New research sheds light on potentially negative effects of cannabis
March 30, 2020
Science Daily/Washington State University
Coughing fits, anxiety and paranoia are three of the most common adverse reactions to cannabis, according to a recent study by Washington State University researchers.
The researchers surveyed more than 1,500 college students on the type and frequency of adverse reactions they had experienced while using cannabis for their study in the Journal of Cannabis Research. They also collected information on the students' demographics, personality traits, cannabis use patterns and motives for using the drug.
"There's been surprisingly little research on the prevalence or frequency of various adverse reactions to cannabis and almost no research trying to predict who is more likely to experience these types of adverse reactions," said Carrie Cuttler, assistant professor of psychology and an author on the paper. "With the legalization of cannabis in Washington and 10 other states, we thought it would be important to document some of this information so that more novice users would have a better sense of what types of adverse reactions they may experience if they use cannabis."
More than 50% of the study participants reported having experienced coughing fits, anxiety and/or paranoia while using cannabis. On the other end of the spectrum, the three least-common reported reactions were fainting/passing out, non-auditory/visual hallucinations and cold sweats.
The researchers found the most frequently occurring adverse reactions were coughing fits, chest/lung discomfort and body humming, which a subset of the study group reported occurring approximately 30-40% of the time they were using cannabis.
Panic attacks, fainting and vomiting were considered the most distressing of the 26 possible adverse reactions.
"It is worth noting even the most distressing reactions to cannabis were only rated between moderately' and quite distressing," Cuttler said. "This suggests cannabis users do not, in general, find acute adverse reactions to cannabis to be severely distressing."
The least distressing reactions were reported to be body humming, numbness and feeling off balance/unsteady, the researchers found.
The study showed less frequent users are more likely to report negative effects. Additionally, individuals who reported using cannabis to try to fit in with friends, displayed cannabis use disorder symptoms or had anxiety sensitivity -- a tendency to imagine the worse possible outcome -- were more likely to report adverse reactions as well as experiencing a greater amount of distress.
"Interestingly, we didn't find that quantity of use during a single session predicted very much in terms of whether or not a person was going to have a bad reaction," Cuttler said. "It was the people who smoke on a less frequent basis who tend to have these bad experiences more often."
Moving forward, Cuttler hopes the results of the study will be put to use by doctors, medical cannabis distributors and even bud tenders to give people a better idea of what could go wrong when they get high.
"When you get any other kind of medication, there will be a leaflet or a warning printed on the bottle about the drug's potential side effects," Cuttler said. "There really isn't very much out there on this for cannabis, and we think that it is important for people to have access to this kind of information."
https://www.sciencedaily.com/releases/2020/03/200330130543.htm
Legal marijuana products too strong for pain relief
March 26, 2020
Science Daily/Wake Forest Baptist Medical Center
More than 90% of the legal marijuana products offered in medical dispensaries are much stronger than what clinical studies have shown that doctors recommend for chronic pain relief, according to a study published in the March 26 online edition of the journal PLOS ONE.
To many that may seem like a good thing, but just the opposite is true.
"We know that high-potency products should not have a place in the medical realm because of the high risk of developing cannabis-use disorders, which are related to exposure to high THC-content products," said the study's lead author, Alfonso Edgar Romero-Sandoval, M.D., Ph.D., associate professor of anesthesiology at Wake Forest School of Medicine, part of Wake Forest Baptist Health.
"Several earlier studies showed that levels of up to 5% tetrahydrocannabinol (THC) -- the main psychoactive compound in marijuana that provides pain relief as well as intoxication -- were sufficient to reduce chronic pain with minimal side effects."
The goal of this study was to evaluate the advertised THC and CBD content of legal cannabis products to determine their suitability for medicinal use, and to compare the potency of the products offered in medical and recreational programs.
The researchers recorded the concentrations of THC and cannabidiol (CBD) -- the non-euphoric compound in marijuana -- in all plant cannabis products provided by legal dispensary websites and compared them between or within the states in the study: California, Colorado, Maine, Massachusetts, New Hampshire, New Mexico, Rhode Island, Vermont and Washington. A total of 8,505 cannabis products across 653 dispensaries were sampled.
