Gaps in Identification, Referral and Treatment of Cannabis Use in VA Primary Care

退伍军人事务部初级保健中大麻使用识别、转诊和治疗方面的差距

• 批准号: 10634475
• 负责人: Carolyn Gibson
• 金额: --
• 依托单位: VETERANS AFFAIRS MED CTR SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10634475
• 关键词: Accident and Emergency department; Address; Adult; Age; Alcohol consumption; Alcohols; Anxiety; Area; Behavior; Behavior Therapy; Cannabis; Caring; Characteristics; Chronic; Cognitive Therapy; Confusion; Data; Drug Screening; Drug usage; Ensure; Feeling suicidal; Foundations; Frequencies; Health; Hospitalization; Individual; Intervention; Interview; Malignant Neoplasms; Marijuana Smoking; Marketing; Measures; Medical Records; Mental Depression; Mental Health; Methodology; Monitor; Motivation; Needs Assessment; Outcome; Patients; Pattern; Pharmaceutical Preparations; Polypharmacy; Population; Populations at Risk; Post-Traumatic Stress Disorders; Prevalence; Primary Care; Provider; Psychoses; Reporting; Respiratory Signs and Symptoms; Risk; Sampling; Sleeplessness; Smoking; Subgroup; Substance Use Disorder; Symptoms; Telephone; Tobacco; Tobacco use; Treatment outcome; United States; Urine; Validation; Veterans; Women' s Health; adverse outcome; aged; brief intervention; cannabis use behavior; cannabis withdrawal; cohort; comorbidity; effective therapy; experience; functional disability; gabapentin; high risk; improved; innovation; marijuana use; marijuana use disorder; marijuana user; middle age; military veteran; motivational enhancement therapy; opioid use; physical conditioning; primary care patient; primary care provider; primary care setting; prospective; psychologic; racial minority; screening; sexual minority; telephone based; treatment services

Background: Cannabis use and cannabis use disorder (CUD) are increasing in the US population, and adults aged 50 and older are among the fastest growing groups of cannabis users. While cannabis use is increasing, it is often perceived as harmless and marketed to patients as helpful for several conditions despite a lack of evidence. There is no data on past month cannabis use, daily cannabis use, and CUD among Veterans using primary care, but there is evidence that cannabis use is common in specific Veteran subgroups (11% to 25%) and that CUD identified using administrative data is increasing. Significance: There are reasons to be concerned about the potential under-identification of cannabis use among Veterans. Smoking cannabis is the most common form of cannabis use among Veterans, and there is evidence that cannabis use is associated with respiratory symptoms and cancer. Comorbid mental health conditions are prevalent among Veterans, and these conditions are commonly reported as motivation for regular cannabis use. Cannabis use negatively impacts treatment outcomes of Veterans with anxiety, depression, and post-traumatic stress disorder (PTSD), and use is associated with psychosis and suicidal ideation. Symptoms of cannabis withdrawal can frequently be confused with symptoms of mental health conditions by patients which can perpetuate use. Finally, there are effective behavioral treatments available for CUD and several medications that have shown benefit in treatment of CUD and withdrawal from cannabis in trials. It is important to identify cannabis users to ensure access to effective therapies. Innovation and Impact: This proposal will address important gaps in the priority areas of women’s health, substance use disorders, and mental health. This proposal will lay the foundation for the validation of a simple, frequency-based screening measure for cannabis use that could be feasible in the primary care setting. Specific Aims: We propose to improve our understanding of at-risk populations and determine whether cannabis treatment services in the Veteran population are being underused. We also propose to determine if certain use patterns are associated with adverse mental and physical health outcomes, placing individuals at higher risk. Such individuals (if identified) may also require brief intervention, referral, and/or treatment. Aim 1: To examine the patterns of cannabis use (past month use, daily use, CUD, persistent use), behaviors (e.g., alcohol use) associated with use, and characteristics associated with use among a nationally representative sample of Veterans 50 and older who receive VA primary care. Aim 2a: To determine whether Veterans discuss cannabis use with their providers and whether providers document use and/or intervene upon use or CUD. Aim 2b: To explore provider experiences assessing cannabis use and initiating CUD-related treatment and referrals in the primary care setting. Aim 3: Using the cohort created in Aim 1, we will prospectively examine the association of cannabis use with depression, anxiety, PTSD, insomnia, emergency department use, and all-cause hospitalization. Methodology: We will construct a nationally representative cohort of Veterans 50 and older using VA data, chart review and phone interviews. We will conduct qualitative interviews with primary care providers to understand gaps in care. Next Steps/Implementation: As with alcohol and tobacco, regular cannabis use may be effectively monitored and managed with identification and brief intervention. This proposal will improve our understanding of the prevalence of unidentified cannabis use and gaps in care in the primary care setting, the need for screening, and improve our understanding of the harms associated with use. This proposal will lay the foundation for addressing gaps in care related to cannabis use and CUD among older Veterans.

