休闲大麻零售商分配对急诊科访问量的影响：利用彩票设计的自然实验。

IF 4.4 2区医学 Q1 SUBSTANCE ABUSE

International Journal of Drug Policy Pub Date : 2025-01-21 DOI:10.1016/j.drugpo.2025.104708

Yihong Bai , Peiya Cao , Chungah Kim , Kristine Ienciu , Antony Chum

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引用次数: 0

摘要

背景：2018年10月，加拿大将娱乐性大麻合法化，安大略省于2019年通过彩票系统分发零售商许可证。本研究调查了娱乐性大麻零售商分配对与大麻、酒精和阿片类药物相关的急诊室（ED）访问量的影响。方法：对安大略省278个社区（由前向分类区（Forward classification Areas, FSAs）代理）进行纵向研究，使用所有安大略省公共健康保险居民的ICES健康管理数据。该队列包括11156100名18岁及以上的成年人，从2016年1月到2023年3月每季度监测一次。通过随机抽签系统分配大麻零售商提供了一个自然实验。由Callaway和Sant'Anna （CSDID）模型提出的交错差中差，由零售商分配的逆概率加权，用于估计大麻商店开业对ED访问量的影响，比较有和没有零售商的金融服务机构。结果：在大麻零售商分配后，大麻、酒精或阿片类药物相关的急诊科就诊未发现显著影响。敏感性分析，包括替代诊断代码，大麻和其他物质的共同使用，以及大麻在没有其他物质的情况下使用，证实了我们的主要发现。无效结果可能是由于在线大麻销售先于零售店开业，地理分布最大限度地减少了获取差异，以及潜在的溢出效应。结论：娱乐性大麻零售商执照的分配对急性护理使用没有显著影响。建议为今后的政策考虑提供持续监测、全面销售跟踪和综合药物使用预防战略。

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The impact of recreational cannabis retailer allocation on emergency department visits: A natural experiment utilizing lottery design

Background

In October 2018, Canada legalized recreational cannabis, with Ontario distributing retailer licenses through a lottery system in 2019. This study investigates the impact of recreational cannabis retailer allocation on emergency department (ED) visits related to cannabis, alcohol, and opioids.

Method

A longitudinal study of 278 communities in Ontario (proxied by Forward Sortation Areas, FSAs) was conducted using health administrative data from ICES for all Ontario residents covered by public health insurance. The cohort included 11,156,100 adults aged 18 and above, monitored quarterly from January 2016 to March 2023. The allocation of cannabis retailers through a randomized lottery system provided a natural experiment. Staggered difference-in-differences proposed by Callaway and Sant'Anna (CSDID) models, weighted by the inverse probability of retailer allocation, were used to estimate the impact of cannabis store openings on ED visits, comparing FSAs with and without retailers.

Results

No significant effects were found in cannabis-, alcohol-, or opioid-related ED visits following the allocation of cannabis retailers. Sensitivity analyses, including alternate diagnostic codes, co-use of cannabis and other substances, and cannabis use without other substances, corroborated our main findings. The null results may be due to online cannabis sales preceding retail store openings, geographic distribution minimizing access disparities, and potential spillover effects.

Conclusion

The allocation of recreational cannabis retailer licenses did not significantly impact acute care use. Continuous monitoring, comprehensive sales tracking, and integrated substance use prevention strategies are recommended for future policy considerations.

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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.