Cannabis Use and Health among VHA Primary Care Patients

背景：虽然有100多万退伍军人经常使用大麻(即在 在过去的一个月里)，只有有限的研究调查了退伍军人健康管理局的大麻使用情况 (VHA)患者。此外，现有的健康记录没有确定使用低于 大麻使用障碍，这表明经常使用大麻的患者中有相当一部分并不是 由其VHA提供商记录或监控。鉴于两者之间的联系，这种数据的缺乏令人担忧 大麻使用和有害的身心健康和社会后果。这样的后果可能是公平的。 在某些人口亚群中更为明显，包括患有精神疾病的人，这些人 在VHA患者群体中比例过高。尽管有潜在的危害，但一些使用大麻的患者 报告指出，它有益于慢性疼痛、创伤后应激障碍(PTSD)和其他疾病的治疗 23个州和哥伦比亚特区已将个人使用大麻合法化。 符合条件的医疗条件。需要进行研究来确定和了解大麻的使用模式。 以及它们与VHA初级保健患者的健康、功能和服务利用之间的关系。 目标：1)描述具有代表性的VHA初级保健患者的大麻使用特征；2) 审查大麻使用与精神活性药物使用(例如鸦片类药物)有关的程度 和其他精神药物)、物质使用、物质使用障碍症状、精神健康症状(例如， 创伤后应激障碍(创伤后应激障碍)、疼痛、功能和治疗利用 大麻和过去一年没有使用过的人；3)确定大麻使用和大麻使用障碍症状 初次初级保健就诊后6个月和12个月的轨迹；4)纵向评估相关性 在大麻轨迹组和精神活性药物使用(例如，阿片剂和其他精神药物)之间， 物质使用，物质使用障碍症状，精神健康症状(如创伤后应激障碍)，疼痛，功能， 和治疗利用。第二个目标是比较使用情况、轨迹和结果 而没有国家颁发的医用大麻证书来检查医用大麻患者是如何 在大麻使用的性质和程度以及问题方面，认证与没有认证的认证有所不同。 方法：为了实现这些目标，拟议的项目将对3岁以下接受初级保健的退伍军人进行筛查 密歇根州的VAMC。通过筛查，该项目将确定一组500名普通大麻患者 使用，定义为在过去一年中至少每月使用，以及年龄和性别匹配的对照组 500名过去一年没有吸食大麻的退伍军人。两组都将完成一项深入的横断面基线 面试。在筛查和基线之后，500名定期使用大麻的患者将组成一个队列 将在6个月和12个月的后续行动中重新评估，以确定大麻使用和大麻使用障碍 症状轨迹和相关的健康、功能和服务利用结果。

Background: Although more than 1 million Veterans regularly use cannabis (i.e., have used cannabis within the past month), only limited research has investigated cannabis use among Veterans Health Administration (VHA) patients. Furthermore, existing health records do not ascertain use that is below the threshold of a cannabis use disorder, suggesting that a substantial portion of patients who regularly use cannabis are not documented or monitored by their VHA providers. This absence of data is concerning given the links between cannabis use and adverse physical, mental health, and social outcomes. Such consequences may be even more pronounced among certain population subgroups, including those with psychiatric illnesses, which are overrepresented in the VHA patient population. Despite potential harms, some patients who use cannabis report that it is beneficial for the management of chronic pain, posttraumatic stress disorder (PTSD), and other illnesses, and 23 States and the District of Columbia have legalized the use of cannabis for individuals with qualifying medical conditions. Research is needed to characterize and understand patterns of cannabis use and how they relate to health, functioning, and service utilization among VHA primary care patients. Objectives: 1) To characterize cannabis use among a representative sample of VHA primary care patients; 2) To examine the extent to which cannabis use is associated with psychoactive medication use (e.g., opiates and other psychotropics), substance use, substance use disorder symptoms, mental health symptoms (e.g., PTSD), pain, functioning, and treatment utilization among a cross-sectional sample of patients with regular cannabis and those with no past-year use; 3) To identify cannabis use and cannabis use disorder symptom trajectories at 6- and 12-months following an initial primary care visit; 4) To longitudinally estimate associations between cannabis trajectory groups and psychoactive medication use (e.g., opiates and other psychotropics), substance use, substance use disorder symptoms, mental health symptoms (e.g., PTSD), pain, functioning, and treatment utilization. A secondary aim is to compare use, trajectories, and outcomes between those with and without State-issued medical cannabis certification to examine how patients with medical cannabis certification differ from those without it in the nature and extent of cannabis use and problems. Methods: To achieve these objectives, the proposed project will screen Veterans receiving primary care at 3 VAMCs in Michigan. Through screening the project will identify a group of 500 patients with regular cannabis use, defined as at least monthly use during the past year, and an age- and sex-matched comparison group of 500 Veterans without past-year cannabis use. Both groups will complete an in-depth cross-sectional baseline interview. Following screening and baseline, the 500 patients with regular cannabis use will comprise a cohort that will be re-assessed at 6- and 12-months follow-up to identify cannabis use and cannabis use disorder symptom trajectories and related health, functioning, and service utilization outcomes.