Changes in Opioid and Benzodiazepine Poisoning Deaths After Cannabis Legalization in the US: A County-level Analysis, 2002-2020.
Changes in Opioid and Benzodiazepine Poisoning Deaths After Cannabis Legalization in the US: A County-level Analysis, 2002-2020.
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美国大麻合法化后阿片类药物和苯二氮卓中毒死亡人数的变化：县级分析，2002-2020 年。
DOI：
10.1097/ede.0000000000001609
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Cerdá,Magdalena
中科院分区：
文献类型：
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作者：
Castillo-Carniglia,Alvaro;Rivera-Aguirre,Ariadne;Santaella-Tenorio,Julian;Fink,DavidS;Crystal,Stephen;Ponicki,William;Gruenewald,Paul;Martins,SilviaS;Keyes,KatherineM;Cerdá,Magdalena
背景：医疗和娱乐目的大麻合法化已被认为是减少阿片类药物和苯二氮卓类药物使用和死亡的有效战略。我们研究了2002年至2020年美国县级医疗和娱乐大麻法律与涉及阿片类药物和苯二氮卓类药物的中毒死亡之间的关系。方法：以49个州为研究对象，进行县域生态时空研究。暴露的问题是州级执行医疗和娱乐用大麻法律，以及州级开始在大麻药房销售大麻。我们的主要结局是涉及任何阿片类药物、任何苯二氮卓类药物和阿片类药物与苯二氮卓类药物的中毒死亡。二级分析包括过量使用天然和半合成阿片类药物、合成阿片类药物和海洛因。结果：医用大麻法律的实施与阿片类药物（比率比[RR]= 1.14； 95%可信区间[CrI]= 1.11, 1.18）、苯二氮卓类药物（RR= 1.19； 95%可信区间[CrI]= 1.12, 1.26）和阿片类药物+苯二氮卓类药物（RR= 1.22; 95% CrI= 1.15, 1.30）相关。允许药房的医用大麻合法化与阿片类药物导致的死亡减少相关（RR= 0.88; 95% CrI= 0.85, 0.91），但与苯二氮卓类药物导致的死亡无关；娱乐性大麻使用和阿片类药物死亡的结果相似（RR= 0.81; 95% CrI= 0.75, 0.88）。允许药房销售娱乐性大麻的法律与阿片类药物（RR= 0.83; 95% CrI= 0.76, 0.91）、苯二氮卓类药物（RR= 0.79; 95% CrI= 0.68, 0.92）以及阿片类药物+苯二氮卓类药物相关中毒（RR= 0.83; 95% CrI= 0.70, 0.98）的持续减少有关。结论：医用大麻法的实施与阿片类药物和苯二氮卓类药物相关死亡率较高有关，而允许更广泛获取大麻的法律，包括娱乐性大麻法的实施以及医疗和娱乐性大麻药房的实施，与较低的死亡率有关。扩大大麻供应的估计影响似乎取决于所执行的法律类型及其规定。
Background:Cannabis legalization for medical and recreational purposes has been suggested as an effective strategy to reduce opioid and benzodiazepine use and deaths. We examined the county-level association between medical and recreational cannabis laws and poisoning deaths involving opioids and benzodiazepines in the US from 2002 to 2020.Methods:Our ecologic county-level, spatiotemporal study comprised 49 states. Exposures were state-level implementation of medical and recreational cannabis laws and state-level initiation of cannabis dispensary sales. Our main outcomes were poisoning deaths involving any opioid, any benzodiazepine, and opioids with benzodiazepines. Secondary analyses included overdoses involving natural and semi-synthetic opioids, synthetic opioids, and heroin.Results:Implementation of medical cannabis laws was associated with increased deaths involving opioids (rate ratio [RR]= 1.14; 95% credible interval [CrI]= 1.11, 1.18), benzodiazepines (RR= 1.19; 95% CrI= 1.12, 1.26), and opioids+ benzodiazepines (RR= 1.22; 95% CrI= 1.15, 1.30). Medical cannabis legalizations allowing dispensaries was associated with fewer deaths involving opioids (RR= 0.88; 95% CrI= 0.85, 0.91) but not benzodiazepine deaths; results for recreational cannabis implementation and opioid deaths were similar (RR= 0.81; 95% CrI= 0.75, 0.88). Recreational cannabis laws allowing dispensary sales was associated with consistent reductions in opioid-(RR= 0.83; 95% CrI= 0.76, 0.91), benzodiazepine-(RR= 0.79; 95% CrI= 0.68, 0.92), and opioid+ benzodiazepine-related poisonings (RR= 0.83; 95% CrI= 0.70, 0.98).Conclusions:Implementation of medical cannabis laws was associated with higher rates of opioid-and benzodiazepine-related deaths, whereas laws permitting broader cannabis access, including implementation of recreational cannabis laws and medical and recreational dispensaries, were associated with lower rates. The estimated effects of the expanded availability of cannabis seem dependent on the type of law implemented and its provisions.