Emergency Medicine Physicians Would Prefer Using Cannabis Over Opioids for First-Line Treatment of a Medical Condition if Provided With Medical Evidence: A National Survey.

Kevin M Takakuwa,Raquel M Schears

doi:10.7759/cureus.19641

Abstract

Objective: To determine emergency medicine (EM) physicians’ preferences for using medical cannabis versus opioids if medical cannabis was legalized.Methods: We surveyed US physicians at the largest national EM conference (American College of Emergency Physicians’ Annual Conference) held in San Diego, CA from October 1 to 4, 2018. Of the thousands of conference participants approached, 539 US physicians completed the anonymous written survey, which represented 15.2% of the US physicians attending the conference.Results: The mean age of the participants was 39.6 ± 10.9 years, men composed 57.5% of the participants, and whites made up 72.8% of the respondents. Participants practicing in medically legal (54.8%) and medically plus adult-use legal cannabis states (23.1%) totaled 77.9%. A majority (70.7%) of the participants believed that cannabis has medical value. EM physicians preferred cannabis over opioids as a first-line treatment addressing a medical condition provided that medical studies found that cannabis was equally effective (p < 0.001, X2 = 36.8 [95% CI 2, 415]), and overwhelmingly preferred cannabis over opioids if it were more effective (p < 0.001, X2 = 90.8 [95% CI 2, 415]). Physicians appeared to prefer opioids over cannabis if medical studies found that cannabis was less effective though it was not significant (p > 0.05). Subgroup analyses showed that belief in the medical value of cannabis significantly increased the odds ratio of choosing cannabis over opioids if cannabis was equally or more effective than opioids.Conclusion: Our study shows that EM physicians believe cannabis has medical value and would prefer using cannabis over opioids if provided with equivalent findings. We believe our findings reflect EM physicians’ experience of the opioid epidemic and suggest the need for further study of this potential therapeutic.

Highlights

Opioid-related deaths claimed 446,032 lives in the US between 1999 and 2018 [1] and emergency medicine (EM) physicians are on the frontlines of care from resuscitating overdoses to managing acute pain while counterbalancing opioid-seeking behavior
Because EM physicians are acutely aware that administering opioids in the emergency department and writing outpatient opioid prescriptions--frequently requested by patients--may contribute to opioid misuse and dependence, many contemplate alternative treatments
Subgroup analyses showed that belief in the medical value of cannabis significantly increased the odds ratio of choosing cannabis over opioids if cannabis was found or more effective than opioids but did not reveal any other significant findings for the remaining eight demographic variables collected except that whites preferred opioids over cannabis if cannabis was shown to be less effective (Table 2)

Summary

Introduction

Opioid-related deaths claimed 446,032 lives in the US between 1999 and 2018 [1] and emergency medicine (EM) physicians are on the frontlines of care from resuscitating overdoses to managing acute pain while counterbalancing opioid-seeking behavior. Because EM physicians are acutely aware that administering opioids in the emergency department and writing outpatient opioid prescriptions--frequently requested by patients--may contribute to opioid misuse and dependence, many contemplate alternative treatments. One such alternative is medical cannabis, which has been proposed as an alternative or adjunct to opioids for pain diminution [2,3], chronic pain [4,5,6,7,8,9]. Since medical cannabis is currently federally illegal and there has never been a study to determine if EM physicians would even consider its use in an acute setting, our objective was to assess EM physicians’ preferences for using medical cannabis compared to opioids in an EM setting were it to become legalized

Methods

Results

Discussion

Conclusion