美国大麻使用与处方阿片类药物使用障碍风险
Cannabis Use and Risk of Prescription Opioid Use Disorder in the United States.
作者信息
Olfson Mark, Wall Melanie M, Liu Shang-Min, Blanco Carlos
机构信息
From the Department of Psychiatry, New York State Psychiatric Institute and Columbia University Medical Center, New York; and the Division of Epidemiology, Services and Prevention Research, NIDA, Bethesda, Md.
出版信息
Am J Psychiatry. 2018 Jan 1;175(1):47-53. doi: 10.1176/appi.ajp.2017.17040413. Epub 2017 Sep 26.
OBJECTIVE
The authors sought to determine whether cannabis use is associated with a change in the risk of incident nonmedical prescription opioid use and opioid use disorder at 3-year follow-up.
METHOD
The authors used logistic regression models to assess prospective associations between cannabis use at wave 1 (2001-2002) and nonmedical prescription opioid use and prescription opioid use disorder at wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Corresponding analyses were performed among adults with moderate or more severe pain and with nonmedical opioid use at wave 1. Cannabis and prescription opioid use were measured with a structured interview (the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV version). Other covariates included age, sex, race/ethnicity, anxiety or mood disorders, family history of drug, alcohol, and behavioral problems, and, in opioid use disorder analyses, nonmedical opioid use.
RESULTS
In logistic regression models, cannabis use at wave 1 was associated with increased incident nonmedical prescription opioid use (odds ratio=5.78, 95% CI=4.23-7.90) and opioid use disorder (odds ratio=7.76, 95% CI=4.95-12.16) at wave 2. These associations remained significant after adjustment for background characteristics (nonmedical opioid use: adjusted odds ratio=2.62, 95% CI=1.86-3.69; opioid use disorder: adjusted odds ratio=2.18, 95% CI=1.14-4.14). Among adults with pain at wave 1, cannabis use was also associated with increased incident nonmedical opioid use (adjusted odds ratio=2.99, 95% CI=1.63-5.47) at wave 2; it was also associated with increased incident prescription opioid use disorder, although the association fell short of significance (adjusted odds ratio=2.14, 95% CI=0.95-4.83). Among adults with nonmedical opioid use at wave 1, cannabis use was also associated with an increase in nonmedical opioid use (adjusted odds ratio=3.13, 95% CI=1.19-8.23).
CONCLUSIONS
Cannabis use appears to increase rather than decrease the risk of developing nonmedical prescription opioid use and opioid use disorder.
目的
作者试图确定在3年随访中，使用大麻是否与非医疗处方阿片类药物使用及阿片类药物使用障碍风险的变化相关。
方法
作者使用逻辑回归模型评估全国酒精及相关疾病流行病学调查中第1波（2001 - 2002年）大麻使用与第2波（2004 - 2005年）非医疗处方阿片类药物使用及处方阿片类药物使用障碍之间的前瞻性关联。在第1波有中度或更严重疼痛且有非医疗阿片类药物使用的成年人中进行了相应分析。大麻和处方阿片类药物使用通过结构化访谈（酒精使用障碍及相关残疾访谈表 - DSM - IV版）进行测量。其他协变量包括年龄、性别、种族/族裔、焦虑或情绪障碍、药物、酒精和行为问题的家族史，以及在阿片类药物使用障碍分析中的非医疗阿片类药物使用情况。
结果
在逻辑回归模型中，第1波大麻使用与第2波非医疗处方阿片类药物使用增加（比值比 = 5.78，95%置信区间 = 4.23 - 7.90）及阿片类药物使用障碍（比值比 = 7.76，95%置信区间 = 4.95 - 12.16）相关。在对背景特征进行调整后，这些关联仍然显著（非医疗阿片类药物使用：调整后比值比 = 2.62，95%置信区间 = 1.86 - 3.69；阿片类药物使用障碍：调整后比值比 = 2.18，95%置信区间 = 1.14 - 4.14）。在第1波有疼痛的成年人中，大麻使用也与第2波非医疗阿片类药物使用增加（调整后比值比 = 2.99，95%置信区间 = 1.63 - 5.47）相关；它还与处方阿片类药物使用障碍增加相关，尽管该关联未达到显著水平（调整后比值比 = 2.14，95%置信区间 = 0.95 - 4.83）。在第1波有非医疗阿片类药物使用的成年人中，大麻使用也与非医疗阿片类药物使用增加（调整后比值比 = 3.13，95%置信区间 = 1.19 - 8.23）相关。
结论
使用大麻似乎会增加而非降低出现非医疗处方阿片类药物使用及阿片类药物使用障碍的风险。
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