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17th October 2022
Medicinal cannabis use appears to be associated with a reduction in patient’s use of opiate-based analgesics and improvements in self-reported physical functioning according to a study by US researchers.
In the US there has been an opiate crisis of epidemic proportions. Data from the CDC indicate that in the year ending in June 2020, 48,006 deaths were attributable to overdosing on synthetic opioids other than methadone. Fortunately, it appears that the level of opiate-related deaths in the US is beginning to fall with a slight decrease in 2019 compared to 2017. Although there may be any number of reasons as to why deaths are falling, one potential explanation for this reduction is greater use of medicinal cannabis (MC) use compared to opiates. In fact, a 2017 study identified how patients reported less use of opiates, antidepressants, alcohol, anti-anxiety, migraine and sleep medications after using MC. Despite this possible rise in use, an overview of the efficacy, tolerability and safety of cannabis-based medicines for chronic pain management concluded that there were inconsistent findings of the efficacy of cannabinoids in neuropathic pain, painful spasms in multiple sclerosis and for any chronic pain. However, many US states have taken steps to legalise and decriminalise the use of MC. As a result, for the present study, the US team sought to characterise the demographics and use patterns of those who had physician-approved medical cannabis access and to examine patient’s perceptions of changes in health functioning and use of opiate-based pain medicines (OBPM) after access to MC. The team developed a 66-item questionnaire that was distributed online, assessing a wide range of factors including demographics, medical conditions, health functioning and changes in pain medication use before and after use of MC.
Medicinal cannabis and changes to opiate-based medicine use
A total of 2,183 responses were included of whom 54.4% were female and nearly two thirds (64.9%) were aged 30 to 59. A third (33%) of respondents reported that they had 6 or more ailments and nearly half (47.9%) reported having pain and mental health issues, whereas pain alone was reported by only 9.1%.
The majority (54.9%) reported using medicinal cannabis regularly throughout the day and 7.8% had been using medicinal cannabis for more than 10 years.
In terms of physical functioning, bodily pain (e.g., the level of pain or interference of pain in normal work) was reportedly improved by 89.6% of respondents after use of MC, as was social functioning (84.3%).
Prior to MC usage, 60.9% of respondents were using OBPM with 36.8% using hydrocodone-acetaminophen (paracetamol) or oxycodone-acetaminophen (26.8%). However, after using MC, 41.7% reported that they had stopped using pain medicines and 37.5% had reduced their pain medicines. Interestingly, 11.5% reported improved functioning after using MC and reducing their OBPM.
The authors concluded that medicinal cannabis may play an important role at both the individual and community level as a viable alternative to opioids for pain management and without negatively affecting health functioning.
Prtichett CE et al. Medical Cannabis Patients Report Improvements in Health Functioning and Reductions in Opiate Use Subst Use Misuse 2022
1st August 2022
In a survey of radiographers, nearly a third stated that they did not know how an artificial intelligence (AI) system made its decisions according to the results of a study by Irish and UK researchers.
A radiology workforce report in 2020 said that across the UK, 1 in 10 radiologist positions was unfilled. Nevertheless, the reporting of radiographic images by radiographers (rather than radiologists) is an established practice in the United Kingdom (UK) and immediate reporting of emergency department radiographs by a radiographer has been deemed a cost-effective service development. Despite representing a cost-effective service development, as with radiologists, there is a national shortage of radiographers in the UK, with 2021 report indicating that the average current UK vacancy rate was 10.5% as of November 2020. To aid both radiologists and radiographers, in recent years there has been an increased use of artificial intelligence (AI) technologies for applications in radiology. Moreover, AI system interpretation of imaging is impressive, with one international study finding that an AI system’s ability to identify breast cancer maintained non-inferior performance and reduced the workload of the second reader by 88%. The introduction of AI systems therefore has the potential to help reduce any backlogs in unreported images. But the extent to which radiographers understand and interact with AI technology was the subject of the present survey by the Irish and UK team. They developed a questionnaire focused on AI as used in radiographer reporting and which was initially piloted with a group of 12 radiographers who had a range of different professional backgrounds. A total of 8 questions focussed specifically on AI and its use in radiographer reporting and respondents answered using a 7-point Likert scale (ranging from strongly agree through to strongly disagree). The survey was disseminated via a link posted on professional social media platforms (e.g. LinkedIn and Twitter).
A total of 411 completed surveys responses were received from radiographers working diagnostic and therapeutic radiographer. However, the results of the present study were limited to diagnostic radiographers (86). Perhaps the first and most illuminating finding, was how 89.5% of respondents indicated that they were not currently utilising AI as a part of their reporting role.
In response to a question which asked “I understand how an AI system reaches its decisions” only 28.8% (aggregate value) reported that they ‘somewhat disagreed’, ‘disagreed’ or ‘strongly disagreed’ although 61.6% (aggregate value) that they ‘agreed’ or ‘somewhat agreed’. In addition, the majority of respondents (59.3%) disagreed that they would be confident in explaining the AI system decision to other healthcare professionals and similarly, only 29.1% agreed that they would be confident explaining the decision to patients or their carers.
While 57% reported that they would feel more certain of their diagnosis if an AI system agreed with their interpretation, the majority (69.8%) stated that they would seek a second opinion if the AI system disagreed with them.
Finally, when asked to rate their trust in an AI system for diagnostic image interpretation on a scale of 1 to 10,, the median score was 5. When asked to choose from a list of possible factors that would increase their level of trust in the AI system, the most common responses were ‘overall performance and accuracy of the system (76%), a visual explanation, such as a heat map (67%) and an indication of the confidence of the AI system in its diagnosis (62%).
The authors concluded that while the majority of respondents were not currently routinely using an AI system as part of their reporting, awareness of how clinicians interact with AI systems was needed as this might promote responsible use of such systems in the future.
Rainey C et al. UK reporting radiographers’ perceptions of AI in radiographic image interpretation – Current perspectives and future developments Radiography 2022