Presented at the 2013 AAPM Annual Meeting « Back

Marijuana Use Predicts Future Aberrant Medication Behaviors in Patients Receiving Opioids for Chronic Nonmalignant Pain

Rachel Porter, MSN RN-BC, rporter@bostonpaincare.com¹, David D. DiBenedetto, MD¹, Lee Silk, MD¹, Mary Jane G. Estrada-Lyder, ANP-BC¹, Christin Harrington, BS², Zahid Bajwa, MD¹, (1) Boston PainCare Center, Waltham, Massachusetts, (2) Boston PainCare Center, West Roxbury, Massachusetts

Purpose: With increasing medical marijuana legalization, clinicians will likely see more chronic pain patients prescribed marijuana. Correlation is reported in the incidence of aberrant drug behaviors (ADB) with the use of illicit drugs in patients receiving chronic opioids. This study examines the relationship between marijuana use and the occurrence of ADB in patients receiving chronic opioids at a large, interdisciplinary pain center. Methods: With IRB approval, initial urine drug test (UDT) results for patients in the Medication Management Program at Boston PainCare Center were examined for over 5 months. We identified two study groups: the THC Group and the Consistent UDT Group. Standardized questionnaires measuring opioid misuse risk (SOAPP-R/COMM), degree of functional impairment (ODI), UDT results, prescribing history, opioid doses, and demographics were compared for 6 months following program enrollment. Results: 60 patients were included in this study. Of those, 6 were initially positive for THC. The two groups had similarities in age and marital status but with a larger proportion of males in the THC group. There was no significant difference in the drug doses or results of the standardized assessments used. There was a 50% higher incidence of ADB in the THC group. Conclusion: This study indicates that marijuana users at the time of their initial UDT may be more likely to exhibit ADB compared to those presenting with consistent UDT. Additional research on a larger sample would be useful to further examine this relationship and to help identify other variables that may influence this risk. References: 1) Fishbain, DA, Cole B, Lewis J, Rosomoff, H. L, Rosomoff, R.S., What Percentage of Chronic Nonmalignant Pain Patients Exposed to Chronic Opioid Analgesic Therapy Develop Abuse/Addiction and/or Aberrant Drug-Related Behaviors? A Structured Evidence-Based Review, Pain Medicine May/June 2008, Volume 9, Issue 4;444-459.

Funding: None