Medical Marijuana Program Participation and Changes in Controlled Substance Use

项目摘要： 美国正在经历前所未有的阿片类药物相关过量死亡率， 阿片类止痛药的使用在过去20年中急剧上升。作为回应，CDC，几个州， 专业组织已经推广了使用非阿片类药物替代品管理疼痛的处方指南 (i.e.,抗炎药、抗抑郁药）。更多的重点是减少 合并使用镇静药物（即苯二氮卓类）和其他受控物质（即 催眠药、肌肉松弛药），协同作用增加致命过量风险，特别是在医学上 妥协的人。最近的报告表明，有医用大麻计划的州 阿片类药物过量死亡率。降低过量率的可能机制包括减少阿片类药物 由于共病焦虑或失眠症状缓解而使用和/或使用镇静药物。 然而，很少有人知道医用大麻计划参与之间的关系， 患者疼痛状况和受控物质使用模式的变化。我们知道的就更少了 关于特定的大麻素产品的差异影响医学分配（如高 四氢大麻酚[THC]与高大麻二酚[CBD]产品）。 纽约州医用大麻计划（2016年1月实施）是最高度的大麻计划之一。 在美国运作的规范和医疗项目。国家许可的药房必须 配备有执业药剂师，并证明他们提供的产品具有一致的大麻素 高THC、高CBD和1：1 THC：CBD产品。因此，纽约州是理想的 对医用大麻计划的参与和大麻素的影响进行严格分析的环境 在慢性疼痛患者中，随着时间的推移，不同THC：CBD比例的产品对受控物质使用的影响。我们 我提议与纽约最大的医用大麻供应商合作（超过10，000名参与者注册为 2017年10月）。通过电子健康记录跟踪参与者活动，患者身份被去除 基线时的特征（人口统计学、符合条件的疾病和症状、合并用药）， 通过州处方链接到包含12个月受控物质处方历史的数据 药物监测计划（PIMs）。对这些去识别化的汇编记录的分析是一种高度创新的 和成本效益的方法，以更好地了解如何参与医疗保健的潜在机制， 大麻项目影响疼痛患者的受控物质使用和过量风险 接受阿片类药物和镇静催眠药的条件，并可以为后续的前瞻性研究设计提供信息。

Project Summary: The United States is experiencing an unprecedented rate of opioid-related overdose death following a dramatic rise in opioid painkiller use over the past 20 years. In response, the CDC, several states, and professional organizations have promoted prescriber guidelines for managing pain with non-opioid alternatives (i.e., anti-inflammatories, anti-depressants). Additional emphasis has focused on reducing the impact of concomitant use of sedating medications (i.e. benzodiazepines) and other controlled substances (i.e. hypnotics, muscle relaxants) that synergistically increase risk of fatal overdose, especially in medically compromised individuals. Recent reports suggest that states with medical marijuana programs have lower rates of opioid overdose death. Possible mechanisms for lower rates of overdose include reductions in opioid use and/or the use of sedating medications due to symptomatic relief of comorbid anxiety or insomnia. However, little is known about the relationship between medical marijuana program participation among patients with pain conditions and changes in use patterns of controlled substance use. Even less is known about the differential impact of specific cannabinoid products medically dispensed (such as high tetrahydrocannabinol [THC] versus high cannabidiol [CBD] products). The New York State medical marijuana program (implemented January 2016) is one of the most highly regulated and medicalized programs in operation in the United States. State-licensed dispensaries must be staffed with licensed pharmacists and demonstrate that they dispense products with consistent cannabinoid ratios (including high-THC, high-CBD, and 1:1 THC:CBD products). New York State is therefore an ideal setting for a rigorous analysis of medical cannabis program participation and the impact of cannabinoid products with varying THC:CBD ratios on controlled substance use over time among chronic pain patients. We propose to partner with the largest medical marijuana provider in New York (> 10,000 participants enrolled as of October 2017). Participant activity is tracked through an electronic health record with de-identified patient characteristics at baseline (demographics, qualifying condition and symptoms, concomitant medications) that is linked to data containing 12-month controlled substance prescription history through the state’s prescription drug monitoring program (PDMP). The analysis of these de-identified, compiled records is a highly innovative and cost-effective method for better understanding the potential mechanisms of how participation in medical marijuana programs influences controlled substance use and overdose risk among patients with pain conditions receiving opioids and sedative-hypnotics and can inform subsequent prospective study designs.