Cannabis Use and Health among VHA Primary Care Patients

背景：虽然超过100万退伍军人经常使用大麻（即，曾使用大麻， 过去一个月），只有有限的研究调查了退伍军人健康管理局中的大麻使用情况。 (VHA)患者此外，现有的健康记录不能确定使用量是否低于 大麻使用障碍，这表明经常使用大麻的相当一部分患者不是 由其VHA提供商记录或监控。考虑到以下因素之间的联系，缺乏数据令人担忧： 大麻使用和不良的身体，心理健康和社会后果。这样的后果甚至可能是 在某些人口亚群中更为明显，包括那些患有精神疾病的人， 在VHA患者人群中比例过高。尽管有潜在的危害，一些使用大麻的患者 报告说，它是有益的慢性疼痛，创伤后应激障碍（PTSD）的管理，和其他 23个州和哥伦比亚特区已经将大麻的使用合法化， 合格的医疗条件。需要进行研究，以确定和了解大麻使用的模式 以及它们与VHA初级保健患者的健康、功能和服务利用的关系。 目的：1）描述VHA初级保健患者代表性样本中大麻使用的特征; 2） 检查大麻使用与精神活性药物使用相关的程度（例如，阿片剂 和其它精神药物），物质使用，物质使用障碍症状，精神健康症状（例如， PTSD），疼痛，功能和治疗利用率在一个横断面样本的患者， 大麻和那些没有过去一年的使用; 3）确定大麻使用和大麻使用障碍症状 初始初级保健就诊后6个月和12个月的轨迹; 4）纵向估计相关性 大麻轨迹组和精神活性药物使用之间的关系（例如，鸦片制剂和其他精神药物）， 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），疼痛，功能， 和治疗利用率。第二个目的是比较使用，轨迹，和结果之间的那些 如果没有国家颁发的医用大麻证书， 在大麻使用和问题的性质和程度方面，有证书的国家与没有证书的国家不同。 方法：为了实现这些目标，拟议的项目将筛选退伍军人接受初级保健在3 密歇根州的吸血鬼。通过筛选，该项目将确定一组500名经常使用大麻的患者 使用，定义为在过去一年中至少每月使用一次，以及年龄和性别匹配的对照组， 500名退伍军人没有使用大麻。两组都将完成一个深入的横断面基线 采访在筛选和基线后，500名经常使用大麻的患者将组成一个队列， 将在6个月和12个月随访时重新评估，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.