Behavioral Economic Analysis of Medical Marijuana Use in HIV+ Patients

描述(由申请人提供)：允许医用大麻使用的州法律，包括密歇根医用马里瓦纳计划(MMMP)，由于缺乏关于影响以下因素的科学数据而造成政策紧张：大麻使用模式、滥用潜力、寻求/续签医疗认证的决定、使用大麻对艾滋病毒危险行为的影响以及健康结果。这项提案将通过对密歇根州最大的艾滋病毒初级保健诊所(底特律，1700名患者)中使用大麻的艾滋病毒/艾滋病患者(PLWHA)进行前瞻性混合方法研究来解决这些知识差距，具体目标如下：目标1.在120名使用大麻的PLWHA(经过认证的医疗用户、未经认证的治疗用户和娱乐用户；40人/组)中，我们将(A)使用行为经济学模拟来评估大麻需求对实验性操纵单价和收入的敏感性；以及(B)确定大麻价格弹性、与其他药物/疗法的交叉价格弹性以及收入弹性是否在大麻用户群体中有所不同。目的2.在36个吸食大麻的PLWHA(经认证的医疗、非认证的治疗和娱乐使用者；来自AIM 1的12个/组)的子集中，进行基于实验室的双盲、安慰剂对照的大麻吸烟评估(3.5%Delta 9-THC香烟的累积0、4、8和12次吸食)。我们将(A)确定大麻在缓解症状和滥用倾向方面的剂量-效应曲线在不同吸食大麻群体之间是否不同；(B)比较不同群体对吸食大麻的需求；以及(C)比较实验性(“黄金标准”)和自然吸烟影响的强度。目的3.在相同的120个使用大麻-PLWHA的目标1中，使用图表回顾、尿液分析和访谈在基线和一年的季度间隔前瞻性地测量被假设影响大麻使用和医学认证的临床因素：社会经济变化、身心健康、物质使用、刑事司法参与、急性护理利用、艾滋病毒风险传播行为和使用大麻的原因。我们将单独使用临床数据，并结合模拟大麻需求(目标1)和吸食大麻反应(目标2)来预测大麻的纵向模式和替代疗法的使用。目的4.确定在120名患者的预期样本中，经过认证的医用大麻使用、非认证的治疗使用和娱乐使用的流行率是否普遍适用于整个HIV诊所。我们将随机抽样调查300个PLWHA，以(A)确定大麻使用模式是否在这个位于艾滋病毒高感染率地区的大型城市诊所具有代表性，以及(B)将该样本的特征与之前的横断面调查数据进行比较。在该项目结束时，我们预计：(1)这些数据将揭示这一人群中的不同模式；(2)我们将对医用大麻的使用有更深入的了解；(3)我们将能够预测哪些艾滋病毒患者可能受益或受到伤害。这些调查结果将向患者、提供者和社会传播，以促进公共卫生和知情的政策辩论。

DESCRIPTION (provided by applicant): State laws that allow medical marijuana use, including the Michigan Medical Marihuana Program (MMMP), create policy tension due to a paucity of scientific data about factors that influence: marijuana use patterns, abuse potential, decisions to seek/renew medical certification, impact of marijuana use on HIV risk behaviors, and health outcomes. This proposal will address these knowledge gaps by studying marijuana-using persons living with HIV/AIDS (PLWHAs) in Michigan's largest HIV primary care clinic (Detroit, 1700 patients) with a prospective mixed-method approach, as described in these Specific Aims: Aim 1. In 120 marijuana-using PLWHAs (certified medical users, non-certified therapeutic users, and recreational users; 40/group), we will (A) use behavioral economic simulations to evaluate marijuana demand sensitivity to experimental manipulation of unit price and income; and (B) determine whether marijuana price elasticity, cross-price elasticity with other drugs/therapies, and income elasticity differ across marijuana user groups. Aim 2. In a subset of 36 marijuana-using PLWHAs (certified medical, non-certified therapeutic, and recreational users; 12/group from Aim 1), conduct a laboratory-based, double blind, placebo-controlled, marijuana smoking evaluation (cumulative 0, 4, 8 and 12 puffs from 3.5% delta 9-THC cigarettes). We will (A) determine whether marijuana dose-effect profiles for symptom relief and abuse liability differ between marijuana-using groups; (B) compare smoked marijuana demand across groups; and (C) compare intensity of experimental ("gold standard") and naturalistic smoking effects. Aim 3. In the same 120 marijuana-using PLWHAs as Aim 1, use chart review, urinalysis, and interviews to measure prospectively at baseline, and at quarterly intervals for one year, clinical factors that are hypothesized to influence marijuana use and medical certification: socioeconomic changes, physical and mental health, substance use, criminal justice involvement, acute care utilization, HIV risk-transmission behaviors, and reasons for marijuana use. We will use clinical data alone and combined with simulated marijuana demand (Aim 1) and smoked marijuana responses (Aim 2) to predict longitudinal patterns of marijuana and alternative therapy use. Aim 4. Determine whether prevalence of certified medical marijuana use, non-certified therapeutic use, and recreational use in the 120-patient prospective sample generalizes to the entire HIV clinic. We will survey a random sample of 300 PLWHAs to (A) determine whether marijuana use patterns are representative within this large urban clinic located in the area with disproportionally high HIV prevalence, and (B) compare characteristics of this sample to prior cross-sectional survey data. At the conclusion of this project, we anticipate that (1) these data will reveal distinct patterns within this population; (2) we will have achieved a more sophisticated understanding of medical marijuana use, and (3) we will be able to predict which subsets of HIV patients are likely to benefit or be harmed. These findings will be disseminated to patients, providers and society to promote public health and informed policy debate.