School of Nursing, University of Virginia, Charlottesville, VA.
School of Nursing, University of Virginia, Charlottesville, VA.
Nurs Outlook. 2018 Jan-Feb;66(1):56-65. doi: 10.1016/j.outlook.2017.08.012. Epub 2017 Sep 21.
A staggering number of Americans are dying from overdoses attributed to prescription opioid medications (POMs). In response, states are creating policies related to POM harm reduction strategies, overdose prevention, and alternative therapies for pain management, such as cannabis (medical marijuana). However, little is known about how the use of cannabis for pain management may be associated with POM use.
The purpose of this article is to examine state medical cannabis (MC) use laws and policies and their potential association with POM use and related harms.
A systematic literature review was conducted to explore United States policies related to MC use and the association with POM use and related harms. Medline, PubMed, CINAHL, and Cochrane databases were searched to identify peer-reviewed articles published between 2010 and 2017. Using the search criteria, 11,513 records were identified, with 789 abstracts reviewed, and then 134 full-text articles screened for eligibility.
Of 134 articles, 10 articles met inclusion criteria. Four articles were cross-sectional online survey studies of MC substitution for POM, six were secondary data analyses exploring state-level POM overdose fatalities, hospitalizations related to MC or POM harms, opioid use disorder admissions, motor vehicle fatalities, and Medicare and Medicaid prescription cost analyses. The literature suggests MC laws could be associated with decreased POM use, fewer POM-related hospitalizations, lower rates of opioid overdose, and reduced national health care expenditures related to POM overdose and misuse. However, available literature on the topic is sparse and has notable limitations.
Review of the current literature suggests states that implement MC policies could reduce POM-associated mortality, improve pain management, and significantly reduce health care costs. However, MC research is constrained by federal policy restrictions, and more research related to MC as a potential alternative to POM for pain management, MC harms, and its impact on POM-related harms and health care costs should be a priority of public health, medical, and nursing research.
大量美国人因处方类阿片药物（POM）而过量死亡。为此，各州正在制定与 POM 减少伤害策略、预防过量和替代疼痛管理疗法（如大麻）相关的政策。然而，人们对大麻用于疼痛管理可能与 POM 使用的关系知之甚少。
本文旨在研究州内医用大麻（MC）使用法律和政策及其与 POM 使用和相关危害的潜在关联。
对美国与 MC 使用相关的政策进行了系统的文献回顾，以探讨与 POM 使用和相关危害的关联。在 Medline、PubMed、CINAHL 和 Cochrane 数据库中检索了 2010 年至 2017 年发表的同行评审文章。使用搜索标准，确定了 11513 条记录，对 789 个摘要进行了审查，然后对 134 篇全文文章进行了筛查以确定其是否符合入选标准。
在 134 篇文章中，有 10 篇符合纳入标准。4 篇是关于 MC 替代 POM 的横断面在线调查研究，6 篇是关于州级 POM 过量死亡、与 MC 或 POM 危害相关的住院治疗、阿片类药物使用障碍入院、机动车死亡以及医疗保险和医疗补助处方费用分析的二次数据分析。文献表明，MC 法规可能与 POM 使用减少、POM 相关住院治疗减少、阿片类药物过量率降低以及与 POM 过量和滥用相关的国家卫生保健支出减少有关。然而，目前关于这一主题的文献很少，且存在明显的局限性。
对现有文献的回顾表明，实施 MC 政策的州可能会降低与 POM 相关的死亡率，改善疼痛管理，并显著降低医疗保健费用。然而，由于联邦政策的限制，MC 研究受到限制，应优先进行与 MC 作为 POM 替代疼痛管理的潜在替代药物、MC 危害及其对 POM 相关危害和医疗保健成本的影响相关的研究，这是公共卫生、医学和护理研究的重点。
