Marijuana During Labour: A Survey of Maternal Opinions.

OBJECTIVE: There is increasing use of marijuana during pregnancy, and online accounts indicate that women are considering use of marijuana for labour pain. However, the number and attitudes of women who would consider this are unknown. METHODS: In a university hospital, over a period of 1 month, a total of 132 women with vaginal deliveries completed a survey exploring attitudes towards labour analgesia and marijuana use. Patients who would and would not consider marijuana for labour pain were compared using chi-square analysis. RESULTS: The percentages of respondents who reported having epidural or intravenous analgesia were 83% (95% confidence interval [CI] 76-89) and 30% (95% CI 23-38), respectively, with 87% (95% CI 79-92) and 86% (95% CI 71-94) being satisfied. However, 34% (95% CI 26-43) of the respondents reported that they would consider the use of marijuana for labour pain. Of these, 25% (95% CI 14-41) had previously used marijuana for pain compared with 0% (95% CI 0-0) who had not, and 72% (95% CI 56-84) thought it acceptable to use marijuana non-medically compared with 35% (95% CI 26-47) who did not (P < 0.001 for both). The greatest worry was the effect of marijuana on the baby, with 26% (95% CI 19-34) being highly worried and 26% (95% CI 19-34) being extremely worried. Many women (60%; 95% CI 51-68) indicated a lack of knowledge of the side effects of marijuana in labour. However, 59% (95% CI 50-67) of respondents said they would feel comfortable discussing this topic with their obstetrician. CONCLUSION: One third of women would consider the use of marijuana for labour pain, although many are unsure of its effects. Most women would feel comfortable discussing this topic with their obstetrician.

Physician and Patient Survey of Taper Schedule and Family Physician Letters Following Discharged from the Acute Pain Service.

PURPOSE: Following discharge, patients requiring high opioid doses may be at risk for both under- and overdosing, posing a major challenge to community physicians. The aim of this study was to examine the effectiveness and degree of satisfaction with a personalized taper schedule and physician letter through interviews of patients and physicians. METHODS: This was a 1-year prospective study. Following ethics approval and informed written consent, patients admitted for elective surgery, 18 to 60 years of age, receiving opioid analgesics, were recruited. Prior to discharge, the acute pain service team provided patients with a taper schedule explained in detail. Individualized physician letters were faxed to treating family physicians. Patients were contacted by phone 2, 4, and 6 weeks after discharge. Physicians were contacted once, a month after discharge. Patients and physicians were asked to grade the taper schedule on a 1- to 5-point Likert scale. Questions pertained to clarity, usefulness, ability to follow the instructions, and general satisfaction. RESULTS: Twenty-six patients and 21 physicians completed the study. Physicians were generally satisfied with both the taper schedule and letter and rated all aspects between 3.76 and 4.38 of 5. Similarly, patients were satisfied with the taper schedule and rated all aspects between 4.08 and 4.5. CONCLUSIONS: Both physicians and patients generally found the taper schedule and letter helpful in assisting them to taper off their opioid use. This is one way of bridging the gap in continuity of care between the acute and primary care providers while reducing the risk to patients during the transition period.