Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010.
Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010.
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DOI：
10.1001/jamainternmed.2014.4005
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发表时间：
2014-10
影响因子：
39
通讯作者：
Barry, Colleen L.
中科院分区：
文献类型：
--
作者：
Bachhuber, Marcus A.;Saloner, Brendan;Cunningham, Chinazo O.;Barry, Colleen L.
在美国，阿片类镇痛药过量死亡率继续上升，这是由于慢性疼痛处方增加所致。由于慢性疼痛是医用大麻的一个主要适应症，因此建立医用大麻的法律可能会改变与阿片类镇痛剂相关的过量死亡率。确定州医用大麻法律的存在与阿片类镇痛药过量死亡率之间的关联。对1999年至2010年美国医用大麻法律和州一级死亡证明数据进行了时间序列分析;所有50个州都被包括在内。在该州建立医用大麻计划的法律。每个州每10万人口中调整的阿片类镇痛药过量死亡率开发了回归模型，包括州和年固定效应，关于阿片类镇痛药的3种不同政策的存在，以及州特定的失业率。三个州（加州、俄勒冈州和华盛顿）在1999年之前就有医用大麻法。10个州（阿拉斯加、科罗拉多、夏威夷、缅因州、密歇根州、蒙大拿州、内华达州、新墨西哥州、罗得岛和佛蒙特州）在1999年至2010年期间颁布了医用大麻法。与没有医用大麻法的州相比，有医用大麻法的州的平均阿片类药物过量死亡率低24.8%（95%CI，-37.5%至-9.5%; P = 0.003）。在法律实施后的每一年，对医用大麻法律与阿片类镇痛剂过量死亡率之间的关联进行的研究表明，这些法律与较低的过量死亡率有关，并随着时间的推移而普遍加强：（−19.9%; 95% CI，−30.6%至−7.7%; P = .002），第2年（−25.2%; 95% CI，−40.6%至−5.9%; P = .01），第3年（-23.6%; 95%CI，-41.1%至-1.0%; P = 0.04），第4年（−20.2%; 95%CI，−33.6%至−4.0%; P = 0.02）、第5年（−33.7%; 95%CI，−50.9%至−10.4%; P = 0.008）和第6年（−33.3%; 95%CI，−44.7%至−19.6%; P <0.001）。在次要分析中，结果保持相似。医用大麻法律与州一级阿片类药物过量死亡率显着降低有关。需要进一步调查，以确定医用大麻法律如何与旨在防止阿片类镇痛药过量的政策相互作用。
Opioid analgesic overdose mortality continues to rise in the United States, driven by increases in prescribing for chronic pain. Because chronic pain is a major indication for medical cannabis, laws that establish access to medical cannabis may change overdose mortality related to opioid analgesics in states that have enacted them. To determine the association between the presence of state medical cannabis laws and opioid analgesic overdose mortality. A time-series analysis was conducted of medical cannabis laws and state-level death certificate data in the United States from 1999 to 2010; all 50 states were included. Presence of a law establishing a medical cannabis program in the state. Age-adjusted opioid analgesic overdose death rate per 100 000 population in each state. Regression models were developed including state and year fixed effects, the presence of 3 different policies regarding opioid analgesics, and the state-specific unemployment rate. Three states (California, Oregon, and Washington) had medical cannabis laws effective prior to 1999. Ten states (Alaska, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Rhode Island, and Vermont) enacted medical cannabis laws between 1999 and 2010. States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate (95% CI, −37.5% to −9.5%; P = .003) compared with states without medical cannabis laws. Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time: year 1 (−19.9%; 95% CI, −30.6% to −7.7%; P = .002), year 2 (−25.2%; 95% CI, −40.6% to −5.9%; P = .01), year 3 (−23.6%; 95% CI, −41.1% to −1.0%; P = .04), year 4 (−20.2%; 95% CI, −33.6% to −4.0%; P = .02), year 5 (−33.7%; 95% CI, −50.9% to −10.4%; P = .008), and year 6 (−33.3%; 95% CI, −44.7% to −19.6%; P < .001). In secondary analyses, the findings remained similar. Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates. Further investigation is required to determine how medical cannabis laws may interact with policies aimed at preventing opioid analgesic overdose.
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影响因子：
39.2
作者：
Dunn, Kate M.;Saunders, Kathleen W.;Von Korff, Michael
通讯作者：
Von Korff, Michael
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4
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120.7
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Martin, NG
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作者：
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通讯作者：
Hoff, Rani A.