Patients Seen in Radiation Oncology Who Use Cannabis Are More Likely to Also Have Active Prescriptions for Opiates or Benzodiazepines

Abstract

<h3>Purpose/Objective(s)</h3> With changes in state legal frameworks governing cannabis access, more people in the United States have begun using cannabis. Individuals with cancer endorse many reasons for cannabis use in the face of limited data. Some have suggested that cannabis may serve as an alternative to prescription medications such as opioids, benzodiazepines, and sleep aids for symptom management. We hypothesized that patients with cancer using cannabis would be less likely to have active prescriptions for these medication classes commonly used to manage pain, anxiety, and insomnia, respectively. <h3>Materials/Methods</h3> Clinician-collected cannabis history data documented via an electronic medical record-embedded form were abstracted using Michigan Radiation Oncology Analytics Resource (M-ROAR) for adult patients seen in an academic radiation oncology department from 10/2020 to 11/2021 under an IRB-approved protocol. Logistic regression was used to explore associations between recent cannabis use and prescriptions for narcotics, benzodiazepines, and sleep aids. <h3>Results</h3> Data were available for 3059 unique patients, including 343 (11.2%), 235 (7.7%), and 2481 (81.1%) endorsing recent (in the last month), non-recent only (use of cannabis in the past but not in the last month) and no history of cannabis use, respectively. Among those who recently used cannabis, 6.1% used cannabis more than 1 time per day, 54% used cannabis daily, and 21% used cannabis at least weekly but not every day. Most patients smoked cannabis (46%) or used edible forms of cannabis (35%). The most common reasons for cannabis use were pain (27%), insomnia (18%), and anxiety (15%), so we examined concurrent use of cannabis along with prescription opiates, sleep aids, and benzodiazepines. Patients who recently used cannabis were more likely to have an active prescription for an opioid medication (OR: 1.52; 95% CI: 1.21, 1.905; p <0.001) than patients who did not report recent cannabis use. There was no relationship between sleep aid medication prescription and recent cannabis use (OR: 0.62; 95% CI: 0.27, 1.43; p=0.261), but individuals using cannabis were more likely to have an active prescription for a benzodiazepine (OR: 1.40; 95% CI: 1.07, 1.82; p = 0.013). <h3>Conclusion</h3> The use of prescription opiates and prescription benzodiazepines is more prominent in patients who endorse cannabis use. Our data therefore do not support the hypothesis that cannabis use eliminates the need for medications to manage pain or anxiety. This suggests that for many patients, cannabis is used as an adjunct alongside conventional evidence-based therapies for symptom control and not as an alternative to such agents. Patient education is key to help individuals with symptoms locate evidence-based therapies and optimize them for safety and efficacy as we await high quality evidence that supports or refutes the efficacy of cannabis for management of many symptom classes in patients with cancer.