Romero-Sandoval's team found that most of the products offered in the medical dispensaries in the study had more than 10% THC and that many had 15% or more, the same as what is available in products at recreational dispensaries.
This is problematic because between 60% and 80% of people who use medical marijuana use it for pain relief, Romero-Sandoval said. The higher the concentration of THC the greater risk, not only for developing dependency, but also for developing tolerance more quickly, which means higher and higher concentrations might be needed to get the same level of pain relief.
"It can become a vicious cycle," Romero-Sandoval said.
"Better regulation of the potency of medical marijuana products is critical. The FDA regulates the level of over-the-counter pain medications such as ibuprofen that have dose-specific side effects, so why don't we have policies and regulations for cannabis, something that is far more dangerous?"
This study provides the scientific evidence to help policy makers correct mistakes and to create a better framework to protect patients, he said.
https://www.sciencedaily.com/releases/2020/03/200326144354.htm
Cannabis helps fight resistant bacteria
March 24, 2020
Science Daily/University of Southern Denmark
Bacteria are increasingly becoming resistant to antibiotics. By combining antibiotics with the cannabis compound, cannabidiol, researchers have found a way to enhance the antibiotic effect
Since the discovery of penicillin in 1928 by Sir Alexander Fleming, antibiotics have saved millions of lives from fatal infections world-wide. However, with time bacteria have developed mechanisms to escape the effects of antibiotics -- they have become resistant.
With fewer antibiotics available to treat resistant bacterial infections, the possibility of entering a pre-antibiotic era is looming ahead.
Alternative strategies are being explored and helper compounds are attracting attention. Helper compounds are non-antibiotic compounds with the capability of enhancing the efficacy of antibiotics.
How to boost antibiotics
One such helper compound has been suspected to be cannabidiol (CBD); a cannabinoid from the cannabis plant. Now a research team from University of Southern Denmark, has published a scientific study proving the effect of CBD.
Janne Kudsk Klitgaard is Principal Investigator and corresponding author. First author is PhD student Claes Søndergaard Wassmann. The study is published in the journal Scientific Reports.
When we combined CBD and antibiotics, we saw a more powerful effect than when treating with antibiotics alone. So, in order to kill a certain number of bacteria, we needed less antibiotics, they say.
Bacteria clones spread globally
In the study, CBD was used to enhance the effect of the antibiotic bacitracin against Staphylococcus aureus bacteria; a major human pathogen that frequently causes community- and hospital-acquired disease.
Multidrug-resistant clones of this pathogen have spread globally. In some countries, treatment of bacterial infections with these resistant bacteria are difficult and the problem is projected to be an ever-larger problem in the future.
According to the researchers, the combination of CBD and antibiotics may be a novel treatment of infections with antibiotic resistant bacteria.
How do the bacteria die?
Three things happened with the Staphylococcus aureus bacteria, when the researchers treated them with the combination in their study:
The bacteria could no longer divide normally.
The expression of certain key genes (cell division and autolysis genes) in the bacteria was lowered.
The bacterial membrane became unstable.
Anti-resistance must be stopped
According to the researchers, overuse of antibiotics is the main cause of antibiotic resistance.
If we combine an antibiotic with a helper compound, that enhances the effect of the antibiotic, we need less antibiotic to achieve the same effect. This may contribute to the development of fewer resistant bacteria, says Janne Kudsk Klitgaard.
https://www.sciencedaily.com/releases/2020/03/200324131833.htm
Antianxiety and antidepressant effects from a single dose of psychedelic drug persist years later in cancer patients
January 28, 2020
Science Daily/New York University
Following up on their landmark 2016 study, researchers at NYU Grossman School of Medicine found that a one-time, single-dose treatment of psilocybin, a compound found in psychedelic mushrooms, combined with psychotherapy appears to be associated with significant improvements in emotional and existential distress in cancer patients. These effects persisted nearly five years after the drug was administered.
