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

全国范围内都认识到这一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一份具有里程碑意义的 回顾文献，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。到目前为止，31个州和哥伦比亚特区已经采用了医疗 大麻法律（MCL）使家庭种植或药房销售大麻合法化 符合条件的医疗条件。然而，很少有人知道替代远离医疗 当MCL生效时，疼痛的治疗，或这种替代对其他健康的影响 护理利用率本研究的目的是检查MCL与 公立与私立医院慢性非癌性疼痛患者医疗服务利用 保险计划。美国国立卫生研究院2015年国家疼痛战略 组织框架，我们将进行回顾性、纵向、差异性分析 在处方药和疼痛相关的卫生服务利用的患者队列中， 有和没有MCL状态下的慢性疼痛。此外，我们还将对以下方面进行子分析： 患者生活在农村相比，城市地区，并将检查之间的关系 神经性慢性疼痛与伤害性慢性疼痛患者的MCL和卫生保健利用。 我们将分析每季度测量的患者水平面板数据。本研究的数据将来自 来自卫生保健成本研究所的私人保险个人样本 索赔数据库（2015-2019年，覆盖4000万人）和两个独立的样本， 医疗保险（2011-2018年，500万注册者）和医疗补助（2011-2018年，500万注册者）的医疗保险个人 （2011-2017年）索赔数据库。我们将采用一系列不同的- 对每个被保险群体分别估计的差异回归。我们的主要政策 变量将是任何实施的MCL的度量，按类型实施的MCL的度量 （药房，仅限家庭种植，或THC油）。个体患者特征，县和 州人口统计数据，以及州和季度级别的一系列固定效应将被用作 所有模型中的控件。我们亦会在有需要时控制政策内容。慢性疼痛 和阿片类药物的流行是明显的公共卫生危机。初步证据显示， 获得医用大麻可以改变处方止痛药的使用。因此，必须 了解慢性疼痛患者的MCLs与卫生保健利用之间的关系 为了优化公共政策，并为临床医生提供指导， 患者对MCL实施的反应。

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.