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Cannabis Use for Chronic Pain: Advancing Knowledge and Cannabis Use Disorder Assessment with a Mixed Methods Approach

Award Number: R01DA050032
ORGANIZATION: NATIONAL INSTITUTE ON DRUG ABUSE
OPDIV: NIH
AWARD CLASS: DISCRETIONARY
AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)
PERIOD OF PERFORMANCE START DATE: 09/30/2020
PERIOD OF PERFORMANCE END DATE: 01/31/2031

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Cannabis Use for Chronic Pain: Advancing Knowledge and Cannabis Use Disorder Assessment with a Mixed Methods Approach - U.S. adult rates of cannabis use and DSM-5 Cannabis Use Disorder (CUD) have now reached historic peaks, medical cannabis use for pain is legal in 40 states, and the FDA has recommended re-classifying cannabis from Schedule 1 (no medical use, high abuse potential) to Schedule 3 (use for pain, moderate-low dependence potential). These changes have prompted calls to re-examine and improve the DSM-5-TR CUD criteria, which have not been updated in over 10 years. Opioid use disorder (OUD) is a useful reference for re-examining CUD because pain is the most common medical reason for using opioids or cannabis. Earlier, we showed excellent reliability and validity of 3 conceptual models of prescription opioid use disorder (OUD-P), with strongest validity evidence for the ‘fully-adjusted’ model that did not count DSM-5 criteria as positive if they occurred only when opioids were used as prescribed (under medical supervision; i.e., therapeutic use). This framework is our starting point to study potential improvements in CUD diagnostic criteria. However, unlike opioids, cannabis is ‘authorized’, not prescribed; medical supervision is rare; and dosing seldom specified. Knowledge gaps about key medical cannabis behaviors (e.g., efforts to get medical supervision, how therapeutic doses are determined) impede creating guidelines to assess therapeutic cannabis use. In R01DA050032, we used cognitive interviews and online surveys to produce the Cannabis Exposure Index (CEI), a new measure of mg/THC (i.e., cannabis dose). We propose a 5-year renewal to use these methods to compare reliability and validity of 3 CUD models. 1) Unadjusted (DSM-5-TR); 2) Physiologically-adjusted (tolerance, withdrawal criteria not counted towards a CUD diagnosis if they arose solely from therapeutic cannabis use) and 3) Therapeutically-adjusted (novel, fully- adjusted model: any CUD criteria occurring solely during therapeutic use not counted towards a diagnosis). To test the models, we must first fill knowledge gaps on medical cannabis supervision/dosing in order to create guidelines to assess therapeutic use. We will then adapt our diagnostic measure, PRISM-5-OP, into a cannabis version (PRISM-CUD) to test if physiologically- or therapeutically-adjusted CUD models are improvements over DSM-5-TR CUD. Given FDA recommendations, we focus on cannabis for pain, but also explore sleep and anxiety. All participants will have chronic pain and use cannabis daily/near-daily. AIM 1. Fill knowledge gaps about medical cannabis (e.g., efforts to obtain medical supervision or dose information; self-efforts to determine right dose) via online survey (n=1,000). AIM 2. Use findings to create guidelines to differentiate therapeutic from other use for PRISM-CUD measures of the CUD models; pilot and conduct cognitive interviews; refine items. AIM 3. Using PRISM-CUD, compare convergent and discriminant validity of the 3 CUD diagnostic models in online sample (n=3,000), re-testing 400 to determine reliability. Hypothesis: Validity in capturing true cases of CUD will be ordered as: Therapeutically-adjusted>Physiologically-adjusted>Unadjusted. We aim to update and improve validity of CUD diagnoses, thereby improving public health in many areas that require such diagnoses.


