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Marijuana Use Is Not Associated With Changes in Opioid Prescriptions or Pain Severity Among People Living With HIV and Chronic Pain

Merlin, Jessica S., MD, PhDa; Long, Dustin, PhDb; Becker, William C., MDc,d; Cachay, Edward R., MDe; Christopolous, Katerina A., MD, MPHf; Claborn, Kasey R., PhDg; Crane, Heidi M., MD, MPHh; Edelman, Eva Jennifer, MD, MHSi; Lovejoy, Travis I., PhD, MPHj,k; Mathews, William Christopher, MDe; Morasco, Benjamin J., PhDj,k; Napravnik, Sonia, PhDl; O'Cleirigh, Connall, PhDm; Saag, Michael S., MDn; Starrels, Joanna L., MD, MSo; Gross, Robert, MD, MSCEp; Liebschutz, Jane M., MD, MPHa

JAIDS Journal of Acquired Immune Deficiency Syndromes: June 1, 2019 - Volume 81 - Issue 2 - p 231–237
doi: 10.1097/QAI.0000000000001998
Clinical Science
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Background: People living with HIV (PLWH) commonly report marijuana use for chronic pain, although there is limited empirical evidence to support its use. There is hope that marijuana may reduce prescription opioid use. Our objective was to investigate whether marijuana use among PLWH who have chronic pain is associated with changes in pain severity and prescribed opioid use (prescribed opioid initiation and discontinuation).

Methods: Participants completed self-report measures of chronic pain and marijuana use at an index visit and were followed up for 1 year in the Center for AIDS Research Network of Integrated Clinical Systems (CNICS). Self-reported marijuana use was the exposure variable. Outcome variables were changes in pain and initiation or discontinuation of opioids during the study period. The relationship between exposure and outcomes was assessed using generalized linear models for pain and multivariable binary logistic regression models for opioid initiation/discontinuation.

Results: Of 433 PLWH and chronic pain, 28% reported marijuana use in the past 3 months. Median pain severity at the index visit was 6.3/10 (interquartile range 4.7–8.0). Neither increases nor decreases in marijuana use were associated with changes in pain severity, and marijuana use was not associated with either lower odds of opioid initiation or higher odds of opioid discontinuation.

Conclusions: We did not find evidence that marijuana use in PLWH is associated with improved pain outcomes or reduced opioid prescribing. This suggests that caution is warranted when counseling PLWH about potential benefits of recreational or medical marijuana.

aDivisions of General Internal Medicine and Infectious Diseases, Center for Research on Healthcare, University of Pittsburgh School of Medicine, Pittsburgh, PA;

bDepartment of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL;

cSection of General Internal Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT;

dVA Connecticut Healthcare System, West Haven, CT;

eDivision of Infectious Diseases, Department of Medicine, Owen Clinic, University of California at San Diego, San Diego, CA;

fDivision of HIV, Infectious Diseases, and Global Medicine, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA;

gDepartment of Psychiatry, University of Texas at Austin Dell Medical School, Austin, TX;

hDivision of Infectious Disease, Department of Medicine, University of Washington, Seattle, WA;

iYale Schools of Medicine and Public Health, New Haven, CT;

jDepartment of Psychiatry, Oregon Health & Science University, Portland, OR;

kCenter to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR;

lDivision of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC;

mDepartment of Psychiatry, Massachusetts General Hospital/Harvard Medical School, The Fenway Institute, Boston, MA;

nDivision of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL;

oDivision of General Internal Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; and

pDivision of Infectious Diseases, Department of Medicine, and Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.

Correspondence to: Jessica S. Merlin, MD, PhD, Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Suite 600, Pittsburgh, PA 15213 (e-mail: merlinjs@upmc.edu).

Supported by the National Institutes of Health (K23MH104073 to J.S.M., R01DA040471 to E.J.E., R01DA039046 to J.L.S., K23DA039037 to K.R.C., and R01AG053081 to T.I.L.), the Penn Center for AIDS Research (CFAR) (P30 AI 045008 to R.G.), and the Penn Mental Health AIDS Research Center (PMHARC) (P30 MH 097488 to R.G.). Additional support came from the National Institute of Allergy and Infectious Diseases (NIAID) at the National Institutes of Health (CNICS R24 AI067039, UW CFAR NIAID Grant P30 AI027757, UNC CFAR grant P30 AI50410, and UAB CFAR grant P30 AI027767) and the National Institutes of Alcohol Abuse and Alcoholism (NIAAA) at the National Institutes of Health (U24AA020801, U01AA020793, and U01AA020802).

H.M.C. has served on an advisory board for VIIV. R.G. is a member of a Data and Safety Monitoring Board for a Pfizer drug unrelated to HIV or pain treatment. J.L.S. receives research support from the Opioid Postmarketing Requirement Consortium to conduct FDA‐mandated observational research. M.S.S. is a scientific advisor for ViiV, Merck, and Gilead. The remaining authors had no conflicts of interest to disclose.

Received November 19, 2018

Accepted January 14, 2019

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