Journal Article Annotations
2019, 4th Quarter


Annotations by Walter Luchsinger, MD, FAPA
December 2019

  1. Association Between Marijuana Use and Risk of Cancer A Systematic Review and Meta-analysis
  2. Patient-centered Outcomes in Participants of a Buprenorphine Monthly Depot (BUP-XR) Double-blind, Placebo-controlled, Multicenter, Phase 3 Study
PUBLICATION #1 — Addiction
Association Between Marijuana Use and Risk of Cancer A Systematic Review and Meta-analysis.
Mehrnaz Ghasemiesfe, MD; Brooke Barrow, BA; Samuel Leonard, MS; et al Salomeh Keyhani, MD, MPH; Deborah Korenstein, MD.

The Finding: 

This systematic review and meta-analysis identified 25 English-language studies assessing marijuana use and the risk for developing lung, head and neck, urogenital, and other cancers. In meta-analyses, regular marijuana use was associated with development of testicular germ cell tumors, although the strength of evidence was low; evidence regarding other cancers was insufficient. Sustained marijuana use may increase the risk for testicular cancer, but overall, the association of marijuana use and cancer development remains unclear.

Strength and weaknesses 

Strengths: A Systematic Review and Meta-analysis

Weaknesses: This systematic review and meta-analysis has limitations. Non–English-language articles were excluded; therefore, we may have overlooked relevant studies. Study populations were young, and few studies measured longitudinal exposure. The included studies were often limited by selection bias, recall bias, small sample of marijuana-only smokers, reporting of outcomes on marijuana users and tobacco users combined, and inadequate follow-up for the development of cancer. In addition, despite clear methodological differences across studies, we pooled some data. Although we used a conservative approach, these pooled estimates provide only a rough approximation of the association. Most studies poorly assessed exposure, and some studies did not report details on exposure, preventing meta-analysis for several outcomes. Understanding of the long-term health consequences of marijuana use could be improved by standardizing assessment tools to quantify use, including studies with larger samples of marijuana-only smokers, performing subanalysis based on form of use, and having longer follow-up times.

The findings are notable in a time of increasing marijuana use in the United States, with novel drug delivery methods, including vaping and edibles, becoming more popular, particularly in states that have legalized recreational useand among adolescents.

Type of study
A Systematic Review and Meta-analysis

PUBLICATION #2 — Addiction
Patient-centered Outcomes in Participants of a Buprenorphine Monthly Depot (BUP-XR) Double-blind, Placebo-controlled, Multicenter, Phase 3 Study
Ling, Walter MD; Nadipelli, Vijay R. MS; Solem, Caitlyn T. PhD; Ronquest, Naoko A. PhD; Yeh, Yu-Chen MS; Learned, Susan M. MD; Mehra, Vishaal MD; Heidbreder, Christian PhD.


The Finding
Participants receiving up to 6 monthly injections of BUP-XR compared with placebo consistently showed improved health status and HRQoL, increased medication satisfaction, higher employment rates and hours worked, and increased health insurance coverage without incurring additional healthcare utilization.n

Strength and weaknesses: 

Strengths: Double-blind, Placebo-controlled, Multicenter trial

Weaknesses: There are some limitations of this study. As this trial was powered based on the primary clinical endpoint of abstinence, it may not be powered to detect differences for certain patient-centered outcome measures. The statistical models used assume data were missing at random; nevertheless, the possibility that data were missing not at random exists; indeed, some differences between patients who completed through end of study and those who did not were observed. The generalizability of our results to a broader population of people with OUD seeking treatment warrants further study. Additional research on the applicability of our observed results in a real-world OUD population is needed.

Removing the daily burden of medication management may allow people with OUD to focus more on living a full life. The beneficial effects of a full life can be measured by evaluating outcomes pertaining to HRQoL, employment, and healthcare use. The use of HRQoL endpoints in OUD treatment programs remains rare. To date, no randomized controlled trial of OUD treatment has investigated the effect of treatment on recovery. 

Type of study
A double-blind, Placebo-controlled, Multicenter trial