Walden University ScholarWorks Walden Dissertations and Doctoral Studies Walden Dissertations and Doctoral Studies Collection 2020 Cannabis as a Safer Alternative to Opioid Management of Chronic Pain Loren Nedelman Walden University Follow this and additional works at: https://scholarworks.waldenu.edu/dissertations Part of the Nursing Commons This Dissertation is brought to you for free and open access by the Walden Dissertations and Doctoral Studies Collection at ScholarWorks. It has been accepted for inclusion in Walden Dissertations and Doctoral Studies by an authorized administrator of ScholarWorks. For more information, please contact [email protected]. Walden University College of Health Sciences This is to certify that the doctoral study by Loren Nedelman has been found to be complete and satisfactory in all respects, and that any and all revisions required by the review committee have been made. Review Committee Dr. Eric Anderson, Committee Chairperson, Nursing Faculty Dr. Amelia Nichols, Committee Member, Nursing Faculty Dr. Faisal Aboul-Enein, University Reviewer, Nursing Faculty Chief Academic Officer and Provost Sue Subocz, Ph.D. Walden University 2020 Abstract Cannabis as a Safer Alternative to Opioid Management of Chronic Pain by Loren Nedelman MSN, Uniformed Services University of Health Sciences, 2013 MA, Webster University, 2009 BSN, Florida Atlantic University, 2004 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2020 Abstract Chronic pain affects approximately 100 million American adults and costs the United States upwards of $635 billion each year in medical treatments and lost productivity. Opioid prescription for pain has increased exponentially over the past several years, with the CDC estimating 20% of prescriptions lasting longer than 3 months for patients with noncancerous pain. Opioid addiction has become a national public health crisis with mortality surpassing 100,000 deaths annually due to overdose. As States have begun to deregulate the use of cannabis and cannabis derivatives for medical purposes; oversight and regulation by the federal government on its use as a Schedule I medication has been found to be lacking. Medical centers that derive funding from federal sources are unable to continue using this substance without forfeiting funds. The purpose of this systematic review was to explore available peer-reviewed evidence related to the use of cannabis as a potential alternative to opioids in the treatment of chronic pain. The Johns Hopkins Nursing Evidence-Based Practice model was used to review 32 peer-reviewed articles published between 2008 and 2018. Findings suggest cannabis as a promising alternative to opioids and supports the medical use of cannabis as a safer first-line pharmacological treatment for chronic pain compared to opioids. The use of cannabis as a safer alternative to opioids can promote social change directly and indirectly across a variety of social and economic dimensions due to increased access to medication at reduced cost, elimination of opioid-related death due to overdose, diminished individual and social harms related to cannabis. A medical alternative to opioids may also lead to a reduction of the inequitable incarceration of cannabis users across demographic categories of ethnicity and race. Is Cannabis a Safer and Equally Effective Medication for the Treatment of Chronic Pain as Compared with Opioids? by Loren Nedelman MSN, Uniformed Services University of Health Sciences, 2013 MA, Webster University, 2009 BSN, Florida Atlantic University, 2004 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2020 Dedication I would like to dedicate my project to my family for enduring my late nights, and vacations interrupted by myself completing this project. Table of Contents List of Figures .................................................................................................................... iii Section1: Introduction ..........................................................................................................1 Introduction ....................................................................................................................1 Problem Statement .................................................................................................. 1 Purpose Statement and Project Objectives. ............................................................ 2 Nature of the Project……… ................. ………………………………………… 3 Significance .............................................................................................................4 Summary ................................................................................................................. 8 Section 2: Background and Context ..................................................................................11 Concepts, Model or Theories ................................................................................ 11 Relevance to Nursing Practice .............................................................................. 11 Local Background and Context ............................................................................ 12 Role of the DNP Student........................................................................................14 Summary ............................................................................................................... 15 Section 3: Collection and Analysis of Evidence ................................................................17 Introduction ..................................................................................................................17 Practice-Focused Question(s) ............................................................................... 18 Sources of Evidence .............................................................................................. 18 Analysis and Synthesis ..........................................................................................20 Summary ................................................................................................................21 Section 4: Findings and Recommendations……………………………………………. 22 i Introduction …………………………………………………………………….22 Findings and Implications ……………………………………………………...23 Implications for Policy………………………………………………… 27 Implications for Research……………………………………………….28 Implications for Practice...……………………………………………....28 Recommendations …………………………………………………………........29 Recommendations for Policy Change…………………………………...29 Recommendations for Research………………………………………....30 Recommendations for Practice…………………………………………..30 Strength and Limitations of the Project ………………………………………....31 Section 5: Dissemination Plan…………………………………………………………...32 Analysis of Self ………………………………………………………………....32 Summary ………………………………………………………………………..33 References ……………………………………………………………………………....34 ii List of Figures Figure 1. Identification of literature…………...…………………………….....………...19 Figure 2. Decision tree for medical cannabis recommendation ………………………....32 iii 1 Section 1: Nature of the Project Introduction According to Brownstein (1993), most scholars believe that the use of opioids can be attributed to the Sumerians about 3 B.C.E. near present-day Iraq. There is some debate whether Homer described the euphoric substance in The Odyssey around 9-10 B.C.E. Although early function of the poppy plant was to cause euphoria during religious ceremonies, scientists in 1806 were able to isolate morphine from poppy plants and used it for pain control (Brownstein, 1993). The addictive quality of this compound forced researchers to seek a nonaddictive pain reliever, and in 1898 they first synthesized heroin (Brownstein, 1993). Many patients with chronic pain had no other options. But given the addictive qualities of opiate substances, once they started using them, they could not stop. Further studies on cannabis have shown it to be positively correlated with the reduction of pain, in some cases up to 30% (Kondrad, 2013). Problem Statement As in the past, nonmedical use of opioids has continued, and the National Survey on Drug Use and Health estimates that in 2014, more than 10 million people in the United States used prescription opioids for nonmedical use (Wickramatilake et al., 2017). Drug overdose deaths overtook automobile accidents as a leading cause of mortality in 2015, with over 33,000 lives lost (Wickramatilake et al., 2017). The problem addressed by this study is the need for a safer alternative for [chronic] pain relief than opioid medications. Cannabis may be that safer alternative for treating chronic pain. By using cannabis instead of opioids for chronic pain, many unwarranted deaths may be avoided. 2 The resources used to combat this epidemic could then be allocated on other public health initiatives and free nursing practice to address other areas of interest or concern. Purpose Statement The potential positive impact of reducing opioid prescribing would include better pain management with alternatives that are safer and effective, and reduced costs to insurers and other health care plan beneficiaries (Franklin et al., 2015). By promoting the appropriate use of these medicines will enhance health care and society as a whole. The purpose of this project was to objectively review the current evidence on the use of cannabis for pain. Many states have enacted laws to allow for medical marijuana,