UPMC Centers for High Value Health Care and Value-Based Pharmacy Initiatives, UPMC Health Plan, Pittsburgh, PA, USA.
Express Scripts, a Cigna subsidiary, St. Louis, MO, USA.
J Gen Intern Med. 2021 Nov;36(11):3417-3422. doi: 10.1007/s11606-020-06530-6. Epub 2021 Feb 11.
Given efforts to reduce opioid use, and because marijuana potentially offers a lower-risk alternative for treating chronic pain, there is interest in understanding the public health impact of marijuana legalization on opioid-related outcomes.
Assess the impact of recreational and medical marijuana legalization on opioid utilization among patients receiving pharmacotherapy for pain.
Retrospective claims-based study of commercially insured patients continuously eligible for pharmacy and medical benefits from July 8, 2014 to June 30, 2017. Index pain prescription period was defined between January 8, 2015 and June 30, 2015, and longer-term opioid use examined during 2-year follow-up. Marijuana state policy on July 1, 2015, was assigned: none; medical only; or medical and recreational.
Patients aged 18-62 without cancer diagnosis.
Patient receiving (1) opioid at index; (2) > 7 days' supply of index opioid; (3) opioid during follow-up; and (4) ≥ 90 days' opioid supply during follow-up. Multivariable regression assessed associations between opioid utilization and state marijuana policy, adjusting for age, gender, overall disease burden, mental health treatment, concomitant use of benzodiazepine or muscle relaxant, and previous pain prescription.
Of 141,711 patients, 80,955 (57.1%) resided in states with no policy; 56,494 (39.9%) with medical-only; and 4262 (3.0%) with medical and recreational. Patients in states with both policies were more likely to receive an index opioid (aOR = 1.72, 95% CI = 1.61-1.85; aOR = 1.90, 95% CI = 1.77-2.03; P < 0.001) but less likely to receive > 7 days' index supply (aOR = 0.84, 95% CI = 0.77-0.91; aOR = 0.76, 95% CI = 0.70-0.83; P < 0.001) than patients in states with no policy or medical-only, respectively. Those in states with both policies were more likely to receive a follow-up opioid (aOR = 1.87, 95% CI = 1.71-2.05; aOR = 2.20, 95% CI = 2.01-2.42; P < 0.001) than those in states with no policy or medical-only, respectively, and more likely to receive ≥ 90 cumulative follow-up opioid days' supply (aOR = 1.18, 95% CI = 1.07-1.29; P < 0.001) than those in states with no policy.
Our analysis does not support the supposition that access to marijuana lowers use of chronic opioids for pain.
鉴于减少阿片类药物使用的努力，以及大麻为治疗慢性疼痛提供了潜在的低风险替代方案，人们对了解大麻合法化对阿片类药物相关结果的公共卫生影响感兴趣。
评估娱乐和医用大麻合法化对接受疼痛药物治疗的患者阿片类药物使用的影响。
对 2014 年 7 月 8 日至 2017 年 6 月 30 日连续有药房和医疗福利资格的商业保险患者进行回顾性基于索赔的研究。索引疼痛处方期定义为 2015 年 1 月 8 日至 2015 年 6 月 30 日，在 2 年随访期间检查长期阿片类药物使用情况。2015 年 7 月 1 日的大麻州政策分配为：无；仅医用；或医用和娱乐用。
年龄在 18-62 岁且无癌症诊断的患者。
患者在索引时接受（1）阿片类药物；（2）> 7 天索引阿片类药物供应；（3）随访期间的阿片类药物；（4）随访期间至少 90 天的阿片类药物供应。多变量回归分析了阿片类药物使用与州大麻政策之间的关联，调整了年龄、性别、整体疾病负担、心理健康治疗、苯二氮䓬类药物或肌肉松弛剂的同时使用以及先前的疼痛处方。
在 141711 名患者中，80955 名（57.1%）居住在无政策的州；56494 名（39.9%）有医疗专用；4262 名（3.0%）有医疗和娱乐专用。有两种政策的州的患者更有可能接受索引阿片类药物（调整后优势比[aOR] = 1.72，95%置信区间[CI] = 1.61-1.85；aOR = 1.90，95%CI = 1.77-2.03；P < 0.001），但不太可能接受> 7 天的索引供应（aOR = 0.84，95%CI = 0.77-0.91；aOR = 0.76，95%CI = 0.70-0.83；P < 0.001）与无政策或医疗专用州的患者相比。与无政策或医疗专用州的患者相比，有两种政策的州的患者更有可能接受后续阿片类药物（aOR = 1.87，95%CI = 1.71-2.05；aOR = 2.20，95%CI = 2.01-2.42；P < 0.001），并且更有可能接受≥ 90 天的累积后续阿片类药物供应（aOR = 1.18，95%CI = 1.07-1.29；P < 0.001）与无政策州的患者相比。
我们的分析不支持这样的假设，即获得大麻会降低慢性疼痛的阿片类药物使用。
