Marijuana use and its associations with pain, opioid dose, and HIV viral suppression among persons living with HIV on chronic opioid therapy

Abstract

Background: Medical marijuana is legal in 29 US states and the District of Columbia: both HIV and chronic pain are “approved conditions” for receipt. Chronic pain is common among people living with HIV (PLWH). We anticipate PLWH will question their providers about medical marijuana for chronic pain. We examined marijuana use and its associations with pain, opioid dose and HIV viral suppression among PLWH receiving chronic opioid therapy (COT). Methods: PLWH prescribed COT were recruited into the Targeting Effective Analgesia in Clinics for HIV cohort. The main exposure variable was any past 12-month marijuana use. The primary outcomes were 1) opioid misuse (≥9 on the Current Opioid Misuse Measure) and 2) opioid dose (morphine equivalent daily dose). HIV viral load (VL) suppression (<200 copies/uL) and pain severity and interference using the Brief Pain Inventory were exploratory outcomes. Results: Participants (n=166) were male (65%), Black (72%), and had an undetectable VL (89%). We found no significant association between current marijuana use and opioid misuse, opioid dose, or pain. Current marijuana use was associated with 3.03 times the odds of having a detectable VL (95% OR: 1.11 – 8.31, p=0.03) while controlling for depressive symptoms and other substance use. Discussion: We did not detect an association between marijuana use and opioid misuse behaviors, opioid dose, or pain. In an exploratory analysis, current marijuana use was associated with 3x greater odds of having a detectable VL. This study provides insights into potential consequences of marijuana use among PLWH with chronic pain.