Perception of Benefits and Harms of Medical Cannabis among Seriously Ill Patients in an Outpatient Palliative Care Practice

Zarrabi, Ali John; Welsh, Justine W.; Sniecinski, Roman; Curseen, Kimberly; Gillespie, Theresa W.; Baer, Wendy; McKenzie-Brown, Anne Marie; Singh, Vinita

doi:10.1089/jpm.2019.0211

Cited by 21 publications

(12 citation statements)

References 11 publications

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“…After full-text screening, 15 studies (reported in 16 articles) proved eligible for review, including nine quantitative studies, five qualitative studies and one mixedmethod study (figure 1, online supplemental appendices 5 and 6) [20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35]…”

Section: Resultsmentioning

confidence: 99%

Values and preferences towards medical cannabis among people living with chronic pain: a mixed-methods systematic review

et al. 2021

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ObjectiveTo explore values and preferences towards medical cannabis among people living with chronic pain.DesignMixed-methods systematic review.Data sourcesWe searched MEDLINE, EMBASE and PsycINFO from inception to 17 March 2020.Study selectionPairs of reviewers independently screened search results and included quantitative, qualitative and mixed-methods studies reporting values and preferences towards medical cannabis among people living with chronic pain.Review methodsWe analysed data using meta-narrative synthesis (quantitative findings were qualitised) and tabulated review findings according to identified themes. We used the Grading of Recommendations Assessment, Development and Evaluation approach to assess certainty of evidence.ResultsOf 1838 initial records, 15 studies proved eligible for review. High to moderate certainty evidence showed that patient’s use of medical cannabis for chronic pain was influenced by both positive (eg, support from friends and family) and negative social factors (eg, stigma surrounding cannabis use). Most patients using medical cannabis favoured products with balanced ratios of tetrahydrocannabinol (THC) and cannabidiol (CBD), or high levels of CBD, but not high THC preparations. Many valued the effectiveness of medical cannabis for symptom management even when experiencing adverse events related to concentration, memory or fatigue. Reducing use of prescription medication was a motivating factor for use of medical cannabis, and concerns regarding addiction, losing control or acting strangely were disincentives. Out-of-pocket costs were a barrier, whereas legalisation of medical cannabis improved access and incentivised use.Low to very low certainty evidence suggested highly variable values towards medical cannabis among people living with chronic pain. Individuals with pain related to life-limiting disease were more willing to use medical cannabis, and preferred oral over inhaled administration.ConclusionsOur findings highlight factors that clinicians should consider when discussing medical cannabis. The variability of patients’ values and preferences emphasise the need for shared decision making when considering medical cannabis for chronic pain.

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Section: Resultsmentioning

confidence: 99%

Values and preferences towards medical cannabis among people living with chronic pain: a mixed-methods systematic review

et al. 2021

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“…Alcohol and tobacco have been associated with several diseases, having a higher disease-risk perception (33,34). On the other hand, cannabis and analgesics have a lower disease-risk perception, being associated with misperceptions of medical benefits (35,36). In the acute post-COVID-19 phase, many patients experience very uncomfortable symptoms, such as fatigue, muscle weakness, pain, dyspnea, headache, and fever, which may impact functionality (7).…”

Section: Discussionmentioning

confidence: 99%

Substance Use in Mild-COVID-19 Patients: A Retrospective Study

Ismael

Zaramella

Battagin

et al. 2021

Front. Public Health

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Background: There is a need for prospective studies investigating substance use variations in mild COVID-19 patients. These individuals represent the majority of patients affected by the disease and are routinely treated at home, facing periods of quarantine.Methods: This was a retrospective cohort study. All people who tested positive for COVID-19 and classified as mild cases (i.e., no alarm sign/symptom, no need for in-person consultation) during the treatment in the public health system of a Brazilian city with around 160,000 inhabitants were monitored by phone for all the COVID-19 symptoms listed by the Centers for Disease Control and Prevention (CDC) during the active phase of the disease (i.e., no longer experiencing symptoms, up to 14 days in mild cases). After this phase (median = 108 days after intake, IQR = 76–137), we asked these patients who were classified as experiencing mild COVID-19 (n = 993) about last-month substance use in three time-points: pre-COVID, just after COVID-19 acute phase (post-COVID acute phase) and in the period before survey (post-COVID follow-up phase).Results: The number of COVID-19 symptoms was not associated with pre- or post-infection substance use. Pre-COVID alcohol and non-medical benzodiazepine use were associated with specific COVID-19 symptoms. However, sensitivity analyses showed that such associations could be explained by previous psychiatric and medical profiles. Alcohol and tobacco use decreased and non-medical analgesics increased in the post-COVID acute phase. However, just alcohol use remained lower in the post-COVID follow-up period. Higher pre-COVID levels of tobacco and alcohol were associated with post-COVID follow-up cannabis and non-medical analgesic use, respectively. Non-medical benzodiazepine use had positive and negative bi-directional associations with cannabis and non-medical analgesic use, respectively.Conclusion: We were not able to find specific associations between substance use and COVID-19 symptomatology in the present study. Patients with mild COVID-19 should be monitored for substance use in the post-COVID-19 period, and preventive interventions for non-medical analgesic use should be implemented. Focused preventive interventions increasing the perceived risks of cannabis and non-medical benzodiazepine and analgesic use among people experiencing mild COVID-19 that reported previous substance use could be useful.

