Why carry out this study?
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Cannabis is a commonly used psychoactive substance, and its use has been suggested to have a high prevalence among patients with chronic pain |
With the recent legalization of marijuana across several states in the US, there is a dire need to establish a baseline use among hospitalized patients |
The aim of this study is to investigate the trends in cannabis use among chronic pain in-patients from 2011 to 2015 in the US |
What was learned from the study?
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We found that cannabis use is increasing among chronic pain patients and a subpopulation of chronic pain patients (tobacco users, men, low household income, Medicaid insurance coverage, and certain chronic pain syndromes). However, we observed that the rates of cannabis use in opioid users were down-trending simultaneously |
In the era of recent legalization of cannabis use in certain regions of the US, our study reveals a rising trend among certain groups of hospitalized patients with chronic pain |
Introduction
Methods
Database Characteristics
Inclusion and Exclusion Criteria
Outcomes
Statistical Analysis
Compliance with Ethics Guidelines
Results
Trends of Cannabis Use in Chronic Pain Patients
Characteristics | Overall | 2011 | 2012 | 2013 | 2014 | 2015 | Trend P value |
---|---|---|---|---|---|---|---|
Total patients with cannabis use, weighted no. (SE) | 247,949 (3473) | 33,189 (1960) | 39,700 (1328) | 45,935 (1565) | 57,010 (1856) | 72,115 (2263) | 0.00 |
Prevalence of cannabis use disorder (%) | 2.4 | 1.9 | 2.1 | 2.3 | 2.6 | 3.0 | |
Patient characteristics | |||||||
Age | |||||||
Mean (SE), years | 44.3 (0.08) | 42.8 (0.25) | 43.3 (0.17) | 44.1 (0.17) | 44.8 (0.15) | 45.4 (0.14) | 0.00 |
< 45% | 47.5 (0.28) | 51.5 (0.88) | 49.9 (0.66) | 47.7 (0.65) | 46.4 (0.53) | 45.2 (0.5) | |
45–64 | 48.3 (0.26) | 45.9 (0.83) | 47 (0.63) | 48.6 (0.62) | 49.1 (0.51) | 49.2 (0.47) | |
65–84 | 4.2 (0.1) | 2.6 (0.2) | 3.0 (0.2) | 3.7 (0.21) | 4.4 (0.22) | 5.6 (0.22) | |
> 84 | 0.04 (0.00) | 0.01 (0.01) | 0.04 (0.02) | 0.02 (0.02) | 0.05 (0.02) | 0.04 (0.02) | |
Female sex, % (SE) | 39.7 (0.23) | 38.7 (0.71) | 39.6 (0.59) | 39.4 (0.54) | 39.4 (0.48) | 40.7 (0.42) | 0.03 |
Race, % (SE) | 0.24a | ||||||
White | 70.1 (0.39) | 71.4 (1.5) | 70.5 (0.89) | 70.1 (0.85) | 69.7 (0.78) | 69.7 (0.74) | |
Black | 20.1 (0.34) | 17.8 (1.2) | 18.8 (0.78) | 20.4 (0.76) | 20.8 (0.71) | 21 (0.66) | |
Hispanic | 6.4 (0.2) | 6.6 (0.82) | 7.2 (0.5) | 6.4 (0.45) | 6.0 (0.36) | 6.2 (0.32) | |
Asian/Pacific Islander | 0.51 (0.05) | 0.36 (0.08) | 0.44 (0.09) | 0.44 (0.1) | 0.59 (0.13) | 0.59 (0.12) | |
Native Americans | 1.2 (0.13) | 1.8 (0.88) | 1 (0.18) | 1.1 (0.19) | 0.99 (0.15) | 1.1 (0.17) | |
Others | 1.8 (0.1) | 2.1 (0.4) | 2.1 (0.28) | 1.6 (0.18) | 2.0 (0.2) | 1.5 (0.14) | |
Income quartiles, % (SE)b | 0.02c | ||||||
0–25 | 39.4 (0.47) | 36.1 (1.9) | 39 (1.00) | 39.7 (1.0) | 39.2 (0.93) | 40.9 (0.84) | |
26–50 | 28.0 (0.34) | 28.5 (1.3) | 27.3 (0.75) | 28.8 (0.77) | 30.0 (0.67) | 26.2 (0.60) | |
51–75 | 20.7 (0.3) | 22.3 (1.2) | 21.0 (0.66) | 20.4 (0.66) | 19.4 (0.58) | 21.0 (0.53) | |
76–100 | 11.9 (0.28) | 13.1 (1.1) | 12.7 (0.63) | 11.1 (0.58) | 11.5 (0.52) | 12.0 (0.52) | |
Administrative/financial details | |||||||