In the original study, published in the Journal of Psychopharmacology, psilocybin produced immediate, substantial, and sustained improvements in anxiety and depression and led to decreases in cancer-related demoralization and hopelessness, improved spiritual well-being, and increased quality of life. At the final 6.5-month follow-up assessment, psilocybin was associated with enduring antianxiety and antidepressant effects. Approximately 60 percent to 80 percent of participants continued with clinically significant reductions in depression or anxiety, sustained benefits in existential distress and quality of life, as well as improved attitudes toward death.
The present study, publishing online Jan. 28 in the same journal, is a long-term follow-up (with assessments at about 3 years and 4.5 years following single-dose psilocybin administration) of a subset of participants from the original trial. The study reports on sustained reductions in anxiety, depression, hopelessness, demoralization, and death anxiety at both follow-up points.
Approximately 60 percent to 80 percent of participants met criteria for clinically significant antidepressant or anxiolytic responses at the 4.5 year follow-up. Participants overwhelmingly (71 to 100 percent) attributed positive life changes to the psilocybin-assisted therapy experience and rated it among the most personally meaningful and spiritually significant experiences of their lives.
"Adding to evidence dating back as early as the 1950s, our findings strongly suggest that psilocybin therapy is a promising means of improving the emotional, psychological, and spiritual well-being of patients with life-threatening cancer," says the 2016 parent study's lead investigator, Stephen Ross, MD, an associate professor of psychiatry in the Department of Psychiatry at NYU Langone Health. "This approach has the potential to produce a paradigm shift in the psychological and existential care of patients with cancer, especially those with terminal illness."
An alternative means of treating cancer-related anxiety and depression is urgently needed, says Ross. According to statistics from several sources, close to 40 percent of the global population will be diagnosed with cancer in their lifetime, with a third of those individuals developing anxiety, depression, and other forms of distress as a result. These conditions, experts say, are associated with poorer quality of life, increased rates of suicide, and lowered survival rate. Unfortunately, conventional pharmacologic treatment methods like antidepressants work for less than half of cancer patients and tend to not work any better than placebos. In addition, they have no effect whatsoever on existential distress and death anxiety, which commonly accompany a cancer diagnosis and are linked to a hastened desire for death and increased suicidality, says Ross.
The researchers say psilocybin may provide a useful tool for enhancing the effectiveness of psychotherapy and ultimately relieving these symptoms. Although the precise mechanisms are not fully understood, experts believe that the drug can make the brain more flexible and receptive to new ideas and thought patterns. In addition, previous research indicates that the drug targets a network of the brain, the default mode network, which becomes activated when we engage in self-reflection and mind wandering, and which helps to create our sense of self and sense of coherent narrative identity. In patients with anxiety and depression, this network becomes hyperactive and is associated with rumination, worry, and rigid thinking. Psilocybin appears to acutely shift activity in this network and helps people to take a more broadened perspective on their behaviors and lives.
How the Original Research and Follow-up Were Conducted
For the original study, the NYU Langone team provided 29 cancer patients with nine psychotherapy sessions, as well a single dose of either psilocybin or an active placebo, niacin, which can produce a physical flush sensation that mimics a psychedelic drug experience. After seven weeks, all participants swapped treatments and were monitored with clinical outcome measures for anxiety, depression, and existential distress, among other factors.
Although researchers found that the treatment's antianxiety and antidepressant qualities persisted 6.5 months after the intervention, little was known of the drug's effectiveness in the long term. The new follow-up study is the longest-spanning exploration of psilocybin's effects on cancer-related psychiatric distress to date, the study authors say.
"These results may shed light on how the positive effects of a single dose of psilocybin persist for so long," says Gabby Agin-Liebes, PhD candidate, lead investigator and lead author of the long-term follow-up study, and co-author of the 2016 parent study. "The drug seems to facilitate a deep, meaningful experience that stays with a person and can fundamentally change his or her mindset and outlook," she says.
