Impact of Recreational and Medical Marijuana legalization on cannabis use disorders, serious mental illness, and mortality outcomes among Medicaid enrolled youth

娱乐和医用大麻合法化对参加医疗补助计划的青少年大麻使用障碍、严重精神疾病和死亡率结果的影响

• 批准号: 10675915
• 负责人: Cynthia Ann Fontanella
• 金额: $ 73.94万
• 依托单位: RESEARCH INST NATIONWIDE CHILDREN'S HOSP
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10675915
• 关键词: Achievement; Adolescent; Adolescent and Young Adult; Adult; Affect; Age; American; Behavior; Cannabis; Cannabis policy; Cessation of life; Classification; Data; Development; District of Columbia; Drug Prescriptions; Emergency department visit; Enrollment; Exhibits; Goals; Health; Health Benefit; Heterogeneity; High Prevalence; Hospitalization; Individual; Intervention; Knowledge; Laws; Legal; Mediating; Medicaid; Medical; Medical Marijuana; Mental Health; Mental Health Services; Modeling; National Institute of Drug Abuse; Occupations; Outcome; Outpatients; Pattern; Perception; Pharmaceutical Preparations; Policies; Policy Maker; Policy Making; Population; Positioning Attribute; Prevalence; Privatization; Public Health; Public Policy; Quasi-experiment; Records; Recreation; Research; Residential Treatment; Risk; Risk Taking; Sales; Sampling; Science; Substance Use Disorder; Suicide; Taxonomy; Teenagers; US State; Vulnerable Populations; Work; Youth; aged; clinical care; experience; illicit drug use; indexing; interest; marijuana legalization; marijuana use; marijuana use disorder; mortality; multilevel analysis; opioid overdose; outcome disparities; overdose death; peer; physical conditioning; poor health outcome; population health; programs; severe mental illness; study population; substance use; substance use treatment; vehicular accident; young adult

ABSTRACT Adolescent cannabis use is a major public health crisis. Marijuana laws (ML) carries significant health impli- cations for American youth. Decriminalization, medicalization, and legalization of cannabis by a majority of US states over the past 25 years has dramatically shifted societal perceptions and adult use patterns. How mariju- ana policy changes have affected population-wide health of US youth and the downstream public health impli- cations of ML remain topics of significant debate. Cannabis is the most commonly used illicit drug by US ado- lescents and the main drug for which US teens obtain substance use (SU) treatment. Adolescent cannabis use is associated with negative long-term consequences on mental health outcomes, risk-taking behaviors (eg, motor vehicle accidents: MVA), and academic/job achievement. Currently, 36 states and the District of Colum- bia (DC) have enacted medical ML (MML); of these, 18 states and DC have enacted recreational ML (RML). While studies have assessed the association between MML and marijuana use in youth, little is known about the impact of ML on mental health outcomes for American youth. No studies to date have evaluated the impact of MML and RML enactment on youth mental health or mortality outcomes. This represents a major knowledge gap in research that, if answered, will provide critical information to guide ML policymaking. The overarching goal of this NIDA RFA-DA-22-037 application is to characterize the effects of state-level MML and RML, including degree of ML restrictiveness and the effect of varying provisions, on changes in can- nabis use disorder (CUD), serious mental illness (SMI), non-cannabis substance use disorder (NCSUD), sui- cide-related outcomes (SROs), all-cause mortality (ACM), and treatment utilization for SU and MH services, including prescription medication, in American youth. Our central hypothesis is that ML will increase CUD, SMI, NCSUD, SROs, and ACM, with less restrictive ML being associated with worse health outcomes. To achieve study objectives, a difference in difference (DID) quasi-experimental design will be implemented. The main in- tervention of interest is ML, specifically, enactment of MML and RML. We will use national Medicaid data from all 50 states and DC for the period 1/1/2008 to 12/31/2020 merged with the National Death Index data. The study population will include a 20% random sample of all US adolescents (12-17 years) and young adults (18- 25 years) (N=55 million). Medicaid-enrolled adolescents and young adults have higher prevalence rates of mental health and substance use disorders and poorer physical and mental health outcomes compared to age matched peers; thus, they are a large and vulnerable population in whom MML and RML effects are unknown. Multilevel models will be fit to obtain estimates of before vs. after changes among adolescents and young adults in states enacting MML and RML compared to changes in other states, controlling for Individual and state-level covariates.

摘要 青少年使用大麻是一个重大的公共卫生危机。海洋法（ML）对健康有重大影响， 为美国青年服务。大麻的合法化，医疗化和合法化 在过去25年中，美国的社会观念和成人使用模式发生了巨大变化。怎么会- 政策变化影响了美国青年的整体健康，并对下游的公共卫生产生了影响。 ML的阳离子仍然是重要辩论的主题。大麻是美国最常用的非法药物， 是美国青少年获得物质使用（SU）治疗的主要药物。青少年使用大麻 与心理健康结果、冒险行为（例如， 机动车事故（MVA）和学术/工作成就。目前，36个州和科隆区- bia（DC）颁布了医疗ML（MML）;其中，18个州和DC颁布了娱乐ML（RML）。 虽然研究已经评估了MML和青少年大麻使用之间的关联，但人们对MML和大麻使用之间的关系知之甚少。 ML对美国青年心理健康结果的影响。到目前为止，还没有研究评估其影响。 MML和RML颁布对青年心理健康或死亡率结果的影响。这代表了一个主要的知识 研究中的空白，如果得到回答，将提供指导ML政策制定的关键信息。 本NIDA RFA-DA-22-037应用的总体目标是表征状态级 MML和RML，包括ML的限制程度和不同规定的影响，对可 大麻使用障碍（CUD），严重精神疾病（SMI），非大麻物质使用障碍（NCSUD）， 死亡相关结局（SRO）、全因死亡率（ACM）以及SU和MH服务的治疗利用率， 包括处方药在内的药物。我们的中心假设是，ML将增加CUD，SMI， NCSUD、SRO和ACM，限制性较少的ML与更差的健康结果相关。实现 研究目的，将实施差异中的差异（DID）准实验设计。主要在- 利益的干预是ML，具体地说，MML和RML的制定。我们将使用国家医疗补助数据， 所有50个州和DC在2008年1月1日至2020年12月31日期间与国家死亡指数数据合并。的 研究人群将包括所有美国青少年（12-17岁）和年轻成人（18- 18岁）的20%随机样本。 25岁）（N= 5500万）。接受医疗补助的青少年和年轻人的患病率较高， 与年龄相比，精神健康和物质使用障碍以及较差的身心健康结果 匹配的同行;因此，他们是一个大的和脆弱的人口中，MML和RML的影响是未知的。 将拟合多水平模型，以获得青少年和年轻人变化前后的估计值 与其他州的变化相比，制定MML和RML的州的成年人， 州一级协变量