70 mg, p = 0.02).…”