State medical marijuana laws and NSDUH marijuana use and consequences since 2004

描述（由申请人提供）：自1996年以来，20个州和哥伦比亚特区通过了大麻医用合法化的法律（占所有州的40%），其他州正在考虑此类法律。这些快速变化的法律是否会导致大麻使用（MU）的增加，现在很大程度上是一个观点和辩论的问题。根据NIDA PA 11-230的要求，我们建议调查MML与MU之间的关系，MU障碍和MU在青少年和成人中的后果，使用一个优秀的资源，即来自2004年国家药物使用和健康调查（NSDUH）的限制访问数据文件，我们被授权通过SAMHSA的新NSDUH限制使用文件数据门户访问。这些数据文件包括公共使用文件中未包含的重要变量，包括居住地，确切的受访者年龄和详细的种族/民族信息。我们还将纳入NSDUH以外的州级数据（例如，人口普查数据、州逮捕率、急诊科访问量、MML变化），作为我们比较有和没有MML的州的模型中的潜在混杂因素和结果。拟议的研究是对这些问题的全面、及时和创新的调查，旨在为卫生科学家、决策者和公众提供急需的重要信息。主要目的是：1a)检查2004 - 2014年个体水平MU和MU障碍作为国家级MML的功能；1b)使用2004年之后批准MML的美国各州的数据，检查法律通过前后不同时间滞后（例如1年、2年）对个体水平MU和MU障碍的影响。2)探索MML或MML的特定方面（例如，每个患者允许的数量的变化，注册规则，允许的医疗条件）是否与MU的流行有关，个人如何获得大麻，以及他们为此支付多少钱。3)相对于没有MML的美国各州的趋势（根据门户假设增加；或根据替代假设减少），调查州MML通过后是否会发生(a)其他物质（酒精、非医疗处方阿片类药物、可卡因、海洛因使用）的个人风险变化；(b)与大麻使用有关的后果（即逮捕、监禁、法律问题），相对于在没有MML的州发生这些后果的风险变化。4)调查种族/民族（非西班牙裔白人、非西班牙裔黑人、亚洲人和西班牙裔）和年龄（即青少年、年轻人和老年人）过去一年和过去一个月MU和MU疾病患病率的差异，以及MU变化的潜在后果是否与州级MML的通过有关。我们的研究团队包括药物滥用流行病学和生物统计学方面的专家，以及在大麻法律和大麻市场方面具有广泛专业知识的专家。我们的分析将采用多层回归模型。本研究将解决具有重大公共卫生意义的问题，增加关于快速变化的大麻法律及其对成人和青少年MU的影响的重要知识，有助于了解立法与物质使用关系的一般知识。

DESCRIPTION (provided by applicant): Since 1996, 20 states and DC passed laws legalizing medical use of marijuana (40% of all states), and other states are considering such laws. Whether these fast-changing laws lead to increases in marijuana use (MU) is now largely a matter of opinion and debate. Responding to NIDA PA 11-230, we propose to investigate the relationship between MML and MU, MU disorders and consequences of MU in both adolescents and adults, using an outstanding resource, the restricted access data files from the National Survey on Drug Use and Health (NSDUH), 2004 and onwards, that we are authorized to access through SAMHSA's new NSDUH Restricted Use Files Data Portal. These data files include important variables not included in the public use files, including state of residence, exact respondent age, and detailed race/ethnicity information. We will also incorporate state-level data external to NSDUH (e.g., Census demographic data, state arrest rates, emergency department visits, MML variation) as potential confounders and outcomes in our models comparing states with and without MML. The proposed study is a comprehensive, timely, and innovative investigation of these issues, designed to provide much-needed, important information to health scientists, policy-makers and the public. Primary aims are to: 1a) Examine individual-level MU and MU disorder from 2004 to 2014 as a function of state-level MML; 1b) Using data from the US states that approved MML after 2004, examine the effects of different time lags (e.g., 1-, 2-years) before and after passage of the laws on individual-level MU and MU disorder. 2) Explore whether state-level variations in MML or specific aspects of MML (e.g., variations of amounts allowed per patient, registration rules, permitted medical conditions) are associated with the prevalence of MU, how individuals acquire marijuana, and how much they pay for it. 3) Investigate whether passage of state MML is followed by change in individual risk for (a) other substances (alcohol, nonmedical prescription opioid, cocaine, heroin use), relative to trends in the US states without MML (increase, per the gateway hypothesis; or decrease, per the substitution hypothesis); (b) consequences related to marijuana use (i.e., arrests, incarceration, legal problems), relative to any change in the risk for these consequences in states without MML. 4) Investigate whether racial/ethnic (non-Hispanic White, non-Hispanic Black, Asian, and Hispanic) and age (i.e., adolescents, young adults, and older adults) differences in past-year and past-month prevalence of MU and MU disorders and potential consequences of MU change as a function of the passage of state-level MML. Our research team includes experts in substance abuse epidemiology and biostatistics as well as an expert with extensive expertise in marijuana laws and marijuana markets. Our analyses will employ multilevel regression modeling. This study will address questions of major public health significance, adding important knowledge about fast-changing marijuana laws and their effects on MU among adults and adolescents, contributing to general knowledge about the relationship of legislation to substance use.