一项关于退伍军人阿片类药物处方患者使用大麻的临床讨论的全国性研究。

IF 4.1 Q1 PHARMACOLOGY & PHARMACY Journal of cannabis research Pub Date : 2024-03-16 DOI:10.1186/s42238-024-00221-3
Tauheed Zaman, Dawn M Bravata, Amy Byers, Erin Krebs, Samuel Leonard, Charles Austin, Friedhelm Sandbrink, Deborah S Hasin, Salomeh Keyhani
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引用次数: 0

摘要

背景:退伍军人健康管理局跟踪长期阿片类药物治疗(LTOT)患者的尿液药物检测(UDT)情况,并建议讨论使用大麻对健康的影响:确定在 UDT 呈大麻阳性后的六个月内,医疗服务提供者与接受长期阿片类治疗的患者之间进行大麻相关讨论的情况,并研究与记录大麻使用情况相关的因素:我们确定了 2019 年大麻 UDT 阳性的 LTOT 处方患者。我们开发了一种文本处理工具,从他们的病历中提取有关大麻使用的讨论:共纳入 1.27 万名患者。对随机抽样的1946名患者进行了病历审查:病历中出现大麻术语,表明有大麻使用记录或与大麻有关的讨论。对部分患者的讨论内容进行提取。采用逻辑回归法研究患者因素(包括居住州的法律地位)与大麻使用记录之间的关联:在 12,070 名患者中,65.8%(N=7,948)的患者有大麻用语,而 34.1%(N=4,122)的患者没有大麻用语,这表明医疗服务提供者和患者之间没有大麻使用记录或讨论。在有讨论记录的患者子集中,47% 与出于医疗原因使用大麻有关,35% 与退伍军人事务部的政策或法律问题讨论有关,17% 与医疗风险或减低危害策略的具体讨论有关。在调整分析中,与非合法州的患者相比,娱乐性大麻合法化州的居民进行任何大麻相关讨论的可能性较低[OR 0.73,95% CI 0.64-0.82]:三分之一的 LTOT 患者在大麻 UDT 阳性后的 6 个月内没有在病历中记录大麻使用情况。有关使用大麻的医疗风险或减少危害策略的讨论并不常见。
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A national study of clinical discussions about cannabis use among Veteran patients prescribed opioids.

Background: The Veterans Health Administration tracks urine drug tests (UDTs) among patients on long-term opioid therapy (LTOT) and recommends discussing the health effects of cannabis use.

Objective: To determine the occurrence of cannabis-related discussions between providers and patients on LTOT during six months following UDT positive for cannabis, and examine factors associated with documenting cannabis use.

Design: We identified patients prescribed LTOT with a UDT positive for cannabis in 2019. We developed a text-processing tool to extract discussions around cannabis use from their charts.

Subjects: Twelve thousand seventy patients were included. Chart review was conducted on a random sample of 1,946 patients.

Main measures: The presence of a cannabis term in the chart suggesting documented cannabis use or cannabis-related discussions. Content of those discussions was extracted in a subset of patients. Logistic regression was used to examine the association between patient factors, including state of residence legal status, with documentation of cannabis use.

Key results: Among the 12,070 patients, 65.8% (N = 7,948) had a cannabis term, whereas 34.1% (N = 4,122) of patients lacked a cannabis term, suggesting that no documentation of cannabis use or discussion between provider and patient took place. Among the subset of patients who had a discussion documented, 47% related to cannabis use for medical reasons, 35% related to a discussion of VA policy or legal issues, and 17% related to a discussion specific to medical risks or harm reduction strategies. In adjusted analyses, residents of states with legalized recreational cannabis were less likely to have any cannabis-related discussion compared to patients in non-legal states [OR 0.73, 95% CI 0.64-0.82].

Conclusions: One-third of LTOT patients did not have documentation of cannabis use in the chart in the 6 months following a positive UDT for cannabis. Discussions related to the medical risks of cannabis use or harm reduction strategies were uncommon.

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