Agin-Liebes, who is pursuing her PhD in clinical psychology at Palo Alto University in California, cautions that psilocybin does not inherently lead to positive therapeutic effects when used in isolation, and in uncontrolled, recreational settings, and "should be taken in a controlled and psychologically safe setting, preferably in conjunction with counseling from trained mental health practitioners or facilitators," she adds.
Next, the researchers plan to expand this research with larger trials in patients from diverse socioeconomic and ethnic groups who have advanced cancer-related psychiatric and existential distress.
"This could profoundly transform the psycho-oncologic care of patients with cancer, and importantly could be used in hospice settings to help terminally ill cancer patients approach death with improved emotional and spiritual well-being," says Ross.
https://www.sciencedaily.com/releases/2020/01/200128115423.htm
Real risks associated with cannabis exposure during pregnancy
January 17, 2020
Science Daily/University of Western Ontario
A new study from researchers at Western University and Queen's University definitively shows that regular exposure to THC, the main psychoactive ingredient in cannabis, during pregnancy has significant impact on placental and fetal development. With more than a year since the legalization of recreational cannabis in Canada, the effects of its use during pregnancy are only now beginning to be understood.
The study, published today in Scientific Reports, uses a rat model and human placental cells to show that maternal exposure to THC during pregnancy has a measurable impact on both the development of the organs of the fetus and the gene expression that is essential to placental function.
The researchers demonstrated in a rat model that regular exposure to a low-dose of THC that mimics daily use of cannabis during pregnancy led to a reduction in birth weight of 8 per cent and decreased brain and liver growth by more than 20 per cent.
"This data supports clinical studies that suggest cannabis use during pregnancy it is associated with low birth weight babies. Clinical data is complicated because it is confounded by other factors such as socioeconomic status," said Dan Hardy, PhD, Associate Professor at Western's Schulich School of Medicine & Dentistry and co-author on the paper. "This is the first study to definitively support the fact that THC alone has a direct impact on placental and fetal growth."
The research team was also able to characterize how THC prevents oxygen and nutrients from crossing the placenta into the developing fetus. By studying human placental cells, the researchers found that exposure to THC caused a decrease in a glucose transporter called GLUT-1. This indicates that the THC is preventing the placental transfer of glucose, a key nutrient, from the mother to the fetus. They also found a reduction in placental vasculature in the rat model suggesting reduced blood flow from the mother to the fetus.
The researchers say both of those factors are likely contributing to the growth restriction that they observed in the offspring.
The researchers point out that there are currently no clear guidelines from Health Canada on the use of cannabis in pregnancy and some studies have shown that up to one in five women are using cannabis during pregnancy to prevent morning sickness, for anxiety or for social reasons.
"Marjiuana has been legalized in Canada and in many states in the US, however, its use during pregnancy has not been well studied up until this point. This study is important to support clinicians in communicating the very real risks associated with cannabis use during pregnancy," said David Natale, PhD, Associate Professor at Queen's and co-author on the paper.
https://www.sciencedaily.com/releases/2020/01/200117104756.htm
Focus on opioids and cannabis in chronic pain media coverage
January 17, 2020
Science Daily/University of Otago
New Zealand media reports on chronic pain are focusing on treatments involving opioids and cannabis at the expense of best practice non-drug treatments, researchers have found.
Chronic pain, defined as persistent or recurring pain present for more than three months, is the leading cause of disability worldwide and affects one in five New Zealanders.
The researchers analysed 240 news articles on chronic pain published in the New Zealand news media between January 2015 and June 2019. Their report is published in the latest issue of the New Zealand Medical Journal.
Lead author Dr Hemakumar Devan, a Postdoctoral fellow at the Centre for Health, Activity and Rehabilitation Research at the University of Otago, Wellington's School of Physiotherapy, says few of the news stories included information about non-pharmaceutical treatments for chronic pain, despite these being the preferred option for most chronic pain conditions.
"Pharmacological strategies are only recommended for some chronic pain conditions, such as cancer pain and neuropathic pain. For other pain conditions, drug treatments are recommended to be used with care and caution because of potential side effects and limited long-term effectiveness."
