Perception of Marijuana Use, Risk/Benefits in Sickle Cell Disease

Background: Pain in Sickle Cell Disease (SCD) is responsible for frequent hospitalizations and significant morbidity and mortality. Patients SCD need effective, long-term pain management in the outpatient setting to reduce hospital length of stays, readmissions and ultimately decrease the healthcare system economic burden. Treatment of chronic SCD pain has primarily relied on opiates. Safer and more effective alternative treatments are needed. Anxiety, depression and sleep disturbances are well known moderators of pain. Few studies have evaluated the use of marijuana in SCD. One showed that SCD patients had used cannabis in the previous 12 months to relieve symptoms associated with SCD. Currently, only four USA states, included SCD as a qualifying condition for the use of medical marijuana. A large number of our SCD patients report using recreational and medical marijuana to treat SCD related symptoms. This study seeks to learn how adults with SCD use and/or are interested in using different forms of marijuana to help manage SCD-related pain and behavioral complications affecting them such as depression, anxiety, mood changes, etc. The results will be used to educate providers and patients about their preference for non-medication options to manage SCD-related complications and further studies on marijuana use risks / benefits for SCD.

Methods: Adults (18 years old ) with diagnosis of SCD were asked to complete an IRB approved anonymous and confidential online Qualtrics-based survey. The survey consisted of 35 questions including demographics data age, gender, and socioeconomic status, pain characteristics and its management as well as reasons, frequency and type of the two different marijuana types, i.e. Non prescribed Marijuana (NPM), defined as any marijuana compound obtained and used without medical certification or prescription. Prescribe Medical Marijuana(MM) defined as any marijuana compound obtained after certification by a provider and used based on recommended specific doses and frequency. Descriptive statistics were used to report the data.

Results: Of the 55 participants that initiated the survey, 44 were completed and that data was included in this analysis. One third, 16 of the 44 patients were between the ages of 26-35 years old (yrs.) and 56% were between the ages of 18 and 35 yrs. Twenty seven (61% ) of the responders were females. As, shown on the table, thirty-two (72%) participants reported regularly experiencing more than one combination of mood swing (31), fatigue(31), restless sleep (27), depression (24) or anxiety (23). Five (11%) did not reported any symptoms.

The average pain score was 5 and did not differ between those using Marijuana independently of the type or not. Most of the participants reported having chronic pain and most of those used a form of Marijuana regularly. Two third of the participants reported using opioids pain treatment on a daily basis, with most of them also using either NPM, MM or both at the same time.

Contrary than excepted, those using NPM preferred ingestible methods over inhalation or topicals, while those using MM preferred inhaled methods, specially blunt and vaporizers over ingestible or topics methods. Most of the participants that have not used any form of Marijuana in the past two years, have considered using them. The most common reason for considering using marijuana was to relieve pain.

Conclusion: This data shows a high use of both NPM and MM in adults with SCD, for management of pain and pain modifiers such as depression, anxiety, sleep and mood disorders. The predominance of NPM over the MM on a state with MM is approved for management of Sickle Cell Disease presentations, may be related to some barriers of obtaining medical marijuana, including certification process, cost, lack of insurance coverage and overall availability. Further studies are needed to evaluate role of medical marijuana as a non-medication intervention in SCD, appropriate dosing, methods of use, and combined effect with other medications prescribed for Sickle Cell Disease patients.

Decastro:Bayer: Research Funding; Global Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Ironwood Pharmaceuticals: Research Funding; Novartis: Membership on an entity's Board of Directors or advisory committees, Research Funding.