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Matched pilot study examining cannabis-based dronabinol for acute pain following traumatic injury
  1. Elisabeth Schneider-Smith1,
  2. Kristin Salottolo2,
  3. Claire Swartwood1,
  4. Casey Melvin1,
  5. Robert M Madayag3,
  6. David Bar-Or2
  1. 1Pharmacy Department, St. Anthony Hospital and Medical Campus, Lakewood, Colorado, USA
  2. 2Trauma Research Department, St. Anthony Hospital and Medical Campus, Lakewood, Colorado, USA
  3. 3Trauma Services Department, St. Anthony Hospital and Medical Campus, Lakewood, Colorado, USA
  1. Correspondence to Dr David Bar-Or; davidbme49{at}gmail.com

Abstract

Background To determine whether adjunctive dronabinol, a licensed form of delta-9-tetrahydrocannabinol, reduces opioid consumption when used off-label for managing acute pain following traumatic injury.

Methods This matched cohort study included patients who were admitted with a traumatic injury between 1 March 2017 and 30 October 2017. The hospital pharmacy database was used to identify patients who received dronabinol (cases), and they were matched 1:1 to patients who did not receive dronabinol (controls) using age, cause of injury and hospital length of stay. The primary outcome, change in opioid consumption, was calculated using morphine milligram equivalents (MME). The change in MME was calculated for cases as total MME over 48 hours with adjunctive dronabinol minus 48 hours prior to dronabinol, and for controls as total MME 48–96 hours from admission minus 0–48 hours from admission. Data are presented as mean and SE or median and IQR. Statistical analysis was performed using paired t-tests and McNemar’s tests.

Results There were 66 patients included: 33 cases and 33 matched controls. Dronabinol was initiated 55 (28–107) hours from admission. Cases and controls were well matched. Cases had a significant reduction in opioid consumption with adjunctive dronabinol (−79 (20) MME, p<0.001), while opioid consumption was unchanged for controls (−9 (20) MME, p=0.63). This resulted in a ninefold greater reduction in opioid consumption for cases versus controls that was statistically different between pairs (p=0.02). Nineteen (58%) cases reported using marijuana; in this subset, opioid consumption was reduced with adjunctive dronabinol (−97 (24) MME, p<0.001) versus a non-significant increase in opioid consumption in matched controls (11 (29) MME, p=0.70); difference between groups, p=0.01.

Conclusions The results of this study suggest adjunctive dronabinol reduces opioid consumption following traumatic injury. The opioid-sparing effect of dronabinol may be greater in patients who are marijuana users.

Level of evidence III.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Presented at This paper was presented at the 2018 American Society of Health-System Pharmacists meeting (Anaheim, California, USA) and the 2018 American College of Clinical Pharmacy Global Conference (Seattle, Washington, USA).

  • Contributors All authors made substantial contributions to the manuscript as follows: ES-S is responsible for literature search, data acquisition and drafting the manuscript. KS is responsible for data analysis, interpretation of data and drafting the manuscript. CS is responsible for study conception, interpretation of the data and critical revisions. CM is responsible for literature search, data acquisition and manuscript revisions. RMM is responsible for interpretation of the data and critical revisions. DB is responsible for interpretation of the data and critical revisions. All authors provided final approval of the submitted manuscript.

  • Funding The study was investigator initiated. Internal funding was provided by St. Anthony Hospital.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Institutional Review Board of St. Anthony Hospital (Catholic Health Initiatives) with a waiver of informed consent.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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