Examining the Synergistic Effects of Cannabis and Prescription Opioid Policies on Chronic Pain, Opioid Prescribing, and Opioid Overdose

家长奖摘要 在过去的17年里，阿片类药物过量死亡人数的迅速上升与处方阿片类药物的三倍相吻合。 (PO)处方分发，主要是治疗慢性疼痛。苯二氮卓类药物联合处方增加 （BZD）和阿片类药物也大大增加了过量的风险。大麻被提议作为一种 慢性疼痛的替代治疗，可以改善阿片类药物戒断症状并帮助恢复 阿片类药物和BZD依赖两大政策转变可能会改变处方做法和滥用 PO和BZD。首先，在过去的十年中，大多数州都制定了规范PO处方的政策 和配药。第二，自1996年以来，29个州将大麻用于医疗目的合法化，9个州将大麻用于医疗目的合法化。 美国各州已将娱乐用大麻合法化。规范PO访问的政策可能会减少 用于慢性疼痛的阿片类药物处方和同时发生的PO/BZD处方的数量，而法律允许 更容易获得大麻可能会提供PO，海洛因和BZD的替代品。更严格的PO组合 政策和限制较少的大麻法律可能会在更大程度上减少阿片类药物相关的危害 独自衡量。随着各州对PO政策和大麻法律做出前所未有的改变，我们需要 审查这两类措施对阿片类药物处方的独立和协同作用 实践和阿片类药物过量，有和没有BZD。我们建议在两个人群中实现这一目标：（1） 在美国人口中，使用国家统计局各州嵌套的个人重复横截面数据， 药物使用和健康调查;（2）在患有慢性疼痛的医疗补助患者中（10次 相对于私人保险患者，阿片类药物使用障碍的风险更大），使用45个州的医疗补助分析 提取纵向队列。我们的具体目标是：（1）检查，在NSDUH，是否非医疗用途的PO， BZD和海洛因以及阿片类药物和BZD使用障碍减少（大麻使用/障碍增加）， 与趋势相比，2004-2019年颁布的PO政策限制性更强，大麻法律限制性更弱 在没有制定这些措施的州;（2）测试医疗补助患者是否不太可能有 阿片类药物处方（单独和与BZD重叠）、慢性疼痛和阿片类药物的门诊访视的声明 在制定更具限制性的PO政策后过量（伴或不伴BZD过量） 2001-2019年，与没有制定这些法律的州的患者相比， 措施对于目标2，我们将每年对10，000名患有慢性疼痛的医疗补助患者进行抽样， 4年（n= 190，000），并将队列组合联合收割机以构建加速纵向队列。国将 根据其PO策略的限制性或宽松程度来分类（例如，处方药监测项目，疼痛 诊所条例），以及他们是否将大麻合法化用于医疗和/或娱乐用途。之际 阿片类药物过量死亡正在以前所未有的速度增加，这项研究将提供关键的，政策相关的 关于最有可能结束阿片类药物流行病的政策类型的调查结果。

Parent Award Abstract The rapid rise in opioid overdose deaths in the past 17 years has coincided with a tripling of prescription opioid (PO) prescriptions dispensed, largely to treat chronic pain. Increased co-prescription of benzodiazepines (BZDs) and opioids also substantially increased the risk of overdose. Cannabis has been proposed as an alternative treatment for chronic pain that could ameliorate opioid withdrawal symptoms and assist in recovery from opioid and BZD dependence. Two major policy shifts are likely to change prescribing practices and abuse of POs and BZDs. First, in the past decade, most states have enacted policies that regulate PO prescribing and dispensing. Second, since 1996, 29 states have legalized use of cannabis for medical purposes, and 9 states have legalized cannabis for recreational use. Policies that regulate access to POs may decrease the number of opioid prescriptions for chronic pain and co-occurring PO/BZD prescribing, while laws that allow greater access to cannabis may offer a substitute for POs, heroin, and BZDs. The combination of stricter PO policies and less restrictive cannabis laws may reduce opioid-related harm to a greater extent than either measure alone. As states make unprecedented changes to PO policies and cannabis laws, we need to examine the independent and synergistic contributions that both types of measures have on opioid prescribing practices and opioid overdoses, with and without BZDs. We propose to pursue this aim in two populations: (1) in the U.S. population, using repeated cross-sectional data of individuals nested in states from the National Survey on Drug Use and Health; and (2) among Medicaid patients with chronic pain (who have 10 times greater risk of opioid use disorder relative to privately insured patients), using a 45-state Medicaid Analytic Extract longitudinal cohort. Our specific aims are: (1) to examine, in NSDUH, whether nonmedical use of POs, BZDs and heroin, and opioid and BZD use disorders decrease (and cannabis use/disorder increases) following enactment of more restrictive PO policies and less restrictive cannabis laws in 2004-2019, compared to trends in states that did not enact these measures; and (2) to test whether Medicaid patients are less likely to have claims for opioid prescribing (alone and overlapping with BZDs), clinic visits for chronic pain, and opioid overdoses (with and without co-occurring BZD overdose) following enactment of more restrictive PO policies and less restrictive cannabis laws in 2001-2019, compared to patients in states that did not enact these measures. For Aim 2, we will sample 10,000 Medicaid patients with chronic pain per year, follow each cohort for 4 years (n=190,000), and combine the cohorts to construct an accelerated longitudinal cohort. States will be classified by how restrictive or lenient their PO policies are (e.g., prescription drug monitoring programs, pain clinic regulations), and whether they legalized cannabis for medical and/or recreational use. At a time when opioid overdose deaths are increasing at an unprecedented rate, this study will provide critical, policy-relevant findings about the types of policies that are most likely to end the opioid epidemic.