Payment source, % (SE) | 0.02d | ||||||
Medicare | 30.8 (0.25) | 29.0 (0.79) | 30.1 (0.6) | 31.9 (0.58) | 30.6 (0.5) | 31.4 (0.50) | |
Medicaid | 36.8 (0.33) | 32.7 (1.1) | 33.2 (0.68) | 32.3 (0.63) | 40.7 (0.71) | 40.4 (0.63) | |
Private insurance | 16.7 (0.25) | 17.6 (0.91) | 16.4 (0.52) | 16.1 (0.53) | 16.2 (0.5) | 17.4 (0.48) | |
Elective admissions | 12.1 (0.29) | 12.6 (1.2) | 12.3 (0.66) | 11.5 (0.57) | 11.6 (0.53) | 12.5 (0.49) | |
Bed size, % (SE)e | 0.00f | ||||||
Small | 14.0 (0.43) | 8.4 (1.2) | 12.0 (0.94) | 12.4 (0.96) | 17.3 (1.08) | 15.9 (0.97) | |
Medium | 26.1 (0.57) | 23.5 (2.32) | 26.7 (1.41) | 25.1 (1.35) | 26.6 (1.33) | 27.4 (1.27) | |
Large | 59.9 (0.66) | 68.2 (2.56) | 61.3 (1.57) | 62.5 (1.56) | 56.1 (1.57) | 56.7 (1.50) | |
Teaching hospital, % (SE) | 56.7 (0.7) | 42.9 (3.0) | 50.1 (1.67) | 51.5 (1.69) | 63.5 (1.48) | 64.5 (1.39) | 0.00 |
Hospitals in urban locations | 89.4 (0.42) | 86.1 (2.22) | 88.9 (0.95) | 88.4 (0.91) | 90.5 (0.8) | 90.0 (0.66) | 0.01 |
Trends of Cannabis Use and Patient Characteristics
Trends of Cannabis Use Among Subgroups of Chronic Pain Diagnosis
Chronic pain diagnosis subgroups | Overall | 2011 | 2012 | 2013 | 2014 | 2015 | Trend P value |
---|---|---|---|---|---|---|---|
CRPS, % (SE) | 1.45 (0.09) | 1.25 (0.17) | 1.23 (0.18) | 1.60 (0.2) | 1.28 (0.18) | 1.96 (0.24) | 0.02 |
Trauma, % (SE) | 6.89 (0.29) | 5.23 (0.56) | 6.62 (0.63) | 6.73 (0.67) | 6.95 (0.62) | 8.98 (0.71) | 0.00 |
Post-surgical, % (SE) | 2.42 (0.2) | 2.39 (0.42) | 2.3 (0.46) | 2.18 (0.41) | 2.96 (0.51) | 2.34 (0.45) | 0.72 |
Spondylosis, % (SE) | 0.84 (0.02) | 0.57 (0.04) | 0.67 (0.03) | 0.85 (0.04) | 0.95 (0.04) | 1.2 (0.05) | 0.00 |
FBSS, % (SE) | 0.7 (0.06) | 0.47 (0.12) | 0.5 (0.11) | 0.69 (0.13) | 0.9 (0.14) | 0.97 (0.15) | 0.00 |
Other chronic pain, % (SE) | 2.93 (0.03) | 2.4 (0.11) | 2.61 (0.06) | 2.78 (0.07) | 3.06 (0.07) | 3.49 (0.07) | 0.00 |
Trends of Cannabis Use and Healthcare Utilization
Characteristics | Overall | 2011 | 2012 | 2013 | 2014 | 2015 | Trend P-value |
---|---|---|---|---|---|---|---|
Hospitalization cost, % (SE), 2015 US$ | 35,026 (428) | 31,271 (1333) | 30,999 (808) | 34,009 (944) | 26,174 (830) | 38,684 (946) | 0.00 |
Length of stay, mean (SE), days | 5.2 (0.04) | 5.11 (0.15) | 4.98 (0.08) | 5.22 (0.08) | 5.29 (0.08) | 5.27 (0.07) | 0.03 |
Number of procedures, mean (SE), n | 1.06 (0.01) | 0.99 (0.04) | 1.00 (0.03) | 1.10 (0.03) | 1.1 (0.03) | 1.07 (0.03) | 0.01 |
Hospitalization outcome, % (SE) | |||||||
Home or self-care | 77.9 (0.22) | 79.25 (0.68) | 79.3 (0.51) | 77.95 (0.49) | 77.43 (0.46) | 76.98 (0.43) | |
Short-term hospital | 1.97 (0.07) | 2.3 (0.25) | 2.17 (0.18) | 2.04 (0.16) | 1.93 (0.14) | 1.71 (0.11) | |
Skilled care facility | 8.66 (0.14) | 8.26 (0.42) | 7.98 (0.33) | 8.71 (0.32) | 8.68 (0.29) | 9.17 (0.26) | |
Home health care | 6.43 (0.13) | 5.21 (0.38) | 5.19 (0.28) | 6.05 (0.28) | 7.13 (0.29) | 7.35 (0.27) | |
Discharge diagnosis, % (SE) | |||||||
Tobacco use disorder | 68.8 (0.31) | 63.8 (1.20) | 65.9 (0.68) | 67.5 (0.62) | 70.0 (0.55) | 72.4 (0.50) | 0.00 |
Depression | 20.0 (0.24) | 19.7 (0.84) | 19.4 (0.51) | 19.5 (0.51) | 20.1 (0.45) | 20.8 (0.46) | 0.09 |
Opioid use disorder | 21.9 (0.27) | 23.8 (1.10) | 23.0 (0.64) | 23.0 (0.59) | 21.6 (0.53) | 19.9 (0.45) | 0.00 |