Characteristics of patients with chronic pain accessing treatment with medical cannabis in Washington State

Sunil K. Aggarwal, PhD, MD Candidate; Gregory T. Carter, MD, MS; Mark D. Sullivan, MD, PhD; Craig ZumBrunnen, PhD; Richard Morrill, PhD; Jonathan D. Mayer, PhD

doi:10.5055/jom.2009.0028

Authors

Sunil K. Aggarwal, PhD, MD Candidate
Gregory T. Carter, MD, MS
Mark D. Sullivan, MD, PhD
Craig ZumBrunnen, PhD
Richard Morrill, PhD
Jonathan D. Mayer, PhD

DOI:

https://doi.org/10.5055/jom.2009.0028

Keywords:

cannabis, marijuana, cannabinoids, chronic pain, opioids, opiates

Abstract

Objectives: This study was conducted to better understand the characteristics of chronic pain patients seeking treatment with medicinal cannabis (MC).
Design: Retrospective chart reviews of 139 patients (87 males, median age 47 years; 52 females, median age 48 years); all were legally qualified for MC use in Washington State.
Setting: Regional pain clinic staffed by university faculty.
Participants: Inclusion criteria: age 18 years and older; having legally accessed MC treatment, with valid documentation in their medical records. All data were de-identified.
Main Outcome Measures: Records were scored for multiple indicators, including time since initial MC authorization, qualifying condition(s), McGill Pain score, functional status, use of other analgesic modalities, including opioids, and patterns of use over time.
Results: Of 139 patients, 15 (11 percent) had prior authorizations for MC before seeking care in this clinic. The sample contained 236.4 patientyears of authorized MC use. Time of authorized use ranged from 11 days to 8.31 years (median of 1.12 years). Most patients were male (63 percent) yet female patients averaged 0.18 years longer authorized use. There were no other gender-specific trends or factors. Most patients (n = 123, 88 percent) had more than one pain syndrome present. Myofascial pain syndrome was the most common diagnosis (n = 114, 82 percent), followed by neuropathic pain (n = 89, 64 percent), discogenic back pain (n = 72, 51.7 percent), and osteoarthritis (n = 37, 26.6 percent). Other diagnoses included diabetic neuropathy, central pain syndrome, phantom pain, spinal cord injury, fibromyalgia, rheumatoid arthritis, HIV neuropathy, visceral pain, and malignant pain. In 51 (37 percent) patients, there were documented instances of major hurdles related to accessing MC, including prior physicians unwilling to authorize use, legal problems related to MC use, and difficulties in finding an affordable and consistent supply of MC.
Conclusions: Data indicate that males and females access MC at approximately the same rate, with similar median authorization times. Although the majority of patient records documented significant symptom alleviation with MC, major treatment access and delivery barriers remain.

Author Biographies

Sunil K. Aggarwal, PhD, MD Candidate

Medical Scientist Training Program, University of Washington, Seattle, Washington.

Gregory T. Carter, MD, MS

Professor, Department of Rehabilitation Medicine, School of Medicine, University of Washington, Seattle, Washington.

Mark D. Sullivan, MD, PhD

Professor, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington Seattle, Washington; Department of Bioethics and Humanities, School of Medicine, University of Washington Seattle, Washington.

Craig ZumBrunnen, PhD

Professor, Department of Geography, University of Washington, Seattle, Washington.

Richard Morrill, PhD

Professor Emeritus, Department of Geography, University of Washington, Seattle, Washington.

Jonathan D. Mayer, PhD

Professor, Department of Epidemiology, University of Washington, Seattle, Washington; Department of Geography, University of Washington, Seattle, Washington; Department of Global Health, University of Washington, Seattle, Washington; Department of Medicine, University of Washington, Seattle, Washington; Department of Family Medicine, University of Washington, Seattle, Washington; Department of Health Services, University of Washington, Seattle, Washington.

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