Research on Health-Related Quality of Life in Medical Cannabis-Using Patients
March 27, 2013 | Sunil Aggarwal
In August 2012, I published an article based on my PhD research in the American Journal of Hospice and Palliative Medicine which documented symptom relief and health-related quality of life in a surveyed series of medical cannabis using patients in Washington State who were recruited from a medical cannabis dispensing site and were all drawing from the same batch of herbal cannabis. You can read the article, entitled "Prospectively Surveying Health-Related Quality of Life and Symptom Relief in a Lot-Based Sample of Medical Cannabis-Using Patients in Urban Washington State", here and see the supplementary material here. My colleague, Dr. Jahan Marcu, who blogs here, contacted me soon after the publication to do an interview by email with me about the article. I wrote up the responses to his questions, but unfortunately, due to busyness and other competing demands, the interview never made it out into the blogosphere. Given that I now have this space to blog, and given that I presented a poster summarizing this data at the ASA National Medical Cannabis Unity Conference last month, I thought that I would share my interview here about this research. I hope you like it!
In other news, the other poster I presented at the ASA Conference, "Cannabinergic Pain Medicine: Developing A Concise Clinical Primer and Surveying Randomized-controlled Trial Results" I also presented a few weeks later at the American Academy of Hospice and Palliative Medicine Annual Assembly in New Orleans where it received a poster award from the Scientific Subcommittee! It was prominently displayed at the conference where ~2,500 physicians and nurses were in attendance. Here is the publication that this poster was based on--the article was featured on the journal's cover last month!
Thank you to Dr. Marcu for the great question prompts below on the article "Prospectively Surveying Health-Related Quality of Life and Symptom Relief in a Lot-Based Sample of Medical Cannabis-Using Patients in Urban Washington State"!
What is the scientific significance of the article?
The research is significant as it is the only study that has used standard tools to assess self-rated health and HRQoL (health-related quality of life) in a uniquely drawn sample of patients using medical cannabis. To date, little is known about the characteristics of medical cannabis patient populations. Much of the information in the public domain about characteristics of patients who seek medical authorization to use cannabis or who go to access points where medical cannabis is dispensed is garnered through media reports and public campaigns by proponents and opponents of medical cannabis systems. Here, standard instruments and dispensed-lot-based sampling provide unique and unprecedented insight into the health characteristics of this politicized patient population who face legalized discrimination in the US.
How were the subjects sampled and surveyed?
Data were collected from patients receiving medical cannabis from a pre-chosen strain-specific lot of cannabis, and only patients who received cannabis from that lot of locally produced cannabis (strain name: plum) were recruited. The study subjects had the unprecedented protection of an NIH-issued Certificate of Confidentiality, which offers the strongest protections a federal agency provides to researchers and subjects.
Subjects were surveyed with a variety of instruments to assess diagnoses, symptom-relief, and health-related quality of life. The latter is important as it has been shown that subjective ratings of health status are extremely predictive for long-term morbidity and mortality, often better than objective ratings.
What were some of the noteworthy findings?
Some interesting findings were that all possible state-approved qualifying diagnoses for the use of medical cannabis were found in this lot-based patient sample (n = 38), from seizure disorders to HIV. Secondly, the most frequently reported symptoms that cannabis was reported to alleviate were first and second, depression and anxiety, respectively, and third pain.
Another important finding was that the average health-related quality of life (HRQoL) in this sample of medical cannabis-using patients was on par with that seen in previously reported medical literature on chronically ill patient populations who suffer from congestive heart failure, limb loss, or major depression. The use of standard instruments to measure HRQoL made such comparisons possible. Finally, a significant proportion of the sample reported requiring assistance with their functional activities of daily living such as bathing and grooming or their instrumental activities of daily living such as cooking, cleaning, and shopping. While the follow-up rate on the take-home survey was low, a majority of respondents reported that the use of cannabis helped to maintain or improve their functionality, mainly due to improved symptom control and resultant ability to work or attend to chores.
How was the study funded?
This study was unfunded. I conducted the research as a National Science Foundation Graduate Research Fellow. My co-authors were members of my doctoral supervisory committee at the University of Washington.
What are the policy implications?
Policy wise, I hope that the study allows for a clearer picture of the health status of medical cannabis-using patients to be painted, which would hopefully lead to more humane consideration of this patient population in policy at all levels.
There are two additional studies that will soon be publish related related to this group of patients: one on the kinds and levels of psychological stress/distress subjects reported related to their federally criminalized status and how they cope with this and another on the actual human-environment relations involved in the delivery of that particular lot of plum cannabis.
What's next for me?
Clinically, I am planning to complete a fellowship in hospice and palliative medicine at the National Institutes of Health starting next year.