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的快速上升与处方阿片类药物的三倍增长不谋而合 (Po)配药，主要用于治疗慢性疼痛。增加苯二氮类药物的联合处方 苯并二氮卓类药物和阿片类药物也大大增加了过量服药的风险。大麻已被提议作为一种 可缓解阿片类药物戒断症状并有助于康复的慢性疼痛替代疗法 阿片类药物和BZD依赖。两大政策转变可能会改变开处方的做法和滥用 POS和BZD。首先，在过去的十年里，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个州已将用于医疗目的大麻合法化，9个州 各州已将用于娱乐用途的大麻合法化。监管POS访问的政策可能会减少 治疗慢性疼痛的阿片类药物处方数量和同时出现的PO/BZD处方，而允许 更多地获得大麻可能会成为POS、海洛因和BZD的替代品。结合更严格的PO 政策和限制较少的大麻法律可以在更大程度上减少阿片类药物相关的危害，而不是 单打独斗。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，使用和不使用BZD。我们建议在两个人群中实现这一目标：(1) 在美国人口中，使用国家统计局在各州筑巢的个体的重复横截面数据 药物使用与健康的调查；以及(2)在患有慢性疼痛的医疗补助患者中(他们有10次 与私人保险患者相比，阿片类药物使用障碍的风险更高)，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)在NSDUH检查POS的非医疗用途， BZD和海洛因，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年颁布了限制性更强的PO政策和限制较少的大麻法律 在没有颁布这些措施的州；以及(2)测试医疗补助患者是否不太可能患上 阿片类药物处方(单独和与BZD重叠)、慢性疼痛的诊所就诊和阿片类药物的索赔 在颁布更具限制性的PO政策后，服药过量(合并和不合并BZD过量) 与没有颁布这些法律的州的患者相比，2001-2019年的大麻法律限制较少 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，跟踪每个队列 4年(n=19万)，并结合队列构建加速纵向队列。各州将成为 根据其PO政策的限制或宽松程度进行分类(例如，处方药监控计划、疼痛 诊所条例)，以及是否将用于医疗和/或娱乐用途的大麻合法化。在这个时候， 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、与政策相关的 关于最有可能结束阿片类药物流行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.