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“…Only three studies [ 46 – 48 ] examined a single type of cancer. A few studies ( n = 11) did not specify participants’ type of cancer [ 49 – 59 ]. Almost half of the cancer diagnoses (42.5%, n = 7,949/18,684) were not reported in the primary studies.…”

Section: Resultsmentioning

confidence: 99%

“…Interestingly, 32 studies [ 7 , 8 , 17 , 30 , 48 – 50 , 52 , 58 – 60 , 62 , 65 , 66 , 69 , 77 , 79 , 80 , 85 , 86 , 88 , 96 , 100 , 102 – 108 ] indicate that use of medical cannabis was linked to at least one overall quality-of-life reason. Some authors [ 6 , 17 , 51 , 59 , 125 , 126 ] even suggest that cannabis use may influence quality of life of people diagnosed with cancer because of cannabis’ multidimensional effect. Furthermore, other studies [ 48 , 127 ] have found medical cannabis to significantly improve the quality of life of people diagnosed with cancer.…”

Section: Discussionmentioning

confidence: 99%

Routes of administration, reasons for use, and approved indications of medical cannabis in oncology: a scoping review

et al. 2022

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Introduction Some patients diagnosed with cancer use medical cannabis to self-manage undesirable symptoms, including nausea and pain. To improve patient safety and oncological care quality, the routes of administration for use of medical cannabis, patients’ reasons, and prescribed indications must be better understood. Methods Based on the Joanna Briggs Institute guidelines, a scoping review was conducted to map the current evidence regarding the use of medical cannabis in oncological settings based on the experiences of patients diagnosed with cancer and their healthcare providers. A search strategy was developed with a scientific librarian which included five databases (CINAHL, Web of Science, Medline, Embase, and PsycINFO) and two grey literature sources (Google Scholar and ProQuest). The inclusion criteria were: 1) population: adults aged 18 and over diagnosed with cancer; 2) phenomena of interest: reasons for cannabis use and/or the prescribed indications for medical cannabis; 3) context: oncological setting. French- or English-language primary empirical studies, knowledge syntheses, and grey literature published between 2000 and 2021 were included. Data were extracted by two independent reviewers and subjected to a thematic analysis. A narrative description approach was used to synthesize and present the findings. Results We identified 5,283 publications, of which 163 met the eligibility criteria. Two main reasons for medical cannabis use emerged from the thematic analysis: limiting the impacts of cancer and its side effects; and staying connected to others. Our results also indicated that medical cannabis is mostly used for three approved indications: to manage refractory nausea and vomiting, to complement pain management, and to improve appetite and food intake. We highlighted 11 routes of administration for medical cannabis, with oils and oral solutions the most frequently reported. Conclusion Future studies should consider the multiple routes of administration for medical cannabis, such as inhalation and edibles. Our review highlights that learning opportunities would support the development of healthcare providers’ knowledge and skills in assessing the needs and preferences of patients diagnosed with cancer who use medical cannabis.

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Perception of Benefits and Harms of Medical Cannabis among Seriously Ill Patients in an Outpatient Palliative Care Practice

Cited by 21 publications

References 11 publications

Values and preferences towards medical cannabis among people living with chronic pain: a mixed-methods systematic review

Values and preferences towards medical cannabis among people living with chronic pain: a mixed-methods systematic review

Substance Use in Mild-COVID-19 Patients: A Retrospective Study

Routes of administration, reasons for use, and approved indications of medical cannabis in oncology: a scoping review

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