Cancer rates have skyrocketed in recent years, and the suffering that accompanies with it is excruciating. As the condition progresses, the discomfort worsens as the bones breakdown and become weaker. It may result in bone fractures, creating additional pain. The study focuses on the use of medical marijuana versus opioids for pain management. The topic was chosen because people have continuously associated marijuana with illegal, addictive chemicals that can lead to addiction and ongoing use even when it is not required. Some believe that legalizing would have a knock-on effect, encouraging public usage of marijuana. However, it is key to understand that opioids have tremendous negative impact including addiction and eventual death (Boehnke, Litinas, & Clauw, 2016). The use of marijuana could reduce such dependency and improve the quality of life.
The topic is important to me as an aspiring nurse because nursing calls for taking care of patients and ensuring they are comfortable especially when unwell. Through the study, the public’s perception will be changed through knowledge and understanding. It is anticipated that people will understand how medical marijuana works compared to opioids and give recommendations that are fact founded as opposed to speculative reasoning. The comparison will provide a basis to patients in making a choice of the medication to take and the impact that both have on their current health status and the future.
Clinical practice in use of medical marijuana compared to opioids in pain management
The chronic pain experienced by patients with bone cancer is a concern to physicians worldwide. However, despite the knowledge that opioids are not efficient in chronic pain relief, medics are inclined to their use. The inclination is based on lack of adequate research on the benefits of medical marijuana and base their judgment on past knowledge (Clauw, 2016). The use of medication to relieve pain rests on weighing the level of pain and the benefits versus the downside of each. The conservative nature of the doctors makes them take a route that is well known of opioids as opposed to medication that is not well embraced by the community yet could have better results.
The Drug Enforcement Administration (DEA) does not permit the use of marijuana based on a lack of scientific evidence to support its use. However, the legal system does not prioritize pursuing persons using medical marijuana. The law is, however, keen on following up on caregivers to ensure they abide by the state by avoiding issuance of marijuana for other purposes other than pain management. Medical practitioners can prescribe opioids, but they cannot do the same with marijuana. They can only recommend its use for pain therapy in bone cancer and other conditions according to the law. Medics are thereby protected by the law on such free speech and are not liable to punishment on offering the advice (Marcoux, Larrat, & Vogenberg, 2013).
Medics face challenges in an event where an individual had been using marijuana in the past and failed to disclose during the taking of medical history. It would put a patient at risk if combined with other prescriptions (Marcoux, Larrat, & Vogenberg, 2013). Practitioners need an understanding of the short term and long term impact of marijuana use before making a sound judgment on recommending its use.
Management of pain for bone cancer patients requires reducing pain to levels that are manageable. Increasing pain calls for an increase in opioids prescribed that is an indication that the body is becoming used to the medicine. An increase in the use would lead to addiction and possible addiction to the drug. Use of cannabis Sativa fumes in combination with some pain medication could reduce pain to levels that opioids could never manage. Medics have a role to ensure the choice of pain relief is administered with care to get pain in control while preventing adverse effects of the drugs (Bonneau, 2008). The ability to recognize the principles of pain and medication are fundamental followed by understanding what the law states with regards to use of marijuana. It is crucial for nurses to continually differentiate between a patient recovering from pain and one that is becoming addicted to a drug. It is through this that they can distinguish between acute and chronic pain. These guidelines form a basis for caregivers in dealing with clients individually through the unique perspectives of their situations.
Research Process
The research started with the documentation of the topic that is relevant to nursing and would have an impact on the society and improvement of the well-being of people. It was followed by getting the background of the topic through identification of keywords and phrases. They are critical in getting information on the subject of study and thereby saving time. Phrases such as the medical use of opioids and cannabinoids enabled search of relevant information and pulling up of significant journals. They capture the core of the study through the creation of a focus as opposed to randomly searching for information.
The keywords and phrases acted as a guide is identifying relevant and up to date information. Internet sources were the primary sources of articles with a focus on peer-reviewed journals. An analysis of the information from the articles was identified to determine applicability to the study and relevance to the findings and recommendations to be made. The research design focused on the use of case studies which is a method of studies that has proven useful in medical research. The design had an emphasis on quantitative analysis that entailed the use of samples in collecting relevant information.
