Development of a Longitudinal Observational Research Registry for the Study of Medicinal Cannabis Use and Health

由于大麻政策的变化，大多数美国人现在可以获得一系列零售的大麻产品。 据估计，有550万美国人登记在州政府监管的医用大麻项目中， 联邦合法大麻(如CBD)产品的治疗用途很广泛。尽管大多数州都已合法化 医用大麻的使用，对这些患者的特征、他们的大麻产品知之甚少 或其医用大麻使用对患者健康的影响。填补这些知识空白仍然存在 一个紧迫的公共卫生需求。我们建议：1)设计和实现一个未来的医用大麻患者 用于纵向数据收集的登记册。我们将新招募一个具有全国代表性的患者队列 开始在纵向观察性研究登记册中使用用于治疗目的的大麻。我们会 评估患者的人口学特征、大麻产品的使用情况以及在此之前和之后的一系列健康后果 在通过网络调查开始使用医用大麻之后。一部分患者将完成重症监护 通过生态瞬时评估(EMA)收集数据和/或为临床化学提供生物样品 测试以确定药用大麻的使用对日常功能和症状管理的影响 除了潜在的潜在危害，如肝脏毒性；2)建立医用大麻产品计划 基于不良事件报告和在患者登记处或通过 监测其他数据来源(例如，毒物控制数据、FDA警告、在线论坛帖子)。产品 与不良事件或其他伤害相关的将被作为与剂量标签准确性相关的测试的目标， 大麻素含量和污染物的存在；3)确定和整合现有的数据源，这些数据源可以 告知使用医用大麻对健康的影响。这包括电子病历(EMR)数据库 以及研究团队先前和正在进行的研究项目(例如，关怀观察研究领域 4)开发和实施一个网站，其中将包括合并数据的年度摘要报告， 研究人员为进行新的分析而访问未识别的数据的应用程序，以及 关于医用大麻使用对健康影响的已发表论文档案。一项试点研究计划，以 对探索数据存储库感兴趣的基金科学家将被建立。我们的团队包括国际上的 在所提出的综合研究方法方面具有公认的专业知识。这个项目的结果将是一个丰富的 了解医用大麻使用对健康影响的数据资源。数据将包括患者级别 结果涉及广泛的治疗目的，包括使用各种大麻产品。数据 将有助于为临床决策提供信息，涉及大麻产品的启动、产品指南、路线 给药和剂量选择、与不良事件相关的风险、伤害/中毒风险和滥用责任。 研究结果还将帮助地方和联邦政府机构制定有效的政策、计划和 旨在减轻与快速增长的大麻产业相关的危害的监管战略。

Due to changes in cannabis policy, most Americans now have access to an array of retail cannabis products. An estimated 5.5 million Americans are registered with state-regulated medical cannabis programs and the therapeutic use of federally legal hemp (e.g. CBD) products is widespread. Despite most states having legalized medicinal cannabis use, little is known about the characteristics of these patients, the cannabis products they use, or the patient-level health impact of their medicinal cannabis use. Filling these gaps in knowledge remains an urgent public health need. We propose to: 1) design and implement a prospective medicinal cannabis patient registry for longitudinal data collection. We will recruit a nationally representative cohort of patients newly initiating the use of cannabis for therapeutic purposes into a longitudinal observational research registry. We will assess patient demographics, cannabis product use, and a range of health outcomes prior to and repeatedly after initiation of medicinal cannabis use via web-based surveys. A subset of patients will complete intensive data collection via ecological momentary assessment (EMA) and/or provide biospecimens for clinical chemistry testing to determine the impact of medicinal cannabis use on daily functioning and symptom management in addition to potential unseen harms such as liver toxicity; 2) Establish a program of medicinal cannabis product testing based on adverse event reporting and other mentions of injury/harm in the patient registry or via surveillance of other data sources (e.g. poison control data, FDA warnings, online forum posts). Products associated with adverse events or other harms will be targeted for testing related to dose-label accuracy, cannabinoid content, and presence of contaminants; 3) Identify and integrate existing sources of data that can inform the health impacts of medicinal cannabis use. This includes electronic medical record (EMR) databases as well as prior and ongoing research projects of the study team (e.g., Realm of Caring Observational Research Registry); 4) Develop and implement a website that will include annual summary reports of the combined data, an application process for researcher access to de-identified data for the conduct of novel analyses, and an archive of published papers related to the health impacts of medicinal cannabis use. A pilot research program to fund scientists interested in probing the data repository will be established. Our team includes internationally recognized expertise in the comprehensive research methods proposed. The result of this project will be a rich data resource for understanding the health impacts of medicinal cannabis use. Data will include patient-level outcomes across a broad range of therapeutic purposes and include use of a variety of cannabis products. Data will help inform clinical decision making related to initiation of cannabis products, guidance on product, route of administration and dose selection, risks related to adverse events, injury/poisoning risk and abuse liability. Findings will also help local and federal government agencies develop effective policies, programs, and regulatory strategies to mitigate harms associated with the rapidly growing cannabis industry.