Measuring Response Style Stability Across Constructs With Item Response Trees

Individual response style behaviors, unrelated to the latent trait of interest, may influence responses to ordinal survey items. Response style can introduce bias in the total score with respect to the trait of interest, threatening valid interpretation of scores. Despite claims of response style stability across scales, there has been little research into stability across multiple scales from the beneficial perspective of item response trees. This study examines an extension of the IRTree methodology to include mixed item formats, providing an empirical example of responses to three scales measuring perceptions of social media, climate change, and medical marijuana use. Results show extreme and midpoint response styles were not stable across scales within a single administration and 5-point Likert-type items elicited higher levels of extreme response style than the 4-point items. Latent trait of interest estimation varied, particularly at the lower end of the score distribution, across response style models, demonstrating as appropriate response style model is important for adequate trait estimation using Bayesian Markov chain Monte Carlo estimation.

Racial Differences of Attitudes Towards Medical Marijuana Use Among American Older Adults

Background: Extensive evidence documented that medical marijuana (MM) could be used for pain management with fewer side effects. Although MM legalization remains controversial as it is perceived to be a “gateway drug”, more states are striving for MM legalization and calling for health insurance coverage. Racial difference in the use of opioids for pain management is well-documented, which may also exist in the use of MM. This study explored an understudied topic on how people from different racial backgrounds perceive MM and its behind mechanism. Method: Data is from Health and Retirement Study Wave 2018 who answered the special modules on MM (n=1340). The attitude is proxied by two dichotomous measures on whether they think MM is acceptable and would lead to hard drug. Logistic regressions were used to evaluate the relationships between attitude and race, adjusted for sociodemographic, health and mental health, and MM knowledge. Moderating effects of diseases and socioeconomic-status (SES) were tested using interaction terms. Results: Older adults who hold positive attitudes towards MM are more likely to be younger, high SES, using opioids. Hispanics and Blacks are more negative towards MM relative to White counterparts. Blacks with cancer (OR=.30) are less likely to believe MM is acceptable, whereas blacks with arthritis are more likely to accept MM (OR=2.08) compared to Whites. Hispanic females (OR=.26) are more likely to oppose MM while Hispanics with higher education background (OR=4.3) are more likely to hold positive attitudes. Implication: The results may guide development of future guidelines on MM prescription.

Characteristics of Older Adults Who Were Early Adopters of Medical Cannabis in the Florida Medical Marijuana Use Registry

Use of medical marijuana is increasing in the United States and older adults are the fastest growing user group. There is little information about the characteristics and outcomes related to medical marijuana use. This study is a descriptive analysis of older adults (aged ≥50 years old) who were early adopters of a medical marijuana program in the U.S. state of Florida. Per state legislation, initial and follow-up treatment plans were submitted to the University of Florida College of Pharmacy. Data collection included demographics, clinical history, medical conditions, substance use history, prescription history, and health status. Follow-up treatment plans noted changes in the chief complaint and actions taken since the initial visit. Of the state’s 7548 registered users between August 2016 and July 2017, N = 4447 (58.9%) were older adults. Patients utilized cannabidiol (CBD)-only preparations (45%), preparations that had both tetrahydrocannabinol (THC) and CBD (33.3%) or were recorded to use both CBD-only and THC + CBD products (21.7%). The chief complaints indicating medical cannabis treatment were musculoskeletal disorders and spasms (48.4%) and chronic pain (45.4%). Among other prescription medications, patients utilized antidepressants (23.8%), anxiolytics and benzodiazepines (23.5%), opioids (28.6%), and cardiovascular agents (27.9%). Among all drug classes with potential sedating effects, 44.8% of the cohort were exposed to at least one. Patients with follow-up visits (27.5%) exhibited marked improvement as assessed by the authorizing physicians. However, the patient registry lacked detailed records and linkable information to other data resources to achieve complete follow up in order to assess safety or efficacy. Future improvements to registries are needed to more adequately capture patient information to fill knowledge gaps related to the safety and effectiveness of medical marijuana, particularly in the older adult population.

Potential Adverse Drug Events with Tetrahydrocannabinol (THC) Due to Drug–Drug Interactions

Tetrahydrocannabinol (THC) is the primary psychoactive ingredient in cannabis. While the safety of THC and cannabis has been extrapolated from millennia of recreational use, medical marijuana programs have increased exposure among medically complex individuals with comorbid conditions and many co-prescribed medications. Thus, THC should be recognized as a pharmacologically complex compound with potential for drug–drug interactions and adverse drug events. This review summarizes potential adverse drug events related to THC when combined with other medications. Metabolic drug–drug interactions are primarily due to THC conversion by CYP3A4 and CYP2C9, which can be impacted by several common medications. Further, CYP2C9 polymorphisms are highly prevalent in certain racial groups (up to 35% in Caucasians) and increase the bioavailability of THC. THC also has broad interactions with drug-metabolizing enzymes and can enhance adverse effects of other medications. Pharmacodynamic interactions include neurological effects, impact on the cardiovascular system, and risk of infection. General clinical recommendations for THC use include starting with low doses and titrating to desired effects. However, many interactions may be unavoidable, dose-limiting, or a barrier to THC-based therapy. Future work and research must establish sufficient data resources to capture medical marijuana use for such studies. Meanwhile, clinicians should balance the potential risks of THC and cannabis and the lack of strong evidence of efficacy in many conditions with patient desires for alternative therapy.

Documentation of medical marijuana use in cancer patients

Purpose Medical marijuana is often used as adjuvant therapy in cancer patients for symptom management, although limited evidence-based studies evaluating its efficacy or safety exist. Similar to over-the-counter medications, supplements, or herbal products, documentation of medical marijuana is important to monitor efficacy, potential adverse effects, or interactions. The objective of this quality improvement study was to improve the consistency of medical marijuana documentation in cancer patients by assessing current practices; educating healthcare team members about the importance of documentation and newly established documentation process; and evaluating the new documentation process. Methods This three-part quality improvement study was approved by the Institutional Review Board. In part I, a voluntary survey was sent via email to Cancer Center healthcare personnel to assess the current documentation process of medical marijuana. In part II, a best practice process for documenting medical marijuana in the electronic medical record was established. Medical marijuana was to be listed as a historical medication in the medication list. In-person and electronic education sessions were offered to Cancer Center clinical staff. The education emphasized the importance of documenting medical marijuana use and provided a detailed process for electronic medical record documentation. A pre- and post-test to assess understanding was also included. Part III was a retrospective chart review to evaluate documentation practices of certified medical marijuana users in the Cancer Center. Patients included in the study were greater than 18 years old and certified for medical marijuana use on or after 1 January 2018. Department of Corrections patients were excluded. Descriptive statistics were used for data analysis. Results The survey results in part I demonstrated a lack of consistency in the documentation of medical marijuana in the Cancer Center. The pre- and post-test scores measured in part II showed a significant improvement in understanding after education was provided. The average pre-test score was a 61 and post-test score was 88, indicating an average increase of 27 points. A larger increase in test scores was observed in those attending the in-person education than the online sessions ( p < 0.002). The results of the retrospective chart review in part III revealed 56 patients who met inclusion criteria, but only 39 patients were alive and evaluated at the time of the retrospective chart review. Of the 39 patients, 22 never completed the patient registration process and therefore, would never have been able to obtain medical marijuana. Seven patients had medical marijuana properly documented in their medication list and 10 patients were missing documentation in the medication list, showing room for improvement in documentation practices. Conclusions This quality improvement study led to the implementation of medical marijuana documentation in the medication list. Education increased healthcare team members understanding of medical marijuana utilization and the importance of documentation.