He says media coverage of pharmaceutical treatments for chronic pain focused almost entirely on opioid-based painkillers and cannabis. Stories on opioids mentioned their ineffectiveness in treating chronic pain and their potential for dependence and addiction, while reports about medicinal cannabis portrayed it as an effective and safe treatment with minimal side effects. This was despite the lack of scientific evidence to support its long-term use for chronic pain.
"The personal experience stories about cannabis focused on its positive effects and fewer side effects compared to opioid-based analgesics. There is, however, limited evidence to suggest cannabis as a substitute for opioids and a lack of high-quality evidence to support the use of cannabis for chronic pain.
"There was no reporting on the potential adverse effects of medicinal cannabis use, such as cognitive deficits, dependency and mood changes, which could particularly affect young people."
The researchers also found media coverage was dominated by the struggle associated with living in chronic pain, with little attention given to the resources available to support people to manage pain successfully and live a meaningful life.
"Non-drug based self-management strategies, which include exercise, relaxation and cognitive behavioural treatments, are a key component of managing chronic pain and are proven to be effective in the long term."
Dr Devan says the difficulties faced by patients in accessing pain services because of the lack of trained multidisciplinary health professionals, and inequities in terms of access for Māori and Pasifika, were accurately reflected by the media coverage.
The researchers found the level of media interest in chronic pain had increased in recent years.
"We expect this will continue to rise, with chronic pain becoming increasingly relevant in the lead up to New Zealand's 2020 cannabis referendum; and as the number of people living with chronic pain increases as the population ages."
https://www.sciencedaily.com/releases/2020/01/200117094323.htm
Impaired driving -- even once the high wears off
January 14, 2020
Science Daily/McLean Hospital
A study by McLean Hospital's Mary Kathryn Dahlgren, PhD, Staci Gruber, PhD, and their team from McLean's Cognitive and Clinical Neuroimaging Core and the Marijuana Investigations for Neuroscientific Discovery (MIND) program, has found that recreational cannabis use affects driving ability even when users are not intoxicated by marijuana.
Published in the Drug and Alcohol Dependence journal, the study "Recreational Cannabis Use Impairs Driving Performance in the Absence of Acute Intoxication," finds that in addition to chronic, heavy, recreational cannabis use being associated with poorer driving performance in non-intoxicated individuals compared to non-users, the researchers linked earlier onset of marijuana use (under age 16) to worse performance.
Recreational cannabis use has expanded across the United States in the last several decades and so has public concern about the substance's impact on activities that present safety issues.
While several studies have examined the direct effect of cannabis intoxication on driving, no other studies until now have examined the effects on driving in heavy marijuana users who are not high.
Senior author Gruber, along with Dahlgren, used a customized driving simulator to assess the potential impact of cannabis use on driving performance. At the time of study, marijuana users had not used for at least 12 hours and were not intoxicated.
Overall, heavy marijuana users demonstrated poorer driving performance as compared to non-users. For example, in the simulated driving exercise, marijuana users hit more pedestrians, exceeded the speed limit more often, made fewer stops at red lights, and made more center line crossings.
Gruber, who is among the world's foremost experts in the cognitive effects of marijuana, said the idea that differences can be detected in sober cannabis users may be surprising to the public.
"People who use cannabis don't necessarily assume that they may drive differently, even when they're not high," she said. "We're not suggesting that everyone who uses cannabis will demonstrate impaired driving, but it's interesting that in a sample of non-intoxicated participants, there are still differences in those who use cannabis relative to those who don't."
When researchers divided the marijuana users into groups based on when they started using cannabis, they found that significant driving impairment was detected and completely localized to those who began using marijuana regularly before age 16.
"It didn't surprise us that performance differences on the driving simulator were primarily seen in the early onset group," Dahlgren said. "Research has consistently shown that early substance use, including the use of cannabis, is associated with poorer cognitive performance."
