Current Marijuana Usage By MS Status and Disability in the NARCOMS Registry. Stacey S. Cofield, PhD

Transcription

1 Current Marijuana Usage By MS Status and Disability in the NARCOMS Registry Stacey S. Cofield, PhD Amber R Salter, Tuula Tyry, Sandre McNeal, Gary R Cutter, Ruth Ann Marrie, and Robert J Fox Disease Management, Mechanisms, and Treatment CMSC DX May 9, Disclosures NARCOMS is a project of the CMSC & the Foundation of the CMSC Drs. Cofield, Cutter, Marrie, Fox and Salter have received fees/support for for consulting, DMSB service, and/or grant related activities. See CMSC program for complete disclosures. Dr. Tyry and Ms. McNeal have nothing to disclose. Drs. Cofield, Cutter, Salter and Ms. McNeal: Biostatistics, University of Alabama at Birmingham, Birmingham, AL Dr. Tyry: Dignity Health, St. Joseph's Hospital and Medical Center, Phoenix, AZ Dr. Marrie: University of Manitoba, Winnipeg, MB, Canada Dr. Fox: Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH

2 Medical Marijuana Recent research suggests that cannabinoids can help alleviate some symptoms of multiple sclerosis (MS). Individual state and US laws are changing regarding marijuana and medical marijuana. In April, AAN issued Findings on Use of Medical Marijuana in Treatment of Certain Brain Diseases, including MS. Evidence indicating use of specific oral and oromucosal forms of cannabis to improve some symptoms in patients with MS symptoms such as tremor and spasticity. : Yadav V, Bever C Jr, Bowen J, Bowling A, Weinstock-Guttman B, Cameron M, Bourdette D, Gronseth GS, and Narayanaswami P. Summary of evidence-based guideline: Complementary and alternative medicine in multiple sclerosis: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology ; 8:8-9 Marijuana in US In December, the US government ended restrictions on the use of medical marijuana in those states where it had been legal before May. 6 states and the District of Columbia with laws allowing, at a minimum, medical marijuana usage. Medical: marijuana legal for medical use only, with prescription No Jail Personal Use: no jail time for possession under a certain weight, varies by state

3 NARCOMS Survey In August, all active NARCOMS participants were invited to complete a one-time, anonymous survey Marijuana referred to smoking, ingesting, or other controlled substance derived from marijuana or synthetic marijuana. Goals of survey: Characterize marijuana usage: past and current behaviors and attitudes on usage and legality Determine if participants have spoken to their doctor about marijuana Characterize MS disease status & current disability according to marijuana usage Survey Response 6 66 respondents 6.% of invitees 9.% live where marijuana is legal in some form.% outside of the US 8% reported not currently using marijuana: % Never % Past use Prior to MS (No MS Use) % Past use for MS 6% Current use for MS: median days of use in past days: (IQR: -)

4 7 Disposition by Current MS Group 6 9.% with Relapse History % in August RRMS-Active Relapse < Years (RRMS-A) RRMS-Stable Relapse + Years (RRMS-S) Progressive Relapses in Past (P-Rel) Progressive No Relapses (PPMS) Age at Dx, Aug : 6,, 7, 9, 6 % Female: 8.8% 8.% 7.6% 6.% Current Disability 8 Bedridden 8 Wheelchair/Scooter 7 Bilateral Support 6 Late Cane Early Cane Patient Determined Disease Steps (PDDS) Gait Disability Moderate Disability overall median Mild Disability Normal MS Type N RRMS-A 7 RRMS-S 7 P-Rel 9 PPMS

5 Current Spasticity 9 Total Severe Moderate Mild overall median Minimal None MS Type N RRMS-A 7 RRMS-S 7 P-Rel 9 PPMS Spasticity Performance Scales, Copyright Registration Number / Date: TXu769 / 996--; assigned to DeltaQuest Foundation, Inc., effective October,. U.S. Copyright law governs terms of use. Use by MS Type Use Overall Never.% % Marijuana Use Past.% RRMS-A RRMS-S P-Rel PPMS N Current 6.%

6 Use by PDDS Never % Use History Past 9. Normal (89). Mild (769) Moderate (9) Gait (78) Early Cane (89) Late Cane (78) Bilateral (68) 7 Wheelchair Scooter (69). 8 Bedridden (9) Current Use by Spasticity Never % Use History Past 6. None (887). Minimal (68) Mild () Moderate (6) Severe (7) Total () Current 6

7 by Current MS Type.. Odds Ratio ± 9% CI for likelihood of Current Use vs Not Current Use RRMS-Stable less likely to be current user than other types of MS Progressive with history of relapse more likely than RRMS-Active Current age Current PDDS P-Rel vs RRMS-S PPMS vs RRMS-S RRMS-A vs RRMS-S P-Rel vs RRMS-A p<. p=. p=. p=.7 by Current PDDS.. Odds Ratio ± 9% CI for likelihood of Current Use vs Not Current Use All levels (except bedridden) more likely to be current users than normal PDDS Current age Current MS Type... 7 vs 6 vs vs vs vs vs vs p<..9 <. <. <. <.. 7

8 .6 for Current PDDS Odds Ratio ± 9% CI for likelihood of Current Use vs Not Current Use Current age Current MS Type Bilateral Support (6) less likely to be current users compared to late cane, early cane, and moderate disability Cane use, moderate and gait disability more likely to be current users compared to mild disability 6 vs 6 vs 6 vs 6 vs vs vs vs vs p= for Current Spasticity Odds Ratio ± 9% CI for likelihood of Current Use vs Not Current Use All levels more likely to be current users than normal Current age Current MS Type 6 vs vs vs vs vs all p<. 8

9 for Current Spasticity 7.. Odds Ratio ± 9% CI for likelihood of Current Use vs Not Current Use Higher levels more likely to be current users compared to minimal spasticity Current age Current MS Type Severe and moderate more likely to be current users compared to mild spasticity.. vs vs vs vs vs vs p=.7 <. <. <...9 Summary 8 6+ responses indicate those living with MS are willing to answer questions about the topic Limitation: cross-sectional, anonymous >% have used marijuana 6% current users Likelihood of use lower for: RRMS-Stable + years Lower PDDS disability levels Lower Spasticity levels 9