Recreational marijuana legalization and prescription opioids received by Medicaid enrollees
Recreational marijuana legalization and prescription opioids received by Medicaid enrollees
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DOI：
10.1016/j.drugalcdep.2018.09.016
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发表时间：
2019-01-01
影响因子：
4.2
通讯作者：
Grant, Igor
中科院分区：
文献类型：
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作者：
Shi, Yuyan;Liang, Di;Grant, Igor
目的：医用大麻的使用可能取代处方阿片类药物的使用，而非医用大麻的使用可能是处方阿片类药物滥用的一个风险因素。本研究探讨了娱乐性大麻合法化和处方阿片类药物之间的关联收到的Medicaid enrollees.Methods：国家一级的季度处方药使用记录的医疗补助参保人在2010-2017年期间，从医疗补助国家药物利用数据。主要结局是收到的阿片类药物处方，通过三个人口调整变量来衡量：阿片类药物处方数量、阿片类药物处方总剂量（吗啡毫克当量）以及每100名注册者每季度的相关医疗补助支出。两个差异中的差异模型被用来测试这种关联：在研究期间将娱乐性大麻合法化的八个州和DC首先进行了比较，然后与研究期间之前将医用大麻合法化的六个州进行了比较。附表II和III阿片类药物分别进行了分析。结果：在比较八个州和DC的模型中，合法化与附表II阿片类药物的结果无关; 2015年娱乐性大麻合法化与处方数量，总剂量和附表III阿片类药物支出减少32%有关（95% CI：（-49%，-15%），p = 0.003）、30%（（-55%，-4.4%），p = 0.027）和31%（（-59%，-3.6%），p = 0.031）。在模型比较八个州和DC六个州与医用大麻合法化，娱乐性大麻合法化与任何阿片类药物outcome.Conclusions：没有证据表明，娱乐性大麻合法化增加处方阿片类药物收到的医疗补助登记。在一些州，有证据表明，在合法化后，附表三阿片类药物有所减少。
Objectives: Medical marijuana use may substitute prescription opioid use, whereas nonmedical marijuana use may be a risk factor of prescription opioid misuse. This study examined the associations between recreational marijuana legalization and prescription opioids received by Medicaid enrollees.Methods: State-level quarterly prescription drug utilization records for Medicaid enrollees during 2010-2017 were obtained from Medicaid State Drug Utilization Data. The primary outcome, opioid prescriptions received, was measured in three population-adjusted variables: number of opioid prescriptions, total doses of opioid prescriptions in morphine milligram equivalents, and related Medicaid spending, per quarter per 100 enrollees. Two difference-in-difference models were used to test the associations: eight states and DC that legalized recreational marijuana during the study period were first compared among themselves, then compared to six states with medical marijuana legalized before the study period. Schedule II and III opioids were analyzed separately.Results: In models comparing eight states and DC, legalization was not associated with Schedule II opioid outcomes; having recreational marijuana legalization effective in 2015 was associated with reductions in number of prescriptions, total doses, and spending of Schedule III opioids by 32% (95% CI: (-49%, -15%), p = 0.003), 30% ((-55%, -4.4%), p = 0.027), and 31% ((-59%, -3.6%), p = 0.031), respectively. In models comparing eight states and DC to six states with medical marijuana legalization, recreational marijuana legalization was not associated with any opioid outcome.Conclusions: No evidence suggested that recreational marijuana legalization increased prescription opioids received by Medicaid enrollees. There was some evidence in some states for reduced Schedule III opioids following the legalization.