She added, "What was interesting was when we examined impulsivity in our analyses, most of the differences we saw between cannabis users and healthy controls went away, suggesting that impulsivity may play a role in performance differences."
States where marijuana has been legalized have seen growing public concern that more individuals will drive while intoxicated. But since performance issues can occur even in people who aren't high, Gruber said the public needs to rethink the ways it understands impairment.
"There's been a lot of interest in how we can more readily and accurately identify cannabis intoxication at the roadside, but the truth of the matter is that it is critical to assess impairment, regardless of the source or cause," she said. "It's important to be mindful that whether someone is acutely intoxicated, or a heavy recreational cannabis user who's not intoxicated, there may be an impact on driving, but certainly not everyone demonstrates impairment simply as a function of exposure to cannabis. This is especially important to keep in mind given increasing numbers of medical cannabis patients who differ from recreational users with regard to product choice and goal of use."
https://www.sciencedaily.com/releases/2020/01/200114123521.htm
Study reveals increased cannabis use in individuals with depression
December 9, 2019
Science Daily/Wiley
New findings reveal the prevalence of cannabis, or marijuana, use in the United States increased from 2005 to 2017 among persons with and without depression and was approximately twice as common among those with depression in 2017.
The prevalence of cannabis, or marijuana, use in the United States increased from 2005 to 2017 among persons with and without depression and was approximately twice as common among those with depression in 2017. The findings, which are published in Addiction, come from a survey-based study of 728,691 persons aged 12 years or older.
"Perception of great risk associated with regular cannabis use was significantly lower among those with depression in 2017, compared with those without depression, and from 2005 to 2017 the perception of risk declined more rapidly among those with depression. At the same time, the rate of increase in cannabis use has increased more rapidly among those with depression," said corresponding author Renee Goodwin, PhD, MPH, of Columbia University and The City University of New York.
The prevalence of past 30-day cannabis use among those with depression who perceived no risk associated with regular cannabis use was much higher than that among those who perceived significant risk associated with use (38.6% versus 1.6%, respectively).
Certain groups appeared more vulnerable to use. For instance, nearly one third of young adults (29.7%) aged 18-25 with depression reported past 30-day use.
In 2017, the prevalence of past month cannabis use was 18.9% among those with depression and 8.7% among those without depression. Daily cannabis use was common among 6.7% of those with depression and among 2.9% of those without.
https://www.sciencedaily.com/releases/2019/12/191209131956.htm
Cannabis reduces headache and migraine pain by nearly half
November 25, 2019
Science Daily/Washington State University
Inhaled cannabis reduces self-reported headache severity by 47.3% and migraine severity by 49.6%, according to a recent study led by Carrie Cuttler, a Washington State University assistant professor of psychology.
The study, published online recently in the Journal of Pain, is the first to use big data from headache and migraine patients using cannabis in real time. Previous studies have asked patients to recall the effect of cannabis use in the past. There has been one clinical trial indicating that cannabis was better than ibuprofen in alleviating headache, but it used nabilone, a synthetic cannabinoid drug.
"We were motivated to do this study because a substantial number of people say they use cannabis for headache and migraine, but surprisingly few studies had addressed the topic," said Cuttler, the lead author on the paper.
In the WSU study, researchers analyzed archival data from the Strainprint app, which allows patients to track symptoms before and after using medical cannabis purchased from Canadian producers and distributors. The information was submitted by more than 1,300 patients who used the app over 12,200 times to track changes in headache from before to after cannabis use, and another 653 who used the app more than 7,400 times to track changes in migraine severity.
"We wanted to approach this in an ecologically valid way, which is to look at actual patients using whole plant cannabis to medicate in their own homes and environments," Cuttler said. "These are also very big data, so we can more appropriately and accurately generalize to the greater population of patients using cannabis to manage these conditions."
Cuttler and her colleagues saw no evidence that cannabis caused "overuse headache," a pitfall of more conventional treatments which can make patients' headaches worse over time. However, they did see patients using larger doses of cannabis over time, indicting they may be developing tolerance to the drug.
