Impact of State Cannabis Laws on Cancer Pain Management and Outcomes: A mixed-methods study

PROJECT SUMMARY/ABSTRACT More than one third of the approximately 2 million Americans diagnosed with cancer each year experience moderate to severe pain related to their disease and/or its treatment. To date, 38 states and the District of Columbia have adopted medical cannabis laws, and 24 have subsequently adopted adult-use (i.e.,

“recreational”) cannabis use laws, that enable patients with cancer to use cannabis for pain management. Clinical practice guidelines do not recommend the use of cannabis to manage cancer pain, citing limited and mixed evidence. Instead, guidelines continue to emphasize opioid therapy as a cornerstone of cancer pain

management. The strength of such consensus varies somewhat across cancer contexts. Consensus on the appropriateness of opioid therapy is strongest for patients with advanced (i.e., incurable) cancer, especially those with limited life expectancy. It is also strong for patients undergoing active cancer treatment with curative

intent. In contrast, guidelines for chronic pain management among cancer survivors (i.e., those who have completed curative treatment and are in remission) reflect an emerging emphasis on opioid-sparing approaches. Regardless of guideline recommendations, many patients with cancer prefer to limit or avoid

using opioids. In this context and based on prior studies documenting rates of cannabis use exceeding 25% among patients with cancer, cannabis laws could lead patients to use cannabis in place of opioid therapy, with downstream effects that are unknown and may differ across cancer contexts. The objective of the proposed

study is to address evidence gaps about the effects of state cannabis laws on pain management practices (e.g., receipt of opioid therapy) and outcomes (e.g., receipt of treatment for opioid and cannabis use disorder; patient-reported pain) in cancer. We will conduct a quasi-experimental evaluation of state cannabis laws using

a unique combination of two existing population-based data sources (SEER-Medicare and SEER-MHOS). We will also collect and analyze survey and interview data to explore how state cannabis laws have influenced cancer pain management from the perspectives of cancer center leaders, physicians, and patients.

Triangulating results from our policy evaluation with information about cancer center-level implementation of state cannabis laws, physicians’ practices for recommending, and patients’ practices for using cannabis for cancer pain will strengthen the validity of observed policy effects. Each year, states consider, enact, and/or

amend cannabis laws. To inform this rapidly evolving policy context, it is essential to understand how these laws affect pain management for patients with cancer as one of the largest groups of consumers of therapeutic cannabis. Our proposed study has significant potential to impact policy and practice.