Cannabis Use and Cognition in Adults Prescribed Opioids for Persistent Pain

Background: Adults with persistent pain frequently report cannabis use to help manage their symptoms. The impact of cannabis use on cognition in the presence of concurrent symptoms of depression and anxiety is poorly understood. Aims: Our study explored how cannabis use affects relationships among symptoms of depression, anxiety, and cognition. Design: A cross-sectional survey study was conducted. Settings: Surveys were distributed at outpatient clinics treating adults for pain in the Pacific Northwestern United States. Participants: A total of 150 adults prescribed an opioid medicine for persistent pain were recruited. Methods: A pencil and paper survey was used to collect several self-reported ratings of cognition, symptoms of depression and anxiety, and the average potency of cannabis consumed as measured by the percentage of delta-9-tetrahydrocannibinol (THC) and cannabidiol (CBD), as well as frequency of cannabis use. Results: Depression, anxiety and cognition significantly worsened as the reported percentage of CBD, THC and overall frequency of cannabis use in the past 30 days increased. Depression and anxiety both significantly predicted worsening cognition in the sample. The relationship between depressive symptoms and cognition was strengthened as reported percentages of CBD use increased. The relationship was the same for anxiety and cognition, although not as strong. Conclusions: More cannabis use, particularly high CBD products, may be linked with increased symptom burdens and may strengthen relationships between negative affect and cognition. Further cannabis research within persistent pain populations is warranted to add evidence that can assist patients in managing mood and mental processes. Nurses should evaluate how negative affective health symptoms may impact cognition among adults with persistent pain using prescription opioid medications, especially in the context of concurrent cannabis use. (C) 2020 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.