State medical cannabis laws not associated with reduced use of opioid or nonopioid pain treatments

1. State medical cannabis laws not associated with reduced use of opioid or nonopioid pain treatments
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0053
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A study of commercially insured adults with chronic noncancer pain found that state medical cannabis laws did not affect receipt of opioid or nonopioid pain treatment. These findings suggest that cannabis use has not led to large shifts in pain treatment patterns at the population level. The study is published in Annals of Internal Medicine.

In the 37 states and the District of Columbia (D.C.) with medical cannabis laws, people with chronic noncancer pain are eligible to use cannabis for pain management. The concern is that state medical cannabis laws may lead patients with chronic noncancer pain to substitute cannabis in place of prescription opioid or recommended nonopioid prescription pain medications or procedures. However, the research is not clear.

Researchers from Weill Cornell Medicine studied insurance claims data from 12 states that implemented medical cannabis laws and 17 comparison states to assess the effects of such laws on receipt of prescription opioids, nonopioid prescription pain medications, and procedures for chronic noncancer pain. The researchers found that in any given month during the 3 years of law implementation, medical cannabis laws led to a negligible difference in the proportion of patients receiving any pain medication or chronic pain procedure. According to the researchers, slow implementation could contribute to the study findings. Results also may be explained by reluctance among health system leaders and individual clinicians to recommend cannabis for pain.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author, Emma E. McGinty, PhD, please email Christine Zhuang at chz4003@med.cornell.edu.
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2. Repeat testing with a rapid antigen test may be required to rule out SARS-CoV-2 infection
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0385
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A prospective cohort study found that repeat testing in 48-hour intervals with a rapid antigen test (Ag-RDT) may be required to rule out SARS-CoV-2 infection. This means that people testing for SARS-CoV-2 should exercise caution in public settings despite an initial negative result if they suspect they may be infected or have been exposed. The findings are published in Annals of Internal Medicine.

Diagnostic testing for SARS-CoV-2 is an important component in the fight against COVID-19, with at-home rapid tests providing a convenient way for people to test. However, the performance of Ag-RDTs for screening asymptomatic and symptomatic persons for SARSCoV-2 is not well established.

Researchers from the University of Massachusetts Chan Medical School studied 5,353 participants who were asymptomatic and negative for SARS-CoV-2 study day 1 to evaluate the performance of Ag-RDTs. Ag-RDTs were collected at home and reverse transcriptase polymerase chain reaction (RT-PCR) tests were shipped to a central laboratory for analysis. The sensitivity of Ag-RDTs was measured on the basis of testing once (same-day), twice (after 48 hours), and thrice (after 96 hours). Using the PCR test as a comparison, the data showed that the performance of the rapid test was optimized when asymptomatic participants tested 3 times at 48-hour intervals and when symptomatic participants tested 2 times at the same interval. False-positive rates were low for rapid tests, suggesting that repeat testing is not needed for those obtaining a positive result on the first or second try. While testing, people should continue to practice mask wearing and social distancing until infection is ruled out.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Apurv Soni, MD, PhD, please email Sarah Willey at Sarah.Willey@umassmed.edu.
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3. Long-acting injectable ART achieves virologic suppression in patients with detectable viral loads and adherence challenges
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0788
Editorial: https://www.acpjournals.org/doi/10.7326/M23-1427
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A study of publicly insured adults living with HIV found that long-acting injectable antiretroviral therapy (LA-ART) with cabotegravir (CAB) and rilpivirine (RPV) achieved virologic suppression among most people with detectable viral loads and adherence challenges. The study is published in Annals of Internal Medicine.

Efforts to ensure equitable implementation of LA-ART for people with HIV with viral suppression are needed. Injectable CAB and RPV holds promise for improving outcomes among populations with barriers to adherence, but it is only approved for those who have achieved virologic suppression with use of oral ART before initiating injectables.

Researchers from San Francisco General Hospital sought to examine the effect of LA-ART in publicly insured adults living with HIV who either had viral suppression and wished to switch to LA-ART, or people with HIV and viremia who struggled with daily pill adherence but expressed willingness to visit the clinic for regular injections. The cohort faced barriers to adherence, including high rates of unstable housing, mental illness, and substance use. Among 133 patients in the study, 76 started LA-ART with virologic suppression and 57 started with viremia. All but 2 participants with viremia achieved viral suppression at 26 weeks, which is similar to rates from clinical trials.

According to the authors of an accompanying editorial from Boston Medical Center, these findings provide compelling evidence that LA-ART could change the landscape of HIV treatment and prevention by effectively achieving virologic suppression for patients with viremia where there is the greatest need and opportunity.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Monica Gandhi, MD, MPH, please contact monica.gandhi@ucsf.edu.
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4. Gender-affirming care provided to cisgender patients highlights unjust bias against transgender patients
Abstract: https://www.acpjournals.org/doi/10.7326/M23-0704
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Gender-affirming care, such as testosterone therapy and chest surgery, is routinely provided to cisgender patients while legislation in more than 15 states aims to curtail clinician’s authority to provide the same interventions to transgender and gender-diverse (TGD) patients. According to the authors of a commentary published in Annals of Internal Medicine, these gender-affirming procedures are endorsed by every major medical association as standard of care and should be available to all patients without discrimination.

The authors from the Institute for Bioethics and Health Humanities, University of Texas Medical Branch, Galveston demonstrate their point with testosterone therapy and chest surgery because both procedures hold gender affirmation as a goal and share the qualities of being initiated by the patient and evaluated on psychosocial outcomes. Systematic reviews of gender-affirming hormone therapy and surgery for TGD patients report improvements in psychosocial outcomes in many of the same metrics used to evaluate outcomes in cisgender gender-affirming care, including low rates of complications and psychosocial benefits. A look at these procedures shows how current medical practice already provides gender-affirming care for many cisgender patients. Considering how they have been treated differently in practice and policy reveals discrimination being made between categories of people, the authors note.

Media contacts: For an embargoed PDF, please contact Angela Collom at acollom@acponline.org. To speak with the corresponding author Jacob D. Moses, PhD, please contact Christopher Smith Gonzalez at chrissmi@UTMB.EDU.
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