Graduate School of Management, University of California, Davis, California, USA.
School of Management, Yale University, 165 Whitney Avenue, New Haven, CT 06520, USA
BMJ. 2021 Jan 27;372:m4957. doi: 10.1136/bmj.m4957.
To examine county level associations between the prevalence of medical and recreational cannabis stores (referred to as dispensaries) and opioid related mortality rates.
Panel regression methods.
812 counties in the United States in the 23 states that allowed legal forms of cannabis dispensaries to operate by the end of 2017.
The study used US mortality data from the Centers for Disease Control and Prevention combined with US census data and data from Weedmaps.com on storefront dispensary operations. Data were analyzed at the county level by using panel regression methods.
The main outcome measures were the log transformed, age adjusted mortality rates associated with all opioid types combined, and with subcategories of prescription opioids, heroin, and synthetic opioids other than methadone. The associations of medical dispensary and recreational dispensary counts with age adjusted mortality rates were also analyzed.
County level dispensary count (natural logarithm) is negatively related to the log transformed, age adjusted mortality rate associated with all opioid types (β=-0.17, 95% confidence interval -0.23 to -0.11). According to this estimate, an increase from one to two storefront dispensaries in a county is associated with an estimated 17% reduction in all opioid related mortality rates. Dispensary count has a particularly strong negative association with deaths caused by synthetic opioids other than methadone (β=-0.21, 95% confidence interval -0.27 to -0.14), with an estimated 21% reduction in mortality rates associated with an increase from one to two dispensaries. Similar associations were found for medical versus recreational storefront dispensary counts on synthetic (non-methadone) opioid related mortality rates.
Higher medical and recreational storefront dispensary counts are associated with reduced opioid related death rates, particularly deaths associated with synthetic opioids such as fentanyl. While the associations documented cannot be assumed to be causal, they suggest a potential association between increased prevalence of medical and recreational cannabis dispensaries and reduced opioid related mortality rates. This study highlights the importance of considering the complex supply side of related drug markets and how this shapes opioid use and misuse.
研究医疗和娱乐大麻店（以下简称药房）的流行率与阿片类药物相关死亡率之间在县一级的关联。
面板回归方法。
美国 23 个州的 812 个县，这些州允许合法形式的大麻药房在 2017 年底前运营。
本研究使用了美国疾病控制与预防中心的死亡数据，结合了美国人口普查数据和 Weedmaps.com 关于店面药房运营的数据。采用面板回归方法，按县一级进行数据分析。
主要观察指标是与所有阿片类药物相关的、经年龄调整的对数转换死亡率，以及与处方类阿片类药物、海洛因和除美沙酮以外的合成阿片类药物亚类相关的死亡率。还分析了医疗用药房和娱乐用药房数量与年龄调整死亡率之间的关联。
县一级的药房数量（自然对数）与所有阿片类药物相关的、经年龄调整的对数转换死亡率呈负相关（β=-0.17，95%置信区间-0.23 至-0.11）。根据这一估计，一个县的店面药房数量从一家增加到两家，与所有阿片类药物相关的死亡率估计降低 17%。药房数量与除美沙酮以外的合成阿片类药物相关的死亡率呈很强的负相关（β=-0.21，95%置信区间-0.27 至-0.14），与一家增加到两家药房相关的死亡率估计降低 21%。对于医疗与娱乐用店面药房数量与合成（非美沙酮）阿片类药物相关死亡率之间也存在类似的关联。
较高的医疗和娱乐用店面药房数量与阿片类药物相关死亡率的降低相关，特别是与芬太尼等合成阿片类药物相关的死亡率。虽然所记录的关联不能被认为是因果关系，但它们表明医疗和娱乐用大麻药房的流行率增加与阿片类药物相关死亡率的降低之间可能存在关联。本研究强调了考虑相关毒品市场供应方的复杂性以及这如何影响阿片类药物的使用和滥用的重要性。
