医用大麻和非医用大麻的使用与处方类阿片类药物使用障碍风险：基于倾向评分匹配的研究结果。
Medical and non-medical cannabis use and risk of prescription opioid use disorder: Findings from propensity score matching.
机构信息
Department of Family Medicine and Public Health, University of California San Diego, La Jolla, USA.
Department of Anesthesiology, University of California San Diego, La Jolla, USA.
出版信息
Drug Alcohol Rev. 2019 Sep;38(6):597-605. doi: 10.1111/dar.12964. Epub 2019 Jul 25.
INTRODUCTION AND AIMS
Previous research suggested that cannabis use was associated with increased risks of prescription opioid misuse and use disorder. This study examined whether these associations differed by cannabis use purpose.
DESIGN AND METHODS
This is a secondary analysis of cross-sectional surveys with propensity score matching. Medical cannabis users (N = 1295), cannabis dual users with both medical and non-medical purposes (N = 707) and non-medical cannabis users (N = 18 666) were compared with cannabis non-users (N = 57 196) in the pooled 2013-2016 US nationally representative National Survey on Drug Use and Health. Propensity score models were applied to match cannabis non-users to cannabis users with different purposes with respect to potential confounders in individual socioeconomic characteristics, other substance use disorders and health conditions. In a matched sample, logistic regressions were used to assess associations.
RESULTS
Propensity score matching considerably improved the balance of the potential confounders between cannabis non-users and users. In a matched sample, non-medical cannabis use was associated with increased risks of prescription opioid misuse (OR = 3.15, 95%CI: 2.89-3.44) and use disorder (OR = 2.52, 95%CI: 2.06-3.10). Cannabis dual use and medical cannabis use were associated with increased risks of prescription opioid misuse (OR = 2.55, 95%CI: 1.78-3.65; OR = 2.15, 95%CI: 1.58-2.91, respectively), but they were not associated with prescription opioid use disorder.
DISCUSSION AND CONCLUSIONS
Medical and non-medical cannabis use both were both associated with increased risks of prescription opioid misuse. Medical cannabis use, however, was not associated with prescription opioid use disorder, and non-medical cannabis was. There appeared to be differential associations between cannabis use and prescription opioid use disorder by cannabis use purpose.
介绍和目的
之前的研究表明，大麻使用与处方类阿片类药物滥用和使用障碍的风险增加有关。本研究检验了这些关联是否因大麻使用目的而异。
设计和方法
这是一项使用倾向评分匹配的横断面调查的二次分析。将医用大麻使用者（N=1295）、既有医用又有非医用目的的大麻双重使用者（N=707）和非医用大麻使用者（N=18666）与非医用大麻使用者（N=57196）进行比较，这些参与者均来自于 2013-2016 年美国全国代表性的全国药物使用和健康调查。应用倾向评分模型，根据个体社会经济特征、其他物质使用障碍和健康状况的潜在混杂因素，将非医用大麻使用者与具有不同用途的大麻使用者进行匹配。在匹配样本中，使用逻辑回归评估关联。
结果
倾向评分匹配极大地改善了非医用大麻使用者和使用者之间潜在混杂因素的平衡。在匹配样本中，非医用大麻使用与处方类阿片类药物滥用（OR=3.15，95%CI：2.89-3.44）和使用障碍（OR=2.52，95%CI：2.06-3.10）的风险增加有关。大麻双重使用和医用大麻使用与处方类阿片类药物滥用的风险增加有关（OR=2.55，95%CI：1.78-3.65；OR=2.15，95%CI：1.58-2.91），但与处方类阿片类药物使用障碍无关。
讨论和结论
医用和非医用大麻使用都与处方类阿片类药物滥用的风险增加有关。然而，医用大麻使用与处方类阿片类药物使用障碍无关，而非医用大麻则与处方类阿片类药物使用障碍有关。大麻使用与处方类阿片类药物使用障碍之间的关联似乎因大麻使用目的而异。
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