Is Cannabis being used as a substitute for non-medical opioids by adults with problem substance use in the United States? A within-person analysis.
Is Cannabis being used as a substitute for non-medical opioids by adults with problem substance use in the United States? A within-person analysis.
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DOI：
10.1111/add.15228
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发表时间：
2021-05
期刊：
影响因子：
--
通讯作者：
Hasin D
中科院分区：
文献类型：
--
作者：
Gorfinkel LR;Stohl M;Greenstein E;Aharonovich E;Olfson M;Hasin D
生态学研究表明，大麻合法化可能导致阿片类药物过量死亡的减少。这类研究没有提供关于个人是否在不同时间点用大麻取代阿片类药物的信息。目前的研究评估了大麻与阿片类药物使用之间的日常关联的程度，在使用非医用阿片类药物的有痛和无痛的成年人中。前瞻性队列研究。大纽约地区和郊区的住院成瘾项目。2016年5月至2019年6月招募的使用非医用阿片类药物的有问题物质使用的成年人。分析样本包括211名参与者的13271天的观察(男性占41%，白人占41%，未婚占78%，失业占80%，平均年龄43岁)。参与者完成了面试者和自我管理的计算机化调查，然后在接下来的90天里每天对交互式语音应答(IVR)系统进行回应。主要的暴露，大麻使用和疼痛，被定义为对IVR问题做出肯定的反应：“你昨天使用大麻了吗？”和分别认可基线上的中度或重度疼痛。在90天的随访中，主要结果是非医疗或非法使用阿片类药物，被定义为对IVR问题的肯定回答：“你昨天使用海洛因了吗？”或者“你昨天是否超过处方或没有处方地使用处方阿片类药物？”平均IVR完成率为70%。表明同一天使用大麻和阿片类药物的未调整优势比(AOR)为2.00[95%可信区间(CI)=1.54-2.59]。控制人口学特征、招募方法、基线阿片类药物类型和疼痛后，AOR为1.86(95%CI=1.44~2.41)。一项关于疼痛和大麻使用之间相互作用的测试，以确定大麻与阿片类药物使用之间的关联在中度到重度疼痛和轻度疼痛之间是否存在差异，这一测试没有定论。在使用非医用阿片类药物的美国成年人中，使用阿片类药物的几率似乎在使用大麻的日子里大约翻了一番。这种关系在中度或重度疼痛的人与中度疼痛的人之间似乎没有区别，这表明大麻没有被用作非法阿片类药物的替代品。
Ecological studies have suggested that Cannabis legalization might have led to a decrease in opioid overdose deaths. Such studies do not provide information about whether individuals are substituting Cannabis for opioids at different points in time. The current study assessed the magnitude of the daily association between Cannabis and opioid use in individual adults with and without pain who use non-medical opioids. Prospective cohort study. The greater New York area and a suburban inpatient addiction program. Adults with problem substance use who use non-medical opioids, recruited from May 2016–June 2019. The analytical sample included 13 271 days of observation among 211 participants (64% male, 41% white, 78% unmarried, 80% unemployed, mean age 43 years). Participants completed interviewer- and self-administered computerized surveys, and then responded to an interactive voice response (IVR) system daily for the following 90 days. The main exposures, Cannabis use and pain, were defined as responding affirmatively to the IVR question: ‘Did you use Cannabis yesterday?’ and endorsing moderate or severe pain at baseline, respectively. The main outcome, non-medical or illicit opioid use during 90-day follow-up, was defined as responding affirmatively to IVR question: ‘Did you use heroin yesterday?’ or ‘Did you use prescription opioids more than prescribed or without a prescription yesterday?’. The mean IVR completion rate was 70%. The unadjusted odds ratio (aOR) indicating same-day use of Cannabis and opioids was 2.00 [95% confidence interval (CI) = 1.54–2.59]. Controlling for demographic characteristics, recruitment method, opioid types at baseline and pain, the aOR was 1.86 (95% CI = 1.44–2.41). A test of interaction between pain and Cannabis use to determine if the association of Cannabis with opioid use differed between people with moderate-to-severe pain and less-than-moderate pain was inconclusive. Among US adults with problem substance use who use non-medical opioids, the odds of opioid use appear to be approximately doubled on days when Cannabis is used. This relationship does not appear to differ between people with moderate or more severe pain versus less than moderate pain, suggesting that Cannabis is not being used as a substitute for illegal opioids.
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影响因子：
3.7
作者：
Hasin DS;Aharonovich E;Greenstein E
通讯作者：
Greenstein E
影响因子：
39
作者：
Bachhuber, Marcus A.;Saloner, Brendan;Cunningham, Chinazo O.;Barry, Colleen L.
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影响因子：
9.7
作者：
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影响因子：
3.9
作者：
Aharonovich, Efrat;Stohl, Malka;Hasin, Deborah
通讯作者：
Hasin, Deborah
影响因子：
7.7
作者：
Greenland, S
通讯作者：
Greenland, S