Ju-Chen Hu PhD, Kenneth Karan MPH, Hao Zhang PhD, Russell Portenoy MD, William E. Rosa PhD, MBE, APRN, Yiye Zhang PhD, M. Carrington Reid PhD, MD, Rulla M. Tamimi ScD, Fang Zhang PhD, Eduardo Bruera MD, Judith A. Paice PhD, RN, Yuhua Bao PhD
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MML policies were classified into (1) no MML, (2) MML without dispensaries (after MML effective date and before the first state-licensed dispensary opened), and (3) MML with dispensaries. Outcomes included during the 6 months postdiagnosis: (1) any opioid prescription, (2) any short-acting oxycodone, hydrocodone, hydromorphone, or morphine prescription (“strong opioids”), (3) any short-acting tramadol or codeine prescription (“weak opioids”), and (4) total morphine milligram equivalents among patients with opioid prescriptions, (5) any all-cause, and (6) any pain-related emergency department visits or hospitalizations.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>The sample (<i>N</i> = 34,911) included 24,592 patients with breast, 8510 colorectal, and 1809 lung cancer. Compared to no MML, MML with dispensaries was associated with reduced any strong short-acting opioids prescription use (difference = −4.6; 95% CI, −8.6 to −0.5 percentage points [pp]; <i>p</i> = .028) and increased any all-cause adverse hospital events (difference = 2.6; 95% CI, 0.7−4.5 pp; <i>p</i> = .006). MML without dispensaries was associated with increased any weak opioid prescription use (difference = 1.2; 95% CI, 0.5−2 pp; <i>p</i> = .002).</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>MML policies may have affected the type of opioid prescribed and increased adverse hospital events among patients with cancer and resection surgery. 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引用次数: 0
摘要
背景:癌症患者的阿片类药物使用和不良事件可能随着医用大麻的使用而改变。本研究调查了2016年以来医用大麻合法化的影响。方法:采用差异中的差异方法和2016年至2022年的私人保险索赔数据,本横断面研究纳入了截至2016年27个没有MML的州因新诊断的(女性)乳腺癌、结直肠癌或肺癌接受切除手术的患者(年龄18-64岁)。MML政策分为(1)无MML,(2)无药房的MML(在MML生效日期之后,第一家国家许可的药房开业之前)和(3)有药房的MML。诊断后6个月内纳入的结果包括:(1)任何阿片类药物处方,(2)任何短效羟考酮、氢可酮、氢吗啡酮或吗啡处方(“强阿片类药物”),(3)任何短效曲马多或可待因处方(“弱阿片类药物”),(4)阿片类药物处方患者的吗啡总毫克当量,(5)任何全因,(6)任何与疼痛相关的急诊或住院治疗。结果:样本(N = 34,911)包括24,592例乳腺癌,8510例结直肠癌和1809例肺癌患者。与无MML相比,有药房的MML与减少任何强效阿片类药物处方使用相关(差异= -4.6;95% CI, -8.6至-0.5个百分点[pp]; p = 0.028),并增加任何全因不良医院事件(差异= 2.6;95% CI, 0.7-4.5 pp; p = 0.006)。无药房的MML与任何弱阿片类药物处方使用增加相关(差异= 1.2;95% CI, 0.5-2 pp; p = 0.002)。结论:MML政策可能影响了阿片类药物的处方类型,并增加了癌症和切除手术患者的不良医院事件。有必要进一步研究医用大麻对癌症疼痛管理的影响。
Medical marijuana policies, opioid prescriptions, and adverse events among patients undergoing cancer resection surgery
Background
Opioid use and adverse events among cancer patients may change with access to medical marijuana. This study investigated the impacts of medical marijuana legalization (MML) since 2016.
Methods
Using a difference-in-differences approach and 2016 to 2022 private insurance claims data, this cross-sectional study included patients (aged 18–64 years) undergoing resection surgery for newly diagnosed (female) breast, colorectal, or lung cancer in 27 states without MML as of 2016. MML policies were classified into (1) no MML, (2) MML without dispensaries (after MML effective date and before the first state-licensed dispensary opened), and (3) MML with dispensaries. Outcomes included during the 6 months postdiagnosis: (1) any opioid prescription, (2) any short-acting oxycodone, hydrocodone, hydromorphone, or morphine prescription (“strong opioids”), (3) any short-acting tramadol or codeine prescription (“weak opioids”), and (4) total morphine milligram equivalents among patients with opioid prescriptions, (5) any all-cause, and (6) any pain-related emergency department visits or hospitalizations.
Results
The sample (N = 34,911) included 24,592 patients with breast, 8510 colorectal, and 1809 lung cancer. Compared to no MML, MML with dispensaries was associated with reduced any strong short-acting opioids prescription use (difference = −4.6; 95% CI, −8.6 to −0.5 percentage points [pp]; p = .028) and increased any all-cause adverse hospital events (difference = 2.6; 95% CI, 0.7−4.5 pp; p = .006). MML without dispensaries was associated with increased any weak opioid prescription use (difference = 1.2; 95% CI, 0.5−2 pp; p = .002).
Conclusions
MML policies may have affected the type of opioid prescribed and increased adverse hospital events among patients with cancer and resection surgery. Additional investigation of medical marijuana’s impact on cancer pain management is warranted.
期刊介绍:
The CANCER site is a full-text, electronic implementation of CANCER, an Interdisciplinary International Journal of the American Cancer Society, and CANCER CYTOPATHOLOGY, a Journal of the American Cancer Society.
CANCER publishes interdisciplinary oncologic information according to, but not limited to, the following disease sites and disciplines: blood/bone marrow; breast disease; endocrine disorders; epidemiology; gastrointestinal tract; genitourinary disease; gynecologic oncology; head and neck disease; hepatobiliary tract; integrated medicine; lung disease; medical oncology; neuro-oncology; pathology radiation oncology; translational research