Issue Date FY	Funding FY	Legal Entity Name	Legal Entity Address	Legal Entity City	Legal Entity State	Legal Entity Zip Code	Legal Entity COUNTY	Legal Entity COUNTRY	Assistance Listing	Award Code	Budget Year	Action Date	Action Type	Action Amount

Issue Date FY: 2026 ( Subtotal = $780,228 )
2026	2026	TRUSTEES OF DARTMOUTH COLLEGE	7 LEBANON ST	HANOVER	NH	03755	GRAFTON	USA	Drug Use and Addiction Research Programs	001	6	3/6/2026	COMPETING CONTINUATION	$780,228
2026	2024	TRUSTEES OF DARTMOUTH COLLEGE	7 LEBANON ST	HANOVER	NH	03755	GRAFTON	USA	Drug Use and Addiction Research Programs	000	5	2/25/2026	NON-COMPETING CONTINUATION	$0
														Subtotal = $780,228

Issue Date FY: 2025 ( Subtotal = $0 )
2025	2024	TRUSTEES OF DARTMOUTH COLLEGE	7 LEBANON ST	HANOVER	NH	03755	GRAFTON	USA	Drug Use and Addiction Research Programs	000	5	7/28/2025	NON-COMPETING CONTINUATION	$0
														Subtotal = $0

Issue Date FY: 2024 ( Subtotal = $534,160 )
2024	2024	TRUSTEES OF DARTMOUTH COLLEGE	7 LEBANON ST	HANOVER	NH	03755	GRAFTON	USA	Drug Use and Addiction Research Programs	000	5	6/24/2024	NON-COMPETING CONTINUATION	$534,160
														Subtotal = $534,160

Issue Date FY: 2023 ( Subtotal = $624,937 )
2023	2023	TRUSTEES OF DARTMOUTH COLLEGE	7 LEBANON ST	HANOVER	NH	03755	GRAFTON	USA	Drug Use and Addiction Research Programs	000	4	6/26/2023	NON-COMPETING CONTINUATION	$624,937
														Subtotal = $624,937

Issue Date FY: 2022 ( Subtotal = $654,577 )
2022	2022	TRUSTEES OF DARTMOUTH COLLEGE	7 LEBANON ST	HANOVER	NH	03755	GRAFTON	USA	Drug Use and Addiction Research Programs	000	3	7/12/2022	NON-COMPETING CONTINUATION	$654,577
														Subtotal = $654,577

Issue Date FY: 2021 ( Subtotal = $548,854 )
2021	2021	TRUSTEES OF DARTMOUTH COLLEGE	6001 PARKHURST HALL STE 207	HANOVER	NH	03755	GRAFTON	USA	Drug Use and Addiction Research Programs	001	2	6/18/2021	NON-COMPETING CONTINUATION	$548,854
2021	2020	TRUSTEES OF DARTMOUTH COLLEGE	1 HINMAN DARTMOUTH COLLEGE	HANOVER	NH	03755	GRAFTON	USA	Drug Use and Addiction Research Programs	000	1	2/24/2021	NEW	$0
														Subtotal = $548,854

Issue Date FY: 2020 ( Subtotal = $698,204 )
2020	2020	TRUSTEES OF DARTMOUTH COLLEGE	1 HINMAN DARTMOUTH COLLEGE	HANOVER	NH	03755	GRAFTON	USA	Drug Use and Addiction Research Programs	000	1	9/18/2020	NEW	$698,204
														Subtotal = $698,204

Grand Total All Awards = $3,840,960

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Cannabis Use for Chronic Pain: Advancing Knowledge and Cannabis Use Disorder Assessment with a Mixed Methods Approach

Award Number: R01DA050032

ORGANIZATION: NATIONAL INSTITUTE ON DRUG ABUSE

OPDIV: NIH

AWARD CLASS: DISCRETIONARY

AWARD ACTIVITY TYPE: SCIENTIFIC/HEALTH RESEARCH (INCLUDES SURVEYS)

PERIOD OF PERFORMANCE START DATE: 09/30/2020

PERIOD OF PERFORMANCE END DATE: 01/31/2031

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