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

标题：医用大麻法律与物质使用障碍治疗之间的多层次关联 医用大麻法律（MML）在美国越来越多地被采用;超过200万人 一半的人生活在允许医用大麻的州。虽然MML与 物质使用障碍（SUD）的治疗入院，MML和SUD治疗之间的关系 是复杂和动态的，并且可以基于特定的MML规定而变化。例如， 与大麻治疗的增加和阿片类药物治疗的减少有关。 然而，关于MML可以影响的机制，文献中存在关键空白。 SUD治疗使用和相关结局。拟议的研究采用多学科方法， 了解并分离MML对SUD治疗的影响，包括性别和种族/民族， 对个人的核算-（例如，看法）、社区-（例如，刑事司法）和州一级（例如，医疗补助 扩展）因素。估计结构因素（如MML）对SUD治疗使用的影响可能具有 显著的公共卫生影响，因为SUD与各种负面健康后果相关，以及 大多数符合SUD标准的人没有接受SUD治疗。MML对个体SUD的影响 将使用限制使用的全国药物调查的数据来估计治疗需求和看法。 从2004年开始，健康与生活。MML对刑事司法转介到SUD治疗的影响将是 使用1992-2014年治疗Epidemic数据集估计。MML对健康结果的影响， 2004年至2014年的服务成本将在一组接受医疗保险/医疗补助的成年人中进行评估。 将检测性别和人种/种族之间的相互作用，以确定MML是否 有助于改变医疗保健的不平等。本K 01提案中的研究支持国家 药物滥用研究所的目标是“评估联邦、州和系统级政策的影响， 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 纳入执行研究目标，包括：（a）结构性因素的保健差距， SUD治疗;（B）刑事司法、卫生政策和治疗系统之间的动态;（c）卫生 财务和卫生经济学分析。在未来5年内，雄心勃勃的培训和研究目标是可行的 在哥伦比亚大学跨学科导师团队的支持下获得K 01奖（马丁斯博士， Metsch，Hasin和Muennig）和合作者（Fagan博士，Crystal和Alexandre），最终在 开发R 01。职业发展计划将支持申请人的目标和轨迹， 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.