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Does Cannabinoid Use Reduce Opioid Utilization Among Patients with Gastrointestinal Cancer? Evidence from Epic

Eshetu B Worku1, Selamawit A Woldesenbet1, Timothy M Pawlik1

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Medical cannabis did not reduce opioid use in early chemotherapy for GI cancers. Prescribing was higher for pancreatic cancer patients and Black patients, indicating varied supportive care practices.

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Area of Science:

  • Oncology
  • Pharmacology
  • Health Services Research

Background:

  • Opioid use is common in gastrointestinal (GI) cancer patients undergoing chemotherapy.
  • The role of medical cannabis in managing pain and reducing opioid consumption during early chemotherapy is not well understood.

Purpose of the Study:

  • To investigate the association between cannabinoid prescribing and opioid use in patients with GI cancers initiating chemotherapy.
  • To identify factors associated with cannabinoid prescribing in this patient population.

Main Methods:

  • Retrospective analysis of 144,981 patients with GI cancers initiating chemotherapy from the Epic COSMOS database (2016-2025).
  • Cannabis exposure defined by FDA-approved cannabinoid prescriptions recorded in EHR; non-prescription cannabis excluded.
  • Exclusion criteria included prior cannabis/opioid use and death within 90 days; multivariable logistic regression used to assess factors associated with cannabinoid use.

Main Results:

  • Only 2.4% of patients received cannabinoids within 90 days of chemotherapy initiation.
  • Cannabinoid recipients were more likely to receive opioids (60.6%) compared to nonrecipients (31.1%).
  • Adjusted analyses showed higher cannabinoid prescribing among Black patients, women, and those with pancreatic cancer; prescribing varied by region and declined over time.

Conclusions:

  • Early cannabinoid prescribing was not linked to reduced opioid use in GI cancer patients starting chemotherapy.
  • Cannabinoid use was more prevalent in pancreatic cancer patients and Black patients.
  • Findings highlight significant clinical and structural variations in supportive care delivery for cancer patients.