Hirsch Annemarie G, Wright Eric A, Nordberg Cara M, DeWalle Joseph, Stains Elena L, Kennalley Amy L, Zhang Joy, Tusing Lorraine D, Piper Brian J
Department of Population Health Sciences, Geisinger, Danville, PA, USA.
Center for Pharmacy Innovation and Outcomes, Geisinger, Danville, PA, USA.
Med Cannabis Cannabinoids. 2024 Feb 20;7(1):34-43. doi: 10.1159/000537841. eCollection 2024 Jan-Dec.
Pennsylvania opened its first medical marijuana (MMJ) dispensary in 2018. Qualifying conditions include six conditions determined to have no or insufficient evidence to support or refute MMJ effectiveness. We conducted a study to describe MMJ dispensary access in Pennsylvania and to determine whether dispensary proximity was associated with MMJ certifications and community demographics.
Using data from the Pennsylvania Department of Health, we geocoded MMJ dispensary locations and linked them to US Census Bureau data. We created dispensary access measures from the population-weighted centroid of Zip Code Tabulation Areas (ZCTAs): distance to nearest dispensary and density of dispensaries within a 15-min drive. We evaluated associations between dispensary access and the proportion of adults who received MMJ certification and the proportion of certifications for low evidence conditions (amyotrophic lateral sclerosis, epilepsy, glaucoma, Huntington's disease, opioid use disorder, and Parkinson's disease) using negative binomial modeling, adjusting for community features. To evaluate associations racial and ethnic composition of communities and distance to nearest dispensary, we used logistic regression to estimate the odds ratios (OR) and 95% confidence intervals (CI), adjusting for median income.
Distance and density of MMJ dispensaries were associated with the proportion of the ZCTA population certified and the proportion of certifications for insufficient evidence conditions. Compared to ZCTAs with no dispensary within 15 min, the proportion of adults certified increased by up to 31% and the proportion of certifications for insufficient evidence decreased by up to 22% for ZCTAs with two dispensaries. From 2018 to 2021, the odds of being within five miles of a dispensary was up to 20 times higher in ZCTAs with the highest proportions of individuals who were not White (2019: OR: 20.14, CI: 10.7-37.8) and more than double in ZCTAs with the highest proportion of Hispanic individuals (2018: OR: 2.81, CI: 1.51-5.24), compared to ZCTAs with the lowest proportions.
Greater dispensary access was associated with the proportions of certified residents and certifications for low evidence conditions. Whether these patterns are due to differences in accessibility or demand is unknown. Associations between community demographics and dispensary proximity may indicate MMJ access differences.
宾夕法尼亚州于2018年开设了第一家医用大麻药房。符合条件的病症包括六种经判定没有或仅有不足证据支持或反驳医用大麻有效性的病症。我们开展了一项研究，以描述宾夕法尼亚州医用大麻药房的可及性，并确定药房距离是否与医用大麻认证及社区人口统计学特征相关。
利用宾夕法尼亚州卫生部的数据，我们对医用大麻药房的位置进行了地理编码，并将其与美国人口普查局的数据相链接。我们根据邮政编码分区统计区域（ZCTA）的人口加权质心创建了药房可及性指标：到最近药房的距离以及15分钟车程内药房的密度。我们使用负二项式模型评估药房可及性与获得医用大麻认证的成年人比例以及低证据条件（肌萎缩侧索硬化症、癫痫、青光眼、亨廷顿舞蹈症（亨廷顿氏病）、阿片类药物使用障碍和帕金森病）认证比例之间的关联，并对社区特征进行了调整。为了评估社区的种族和民族构成与到最近药房距离之间的关联，我们使用逻辑回归来估计比值比（OR）和95%置信区间（CI），并对收入中位数进行了调整。
医用大麻药房的距离和密度与ZCTA人口的认证比例以及证据不足条件的认证比例相关。与15分钟内没有药房的ZCTA相比，有两家药房的ZCTA中，成年人认证比例最高可增加31%，证据不足条件的认证比例最高可降低22%。从2018年到2021年，在非白人比例最高的ZCTA中，距离药房五英里内的几率比比例最低的ZCTA高出多达20倍（2019年：OR：20.14，CI：10.7 - 37.8），在西班牙裔比例最高的ZCTA中，这一几率比比例最低的ZCTA高出一倍多（2018年：OR：2.81，CI：1.51 - 5.24）。
更高的药房可及性与认证居民的比例以及低证据条件的认证相关。这些模式是由于可及性差异还是需求差异尚不清楚。社区人口统计学特征与药房距离之间的关联可能表明医用大麻可及性存在差异。