The study found a small gender difference with significantly more sessions involving headache reduction reported by men (90.0%) than by women (89.1%). The researchers also noted that cannabis concentrates, such as cannabis oil, produced a larger reduction in headache severity ratings than cannabis flower.
There was, however, no significant difference in pain reduction among cannabis strains that were higher or lower in levels of tetrahydrocannabinol (THC) and cannabidiol (CBD), two of the most commonly studied chemical constituents in cannabis, also known as cannabinoids. Since cannabis is made up of over 100 cannabinoids, this finding suggests that different cannabinoids or other constituents like terpenes may play the central role in headache and migraine relief.
More research is needed, and Cuttler acknowledges the limitations of the Strainprint study since it relies on a self-selected group of people who may already anticipate that cannabis will work to alleviate their symptoms, and it was not possible to employ a placebo control group.
"I suspect there are some slight overestimates of effectiveness," said Cuttler. "My hope is that this research will motivate researchers to take on the difficult work of conducting placebo-controlled trials. In the meantime, this at least gives medical cannabis patients and their doctors a little more information about what they might expect from using cannabis to manage these conditions."
https://www.sciencedaily.com/releases/2019/11/191125100353.htm
Chronic opioid therapy can disrupt sleep, increase risk of sleep disorders
Medical providers must be aware of adverse effects of opioid treatment
November 19, 2019
Science Daily/American Academy of Sleep Medicine
Patients and medical providers should be aware that chronic opioid use can interfere with sleep by reducing sleep efficiency and increasing the risk of sleep-disordered breathing, according to a position statement from the American Academy of Sleep Medicine.
Opioid use has boomed in the last decade, with nearly 92 million Americans using prescription opioids and 11.5 million people misusing them. In addition to understanding the risks of opioid addiction and abuse, it is important for health care providers to be aware that chronic opioid use is associated with changes in sleep architecture and an increased risk of respiratory depression during sleep.
"This statement increases awareness among health care providers of the important adverse events that can occur in patients on chronic opioid therapy," said co-author Dr. R. Nisha Aurora, Associate Professor of Medicine at Rutgers Robert Wood Johnson Medical School in New Jersey. "The paper also highlights the need for providers to recognize and diagnose sleep-related breathing disorders that are frequently seen with chronic opioid use."
The position statement was developed by the AASM board of directors and is published in the Nov. 15 issue of the Journal of Clinical Sleep Medicine.
Patients who have chronic pain often experience fatigue and disturbed sleep. Studies have shown that chronic opioid therapy has the potential to further disrupt sleep by reducing sleep efficiency, slow wave sleep, and rapid eye movement sleep. Another adverse effect of opioid use is respiratory depression, which can increase the risk of sleep-related breathing disorders such as sleep-related hypoventilation, central sleep apnea and obstructive sleep apnea.
If left untreated, sleep-related breathing disorders can be harmful to a patient's health. However, they can be diagnosed by a medical provider following an overnight sleep study in a sleep center. Effective treatments also are available, including several modalities of positive airway pressure therapy. Medical providers who care for patients on chronic opioid therapy need to be aware of the signs of disrupted sleep, such as snoring and excessive daytime sleepiness, in order to provide their patients with high quality care.
"Because of the complex relationship between pain, sleep, daytime functioning, and opioid therapy, a strong collaboration between pain specialists, sleep physicians, and primary care providers is needed to optimize patient benefit and minimize complications when opioids are part of chronic therapy," said Dr. Aurora.
While opioid therapy can contribute to sleep disruption and sleep disorders, it can be an effective treatment for patients with restless legs syndrome (RLS), a sleep disorder associated with disturbed sleep. Some patients with severe, refractory RLS, who are unresponsive or intolerant to other therapies, may find relief by using opioid medications at much lower doses than those used to treat chronic pain.
Dr. Aurora is currently collaborating with the Brain Health Institute at Rutgers to study sleep in those seeking therapy for opioid addiction.
https://www.sciencedaily.com/releases/2019/11/191119143240.htm