The role of cannabis in pain management among people living with HIV who use drugs: A qualitative study

Abstract

Introduction People living with HIV who use drugs commonly experience chronic pain and often use illicit opioids to manage pain. Recent research suggests people living with HIV use cannabis for pain relief, including as an adjunct to opioids. This underscores the need to better understand how people living with HIV who use drugs use cannabis for pain management, particularly as cannabis markets are undergoing changes due to cannabis legalisation. Methods From September 2018 to April 2019, we conducted in‐depth interviews with 25 people living with HIV who use drugs in Vancouver, Canada to examine experiences using cannabis to manage pain. Interviews were audio‐recorded, transcribed and coded. Themes were identified using inductive and deductive approaches. Results Most participants reported that using cannabis for pain management helped improve daily functioning. Some participants turned to cannabis as a supplement or periodic alternative to prescription and illicit drugs (e.g. benzodiazepines, opioids) used to manage pain and related symptoms. Nonetheless, participants' access to legal cannabis was limited and most continued to obtain cannabis from illicit sources, which provided access to cannabis that was free or deemed to be affordable. Discussion and Conclusions Cannabis use may lead to reduced use of prescription and illicit drugs for pain management among some people living with HIV who use drugs. Our findings add to growing calls for additional research on the role of cannabis in pain management and harm reduction, and suggest the need for concrete efforts to ensure equitable access to cannabis.

Changes in marijuana use and associated attitudes and health behaviors among patients in HIV care in the U.S. in the post-legalization era: a qualitative study

“…As found in other studies (Azcarate et al, 2020;Chayama et al, 2021;Sajdeya, 2021), alleviating symptoms was a key goal, with nearly all participants using marijuana to address one or more symptoms such as pain relief, to aid sleep, to reduce anxiety, or to stimulate appetite. Most participants framed marijuana use as a tool for improving their health.…”

“…While there is a potential cause for concern regarding the impact of marijuana's broadening availability on patterns of behavior and health outcomes among PWH, marijuana may help some PWH, who report relief from a broad array of symptoms with use, including pain and anxiety (Chayama et al, 2021;Sajdeya, 2021), or those who use it as an appetite stimulant (Sajdeya, 2021). Indeed, PWH were integral to catalyzing the medicinal marijuana movement in the 1990s (Mann, 2019), and the use of marijuana for medical purposes has long been supported by some care providers (Bridgeman and Abazia, 2017).…”

Prevalence, correlates, and quality-of-life outcomes of major or persistent pain among women living with HIV in Metro Vancouver, Canada

“…While less than daily cannabis use trended towards higher odds of pain, a statistically significant association was not observed. Previous work demonstrates that many PLWH in Metro Vancouver may use cannabis for analgesia [ 14 ] and that cannabis is associated with reduced opioid use in people who use drugs (PWUD) with chronic pain [ 36 ]. However, these study cohorts consisted exclusively of PWUD who reported higher rates of cannabis use than our cohort and may have been more reliant on non-prescription drug use for pain management.…”

“…Substance use factors included non-injection opioid use (daily, less than daily [more than once a week, once a week, 1–3 times per month, less than once per month], none) (last 6 months), injection opioid use (daily, less than daily [more than once a week, once a week, 1–3 times per month, less than once per month], none) (last 6 months), cannabis use (daily, less than daily [more than once a week, once a week, 1–3 times per month, less than once per month], none) (last 6 months), and accidental overdose (last 6 months). Our analysis focused on opioids and cannabis versus other criminalized substances as both have analgesic effects and previous work has demonstrated that people who use criminalized drugs in British Columbia may turn to non-prescription opioids and cannabis for pain management [ 14 , 36 ]. Further, people who use injection opioid in particular may face increased stigma from healthcare providers limiting access to pain care [ 75 ].…”

Cannabis use for pain relief in the context of health service barriers: Accounts of street‐involved Nigerian women suffering chronic pain

“…The lack of consensus among experts on cannabis efficacy in pain treatment and potential adverse consequences notwithstanding, studies have shown that medical cannabis users find cannabis effective for pain management [3,[24][25][26][27]. For example, >80% of a sample of 2,897 medical cannabis patients in the United States reported that comparatively cannabis was more effective for pain than opioid medications [3].…”