Caroline Wilkie

Background: Legalization of cannabis across several US states may increase its use by individuals on hemodialysis, particularly among those with chronic pain. Contemporary data on frequency or factors associated with cannabis use by this population are limited. Methods: We conducted a secondary analysis of the HOPE Consortium Trial to Reduce Pain and Opioid Use in Hemodialysis, a randomized trial that tested whether a cognitive behavioral therapy intervention lowered pain interference in people with chronic pain receiving hemodialysis at 103 US dialysis facilities. We analyzed baseline demographic characteristics, social and medical history, pain intensity, pain interference, and cannabis use. Multivariable logistic regression was used to examine associations of baseline data with cannabis use. Linear regression was used to examine whether cannabis use modified the response to the intervention. Results: Among 643 participants, 102 (16%) reported current cannabis use, 133 (21%) reported former use, and 408 (63%) had never used. Current users were younger than never or past users combined (median age 54 vs. 63 years) and more likely to be disabled (79% vs. 66%), to have received dialysis for >5 years (40% vs. 30%), and to self-report depression (41% vs. 31%), anxiety (28% vs. 20%), or any psychological disorder (51% vs. 38%), and less likely to be married (16% vs. 34%). Current cigarette smoking (odds ratio [OR]=3.22, 95% confidence interval (CI) 1.61-6.46) and alcohol use (OR=2.82, 95% CI 1.37-5.80) were independently associated with cannabis use, as were age, relationship status, neighborhood segregation index, and cocaine/heroin use. Cannabis use did not modify response to the intervention. Conclusions: Current cannabis use was reported by 16% of HOPE participants and was more common among younger, unmarried individuals who use other substances , but did not alter response to our intervention. More research is needed on the consequences of cannabis use among people receiving hemodialysis.

The HOPE Consortium Trial to Reduce Pain and Opioid Use in Hemodialysis was a randomized, controlled trial funded by the National Institute of Diabetes and Digestive and Kidney Diseases. Patients on hemodialysis suffering from chronic pain were randomly assigned to receive usual care or a 12-week pain coping skills training program delivered remotely by trained coaches followed by 12 weeks of skills reinforcement via interactive voice response. Patient advisors participated in all stages of the study, including study design and development of recruitment materials. During the trial, patient advisors met monthly as an Advisory Board. In addition, patient advisors participated in all Steering Committee meetings, including in-person meetings and biweekly remote meetings. Patient advisors were represented on all study committees, with particularly extensive involvement in the Recruitment and Retention Committee. Patient advisors made important contributions to study design and conduct. Their involvement was critical to the study's successful enrollment and retention of study participants. Patient advisors characterized their involvement positively. They attributed their satisfaction with the experience to their full integration into in all aspects of the study and their treatment as equal partners. Several patient advisors have subsequently taken on other research, patient advocacy, or leadership roles, facilitated in part through their participation in the HOPE Trial. This study details the ways patient advisors were enlisted and decided to participate; outlines their many contributions; describes their experience; and provides guidance on how researchers can successfully incorporate patient advisors into future studies.