New York State Psychiatric Institute, New York.
Department of Epidemiology, Mailman School of Public Health, Columbia University Irving Medical Center, New York.
Int J Drug Policy. 2022 Jan;99:103449. doi: 10.1016/j.drugpo.2021.103449. Epub 2021 Sep 26.
Most information on the relationship between medical cannabis laws (MCL) and the risk for opioid overdose fatality has been based on studies with ecological designs. To contribute additional information, we used a novel case-control design and individual-level data from national surveys to assess whether state medical cannabis laws were associated with reduced risk of fatal opioid overdose between 2000-2011.
Data from participants surveyed in the National Health Interview Survey (NHIS) between 1986-2011 were included. For those sampled between 1986-2009, detailed mortality follow-up data were available from the National Death Index up to 12/31/2011. Opioid overdose decedents (n = 791) were classified as cases. Between 2000-2011, all cases arising in a given year were matched to adult controls who were surveyed the same year and eligible for mortality follow-up (n = 723,920). The distribution of exposure to state MCL was contrasted between cases and controls, providing an approximation of the rate ratio of fatal opioid overdose associated with MCLs. Due to a NHIS sample redesign, we stratified analysis using timeframes before and after 2005.
Overall, compared to controls, cases were more likely to be male, middle-aged, non-Hispanic White, separated/divorced; less educated, and have a family income below the poverty threshold. No overall association between state MCLs and the rate of opioid overdose was observed between 2000-2005 (aOR = 1.22, 95% CI: 0.83-1.79) or between 2006-2011 (aOR = 0.87, 95% CI: 0.60-1.25). No significant difference between sampling timeframes was observed (ratio of aOR's = 0.71, 95% CI: 0.49-1.01).
We found no overall protective relationship between state MCLs and opioid overdose. Future research with more recent mortality data and more refined cannabis policy classifications would be useful. The importance of the study is two-fold. First, the findings provide an additional source of information countering claims of a protective effect of MCLs on opioid overdoses, suggesting that other solutions to the opioid overdose crisis are needed. Second, the study offers a potentially useful design to answer important population-level public health questions.
大多数关于医用大麻法规（MCL）与阿片类药物过量致死风险之间关系的信息都基于具有生态设计的研究。为了提供更多信息，我们使用了一种新颖的病例对照设计和来自全国调查的个人水平数据，评估了 2000-2011 年间州医用大麻法规是否与降低致命阿片类药物过量的风险有关。
纳入了参加 1986-2011 年全国健康访谈调查（NHIS）的参与者的数据。对于在 1986-2009 年间抽样的人，从国家死亡索引中获得了截至 2011 年 12 月 31 日的详细死亡随访数据。阿片类药物过量死亡者（n=791）被分类为病例。在 2000-2011 年间，在给定年份发生的所有病例都与同年接受调查且有资格进行死亡随访的成年对照者（n=723920）相匹配。病例和对照者之间对比了暴露于州 MCL 的情况，这提供了与 MCL 相关的致命阿片类药物过量风险的比率比的近似值。由于 NHIS 样本重新设计，我们使用 2005 年前后的时间框架进行分层分析。
总体而言，与对照者相比，病例者更可能是男性、中年、非西班牙裔白人、离异；受教育程度较低，家庭收入低于贫困线。在 2000-2005 年（aOR=1.22，95%CI：0.83-1.79）或 2006-2011 年（aOR=0.87，95%CI：0.60-1.25）期间，州 MCL 与阿片类药物过量率之间没有观察到总体关联。在采样时间框架之间没有观察到显著差异（aOR 的比值=0.71，95%CI：0.49-1.01）。
我们没有发现州 MCL 与阿片类药物过量之间存在总体保护关系。使用最近的死亡率数据和更精细的大麻政策分类进行的未来研究将是有用的。这项研究的重要性有两个方面。首先，研究结果提供了对抗 MCL 对阿片类药物过量的保护作用的主张的额外信息来源，表明需要解决阿片类药物过量危机的其他解决方案。其次，该研究提供了一种潜在有用的设计，可以回答重要的人群公共卫生问题。
