Hasin Deborah S, Sarvet Aaron L, Cerdá Magdalena, Keyes Katherine M, Stohl Malka, Galea Sandro, Wall Melanie M
Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York3Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
Department of Psychiatry, Columbia University Medical Center, New York, New York2New York State Psychiatric Institute, New York.
JAMA Psychiatry. 2017 Jun 1;74(6):579-588. doi: 10.1001/jamapsychiatry.2017.0724.
Over the last 25 years, illicit cannabis use and cannabis use disorders have increased among US adults, and 28 states have passed medical marijuana laws (MML). Little is known about MML and adult illicit cannabis use or cannabis use disorders considered over time.
To present national data on state MML and degree of change in the prevalence of cannabis use and disorders.
DESIGN, PARTICIPANTS, AND SETTING: Differences in the degree of change between those living in MML states and other states were examined using 3 cross-sectional US adult surveys: the National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991-1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001-2002), and the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III; 2012-2013). Early-MML states passed MML between NLAES and NESARC ("earlier period"). Late-MML states passed MML between NESARC and NESARC-III ("later period").
Past-year illicit cannabis use and DSM-IV cannabis use disorder.
Overall, from 1991-1992 to 2012-2013, illicit cannabis use increased significantly more in states that passed MML than in other states (1.4-percentage point more; SE, 0.5; P = .004), as did cannabis use disorders (0.7-percentage point more; SE, 0.3; P = .03). In the earlier period, illicit cannabis use and disorders decreased similarly in non-MML states and in California (where prevalence was much higher to start with). In contrast, in remaining early-MML states, the prevalence of use and disorders increased. Remaining early-MML and non-MML states differed significantly for use (by 2.5 percentage points; SE, 0.9; P = .004) and disorder (1.1 percentage points; SE, 0.5; P = .02). In the later period, illicit use increased by the following percentage points: never-MML states, 3.5 (SE, 0.5); California, 5.3 (SE, 1.0); Colorado, 7.0 (SE, 1.6); other early-MML states, 2.6 (SE, 0.9); and late-MML states, 5.1 (SE, 0.8). Compared with never-MML states, increases in use were significantly greater in late-MML states (1.6-percentage point more; SE, 0.6; P = .01), California (1.8-percentage point more; SE, 0.9; P = .04), and Colorado (3.5-percentage point more; SE, 1.5; P = .03). Increases in cannabis use disorder, which was less prevalent, were smaller but followed similar patterns descriptively, with change greater than never-MML states in California (1.0-percentage point more; SE, 0.5; P = .06) and Colorado (1.6-percentage point more; SE, 0.8; P = .04).
Medical marijuana laws appear to have contributed to increased prevalence of illicit cannabis use and cannabis use disorders. State-specific policy changes may also have played a role. While medical marijuana may help some, cannabis-related health consequences associated with changes in state marijuana laws should receive consideration by health care professionals and the public.
在过去25年里，美国成年人中非法使用大麻及大麻使用障碍有所增加，且有28个州通过了医用大麻法律（MML）。随着时间推移，关于医用大麻法律与成年人非法使用大麻或大麻使用障碍的情况鲜为人知。
呈现关于各州医用大麻法律以及大麻使用和障碍患病率变化程度的全国性数据。
设计、参与者与研究背景：利用三项美国成年人横断面调查，研究了生活在有医用大麻法律州和其他州之间变化程度的差异：全国酒精流行病学纵向调查（NLAES；1991 - 1992年）、全国酒精及相关疾病流行病学调查（NESARC；2001 - 2002年）以及全国酒精及相关疾病流行病学调查三期（NESARC - III；2012 - 2013年）。早期通过医用大麻法律的州在NLAES和NESARC之间通过了MML（“早期阶段”）。后期通过医用大麻法律的州在NESARC和NESARC - III之间通过了MML（“后期阶段”）。
过去一年的非法大麻使用及《精神疾病诊断与统计手册》第四版（DSM - IV）大麻使用障碍。
总体而言，从1991 - 1992年到2012 - 2013年，通过医用大麻法律的州非法大麻使用增加幅度显著高于其他州（多1.4个百分点；标准误，0.5；P = 0.004），大麻使用障碍亦是如此（多0.7个百分点；标准误，0.3；P = 0.03）。在早期阶段，非医用大麻法律州和加利福尼亚州（其患病率一开始就高得多）的非法大麻使用及障碍同样下降。相比之下，在其余早期通过医用大麻法律的州，使用及障碍的患病率上升。其余早期通过医用大麻法律的州和非医用大麻法律州在使用方面差异显著（相差2.5个百分点；标准误，0.9；P = 0.004），在障碍方面相差1.1个百分点（标准误，0.5；P = 0.02）。在后期阶段，非法使用增加的百分点如下：从未通过医用大麻法律的州，3.5（标准误，0.5）；加利福尼亚州，5.3（标准误，1.0）；科罗拉多州，7.0（标准误，1.6）；其他早期通过医用大麻法律的州，2.6（标准误，0.9）；后期通过医用大麻法律的州，5.1（标准误，0.8）。与从未通过医用大麻法律的州相比，后期通过医用大麻法律的州使用增加幅度显著更大（多1.6个百分点；标准误，0.6；P = 0.01），加利福尼亚州（多1.8个百分点；标准误，0.9；P = 0.04），科罗拉多州（多3.5个百分点；标准误，1.5；P = 0.03）。大麻使用障碍患病率较低，其增加幅度较小，但描述性地遵循类似模式，加利福尼亚州（多1.0个百分点；标准误，0.5；P = 0.06）和科罗拉多州（多1.6个百分点；标准误，0.8；P = 0.04）的变化大于从未通过医用大麻法律的州。
医用大麻法律似乎导致了非法大麻使用及大麻使用障碍患病率上升。各州特定的政策变化可能也起到了作用。虽然医用大麻可能对某些人有帮助，但与州大麻法律变化相关的大麻相关健康后果应得到医疗保健专业人员和公众的考虑。
