The Effect of Medical Cannabis Laws on Health Care Use in Insured Populations with Pain

医用大麻法对疼痛参保人群医疗保健使用的影响

• 批准号: 10392432
• 负责人: Amanda J Abraham
• 金额: $ 60.28万
• 依托单位: UNIVERSITY OF GEORGIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10392432
• 关键词: Adopted; American; Cannabis; Categories; Characteristics; Clinical; Clinical Services; Communities; County; Data; Databases; Diagnostic; Disease; District of Columbia; Dose; Drug Prescriptions; Engineering; Enrollment; Expenditure; Functional disorder; Goals; Health Care Costs; Health Services; Healthcare; Home; Incidence; Individual; Inflammation; Injections; Institutes; Insurance Carriers; Laws; Legal; Measures; Medicaid; Medical; Medical Marijuana; Medicare; Medicine; Modeling; Morbidity - disease rate; Morphine; Nervous system structure; Neuropathy; Nociception; Office Visits; Oils; Operative Surgical Procedures; Opioid Analgesics; Oral; Overdose; Pain; Pain management; Patients; Pharmaceutical Preparations; Physical therapy; Physicians; Plants; Policies; Population; Prevalence; Privatization; Procedures; Public Health; Public Policy; Publishing; Qualifying; Replacement Arthroplasty; Reporting; Research; Review Literature; Rural; Sales; Sampling; Series; Service delivery model; Services; Spinal Fusion; Surveys; Testing; Time; Tissues; United States Dept. of Health and Human Services; United States National Academy of Sciences; United States National Institutes of Health; Visit; base; chronic pain; chronic pain management; chronic pain patient; cohort; common treatment; demographics; effective therapy; experience; falls; health care service; health care service utilization; health difference; health service use; individual patient; insurance plan; longitudinal analysis; medically underserved; milligram; non-cancer chronic pain; non-opioid analgesic; opioid epidemic; opioid misuse; painful neuropathy; patient oriented; patient response; prescription opioid; prescription pain reliever; public health priorities; treatment center; treatment strategy; urban area

There is a nationwide recognition of the public health challenges arising from the incidence and prevalence of chronic pain. In 2017, the National Academies of Sciences published a landmark review of the literature and found conclusive evidence that cannabis can be an effective treatment for chronic pain. To date, 31 states and the District of Columbia have adopted medical cannabis laws (MCLs) legalizing either home cultivation or dispensary-based sales of cannabis for qualifying medical conditions. However, little is known about substitution away from medical treatment of pain when MCLs go into effect, or the impact such substitution has on other health care utilization. The goal of the current study is to examine the association between MCLs and health care utilization for patients with chronic non-cancer pain enrolled in public and private insurance plans. Using the National Institutes of Health 2015 National Pain Strategy as an organizational framework, we will conduct a retrospective, longitudinal, analysis of the difference in prescription medication and pain-related health service utilization in a cohort of patients with chronic pain in states with and without MCLs. In addition, we will conduct sub-analyses for patients living in rural compared to urban areas, and will examine the relationship between MCLs and health care utilization for patients with neuropathic versus nociceptive chronic pain. We will analyze patient-level panel data measured quarterly. Data for this study will come from a sample of privately insured individuals from the Health Care Cost Institute comprehensive claims databases (N ≈ 40 million covered lives; 2015-2019) and two separate samples of publically insured individuals from Medicare (N ≈ 5 million enrollees; 2011-2018) and Medicaid (N ≈ 5 million enrollees; 2011-2017) claims databases. We will employ a series of difference-in- differences regressions estimated separately for each of the insured groups. Our key policy variables will be a measure of any implemented MCL, measures of implemented MCLs by type (dispensary, home-cultivation-only, or THC oils). Individual patient characteristics, county and state demographics, and a series of fixed effects at the state and quarter level will be used as controls in all models. We will also control for policy endogeneity where necessary. Chronic pain and the opioid epidemic are clear public health crises. Preliminary evidence suggests that access to medical cannabis can alter prescription pain medication use. It is thus essential to understand the relationship between MCLs and health care utilization for chronic pain patients in order to optimize public policies and to provide guidance to clinical practitioners on likely patient responses to MCL implementation.

全国范围内都认识到发病率和发病率所带来的公共卫生挑战 慢性疼痛的患病率。 2017年，美国国家科学院发表了具有里程碑意义的论文 查阅文献并发现确凿的证据表明大麻可以是一种有效的 治疗慢性疼痛。迄今为止，已有 31 个州和哥伦比亚特区采用了医疗 大麻法 (MCL) 使家庭种植或药房销售大麻合法化 符合资格的医疗条件。然而，人们对医疗以外的替代品知之甚少。 MCL 生效时的疼痛治疗，或这种替代对其他健康的影响 护理利用。当前研究的目的是检查 MCL 和 公立和私立医院的慢性非癌性疼痛患者的医疗保健利用情况 保险计划。使用美国国立卫生研究院 2015 年国家疼痛战略作为 组织框架，我们会进行回顾性的、纵向的、差异性的分析 一组患者的处方药和与疼痛相关的卫生服务利用情况 有或没有 MCL 的状态下的慢性疼痛。此外，我们还将针对 与居住在农村地区的患者与城市地区的患者进行比较，并将检查两者之间的关系 神经性慢性疼痛与伤害性慢性疼痛患者的 MCL 和医疗保健利用。 我们将分析每季度测量的患者水平面板数据。这项研究的数据将来自 来自医疗保健成本研究所综合的私人参保个人样本 索赔数据库（N ≈ 4000 万人；2015-2019 年）和两个单独的样本 参加 Medicare 的公共保险个人（N 约 500 万参保者；2011-2018 年）和 Medicaid （N ≈ 500 万注册者；2011-2017 年）索赔数据库。我们将采用一系列的差异- 对每个被保险群体分别进行差异回归估计。我们的主要政策 变量将是任何已实施的 MCL 的度量，按类型实施的 MCL 的度量 （药房、家庭种植油或 THC 油）。患者个体特征、县和 州人口统计数据以及州和季度层面的一系列固定效应将被用作 所有型号的控制。必要时我们还会控制政策内生性。慢性疼痛 阿片类药物的流行是明显的公共卫生危机。初步证据表明 获得医用大麻可以改变处方止痛药的使用。因此，有必要 了解 MCL 与慢性疼痛患者医疗保健利用之间的关系 为了优化公共政策并为临床从业者提供可能的指导 患者对 MCL 实施的反应。