Impact of Recreational Cannabis Legalization on Opioid Prescribing and Opioid-Related Hospital Visits in Colorado: an Observational Study.
Impact of Recreational Cannabis Legalization on Opioid Prescribing and Opioid-Related Hospital Visits in Colorado: an Observational Study.
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DOI：
10.1007/s11606-023-08195-3
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发表时间：
2023-09
影响因子：
5.7
通讯作者：
Pacula, Rosalie Liccardo
中科院分区：
文献类型：
--
作者：
Buttorff, Christine;Wang, George Sam;Wilks, Asa;Tung, Gregory;Kress, Amii;Schwam, Dan;Pacula, Rosalie Liccardo
大麻可能是阿片类药物的替代品，但以前的研究在使用最近几年的数据时发现了相互矛盾的结果。大多数研究都使用州一级的数据来检查这种关系，而忽略了大麻获取方面的重要亚州差异。以科罗拉多州为例，审查县一级阿片类药物使用大麻合法化的情况。科罗拉多州于2014年1月允许娱乐性大麻商店。当地社区可以决定是否允许药房，从而造成暴露在大麻销售点的水平不同。观察性的准实验设计，利用县级娱乐性药房津贴的差异。科罗拉多州居民我们使用科罗拉多州税务局的许可证信息来衡量县一级对大麻销售点的暴露。我们使用州处方药监测计划(2013-2018)来构建阿片类药物处方措施，包括30天灌装数量和总吗啡当量，每县居民每季度。我们使用科罗拉多州医院协会的数据构建了与阿片类药物相关的住院患者就诊(2011-2018)和急诊科就诊(2013-2018)的结果。我们在差异差异框架中使用线性模型，解释了随着时间的推移，医用和娱乐用大麻的不同暴露情况。分析中使用了2048个县季度的观察数据。我们发现，在县一级，大麻暴露对阿片类药物相关结果的影响喜忧参半。我们发现，娱乐性大麻暴露的增加与30天灌装(系数：−117.6，p值为0.01)和住院次数(系数：−0.8，p值：0.03)的统计显著减少有关，但与MME和ED的总就诊次数无关。在娱乐合法化之前没有医疗接触的县与之前有医疗接触的县相比，30天填充量和MME的数量减少得更多(p=0.02)。我们的混合研究结果表明，大麻的进一步增加超出了医疗范围，可能并不总是减少阿片类药物的处方或在人口层面上与阿片类药物相关的医院就诊。
Cannabis may be a substitute for opioids but previous studies have found conflicting results when using data from more recent years. Most studies have examined the relationship using state-level data, missing important sub-state variation in cannabis access. To examine cannabis legalization on opioid use at the county level, using Colorado as a case study. Colorado allowed recreational cannabis stores in January 2014. Local communities could decide whether to allow dispensaries, creating variation in the level of exposure to cannabis outlets. Observational, quasi-experimental design exploiting county-level variation in allowance of recreational dispensaries. Colorado residents We use licensing information from the Colorado Department of Revenue to measure county-level exposure to cannabis outlets. We use the state’s Prescription Drug Monitoring Program (2013–2018) to construct opioid-prescribing measures of number of 30-day fills and total morphine equivalents, both per county resident per quarter. We construct outcomes of opioid-related inpatient visits (2011–2018) and emergency department visits (2013–2018) with Colorado Hospital Association data. We use linear models in a differences-in-differences framework that accounts for the varying exposure to medical and recreational cannabis over time. There are 2048 county-quarter observations used in the analysis. We find mixed evidence of cannabis exposure on opioid-related outcomes at the county level. We find increasing exposure to recreational cannabis is associated with a statistically significant decrease in number of 30-day fills (coefficient: −117.6, p-value<0.01) and inpatient visits (coefficient: −0.8, p-value: 0.03), but not total MME nor ED visits. Counties with no medical exposure prior to recreational legalization experience greater reductions in the number of 30-day fills and MME than counties with prior medical exposure (p=0.02 for both). Our mixed findings suggest that further increases in cannabis beyond medical access may not always reduce opioid prescribing or opioid-related hospital visits at a population level.
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影响因子：
39
作者：
Bachhuber, Marcus A.;Saloner, Brendan;Cunningham, Chinazo O.;Barry, Colleen L.
通讯作者：
Barry, Colleen L.
影响因子：
9.7
作者：
Bradford, Ashley C.;Bradford, W. David
通讯作者：
Bradford, W. David
影响因子：
4.4
作者：
Dilley, Julia A.;Hitchcock, Laura;Richardson, Susan M.
通讯作者：
Richardson, Susan M.
DOI：
10.1111/add.15228
发表时间：
2021-05
期刊：
Addiction (Abingdon, England)
影响因子：
--
作者：
Gorfinkel LR;Stohl M;Greenstein E;Aharonovich E;Olfson M;Hasin D
通讯作者：
Hasin D
影响因子：
12.7
作者：
Livingston, Melvin D.;Barnett, Tracey E.;Wagenaar, Alexander C.
通讯作者：
Wagenaar, Alexander C.