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State Medical Cannabis Laws, Chronic Pain, and Opioids: A Mixed-Methods Approach

州医用大麻法、慢性疼痛和阿片类药物：混合方法

基本信息

批准号：
10199994
负责人：
Emma Elizabeth McGinty
金额：
$ 72.79万
依托单位：
JOHNS HOPKINS UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-01 至 2024-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10199994
关键词：
Adult Affect Amendment Anticonvulsants Arthritis Attitude Behavior Cannabis Clinical Data Data Sources Effectiveness Environment Fees Guidelines Headache Healthcare Healthcare Systems Individual Interview Laws Lead Literature Location Low Back Pain Medical Medical Marijuana Medicare Medicare claim Methods Opioid Opioid Rotation Outcome Overdose Pain Pain management Patients Pattern Perception Pharmacology Physical therapy Physicians Plant Leaves Poisoning Policies Primary Care Physician Quasi-experiment Reporting Research Role Sales Sampling Societies Specialist Surveys Time Variant arthritic pain chronic pain chronic pain patient clinical care cohort comparison group cost design evidence base experience fibromyalgia pain innovation insight marijuana use marijuana use disorder marijuana user non-cancer chronic pain non-opioid analgesic opioid epidemic opioid overdose opioid policy opioid use opioid use disorder pain patient painful neuropathy prescription opioid

项目摘要

ABSTRACT Thirty-three states and D.C. have enacted medical cannabis laws allowing patients with chronic non-cancer pain to use cannabis, when recommended by a physician, to manage their condition. Policymakers are increasingly considering state medical cannabis laws as a potential solution to the U.S. opioid crisis, with the idea that some patients may substitute cannabis in place of prescription opioids for treatment of chronic non- cancer pain and reduce rates of opioid use disorder and overdose as a result. However, rigorous evidence is lacking: no studies have examined the effects of state medical cannabis laws on opioid-related outcomes among a cohort of patients with chronic non-cancer pain. Further, no existing research has examined how state medical cannabis laws affect chronic non-cancer pain patients’ receipt of guideline-concordant non-opioid pain treatments or how such laws affect cannabis use disorder and poisoning among those with chronic non- cancer pain conditions like low back pain or arthritis. Critically, no prior studies have considered how the considerable variation in provisions and implementation across state medical cannabis laws, and within states over time as states amend their laws and change implementation rules, affect outcomes for chronic pain patients. Our study uses a mixed-methods approach incorporating quasi-experimental difference-in-differences analyses; qualitative interviews with state policy and healthcare leaders; and representative surveys of physicians who treat and patients who experience chronic non-cancer pain to fill these research gaps. Using 50-state data sources including Medicare and Optum UnitedHealthcare administrative claims data, we will examine the effects of state medical cannabis laws on receipt of prescription opioid and guideline-concordant non-opioid pharmacologic (e.g., anticonvulsants) and non-pharmacologic (e.g., physical therapy) pain treatments (Aim 1). We will also use these data to examine the effects of state medical cannabis laws on receipt of treatment for opioid use disorder, opioid overdose, cannabis use disorder, and cannabis poisoning among patients with chronic non-cancer pain (Aim 2). We will conduct qualitative interviews with state policy and healthcare system leaders to characterize implementation of state medical cannabis laws for treatment of chronic non-cancer pain (Aim 3). Finally, we will conduct representative surveys with primary care physicians, pain specialists, and patients with chronic non-cancer pain in states with medical cannabis laws. Surveys will capture key attitudes and reported behaviors related to medical cannabis laws, including the degree to which physicians report recommending and patients report using cannabis in place of opioids for treatment of chronic non-cancer pain (Aim 4). In all Aims, we will consider how differences in law provisions and implementation influence chronic pain treatment. Results will yield information needed by state decision-makers considering implementing new medical cannabis laws as well as those considering changes to existing medical cannabis laws’ provisions and implementation.

抽象的三十三个州和华盛顿特区已颁布医用大麻法，允许慢性非癌症患者使用当医生建议使用大麻来控制病情时，他们会感到痛苦。政策制定者是越来越多地考虑将州医用大麻法作为解决美国阿片类药物危机的潜在解决方案一些患者可能会用大麻代替处方阿片类药物来治疗慢性非癌症疼痛并减少阿片类药物使用障碍和过量服用的发生率。然而，严格的证据表明缺乏：没有研究考察州医用大麻法对阿片类药物相关结果的影响在一组患有慢性非癌症疼痛的患者中。此外，现有的研究还没有探讨如何州医用大麻法影响慢性非癌症疼痛患者接受符合指南的非阿片类药物疼痛治疗或此类法律如何影响慢性非大麻使用障碍和中毒患者癌症疼痛，如腰痛或关节炎。关键的是，之前没有研究考虑过如何各州医用大麻法律以及各州内部的规定和实施存在很大差异随着时间的推移，随着各国修改法律并改变实施规则，会影响慢性疼痛的结果患者。我们的研究采用混合方法，结合了准实验双重差分法分析；对国家政策和医疗保健领导人的定性访谈；和代表性调查治疗慢性非癌症疼痛的医生和经历慢性非癌症疼痛的患者来填补这些研究空白。使用 50 个州的数据源，包括 Medicare 和 Optum UnitedHealthcare 行政索赔数据，我们将检查州医用大麻法对接收处方阿片类药物和指南一致的影响非阿片类药物（例如抗惊厥药）和非药物（例如物理治疗）疼痛治疗（目标 1）。我们还将使用这些数据来研究州医用大麻法对接受阿片类药物使用障碍、阿片类药物过量、大麻使用障碍和大麻中毒的治疗慢性非癌性疼痛患者（目标 2）。我们将对国家政策进行定性访谈和医疗保健系统领导人描述州医用大麻法律的实施情况，以治疗慢性非癌性疼痛（目标 3）。最后，我们将与初级保健医生进行代表性调查，疼痛专家以及在具有医用大麻法律的州患有慢性非癌症疼痛的患者。调查将捕捉与医用大麻法律相关的主要态度和报告的行为，包括程度医生报告建议使用大麻代替阿片类药物治疗慢性病，患者报告使用大麻非癌性疼痛（目标 4）。在所有目标中，我们将考虑法律规定和实施方面的差异影响慢性疼痛的治疗。结果将产生国家决策者所需的信息，考虑到实施新的医用大麻法以及考虑改变现有医用大麻的法律法律的规定和实施。