Association between medical cannabis laws and opioid overdose mortality has reversed over time
Association between medical cannabis laws and opioid overdose mortality has reversed over time
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DOI：
10.1073/pnas.1903434116
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发表时间：
2019-06-25
影响因子：
11.1
通讯作者：
Humphreys, Keith
中科院分区：
文献类型：
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作者：
Shover, Chelsea L.;Davis, Corey S.;Humphreys, Keith
自Bachhuber等人以来，医用大麻一直被吹捧为美国阿片类药物过量危机的解决方案。A.巴赫胡贝尔，B。塞隆纳角O.坎宁安角，澳-地L.巴里，美国医学会实习生。174，1668-1673]发现，从1999年到2010年，具有医用大麻法律的州在阿片类镇痛药过量死亡率方面的增长较慢。该研究在科学文献和大众媒体中受到了极大的关注，并成为大麻行业及其倡导者的谈话要点，尽管作者和其他人警告在使用生态相关性得出因果关系时要谨慎，个人层面的结论。在这项研究中，我们使用相同的方法来扩展Bachhuber等人。的分析，直到2017年。不仅原始分析的结果在较长时间内不成立，而且州医用大麻法律与阿片类药物过量死亡率之间的关联从-21%逆转到+23%，并且在考虑娱乐性大麻法律后仍然保持积极。我们还发现，没有证据表明更广泛（娱乐性）或更严格（低四氢大麻酚）的大麻法律与阿片类药物过量死亡率的变化有关。我们发现，医用大麻（约占美国人口的2.5%）不太可能对阿片类药物过量死亡率产生巨大的冲突影响。一个更合理的解释是，这种关联是虚假的。此外，即使这种关系确实存在，也无法通过汇总数据严格辨别。对大麻治疗潜力的研究应该继续，但颁布医用大麻法律将减少阿片类药物过量死亡的说法应该受到怀疑。
Medical cannabis has been touted as a solution to the US opioid overdose crisis since Bachhuber et al. [M. A. Bachhuber, B. Saloner, C. O. Cunningham, C. L. Barry, JAMA Intern. Med. 174, 1668-1673] found that from 1999 to 2010 states with medical cannabis laws experienced slower increases in opioid analgesic overdose mortality. That research received substantial attention in the scientific literature and popular press and served as a talking point for the cannabis industry and its advocates, despite caveats from the authors and others to exercise caution when using ecological correlations to draw causal, individual-level conclusions. In this study, we used the same methods to extend Bachhuber et al.'s analysis through 2017. Not only did findings from the original analysis not hold over the longer period, but the association between state medical cannabis laws and opioid overdose mortality reversed direction from -21% to +23% and remained positive after accounting for recreational cannabis laws. We also uncovered no evidence that either broader (recreational) or more restrictive (low-tetrahydrocannabinol) cannabis laws were associated with changes in opioid overdose mortality. We find it unlikely that medical cannabis-used by about 2.5% of the US population-has exerted large conflicting effects on opioid overdose mortality. A more plausible interpretation is that this association is spurious. Moreover, if such relationships do exist, they cannot be rigorously discerned with aggregate data. Research into therapeutic potential of cannabis should continue, but the claim that enacting medical cannabis laws will reduce opioid overdose death should be met with skepticism.