Internal Medicine

Medical cannabis participation associated with modest opioid dose reductions in chronic pain

In this Bronx cohort, 204 adults with chronic pain on opioids enrolled in New York’s medical cannabis program and were followed for 18 months. Mean daily opioid dose declined from 73.3 to 57.4 MME during follow-up. Months with a 30-day cannabis supply were associated with 3.53 fewer MME/day versus months without cannabis (β = -3.53; 95% CI, -6.68 to -0.04). Models accounted for time-varying confounders, including unregulated cannabis use and nonprescribed opioid use. 1

Primary care–based methadone improved guideline-concordant care for OUD in Ukraine

This randomized trial assigned 1459 adults with OUD on methadone to primary care–based treatment with telementoring versus specialty clinic care. At 24 months, primary care patients had composite quality health indicator scores 9.1 percentage points higher than specialty clinic patients (95% CI, 6.9-11.2). Both primary and specialty care quality domains improved, suggesting better overall engagement with recommended services. Methadone retention among new patients was similar between groups (67.2% primary care vs 64.7% specialty clinics). 2

Antihypertensive therapy effective in isolated diastolic hypertension across diastolic ranges

An individual patient data meta-analysis pooled 51 BP-lowering trials, including 358,325 participants, of whom 4.4% had isolated diastolic hypertension (IDH). With systolic BP <130 mm Hg, a 5 mm Hg systolic reduction lowered major cardiovascular events similarly in IDH (HR 0.91; 95% CI, 0.82-1.01) and non-IDH (HR 0.90; 95% CI, 0.89-0.92). There was no heterogeneity in treatment effect across baseline diastolic BP levels, down to diastolic BP <60 mm Hg (P for interaction = .26). Relative benefits were consistent by CVD history, age, prior antihypertensive use, and BP measurement method. 3

Risk-based breast cancer screening noninferior to annual mammography for advanced cancers

The WISDOM pragmatic RCT randomized 28,372 US women aged 40–74 years to risk-based versus annual breast cancer screening via an online platform. Risk-based screening used gene panel sequencing, polygenic risk score, and a clinical model to tailor intervals and imaging intensity. Rates of stage IIB or higher cancers were noninferior in the risk-based group: 30.0 versus 48.0 per 100,000 person-years; rate difference -18.0 (95% CI, -40.2 to 4.1). Biopsy rates were not reduced in the risk-based arm compared with annual screening. 4