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

摘要 青少年使用大麻是一项重大的公共卫生危机。大麻法律(ML)具有重大的健康影响- 为美国年轻人准备的阳离子。美国大多数人将大麻非刑事化、医学化和合法化 在过去的25年里，各州已经极大地改变了社会观念和成年人的使用模式。美丽珠是如何- ANA政策的变化已经影响了美国年轻人的全民健康，并对下游的公共卫生产生了影响- ML的阳离子仍然是重要的争论话题。大麻是美国最常用的非法药物-- 灯泡和美国青少年获得物质使用(SU)治疗的主要药物。青少年吸食大麻 与对心理健康结果、冒险行为的负面长期后果有关(例如， 机动车事故：MVA)和学业/工作成就。目前，36个州和科隆区- BIA(DC)制定了医疗性ML(MML)；其中18个州和DC制定了娱乐性ML(RML)。 虽然研究已经评估了MML与青少年吸食大麻之间的联系，但对此知之甚少 ML对美国青年心理健康结果的影响。到目前为止，还没有研究评估这一影响 关于青年心理健康或死亡结果的MML和RML颁布情况。这代表了一门重要的知识 研究方面的差距，如果得到解决，将提供指导ML政策制定的关键信息。 此NIDA RFA-DA-22-037应用程序的总体目标是表征州级别的影响 MML和RML，包括ML的限制程度和不同条款对CAN变化的影响。 NABIS使用障碍(CUD)、严重精神疾病(SMI)、非大麻物质使用障碍(NCSUD)、 SU和MH服务的杀戮相关结果(SRO)、全因死亡率(ACM)和治疗利用率， 包括处方药，在美国年轻人中。我们的中心假设是ML将增加CUD，SMI， NCSUD、SROS和ACM，限制较少的ML与较差的健康结局相关。要实现 研究目的：采用差异性(DID)准实验设计。主要的-- 利益相关的发明是ML，具体地说是MML和RML的制定。我们将使用国家医疗补助数据从 2008年1月1日至2020年12月31日期间，所有50个州和华盛顿特区都与国家死亡指数数据合并。这个 研究人群将包括20%的随机样本，其中包括所有美国青少年(12-17岁)和年轻人(18-18岁) 25年)(N=5500万)。参加医疗补助的青少年和年轻人的患病率较高 心理健康和物质使用障碍以及与年龄相比较差的身心健康结果 配对的同龄人；因此，他们是一个庞大而脆弱的群体，MML和RML的影响尚不清楚。 多水平模型将适合于获得青少年和青少年变化前与变化后的估计 制定MML和RML的州的成年人与其他州的变化相比，控制个人和 州级协变量。

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.