PainRelief.com Interview with:
Deepika Slawek, MD, MS, MPH (she/hers)
Assistant Professor of Medicine, Division of General Internal Medicine
Montefiore Medical Center
Albert Einstein College of Medicine
Bronx, NY 10467
PainRelief.com: What is the background for this study?
Response: Medical cannabis has become increasingly available in the United States over the past 25 years and is commonly used for the management of pain. Little is known about the patterns of medical cannabis use by patients with chronic pain. This information could help providers anticipate patients’ needs and identify potential disparities in access.
We followed 99 adults in New York State who were newly certified for medical cannabis use and who were prescribed opioids over the course of 1 year. Using a latent class trajectory analysis, we identified clusters of participants based on 14-day frequency of medical cannabis use. We used logistic regression to determine factors associated with cluster membership including sociodemographic characteristics, pain, substance use, and mental health symptoms.
PainRelief.com: What are the main findings?
Response: We found three clusters of medical cannabis use: infrequent use (n=30, mean use= 1.5 days/14-day period), occasional use (n=28, mean use=5.7 days/14-day period), and frequent use (n=41, mean use= 12.1 days/14-day period). These patterns did not vary significantly over the course of the year. When compared with infrequent use, frequent use was associated with non-Hispanic White race and ethnicity. Occasional use was associated with being employed when compared with infrequent use.
PainRelief.com: What should readers take away from your report?
Response: We found three distinct and stable patterns of medical cannabis use among adults in New York State using medical cannabis for pain. While there were not clinical differences between clusters, differences did emerge with respect to race and ethnicity. These findings may point toward structural inequities in access to medical cannabis that could reflect locations of medical cannabis dispensaries, disparities in how providers treat pain, or potential reluctance to use medical cannabis given many years of disproportionately aggressive enforcement of cannabis prohibition among Black and Hispanic populations.
PainRelief.com: What recommendations do you have for future research as a result of this work?
Response: There are large gaps in our knowledge on medical cannabis and its clinical use. There is an urgent need for more high-quality research on cannabis that is relevant to the everyday lives of our patients. Additionally, given the long history of racial disparities that pervade the history of cannabis and medicine, more studies are imperative to understand the impact of structural racism on access to medical cannabis and the health consequences of these disparities.
PainRelief.com: Is there anything else you would like to add?
Response: These findings are part of a larger NIH-funded study that is still recruiting participants. There are more findings to come from this study, and much more to learn about the therapeutic use of cannabis.
Jonathan Ross, MD, Deepika E Slawek, MD, Chenshu Zhang, PhD, Joanna L Starrels, MD, Frances R Levin, MD, Nancy L Sohler, PhD, Haruka Minami, PhD, Julia H Arnsten, MD, Chinazo O Cunningham, MD, First-year trajectories of medical cannabis use among adults taking opioids for chronic pain: an observational cohort study, Pain Medicine, 2021;, pnab257, https://doi.org/10.1093/pm/pnab257
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