Multi-level associations between medical marijuana laws and substance use disorder treatment

标题：医用大麻法律与药物使用障碍治疗之间的多层次关联 医用大麻法律(MML)在美国各地得到越来越多的采用；超过 一半的人生活在允许医用大麻的州。虽然MML已经与 物质使用障碍(SUDS)的治疗入院情况、MML与SUD治疗的关系 是复杂和动态的，并且可以根据特定的MML条款而变化。例如，大麻药房， 与大麻治疗的增加和阿片类药物治疗入院人数的减少有关。 然而，关于MML可以影响的机制，文献中存在严重的空白 SUD治疗的使用和相关结果。这项拟议的研究采取了多学科的方法 了解和隔离MML对跨性别和种族/民族的SUD治疗的影响， 考虑个人(例如，感知)、社区(例如，刑事司法)和州一级(例如，医疗补助) 扩展)因素。估计MML等结构性因素对SUD治疗使用的影响可能会 重大的公共健康影响，因为肥皂水与各种负面健康后果有关，以及 符合SUD标准的大多数人没有接受SUD治疗。MML对单个SUD的影响 治疗需求和认知将使用限制使用国家药物调查的数据进行评估 从2004年起使用和健康。MML对刑事司法转介至SUD治疗的影响将是 使用1992-2014年的治疗事件数据集进行估计。MML对健康结局的影响和 2004至2014年间的服务成本将在一组拥有联邦医疗保险/医疗补助的成年人中进行评估。 将测试性别和种族/族裔之间的相互作用，以确定MML是否 有助于改变卫生保健方面的差距。这项K01提案中的研究支持国家 药物滥用问题研究所的目标是“评估联邦、州和系统各级政策对以下方面的影响 药物使用和物质使用障碍对公共健康和福祉的影响。三个具体的培训领域将是 纳入以实现研究目标，包括：(A)造成医疗保健差距的结构性因素 (B)刑事司法、保健政策和治疗系统之间的动态；和(C)保健 融资和卫生经济学分析。雄心勃勃的培训和研究目标在5年内是可行的 在哥伦比亚大学跨学科指导团队的支持下获得K01奖(Martins博士， Metsch，Hasin和Muennig)和合作者(博士Fagan，Crystal和Alexandre)，最终在 R01的开发。职业发展计划将支持申请者的目标和发展轨迹 研究独立性。

TITLE: Multi-level associations between medical marijuana laws and substance use disorder treatment Medical marijuana laws (MMLs) have been increasingly adopted throughout the United States; more than half of people live in states that permit medical use of marijuana. While MMLs have been associated with treatment admissions for substance use disorders (SUDs), the relationship between MML and SUD treatment is complex and dynamic and can vary based on specific MML provisions. Marijuana dispensaries, for example, have been associated with increases in marijuana treatment and decreases in opioid treatment admissions. However, there are critical gaps in the literature regarding the mechanisms through which MMLs can affect SUD treatment use and related outcomes. The proposed research takes a multidisciplinary approach to understand and isolate the effects of MML on SUD treatment across gender and racial/ethnic groups, accounting for individual- (e.g., perceptions), community- (e.g., criminal justice), and state-level (e.g., Medicaid expansion) factors. Estimating the effect of structural factors such as MMLs on SUD treatment use could have significant public health impact, as SUDs are associated with a variety of negative health consequences, and the majority of people who meet SUD criteria do not receive SUD treatment. MML effects on individual SUD treatment need and perceptions will be estimated using data from the restricted use National Survey on Drug Use and Health from 2004 onwards. MML effects on criminal justice referrals to SUD treatment will be estimated using the 1992-2014 Treatment Episodes Data Set. The effects of MMLs on health outcomes and service costs between 2004 and 2014 will be assessed in a cohort of adults with Medicare/Medicaid. Interactions between gender and race/ethnicity will be tested in order to determine whether MMLs are contributing to changes in health care disparities. The research in this K01 proposal supports the National Institute on Drug Abuse objective to “assess the impact of federal, state-, and systems-level policies related to drug use and substance use disorders on public health and well-being.” Three specific training areas will be incorporated to carry out the research aims, including: (a) structural contributors to health care disparities in SUD treatment; (b) dynamics between criminal justice, health policy, and treatment systems; and (c) health financing and health economics analysis. The ambitious training and research aims are feasible in the 5-year K01 award with the support of the interdisciplinary mentorship team at Columbia University (Drs. Martins, Metsch, Hasin, and Muennig) and collaborators (Dr. Fagan, Crystal and Alexandre), culminating in the development of an R01. The career development plan will support the applicant’s goals and trajectory towards research independence.