美国医疗和娱乐大麻法律与阿片类药物滥用和阿片类药物使用障碍的关系：是否取决于大麻使用史？

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-02-01 DOI:10.1016/j.drugpo.2024.104687

Silvia S. Martins , Emilie Bruzelius , Christine M. Mauro , Julian Santaella-Tenorio , Anne E. Boustead , Katherine Wheeler-Martin , Hillary Samples , Deborah S. Hasin , David S. Fink , Kara E. Rudolph , Stephen Crystal , Corey S. Davis , Magdalena Cerdá

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引用次数: 0

摘要

背景：据推测，通过医疗和娱乐合法化（MCL单独和RCL+MCL）扩大大麻的可得性有助于减少阿片类药物的使用、滥用和相关危害。我们研究了各州采用大麻法律是否与阿片类药物结果的总体变化有关，并按大麻使用分层。方法：利用2015 - 2019年全国药物使用与健康调查（NSDUH）数据，估计大麻法律与阿片类药物（处方阿片类药物滥用和/或海洛因使用）滥用和使用障碍的关系。所有逻辑回归模型（总体模型和按大麻使用分层的模型）都包括年份和州的固定效应、个人水平协变量和阿片类药物相关的州政策。分层分析仅限于在法律通过之前报告终生使用大麻的个人，以减少潜在的碰撞偏差。使用错误发现率（FDR）校正和使用e值对未测量混淆的敏感性进行了多重比较。结果：总体而言，MCL和RCL的采用与阿片类药物结局的几率变化无关。在限制受访者报告过去一年的大麻使用情况后，我们观察到过去一年阿片类药物滥用的几率下降(调整优势比[AOR]: 0.57[95%置信区间[CI]: 0.38, 0.85]；FDR p值：0.07)，在有MCL的州与没有大麻法律的州相比。rcl与采用MCL后任何阿片类药物结局的几率变化无关。结论：将MCL单独州的个体与没有此类法律的州的个体进行比较，我们发现阿片类药物结局几率下降的模式不一致，这在报告大麻使用的人群中更为明显。这种模式并不适用于RCL州的个体。根据以替代为导向的观点，研究结果表明，mcl可能与大麻使用者中阿片类药物使用的减少有关，但需要进一步的工作来复制和扩展这些发现。

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The relationship of medical and recreational cannabis laws with opioid misuse and opioid use disorder in the USA: Does it depend on prior history of cannabis use?

Background

Wider availability of cannabis through medical and recreational legalization (MCL alone and RCL+MCL) has been hypothesized to contribute to reductions in opioid use, misuse, and related harms. We examined whether state adoption of cannabis laws was associated with changes in opioid outcomes overall and stratified by cannabis use.

Methods

Using National Survey on Drug Use and Health (NSDUH) data from 2015 to 2019, we estimated cannabis law associations with opioid (prescription opioid misuse and/or heroin use) misuse and use disorder. All logistic regression models (overall models and models stratified by cannabis use), included year and state fixed effects, individual level covariates, and opioid-related state policies. Stratified analyses were restricted to individuals who reported lifetime cannabis use prior to law adoption to reduce potential for collider bias. Estimates accounted for multiple comparisons using false discovery rate (FDR) corrections and sensitivity to unmeasured confounding using e-values.

Results

Overall, MCL and RCL adoption were not associated with changes in the odds of any opioid outcome. After restricting to respondents reporting past-year cannabis use, we observed decreased odds of past year opioid misuse (adjusted odds ratio [AOR]: 0.57 [95 % confidence interval [CI]: 0.38, 0.85]; FDR p-value: 0.07), among individuals in states with MCL compared to those in states without cannabis laws. RCLs were not associated with changes in the odds of any opioid outcome beyond MCL adoption.

Conclusion

Comparing individuals in MCL alone states to those in states without such laws, we found an inconsistent pattern of decreased odds of opioid outcomes, which were more pronounced among people reporting cannabis use. The pattern did not hold for individuals in RCL states. In line with a substitution-oriented perspective, findings suggests that MCLs may be associated with reductions in opioid use among people using cannabis but additional work to replicate and expand on these findings is needed.

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来源期刊

International Journal of Drug Policy SUBSTANCE ABUSE-

CiteScore

7.80

自引率

11.40%

发文量

307

审稿时长

62 days

期刊介绍： The International Journal of Drug Policy provides a forum for the dissemination of current research, reviews, debate, and critical analysis on drug use and drug policy in a global context. It seeks to publish material on the social, political, legal, and health contexts of psychoactive substance use, both licit and illicit. The journal is particularly concerned to explore the effects of drug policy and practice on drug-using behaviour and its health and social consequences. It is the policy of the journal to represent a wide range of material on drug-related matters from around the world.