Changes in Prescribed Opioid Dosages Among Patients Receiving Medical Cannabis for Chronic Pain, New York State, 2017-2019.

Importance: Patients with chronic pain often receive long-term opioid therapy (LOT), which places them at risk of opioid use disorder and overdose. This presents the need for alternative or companion treatments; however, few studies on the association of medical cannabis (MC) with reducing opioid dosages exist. Objective: To assess changes in opioid dosages among patients receiving MC for longer duration compared with shorter duration. Design, Setting, and Participants: This cohort study of New York State Prescription Monitoring Program data from 2017 to 2019 included patients receiving MC for chronic pain while also receiving opioid treatment. Of these, patients receiving LOT prior to receiving MC were selected. Individuals were studied for 8 months after starting MC. Data were analyzed from November 2021 to February 2022. Exposures: Selected patients were divided into 2 groups based on the duration of receiving MC: the nonexposure group received MC for 30 days or fewer, and the exposure group received MC for more than 30 days. Main Outcomes and Measures: The main outcome was opioid dosage, measured by mean daily morphine milligram equivalent (MME). Analyses were conducted for 3 strata by opioid dosage prior to receiving MC: MME less than 50, MME of 50 to less than 90, and MME of 90 or greater. Results: A total of 8165 patients were included, with 4041 (median [IQR] age, 57 [47-65] years; 2376 [58.8%] female) in the exposure group and 4124 (median [IQR] age, 54 (44-62) years; 2370 [57.5%] female) in the nonexposure group. Median (IQR) baseline MMEs for the exposure vs nonexposure groups were 30.0 (20.0-40.0) vs 30.0 (20.0-40.0) in the lowest stratum, 60.0 (60.0-70.0) vs 60.0 (60.0-90.0) in the middle stratum, and 150.0 (100.0-216.2) vs 135.0 (100.0-218.0) in the highest stratum. During follow-up, significantly greater reductions in opioid dosage were observed among the exposure group. A dose-response association of patients' opioid dosage at baseline was observed with the differences in the monthly MME reductions between exposure and nonexposure groups, with a difference of -1.52 (95% CI, -1.67 to -1.37) MME for the lowest stratum, -3.24 (95% CI, -3.61 to -2.87) MME for the middle stratum, and -9.33 (95% CI, -9.89 to -8.77) MME for the highest stratum. The daily MME for the last month of the follow-up period among patients receiving longer MC was reduced by 48% in the lowest stratum, 47% in the middle stratum, and 51% in the highest stratum compared with the baseline dosages. Among individuals in the nonexposure group, daily MME was reduced by only 4% in the lowest stratum, 9% in the middle stratum, and 14% in the highest stratum. Conclusions and Relevance: In this cohort study of patients receiving LOT, receiving MC for a longer duration was associated with reductions in opioid dosages, which may lower their risk of opioid-related morbidity and mortality.

Interview expectancies: awareness of potential biases influences behaviour in interviewees.

Expectancy effects are known to influence behaviour so that what is expected appears to be true. In this study, expectancy was induced using (fabricated) information about honesty and specific group membership. Targets were tested in a non-accusatory interview environment using neutral and information-gathering questions. It was hypothesized that those exposed to the negative information (the expectancy) would demonstrate behaviour consistent with an increased cognitive load, and evidence was found to support this prediction. Due to the investigative nature of the information-gathering questions, it was also expected that the targets exposed to the expectancy would exhibit more of these behaviours in the investigative portion of the interview. Some behaviour was found to support this prediction (i.e. shorter responses and increased speech disturbances); however, indicators of performance altering load were not observed during this phase of the interview. These findings support the hypothesis that expectancy effects can noticeably alter interviewee behaviour.

It Takes Two: The Round-Robin Methodology for Investigative Interviewing Research.

Investigative interviews are complex, dyadic, and social interactions typically studied by evaluating interviewers' questioning strategies. In field settings, interviewers naturally vary in their interviewing practice. Thus, it is important to conduct research reflective of idiosyncrasies in witnesses, interviewers, and the resulting unique pairings. This study explored sources of variation in an interview by using a "round-robin" design. Each session of the study involved five witnesses observing five separate events. Witnesses were then simultaneously, but independently interviewed by four different interviewers, or completed a self-administered written interview. This sequence was repeated until each witness had seen every event and had been interviewed by each interviewer. Over nine sessions (N = 45) this produced 225 total interviews. Individual interview performance (accuracy and level of detail) as well as experience (subjective ratings) were then analyzed in relation to the typical performance of the interviewer, the witness, the event, and the unique paring. We found that witnesses and interviewers could have an effect on statement quality; however, the unique interview experience variance had the greatest influence on interview performance. This study presents the round-robin methodology as a useful tool to study realistic variation in interviewer, witness, and dyad behavior. The preprint of this paper is available at psyarxiv.com/tv5gz/, and materials and data are available at osf.io/ef634/files/.