The first case study used a sample size of 19 journals to study palliative care and cancer pain and the impact that various painkillers have had on relieving pain. The quantitative research design was used in the study with a hospital setting of patients with terminal pain diseases such as cancer. The study measured the impact that palliative care derives from different drugs. The study found that the occurrence of cancer pain in the study was low. The article is important as it creates a basis for understanding the perception of pain which is critical in my research on managing pain in bone cancer (See Appendix).
The second case study was on the interaction of chronic pain with cannabinoid-opioid in the body. A sample of 21 patients with chronic pain was used in the research for five days and used a combination of oxycodone and vaporized cannabis. Blood samples were measured daily which indicated that there was no change in plasma concentration when the combination of the drugs occurred and yet the pain was significantly reduced. The findings are important as they show the impact of combination of drugs such as opioids with cannabis in the management of pain (See Appendix).
The third case study looks into considerations that are fundamental historically, geographically and medically before the recommendation of cannabinergic medication in pain relief. The research uses narrative review of authoritative literature in a bid to draw conclusions with a sample of 38 articles. The research concluded that cannabinoids have significant pain relieving abilities. From the study, we can draw the recommendation on whether marijuana should be used as a different drug in pain relief (See Appendix).
The fourth case study looked into the effects of marijuana on patients with non-cancer pain. Eighteen trials were used as a sample with fifteen tests indicating positively that the adverse impact of marijuana was tolerated and they could be used safely in the treatment of chronic pain. Statistical analysis of information was used with trials being used to draw conclusions. The measurement focused on the analgesic characteristics of opioids. The study is crucial in our making a recommendation based on evidence-based research the related pain management theories that come with the use of marijuana (See Appendix).
The final study was on the medical utilization and abuse of opioids in managing pain. A sample of 29 medical records was reviewed. Retrospective data analysis was done for eight years to measure the optimum use and misuse of opioids. The research findings indicate an escalation in the consumption and abuse of opioids in the era. The study is key to our research in comparing the impact of opioids compared to marijuana in individuals (See Appendix).
Recommendations
It is evident from our studies that medical marijuana has a positive impact and could be safely given to patients with bone cancer to relieve pain. However, the fear of the prescription due to addiction has led to its use being limited in various state. It is in this light that that study makes recommendation that medics should be given the allowance to prescribe marijuana in hospitals. It would be done with adequate training on the positive impact of its use and the negative. The ability to prescribe marijuana would ensure that there is adequate monitoring of patients to avoid misuse if one is no longer in pain or depending on pain levels.
The DEA be in charge of implementing the change and would also manage the use of the drug and open grounds for research and improvement of its distribution. It would tremendously benefit patients as the aim of seeking medical help with pain is to find a way to manage pain to reasonable levels which would be achieved with marijuana. The evaluation would be done through data collection in various health facilities in collaboration with the community to establish whether the positive impact of marijuana use outweighs the negative consequences.
References
Boehnke, K., Litinas, E., & Clauw, D. (2016). Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. The Journal Of Pain, 17(6), 739-744. http://dx.doi.org/10.1016/j.jpain.2016.03.002
Bonneau, A. (2008). Management of bone metastases. Canadian Family Physician, 54(4), 524-527.
Clauw, D. (2016). Doctors Favor Opioids Over Marijuana for Pain Management. Labblog.uofmhealth.org. Retrieved 13 March 2017, from http://labblog.uofmhealth.org/rounds/why-us-doctors-love-opioids-and-hate-marijuana-for-chronic-pain
Marcoux, R., Larrat, E., & Vogenberg, F. (2013). Medical Marijuana and Related Legal Aspects. Pharmacy And Therapeutics, 38(10), 612-619.
