Impact of cannabis legalization on prescription drug use and health outcomes in Connecticut

大麻合法化对康涅狄格州处方药使用和健康结果的影响

• 批准号: 10576002
• 负责人: Rajiv Radhakrishnan
• 金额: $ 26.71万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-04-01 至 2025-03-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10576002
• 关键词: Address; Adolescent and Young Adult; Adult; American; Anxiety; Benefits and Risks; Benzodiazepines; Cannabis; Cannabis policy; Censuses; Cessation of life; Confusion; Connecticut; Consumption; Data; Data Aggregation; Data Linkages; Drops; Drug Prescriptions; Drug usage; Elderly; Electronic Health Record; Emergency department visit; Expenditure; FDA approved; Future; Health; Health Service Area; Healthcare; Healthcare Systems; Hospitalization; Impaired cognition; Incidence; Individual; Legal; Marketing; Medical; Medical Marijuana; Medicare; Monitor; Opioid; Outcome; Overdose; Pain; Pain Disorder; Pain management; Patients; Pattern; Pharmaceutical Preparations; Policies; Policy Maker; Population; Predisposition; Prevalence; Reporting; Respiratory Failure; Risk; Scoring Method; Sedation procedure; Sleep Disorders; Sleeplessness; Statutes and Laws; Surveys; System; Time; United States; Vulnerable Populations; Woman; age group; aged; comorbidity; falls; health care service utilization; innovation; marijuana legalization; marijuana use; marijuana use disorder; mortality; multiple chronic conditions; opioid epidemic; overdose death; pain symptom; permissiveness; prescription monitoring program; prescription opioid; prevent; programs; service utilization; stem; treatment services; trend

ABSTRACT In the United States, overdose is the leading cause of adult deaths with more than 136 Americans dying from overdosing on opioids every day. Medical cannabis has been approved in many states as a treatment for pain disorders and as a potential substitute for prescription opioids, in what is considered by many to be a controversial policy. While state-level aggregate data suggests that states with medical cannabis laws have lower rates of prescription opioid and benzodiazepine use, these results may be confounded by the fact that policies aimed at curbing the opioid epidemic occurred concurrently with medical cannabis legislation in many states. The effects of medical cannabis alone can be isolated using longitudinal, patient-level data. Adults aged ≥50 represent a vulnerable group with highest rates of prescription opioid and benzodiazepine use. They are the largest consumers of prescription medications, and are three times more likely to be prescribed opioids and benzodiazepines to alleviate pain, sleep disorders/insomnia, and anxiety. This group also has multiple medical comorbidities and are hence more susceptible to the detrimental effects of medical cannabis, with prescription drug use patterns being especially problematic among women as they are prescribed these drugs more often, consume them in larger quantities, and use them for longer periods of time. Relevant to NOSI: NOT-DA-20-014, the proposed project will characterize the relationship between medical cannabis use, concomitant prescription opioid and benzodiazepine use, and subsequent health outcomes in the Yale-New Haven Healthcare System (YNHHS) in Connecticut. This system covers a population of approximately 1.5 million, with approximately 750,000 patients seen annually. This will be accomplished by innovative linkage between YNHHS's electronic healthcare records and Connecticut's Prescription Drug Monitoring Program, which, uniquely, includes medical cannabis products, and other statewide census data. Specific Aim 1: To characterize the longitudinal association between medical cannabis use and change in concomitant use of prescription opioids and benzodiazepines. By examining patient-level, longitudinal data (using propensity-score methods), we will clarify the strength of the association, the direction of the association, and the temporal relationship of the association. Specific Aim 2: To determine the association between medical cannabis prescription and healthcare utilization/medical outcomes (e.g., hospitalization, treatment services utilization, overdose) among adults aged ≥50 using patient-level data in the Yale-New Haven Health catchment area. We will investigate association between medical cannabis prescription and all-cause mortality, new-onset drug overdose, emergency department visits, and hospitalization.

摘要 在美国，服药过量是成人死亡的主要原因，超过136名美国人死于 每天过量服用阿片类药物。医用大麻已在许多州被批准作为治疗疼痛的药物 作为处方阿片类药物的潜在替代品，许多人认为这是一种 有争议的政策。虽然州一级的汇总数据表明，拥有医用大麻法律的州 较低的处方阿片类药物和苯二氮卓类药物的使用率，这些结果可能会被以下事实混淆 许多旨在遏制阿片类药物流行的政策与医用大麻立法同时进行。 各州。医用大麻的单独影响可以使用纵向的、患者级别的数据来隔离。成年老年人 ≥50代表了处方阿片类药物和苯二氮卓类药物使用率最高的弱势群体。他们是 最大的处方药消费者，服用阿片类药物和 用于缓解疼痛、睡眠障碍/失眠和焦虑的苯二氮卓类药物。这个群体也有多个医生 合并症，因此更容易受到医用大麻的有害影响，有处方 药物使用模式在女性中尤其成问题，因为她们更频繁地被开这些药物， 大量食用它们，并延长使用时间。 与NOSI相关：NOT-DA-20-014，拟议的项目将表征医疗和医疗之间的关系 大麻使用、处方阿片类药物和苯二氮卓类药物的同时使用，以及随后的健康结果 位于康涅狄格州的耶鲁-纽黑文医疗系统(YNHHS)。该系统覆盖的人口约为 150万，每年约有75万名患者就诊。这将通过创新的联系来实现 在YNHHS的电子医疗记录和康涅狄格州的处方药监测计划之间， 其中独特的包括医用大麻产品和其他全州人口普查数据。 具体目标1：描述医用大麻使用与变化之间的纵向联系 同时使用处方阿片类药物和苯二氮卓类药物。通过检查患者级别、纵向 数据(使用倾向-计分方法)，我们将澄清关联的强度、方向 关联以及关联的时间关系。 具体目标2：确定医用大麻处方与医疗保健之间的联系 利用/医疗结果(如住院、治疗服务利用、过量用药) 在耶鲁-纽黑文健康集水区使用患者水平数据的50岁成年人≥。我们会调查的 医用大麻处方与全因死亡率、新发吸毒过量、 急诊科就诊和住院治疗。