背景：大麻使用和大麻使用障碍(CUD)在美国人口和成年人中呈上升趋势 50岁及以上是吸食大麻人数增长最快的群体之一。虽然大麻的使用量在增加， 它通常被认为是无害的，并向患者推销，认为它对几种疾病有帮助，尽管缺乏 证据。没有关于过去一个月大麻使用量、每日大麻使用量和使用大麻的退伍军人的CUD的数据 初级保健，但有证据表明，大麻使用在特定的退伍军人群体中很常见(11%至25%) 使用管理数据识别的CUD正在增加。 重要意义：有理由对大麻使用的潜在识别不足表示关切 在退伍军人中。吸食大麻是退伍军人中最常见的大麻使用形式，有 有证据表明，大麻的使用与呼吸道症状和癌症有关。共病心理健康 退伍军人中普遍存在这种情况，这些情况通常被报告为 经常吸食大麻。大麻的使用对患有焦虑的退伍军人的治疗结果产生了负面影响， 抑郁症和创伤后应激障碍(PTSD)，使用与精神病和自杀有关 想象力。大麻戒断症状常常与精神健康症状混淆。 患者可能长期使用的情况。最后，有一些有效的行为治疗方法可用于 CUD和几种药物在治疗CUD和戒断大麻方面显示出好处 审判。重要的是查明大麻使用者，以确保获得有效的治疗。 创新和影响：这项提案将解决妇女健康优先领域的重要差距， 物质使用障碍和精神健康。这项提议将为验证一种简单、 在初级保健环境中可能可行的基于频率的大麻使用筛查措施。 具体目标：我们建议提高我们对高危人群的理解，并确定 退伍军人中的大麻治疗服务没有得到充分利用。我们还建议确定是否 某些使用模式与不利的心理和身体健康结果相关，使个人处于 风险更高。这类个人(如果被确认)还可能需要短暂的干预、转介和/或治疗。 目标1：审查大麻的使用模式(过去一个月的使用、日常使用、吸食大麻、持续使用)， 与使用相关的行为(例如，饮酒)，以及与国家之间使用相关的特征 接受退伍军人初级保健的50岁及以上退伍军人的代表性样本。 目标2a：确定退伍军人是否与他们的提供者讨论大麻使用以及提供者是否 文件使用和/或在使用或CUD时进行干预。 目标2b：探索评估大麻使用和启动与CUD相关的治疗的提供者经验 以及初级保健环境中的转诊。 目标3：使用在目标1中创建的队列，我们将前瞻性地检查大麻使用的关联 有抑郁症、焦虑症、创伤后应激障碍、失眠、急诊科使用，以及各种原因住院。 方法：我们将使用退伍军人数据建立一个具有全国代表性的50岁及以上退伍军人队列， 审阅图表和电话采访。我们将与初级保健提供者进行定性访谈，以 了解护理方面的差距。 下一步/执行：与酒精和烟草一样，可以有效地监测常规大麻的使用 并通过识别和短暂的干预进行管理。这项建议将提高我们对 初级保健环境中不明大麻使用率和护理差距、筛查的必要性、 并提高我们对与使用相关的危害的理解。这项建议将为以下工作奠定基础 解决老年退伍军人中与大麻使用和CUD有关的护理差距。