Population-Based Analyses of Healthcare Utilization and Outcomes in Users of Medical Marijuana

项目总结 在临床、医疗保健系统、财政或社会影响方面存在有限的科学共识 医用大麻在各州的合法化。关于MMJ使用的国家政策的迅速变化， 结合目前的全国阿片类药物流行，迫切需要更好地了解 MMJ的临床、药理和行为影响。阿肯色州在2016年批准了MMJ的使用 有特定条件的个人和药房于2019年5月开业。通过以下方式提供独特的数据资产 阿肯色州医疗透明度倡议和阿肯色州健康数据倡议(HDI)包括 单独关联但未确定的强制性所有付款人索赔、生命统计、医院和紧急情况 部门(ED)的出院数据和州警察的机动车碰撞数据，以及 有资格使用MMJ。这将是第一个测量临床和不良事件的人群水平的分析。 MMJ使用者和非使用者的人口通过三个具体目标： 具体目标1：描述人口、地理、社会经济和临床特征；医疗保健 使用、不良事件(新的精神健康诊断、药物滥用/过量、自杀、意外 伤害或MVA事故)；以及阿片类药物和苯二氮类药物在三组中的使用：1)符合条件的个人 对于阿肯色州未获得MMJ卡的MMJ(非持卡人)，2)符合条件的个人 并获得MMJ卡但不购买MMJ(持卡人)，以及3)符合条件的人，获得 卡，并购买MMJ(消费者)。 具体目标2：比较医疗保健前后12个月的用药和费用(住院和门诊护理，ED 就诊和处方药)，以及消费者和非持卡人之间的不良事件。作为一名 分目标，我们将在开始一个疗程后评估阿片类药物和苯二氮卓类药物使用的变化 MMJ疗法。 具体目标3：研究新冠肺炎对MMJ持卡人请求、MMJ购买、医疗保健的影响 使用和不良事件。 这个项目汇集了五个数据来源，以考察MMJ对阿肯色州的影响。这包括 阿肯色州所有付款人索赔数据库(APCD)、MMJ注册表、生命统计文件和数据记录 急诊科就诊和MVA。这些数据可在人员级别链接，从而允许人员级别 分析或医疗保健利用和结果。这将是第一个衡量人口水平的分析 MMJ使用者和非使用者人群中的临床和不良事件。 这项研究的结果将有助于通过确定MMJ的使用是否 生产时的好处(例如，减少医疗保健使用和成本，替代阿片类药物和苯二氮卓类药物) 没有额外的伤害(例如，新的精神健康诊断，MVA)，从而为未来的MMJ政策提供信息。

PROJECT SUMMARY Limited scientific consensus exists on the clinical, healthcare system, financial, or societal impact of legalization of medical marijuana (MMJ) in states. The swift changes in state policies regarding MMJ use, combined with the current national opioid epidemic, creates an impending need to better understand the clinical, pharmacological, and behavioral impact of MMJ. The state of Arkansas approved MMJ use in 2016 by individuals with select conditions, and dispensaries opened in May 2019. Unique data assets available through the Arkansas Healthcare Transparency Initiative and the Arkansas Health Data Initiative (HDI) consist of individually linked but de-identified mandatory all-payer claims, vital statistics, hospital and emergency department (ED) discharge, and state police motor vehicular crash data, along with data on individuals who qualify for MMJ use. This will be the first population-level analysis that measures clinical and adverse events in a population of MMJ users and non-users through three specific aims: Specific Aim 1: Describe demographic, geographic, socioeconomic, and clinical characteristics; healthcare utilization, adverse events (new mental health diagnoses, substance abuse/overdose, suicide, accidental injury, or MVA accidents); and opioid and benzodiazepine use among three groups: 1) individuals eligible for MMJ in Arkansas who do not obtain an MMJ card (non-cardholders) , 2) individuals who are eligible and obtain a MMJ card but do not purchase MMJ (cardholders), and 3) those who are eligible, obtain a card, and purchase MMJ (consumers). Specific Aim 2: Compare 12-month pre- and post-healthcare use and costs (inpatient and outpatient care, ED visits, and prescription medications), and adverse events between consumers and non-cardholders. As a sub-aim, we will evaluate changes in opioid and benzodiazepine utilization after commencing a course of MMJ therapy. Specific Aim 3: Examine the impact of COVID-19 on MMJ cardholder requests, MMJ purchases, healthcare use, and adverse events. This project brings together five data sources to examine the impact of MMJ on Arkansans. This includes the Arkansas All Payer Claims Database (APCD), the MMJ registry, vital statistics files, and data documenting emergency department visits and MVAs. These data are linkable at the person level which allows person-level analyses or healthcare utilization and outcomes. This will be the first population-level analysis that measures clinical and adverse events in a population of MMJ users and non-users. Results of this research will help fill the gap in scientific knowledge by determining whether MMJ use has benefits (e.g, decreased healthcare use and cost, substitution opioids and benzodiazepines) while producing no additional harm (e.g., new mental health diagnosis, MVAs) and thus inform future MMJ policy.