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Marijuana Use and Its Associations With Pain, Opioid Dose, and HIV Viral Suppression Among Persons Living With HIV on Chronic Opioid Therapy

Merlin, Jessica S. MD, PhD, MBAa; Samet, Jeffrey H. MD, MA, MPHb,c,d; Cheng, Debbie M. ScDe; Lira, Marlene C. BAb; Tsui, Judith I. MD, MPHf; Forman, Leah S. MPHg; Colasanti, Jonathan MD, MDPHh,i; Walley, Alexander Y. MD, MsCb,c; Del Rio, Carlos MDh,i; Liebschutz, Jane M. MD, MPHa

JAIDS Journal of Acquired Immune Deficiency Syndromes: October 1, 2019 - Volume 82 - Issue 2 - p 195–201
doi: 10.1097/QAI.0000000000002119
Clinical Science
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Background: Medical marijuana is legal in 29 US states and the District of Columbia: both HIV and chronic pain are “approved conditions” for receipt. Chronic pain is common among people living with HIV (PLWH). We anticipate PLWH will question their providers about medical marijuana for chronic pain. We examined marijuana use and its associations with pain, opioid dose, and HIV viral suppression among PLWH receiving chronic opioid therapy.

Methods: PLWH prescribed chronic opioid therapy were recruited into the Targeting Effective Analgesia in Clinics for HIV cohort. The main exposure variable was any past 12-month marijuana use. The primary outcomes were (1) opioid misuse (≥9 on the Current Opioid Misuse Measure) and (2) opioid dose (morphine equivalent daily dose). HIV viral load (VL) suppression (<200 copies/μL) and pain severity and interference using the Brief Pain Inventory were exploratory outcomes.

Results: Participants (n = 166) were men (65%), Black (72%), and had an undetectable VL (89%). We found no significant association between current marijuana use and opioid misuse, opioid dose, or pain. Current marijuana use was associated with 3.03 times the odds of having a detectable VL (95% odds ratio: 1.11–8.31, P = 0.03) while controlling for depressive symptoms and other substance use.

Discussion: We did not detect an association between marijuana use and opioid misuse behaviors, opioid dose, or pain. In an exploratory analysis, current marijuana use was associated with 3× greater odds of having a detectable VL. This study provides insights into potential consequences of marijuana use among PLWH with chronic pain.

aDivision of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA;

bClinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA;

cDepartment of Medicine, Boston University School of Medicine, Boston, MA;

dDepartment of Community Health Sciences, Boston University School of Public Health, Boston, MA;

eDepartment of Biostatistics, Boston University School of Public Health, Boston, MA;

fSection of General Internal Medicine, Department of Medicine, University of Washington and Harborview Medical Center, Seattle, WA;

gBiostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, MA;

hDivision of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA; and

iHubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA.

Correspondence to: Jessica S. Merlin, MD, PhD, Center for Research on Health Care, Division of General Internal Medicine, University of Pittsburgh, 3609 Forbes Avenue, 2nd Fl, Pittsburgh, PA 15213 (e-mail: merlinjs@upmc.edu).

J.H.S. received grant # R01DA037768 from the National Institute of Drug Abuse (NIDA) and P30AI042853 from the Center for AIDS Research; J.S.M. received grant #R01MH115754 from the National Institute of Mental Health; and C.D.R. received grant # P30AI050409 from the Center for AIDS Research. The remaining authors have no conflicts of interests to disclose.

Received February 19, 2019

Accepted May 15, 2019

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