Protocol: mixed-methods study of how implementation of US state medical cannabis laws affects treatment of chronic non-cancer pain and adverse opioid outcomes.
Protocol: mixed-methods study of how implementation of US state medical cannabis laws affects treatment of chronic non-cancer pain and adverse opioid outcomes.
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DOI：
10.1186/s13012-020-01071-2
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发表时间：
2021-01-07
期刊：
影响因子：
--
通讯作者：
Stuart EA
中科院分区：
文献类型：
--
作者：
McGinty EE;Tormohlen KN;Barry CL;Bicket MC;Rutkow L;Stuart EA
美国33个州和华盛顿特区已经颁布了医用大麻法律，允许慢性非癌症疼痛患者在医生建议的情况下使用大麻来控制自己的病情。然而，临床指南不推荐大麻用于治疗慢性非癌症疼痛，因为有效性的证据有限且喜忧参半。州医用大麻法律如何影响慢性非癌症疼痛循证治疗的交付尚不清楚。这些法律可能导致用大麻取代临床指南--不协调的阿片类药物处方，降低阿片类药物使用障碍和过量使用的风险。相反，国家医用大麻法律可能导致用大麻取代符合指南的治疗方法，如局部止痛药或理疗。该方案描述了一项混合方法研究，考察了国家医用大麻法律在治疗慢性非癌症疼痛方面的实施情况和效果。这项研究的一个关键贡献是检查了国家医用大麻法律的政策实施规则的差异如何影响慢性非癌症疼痛治疗的接受。这项研究采用了并行嵌入式设计。这项研究的主要量化部分采用了差异性设计，采用了政策试验模拟方法。定量分析将评估国家医用大麻法律对慢性非癌症疼痛的治疗以及在慢性非癌症疼痛患者中接受阿片类药物使用障碍、阿片类药物过量、大麻使用障碍和大麻中毒治疗的影响。二次定性和调查方法将通过对州领导人的采访和对医用大麻法律所在州治疗慢性非癌症疼痛的医生和经历过慢性非癌症疼痛的患者的代表性调查，来描述州医用大麻法律的执行情况。这项研究将审查医用大麻法律对患者接受符合指南的非阿片类药物、非大麻治疗慢性非癌症疼痛的影响，并就国家医用大麻法律对阿片类药物不良后果的影响产生新的证据。结果将为许多州每年审议、颁布和/或修订医用大麻法律的动态政策环境提供信息。
Thirty-three US states and Washington, D.C., have enacted medical cannabis laws allowing patients with chronic non-cancer pain to use cannabis, when recommended by a physician, to manage their condition. However, clinical guidelines do not recommend cannabis for treatment of chronic non-cancer pain due to limited and mixed evidence of effectiveness. How state medical cannabis laws affect delivery of evidence-based treatment for chronic non-cancer pain is unclear. These laws could lead to substitution of cannabis in place of clinical guideline-discordant opioid prescribing, reducing risk of opioid use disorder and overdose. Conversely, state medical cannabis laws could lead to substitution of cannabis in place of guideline-concordant treatments such as topical analgesics or physical therapy. This protocol describes a mixed-methods study examining the implementation and effects of state medical cannabis laws on treatment of chronic non-cancer pain. A key contribution of the study is the examination of how variation in state medical cannabis laws’ policy implementation rules affects receipt of chronic non-cancer pain treatments. The study uses a concurrent-embedded design. The primary quantitative component of the study employs a difference-in-differences design using a policy trial emulation approach. Quantitative analyses will evaluate state medical cannabis laws’ effects on treatment for chronic non-cancer pain as well as on receipt of treatment for opioid use disorder, opioid overdose, cannabis use disorder, and cannabis poisoning among people with chronic non-cancer pain. Secondary qualitative and survey methods will be used to characterize implementation of state medical cannabis laws through interviews with state leaders and representative surveys of physicians who treat, and patients who experience, chronic non-cancer pain in states with medical cannabis laws. This study will examine the effects of medical cannabis laws on patients’ receipt of guideline-concordant non-opioid, non-cannabis treatments for chronic non-cancer pain and generate new evidence on the effects of state medical cannabis laws on adverse opioid outcomes. Results will inform the dynamic policy environment in which numerous states consider, enact, and/or amend medical cannabis laws each year.
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