Appendix
Author (Year)
Conceptual Framework
Design/
Method
Sample/
Setting
Major Variables Studies (And Their Definitions)
Measurement
Data Analysis
Findings
Appraisal: Worth to Practice
Kumar, S (2011)
Study of palliative care & cancer pain to derive overall impact of different drugs
Quantitative research based on systematic review
19 palliative care journals w/ 2600 articles initially
Cancer pain- complicated, consistently changing symptom which is the end outcome of mixed mechanism pain. Involved neuropathic, inflammatory, & ischemic processes
Palliative care - care for individuals that have terminal cancer or fatal illness & their families
Study of palliative care & cancer pain to derive overall impacts of different drugs
Quantitative research based on systematic review
The overall occurrence of articles on cancer pain was considerably low. Databases of multidisciplinary nature had more information than MEDLINE & other healthcare related ones
Knowledge from these study findings will actually outline the field perception of cancer pain for my analysis, particularly in bone cancer.
Abrams, D. I., Couey, P., Shade, S. B., Kelly, M. E., & Benowitz, N. L. (2011)
Cannabinoid-Opioid Interaction in Chronic Pain
Quantitative, randomized controlled study
Twenty–one individuals w/ chronic pain, on a regimen of twice–daily doses of sustained–release morphine or oxycodone
Plasma concentration–time curve- the area under the curve to plot concentration of drug in blood plasma against time.
The extent of chronic pain & change in the induction of drugs
Blood sampling
The study outlined that there were no significant changes in the plasma concentration-time curve area for the drugs administered after cannabis exposure. Pain was observed to be decreased in a significant manner after the addition of vaporized cannabis.
The study can be used to observe combination of cannabis meds w/ opioids in lower doses if they can be positive enough, w/ fewer side effects.
Aggarwal, S (2013)
Pragmatic clinical considerations through narrative methodology review
Quantitative, investigations of systematic review w/ meta-analysis
38 published RCTs according to the survey criteria
Cannabinergic Medicine- class of drugs that get their name from cannabinoid botanical plants from isolated & herbal preparation of cannabis
Survey on PubMed & narrowing down the positive & negative published randomized controlled trials along w/ their results of these classes of pain medicines
Qualitative analysis through narrative review
The study outlined that cannabinergic medicines including medical marijuana have efficacies for pain relief for cancer pts.
The information provided can be generally implemented to make reasonable differentiation.
Lynch, M. E., & Campbell, F. (2011)
To provide effects of cannabinoids for chronic non-cancer pain
Quantitative, Systematic review of randomized controlled trials
18 full text articles
Cannabinoids-one of a class of diversified chemical compounds that act on cannabinoid receptors in cells that change neurotransmitter release in CNS.
Efficacy of cannabinoids in terms of their analgesic characteristics
Thematic & statistical analysis of the studies & trials outlined
The study concluded that cannabinoids can be used to treat non-cancer chronic pain in an effectual manner.
Taking into consideration the effects on chronic non-cancer pains, the study can contribute to the EBP in providing different physiological functions. These can be integrated into cancer related pain management theories & possibilities
Sairam Atluri, M. D., Gururau Sudarshan, M. D., & Laxmaiah Manchikanti, M. D. (2014)
The medical use and abuse of opioids in the field of pain management & clinical
Retrospective analysis of data from 2004 to 2011 from 2 databases
29 medical records through DAWN estimates
Opioids-a complex compound having resemblance of opium in physiological influences or addictive characteristics
Analgesics-drugs that can perform & react to relieve different forms of pain
The optimum & positive along w/ misuse & abuse of opioid meds
Schematic derivations & identification of trends from DAWN
There has been an increase in the medical use of all opioids. The abuse of all such meds including codeine increased during this time period as well.
This research is worth outlining since it provides information on multiple opioid drugs that are used to encounter chronic cancer pain. This information can be used to make positive comparisons & efficacy of long term opioid use (effects & side effects)
Key words: Pt(s) = patient(s), w/ = with, Med(s) = medication(s), Tx = treatment, EBP = Evidence Base Practice, CNS = Central Nervous System, RCTs = Randomized clinical trials
Medical use of opioids, inappropriate use of opioids, abuse of opioids, opioid-related fatalities, Automation of Reports and Consolidated Orders System (ARCOS), Drug Abuse Warning Network (DAWN), International Narcotics Control Board (INCB), cannabinoids, chronic non-cancer pain, neuropathic pain, systematic review, cancer pain, palliative care research, reporting characteristics
