Medical marijuana may reduce hospitalizations for patients with sickle cell disease
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Receiving medical marijuana appeared associated with reduced hospital admission rates among patients with sickle cell disease, according to results of a retrospective study published in Blood Advances.
“When we offered medical marijuana as an option to our patients with sickle cell disease, we found the majority of people who were interested were already using illicit marijuana to treat pain,” Susanna Curtis, MD, hematologist at Yale School of Medicine and Yale Cancer Center, said in a press release. “Illicit marijuana is not regulated, so its quality and contents are not standardized.”
Curtis noted that many people with sickle cell disease identify as Black, and although “Black and white people use marijuana at similar rates, Black people are four times more likely to be arrested for possession.”
“We didn’t want our patients using unsafe products or being arrested for trying to control the pain of their condition,” she said.
Pain is the primary reason for hospital admission among patients with sickle cell disease, and improved treatments are needed for the acute and chronic pain these patients experience. Cannabis-based products — which more than one-third of adults with sickle cell disease report using, according to study background — have been explored as nonopioid alternatives to treat pain. Although medical marijuana is legal in several states, only five list sickle cell disease as a qualifying condition, and few data exist to help clinicians determine which patients should be certified for its use.
Curtis and colleagues evaluated data of 50 adults with sickle cell disease who obtained certification for medical marijuana. Among the 29 patients who received medical marijuana (mean age, 30.9 years; 59% men), researchers compared outcomes from 6 months before the date medical marijuana products were first dispensed to 6 months after that date. Among the 21 certified patients who did not obtain medical marijuana (mean age, 34.4 years; 38% men), researchers compared outcomes from 6 months before the date of certification to 6 months after the date of certification.
A change in health care utilization — including opioid dispensation — served as the study’s primary endpoint.
Health care utilization data included the number of impatient hospitalizations, the number of ED visits not resulting in admission, and the number of infusion center visits for pain crisis at Yale Cancer Center.
Results showed obtaining medical marijuana led to a reduction in hospital admissions. Most changes involved one admission, but among those who received medical marijuana, two patients reduced admissions by two, two reduced them by three, one had four fewer admissions and one had five fewer admissions. Only one certified patient who did not receive medical marijuana reduced admissions by two.
Patients who obtained medical marijuana also appeared more likely to use edible vs. inhaled products.
Researchers observed no differences in ED or infusion center visits, total health care utilization or opioids dispensed between the two groups. Median change in opioids dispensed was 0 mg for both groups.
The investigators also compared all those who received medical marijuana certification with 25 random patients who did not request certification. They found those who received certification had higher rates of baseline opioid use and illicit cannabis use than those who did not seek certification.
Researchers surveyed patients to analyze their motivation for requesting medical marijuana certification and to determine how the patients felt about medical marijuana compared with illicit marijuana. Those who obtained medical marijuana responded that they believed it was safer than illicit marijuana and effective for pain control, but they reported barriers including difficulty of access and greater expense.
More studies are urgently needed on the effectiveness of marijuana to reduce pain and hospitalizations in sickle cell disease, Curtis said in the release.
“My patients are living with a very difficult disease that causes a lot of pain,” Curtis said. “We need controlled trials to look at each product, and the effects of how it is taken, so that we can offer regulated, pharmaceutical-grade treatment options.”
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