# Real Time Monitoring of Prescription Opioid and Cannabis Co-Use in Patients with Chronic Pain

> **NIH NIH R21** · JOHNS HOPKINS UNIVERSITY · 2020 · $204,688

## Abstract

PROJECT SUMMARY
 The opioid epidemic in the US is associated with a dramatic increase in problematic opioid use and
overdoses. Chronic pain affects over 100 million Americans and opioids are frequently prescribed to aid
patients in managing pain. Approximately 25% of patients with chronic pain misuse prescription opioids and
approximately 10% have opioid use disorder (OUD).
 Clinical practice guidelines stress the importance of non-opioid medications or non-pharmacological
interventions for chronic pain and recent population-based studies suggest that patients use cannabis for pain
relief. There is considerable interest in determining whether cannabis and cannabinoid products are viable
alternatives to opioids for pain management. However, the potential opioid-sparing effect of cannabis is based
primarily on studies of correlational findings that are limited by retrospective recall bias. Researchers have
noted the need for intensive longitudinal studies on near real-time co-use of these substances and pain
symptoms in the natural environment. A novel method to evaluate opioid and cannabis use patterns among
patients with chronic pain is Ecological Momentary Assessment (EMA). EMA is ideally suited to collect fine-
grained data on substance use and pain, with low recall bias and high ecological or real-world validity.
 The overarching goal of this R21 exploratory research grant application is to conduct a smartphone-based
real-time observational study using EMA to investigate the relationship between opioid use, cannabis use, and
chronic pain.
 We have assembled a strong team of investigators with critical expertise in EMA, opioid and cannabis
research, and chronic pain. Our preliminary studies have shown that we can conduct EMA studies focusing on
substance use and co-use with different populations. Moreover, we have demonstrated that many cannabis
users report chronic pain as the most important reason for their cannabis use. We have also demonstrated that
there is substantial day-to-day variability in pain and opioid use among patients with chronic pain and may be
influenced by factors other than their prescriptive plan.
 The specific aims of this project are to: 1) Develop an EMA data collection protocol and investigate
participant adherence among chronic pain patients who are using opioids and cannabis. 2) Explore the
temporal interplay of cannabis and opioid use on a day-by-day level and associations between use of these
substances and pain ratings. To attain these aims, we will conduct a study consisting of 2 phases. Phase 1 will
conduct cognitive interviews to refine EMA measures and pilot a 14-day EMA data collection with N=20
participants, including follow-up interviews. EMA questions will be refined and clarified based on participant
feedback. Phase 2 will consist of a 30-day EMA data collection with N=100 chronic pain participants.

## Key facts

- **NIH application ID:** 9893084
- **Project number:** 1R21DA048175-01A1
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Johannes Thrul
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $204,688
- **Award type:** 1
- **Project period:** 2020-03-15 → 2022-02-28

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9893084

## Citation

> US National Institutes of Health, RePORTER application 9893084, Real Time Monitoring of Prescription Opioid and Cannabis Co-Use in Patients with Chronic Pain (1R21DA048175-01A1). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9893084. Licensed CC0.

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