Examining the synergistic effects of cannabis and prescription opioid policies on chronic pain, opioid prescribing, and opioid overdose

检查大麻和处方阿片类药物政策对慢性疼痛、阿片类药物处方和阿片类药物过量的协同作用

• 批准号: 10055772
• 负责人: Magdalena Cerda
• 金额: $ 90.42万
• 依托单位: NEW YORK UNIVERSITY SCHOOL OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-01-01 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10055772
• 关键词: Address; Age; Benzodiazepines; Cannabis; Clinic; Clinic Visits; Country; Data; Data Set; Data Sources; Dependence; Disease; Drug usage; Emergency department visit; Ethnic Origin; General Population; Health; Heroin; Individual; Joints; Laws; Lead; Legal; Longitudinal cohort; Measures; Medicaid; Medical Marijuana; Modeling; Nature; Opioid; Outcome; Overdose; Pain Clinics; Patient Self-Report; Patients; Pharmaceutical Preparations; Policies; Population; Prescription opioid overdose; Race; Recovery; Regulation; Reporting; Resistance; Respondent; Risk; Sampling; Socioeconomic Status; Surveys; System; Testing; Time; Visit; Withdrawal Symptom; alternative treatment; benzodiazepine abuse; benzodiazepine misuse; chronic pain; chronic pain patient; cohort; drug testing; health data; heroin use; high risk; improved; injury-related death; longitudinal design; marijuana legalization; marijuana use; marijuana use disorder; opioid epidemic; opioid mortality; opioid overdose; opioid policy; opioid use; opioid use disorder; opioid withdrawal; overdose risk; prescription monitoring program; prescription opioid; prescription opioid abuse; prescription opioid misuse; trend

Abstract The rapid rise in opioid overdose deaths in the past 17 years has coincided with a tripling of prescription opioid (PO) prescriptions dispensed, largely to treat chronic pain. Increased co-prescription of benzodiazepines (BZDs) and opioids also substantially increased the risk of overdose. Cannabis has been proposed as an alternative treatment for chronic pain that could ameliorate opioid withdrawal symptoms and assist in recovery from opioid and BZD dependence. Two major policy shifts are likely to change prescribing practices and abuse of POs and BZDs. First, in the past decade, most states have enacted policies that regulate PO prescribing and dispensing. Second, since 1996, 29 states have legalized use of cannabis for medical purposes, and 9 states have legalized cannabis for recreational use. Policies that regulate access to POs may decrease the number of opioid prescriptions for chronic pain and co-occurring PO/BZD prescribing, while laws that allow greater access to cannabis may offer a substitute for POs, heroin, and BZDs. The combination of stricter PO policies and less restrictive cannabis laws may reduce opioid-related harm to a greater extent than either measure alone. As states make unprecedented changes to PO policies and cannabis laws, we need to examine the independent and synergistic contributions that both types of measures have on opioid prescribing practices and opioid overdoses, with and without BZDs. We propose to pursue this aim in two populations: (1) in the U.S. population, using repeated cross-sectional data of individuals nested in states from the National Survey on Drug Use and Health; and (2) among Medicaid patients with chronic pain (who have 10 times greater risk of opioid use disorder relative to privately insured patients), using a 45-state Medicaid Analytic Extract longitudinal cohort. Our specific aims are: (1) to examine, in NSDUH, whether nonmedical use of POs, BZDs and heroin, and opioid and BZD use disorders decrease (and cannabis use/disorder increases) following enactment of more restrictive PO policies and less restrictive cannabis laws in 2004-2019, compared to trends in states that did not enact these measures; and (2) to test whether Medicaid patients are less likely to have claims for opioid prescribing (alone and overlapping with BZDs), clinic visits for chronic pain, and opioid overdoses (with and without co-occurring BZD overdose) following enactment of more restrictive PO policies and less restrictive cannabis laws in 2001-2019, compared to patients in states that did not enact these measures. For Aim 2, we will sample 10,000 Medicaid patients with chronic pain per year, follow each cohort for 4 years (n=190,000), and combine the cohorts to construct an accelerated longitudinal cohort. States will be classified by how restrictive or lenient their PO policies are (e.g., prescription drug monitoring programs, pain clinic regulations), and whether they legalized cannabis for medical and/or recreational use. At a time when opioid overdose deaths are increasing at an unprecedented rate, this study will provide critical, policy-relevant findings about the types of policies that are most likely to end the opioid epidemic.

抽象的 过去17年中阿片类药物过量死亡的迅速增长与处方阿片类药物的三倍相吻合 （PO）处方分配，主要是为了治疗慢性疼痛。增加苯二氮卓类的共同处方 （BZD）和阿片类药物也大大增加了过量的风险。大麻已被提议 可以减轻阿片类药物戒断症状并有助于康复的慢性疼痛的替代治疗方法 来自阿片类药物和BZD依赖性。两个重大的政策转变可能会改变处方实践和滥用 POS和BZD。首先，在过去的十年中，大多数州制定了规范PO处方的政策 和分配。其次，自1996年以来，有29个州将大麻用于医疗目的合法化，而9个州有9个州 各州已将大麻合法化供娱乐使用。调节POS访问的政策可能会降低 慢性疼痛和同时发生的PO/BZD处方的阿片类药物处方数量，而法律则允许 更多的大麻可以替代POS，海洛因和BZD。更严格的PO的结合 政策和限制性大麻法可能会在更大程度上减少与阿片类药物有关的伤害 单独测量。由于各州对PO政策和大麻法进行了前所未有的更改，我们需要 检查两种措施对阿片类药物处方的独立和协同贡献 实践和阿片类药物过量，没有BZD。我们建议在两个人群中追求这一目标：（1） 在美国人口中，使用国家嵌套在国家嵌套的个体的重复横截面数据 毒品使用和健康调查； （2）在慢性疼痛的医疗补助患者中（患有10次 相对于私人保险患者，阿片类药物使用障碍的风险更大） 提取纵向队列。我们的具体目的是：（1）在nsduh中检查pos的非医学使用是否 随后 与趋势相比 在未采取这些措施的州中； （2）测试医疗补助患者是否不太可能拥有 索赔阿片类药物处方（单独使用BZD和重叠），慢性疼痛的诊所就诊和阿片类药物 颁布更严格的PO策略后，过量服药（有和不存在同时发生的BZD过量） 与未颁布的州的患者相比，2001 - 2019年的限制性大麻法律较少 措施。对于AIM 2，我们将每年采样10,000名慢性疼痛的医疗补助患者，请遵循每个队列 已有4年（n = 190,000），并结合了队列以构建加速的纵向队列。国家将是 根据其PO政策的限制性或宽大范围进行分类（例如，处方药监测计划，痛苦 诊所法规），以及它们是否合法化大麻以供医学和/或娱乐使用。在 阿片类药物过量的死亡人数正在以前所未有的速度增加，这项研究将提供至关重要的，政策与政策相关的 关于最有可能结束阿片类药物流行的政策类型的发现。