The Effect of Medical Cannabis Laws on Health Care Use in Insured Populations with Pain

全国范围内都认识到了由发病率和致残率引起的公共卫生挑战 慢性疼痛的患病率。2017年，美国国家科学院发表了一项里程碑式的 回顾文献，发现确凿的证据表明大麻可以有效地 治疗慢性疼痛。到目前为止，31个州和哥伦比亚特区已经采用了医疗 大麻法(MCL)使家庭种植或药房销售大麻合法化 对于符合条件的医疗条件。然而，人们对医学以外的替代品知之甚少。 MCL生效时疼痛的治疗，或这种替代对其他健康的影响 护理利用情况。目前研究的目标是检查MCL和MCL之间的联系 公立和私立慢性非癌性疼痛患者的卫生保健利用 保险计划。使用美国国立卫生研究院2015年国家疼痛战略作为 组织框架方面，我们将进行回顾、纵向、差异分析 在一组患者的处方药和疼痛相关卫生服务利用方面 慢性疼痛在有和没有MCL的状态下。此外，我们还将对以下项目进行细分分析 将居住在农村的患者与居住在城市的患者进行比较，并检查两者之间的关系 神经性和伤害性慢性疼痛患者的MCL和卫生保健利用。 我们将分析每季度测量的患者级别的小组数据。这项研究的数据将来自 医疗保健费用研究所综合私人保险个人样本 索赔数据库(N≈4,000万覆盖生命；2015-2019年)和两个单独的样本 医疗保险和医疗补助的公共参保个人(N≈500万参保人；2011年至2018年) (n≈500万登记人；2011年至2017年)索赔数据库。我们将采用一系列不同的- 对每个参保组分别估计的差异回归。我们的主要政策 变量将是任何实现的MCL的度量值，是按类型的实现的MCL的度量值 (药房、仅限家庭种植或THC油)。个别患者的特征、地区和 州人口统计数据，以及州和季度层面的一系列固定影响将被用作 所有模型中的控件。我们还将在必要时控制政策的内生性。慢性疼痛 和阿片类药物的流行是明显的公共卫生危机。初步证据表明 获得医用大麻可能会改变处方止痛药的使用。因此，至关重要的是 了解慢性疼痛患者MCL与医疗服务利用的关系 为了优化公共政策，并为临床医生提供关于可能的 患者对MCL实施的反应。

There is a nationwide recognition of the public health challenges arising from the incidence and prevalence of chronic pain. In 2017, the National Academies of Sciences published a landmark review of the literature and found conclusive evidence that cannabis can be an effective treatment for chronic pain. To date, 31 states and the District of Columbia have adopted medical cannabis laws (MCLs) legalizing either home cultivation or dispensary-based sales of cannabis for qualifying medical conditions. However, little is known about substitution away from medical treatment of pain when MCLs go into effect, or the impact such substitution has on other health care utilization. The goal of the current study is to examine the association between MCLs and health care utilization for patients with chronic non-cancer pain enrolled in public and private insurance plans. Using the National Institutes of Health 2015 National Pain Strategy as an organizational framework, we will conduct a retrospective, longitudinal, analysis of the difference in prescription medication and pain-related health service utilization in a cohort of patients with chronic pain in states with and without MCLs. In addition, we will conduct sub-analyses for patients living in rural compared to urban areas, and will examine the relationship between MCLs and health care utilization for patients with neuropathic versus nociceptive chronic pain. We will analyze patient-level panel data measured quarterly. Data for this study will come from a sample of privately insured individuals from the Health Care Cost Institute comprehensive claims databases (N ≈ 40 million covered lives; 2015-2019) and two separate samples of publically insured individuals from Medicare (N ≈ 5 million enrollees; 2011-2018) and Medicaid (N ≈ 5 million enrollees; 2011-2017) claims databases. We will employ a series of difference-in- differences regressions estimated separately for each of the insured groups. Our key policy variables will be a measure of any implemented MCL, measures of implemented MCLs by type (dispensary, home-cultivation-only, or THC oils). Individual patient characteristics, county and state demographics, and a series of fixed effects at the state and quarter level will be used as controls in all models. We will also control for policy endogeneity where necessary. Chronic pain and the opioid epidemic are clear public health crises. Preliminary evidence suggests that access to medical cannabis can alter prescription pain medication use. It is thus essential to understand the relationship between MCLs and health care utilization for chronic pain patients in order to optimize public policies and to provide guidance to clinical practitioners on likely patient responses to MCL implementation.