Are cannabis policy changes associated with alcohol use patterns? Evidence for age-group differences based on primary care screening data.

IF 5.3 1区 医学 Q1 PSYCHIATRY
Addiction Pub Date : 2025-07-24 DOI:10.1111/add.70134
Natalia Van Doren, Felicia W Chi, Kelly C Young-Wolff, Derek D Satre, Stacy A Sterling
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引用次数: 0

Abstract

Background and aims: In California, USA, adult cannabis legalization (ACL) was passed in 2016, with implementation of legal sales commencing in 2018. This study examined whether these policy changes were associated with changes in alcohol use patterns and explored age-group differences.

Design: We examined monthly rates of positive alcohol screens in primary care patients in California from 2015 to 2019. Using an interrupted time series design and autoregressive integrated moving average (ARIMA) models, changes were evaluated in the overall sample and stratified by age groups (21-34, 35-64 and 65+) across two key intervention points for ACL: 9 November 2016 (ACL passage) and 1 January 2018 (ACL implementation). Time-varying confounders of seasonality and autocorrelation were controlled for.

Setting: California, United States; Kaiser Permanente Northern California Healthcare System.

Participants: Across the study period, n = 8 028 627 screenings were completed for  n= 3 525 493 unique patients aged 21+ .

Measurements: Aggregated monthly rates of patients exceeding daily limits, weekly limits, exceeding both daily and weekly limits and frequent heavy episodic drinking (HED), based on current US guidelines set by the National Institute on Alcohol Abuse and Alcoholism.

Findings: Statistically significant, gradual declines in rates of both exceeding weekly alcohol limits [estimate (95% confidence interval [CI]) of slope change = -0.013(-0.019 to -0.008), P < 0.001] and frequent HED followed ACL passage [estimate (95% CI) of slope change = -0.015(-0.024 to -0.005), P = 0.003]. ACL implementation was generally not associated with further changes, suggesting changes after ACL passage were sustained over time. Age-group patterns varied: young adults (21-34) demonstrated an immediate increase, followed by a statistically significant gradual decline in rates of HED post-ACL passage [estimate (95% CI) of slope change = -0.096(-0.160, -0.033), P = 0.003], as well as an immediate decrease post ACL implementation; adults 35-49 showed consistent declines in step and slope in rates of frequent HED post ACL passage; adults 50-64 showed an immediate increase in rates of exceeding weekly limits [estimate (95% CI) of step change = 0.167(0.036-0.297), P = 0.012], with gradual declines in the other drinking limits; adults 65 + had small, gradual decreases. In addition, exploratory analyses in 18-20-year-olds showed gradual increases in rates of frequent HED post ACL passage, but the P value was not significant after Bonferroni correction.

Conclusions: Cannabis policy changes in California, USA, appear to be linked to age-specific changes in alcohol use, with moderate reductions, particularly among middle-aged adults. Findings were associative in nature and causality could not be determined.

大麻政策的变化是否与酒精使用模式有关?基于初级保健筛查数据的年龄组差异证据。
背景和目的:美国加利福尼亚州于2016年通过了成人大麻合法化(ACL),并于2018年开始实施合法销售。这项研究调查了这些政策变化是否与酒精使用模式的变化有关,并探讨了年龄组的差异。设计:我们研究了2015年至2019年加州初级保健患者每月酒精筛查阳性的比率。使用中断时间序列设计和自回归综合移动平均(ARIMA)模型,评估了整个样本的变化,并按年龄组(21-34岁、35-64岁和65岁以上)对ACL的两个关键干预点进行了分层:2016年11月9日(ACL通过)和2018年1月1日(ACL实施)。控制了季节性和自相关的时变混杂因素。地点:美国加利福尼亚州;Kaiser Permanente北加州医疗保健系统。参与者:在整个研究期间,n= 8 028 627例筛查完成,n= 3 525 493例21岁以上的独特患者。测量方法:根据美国国家酒精滥用和酒精中毒研究所制定的现行美国指南,每月患者超过每日限量、每周限量、超过每日和每周限量以及频繁的重度间歇性饮酒(HED)的汇总率。研究结果:具有统计学意义的是,超过每周酒精限量的比率逐渐下降[斜率变化的估计(95%置信区间[CI]) = -0.013(-0.019至-0.008),P结论:美国加利福尼亚州大麻政策的变化似乎与特定年龄的酒精使用变化有关,适度减少,特别是在中年人中。研究结果具有关联性,不能确定因果关系。
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来源期刊
Addiction
Addiction 医学-精神病学
CiteScore
10.80
自引率
6.70%
发文量
319
审稿时长
3 months
期刊介绍: Addiction publishes peer-reviewed research reports on pharmacological and behavioural addictions, bringing together research conducted within many different disciplines. Its goal is to serve international and interdisciplinary scientific and clinical communication, to strengthen links between science and policy, and to stimulate and enhance the quality of debate. We seek submissions that are not only technically competent but are also original and contain information or ideas of fresh interest to our international readership. We seek to serve low- and middle-income (LAMI) countries as well as more economically developed countries. Addiction’s scope spans human experimental, epidemiological, social science, historical, clinical and policy research relating to addiction, primarily but not exclusively in the areas of psychoactive substance use and/or gambling. In addition to original research, the journal features editorials, commentaries, reviews, letters, and book reviews.
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