School of Public Policy, Georgia Institute of Technology, Atlanta.
Department of Public Administration and Policy, University of Georgia, School of Public & International Affairs, Athens.
JAMA Netw Open. 2024 Sep 3;7(9):e2432021. doi: 10.1001/jamanetworkopen.2024.32021.
Mental health disorders are prevalent yet undertreated health conditions in the US. Given perceptions about the potential effect of cannabis on individuals with mental health disorders, there is a need to understand the association of cannabis laws with psychotropic use.
To investigate the association of medical and recreational cannabis laws and dispensary openings with the dispensing of psychotropic medications used to treat mental health disorders in the US.
DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study of 10 013 948 commercially insured patients used a synthetic control method to examine the association of cannabis policies with prescribing. Data on all patients dispensed prescriptions for each of the 5 classes of psychotropic medications from January 1, 2007, to December 31, 2020, were extracted from Optum's deidentified Clinformatics Data Mart Database. Statistical analysis was performed from September 2022 to November 2023.
The 4 exposure variables measured were whether medical or recreational cannabis laws were in effect and whether medical or recreational cannabis dispensaries were open in each state and calendar quarter.
One measure of the extensive margins of dispensing and 2 measures of the intensive margins of dispensing were constructed for 5 medication classes (benzodiazepines, antidepressants, antipsychotics, barbiturates, and sleep medications).
The primary sample (the benzodiazepine sample) included 3 848 721 patients (mean [SD] age, 46.1 [11.4] years; 65.4% women; 53.7% aged 35-54 years). Medical cannabis laws were associated with a 12.4% reduction in the benzodiazepine fill rate (average treatment effect on the treated [ATT], -27.4; 95% CI, -14.7 to 12.0; P = .001), recreational cannabis laws were associated with a 15.2% reduction in the fill rate (ATT, -32.5; 95% CI, -24.4 to 20.1; P = .02), and medical cannabis laws were associated with a 1.3% reduction in the mean number of benzodiazepine fills per patient (ATT, -0.02; 95% CI, -0.02 to 0.02; P = .04). Medical dispensaries were associated with a 3.9% reduction in mean days' supply per benzodiazepine fill (ATT, -1.7; 95% CI, -0.8 to 0.6; P = .001), while recreational dispensaries were associated with a 6.2% reduction (ATT, -2.4; 95% CI, -1.0 to 0.9; P < .001). Medical cannabis laws were associated with a 3.8% increase in antidepressant fills (ATT, 27.2; 95% CI, -33.5 to 26.9; P = .048), and medical dispensaries were associated with an 8.8% increase (ATT, 50.7; 95% CI, -32.3 to 28.4; P = .004). The mean number of antipsychotic medication fills per patient increased by 2.5% (ATT, 0.06; 95% CI, -0.04 to 0.05; P = .02) after medical cannabis laws and by 2.5% (ATT, 0.06; 95% CI, -0.04 to 0.04; P = .02) after medical dispensary openings. Findings for the other drug classes showed substantial heterogeneity by state and direction of association.
This cross-sectional study of commercially insured patients suggests that there may have been meaningful heterogeneous associations between cannabis policy and state and between cannabis policy and drug class (eg, decreases in dispensing of benzodiazepines but increases in dispensing of antidepressants and antipsychotics). This finding suggests additional clinical research is needed to understand the association between cannabis use and mental health. The results have implications for patient substance use and mental health-related outcomes.
心理健康障碍在美国是普遍存在但治疗不足的健康问题。鉴于人们对大麻可能对心理健康障碍患者产生影响的看法，有必要了解大麻法规与精神药物使用之间的关联。
调查医疗和娱乐用大麻法规以及大麻药房开业与美国治疗心理健康障碍的精神药物配药之间的关联。
设计、设置和参与者：这项对 10013948 名商业保险患者的横断面研究使用合成对照法来研究大麻政策与处方之间的关联。从 2007 年 1 月 1 日至 2020 年 12 月 31 日，从 Optum 的匿名 Clinformatics Data Mart 数据库中提取了所有患者每类 5 种精神药物的处方配药数据。统计分析于 2022 年 9 月至 2023 年 11 月进行。
测量的 4 个暴露变量是医疗或娱乐用大麻法规是否生效以及每个州和日历季度的医疗或娱乐用大麻药房是否开业。
为 5 种药物类别（苯二氮䓬类、抗抑郁药、抗精神病药、巴比妥类和睡眠药物）构建了一个广泛配药边缘和两个密集配药边缘的度量。
主要样本（苯二氮䓬类样本）包括 3848721 名患者（平均[标准差]年龄 46.1[11.4]岁；65.4%为女性；53.7%年龄在 35-54 岁之间）。医疗大麻法规与苯二氮䓬类药物配药率降低 12.4%相关（治疗的平均治疗效果[ATT]，-27.4；95%置信区间[CI]，-14.7 至 12.0；P = .001），娱乐用大麻法规与配药率降低 15.2%相关（ATT，-32.5；95%CI，-24.4 至 20.1；P = .02），医疗大麻法规与每位患者的平均苯二氮䓬类药物配药量减少 1.3%相关（ATT，-0.02；95%CI，-0.02 至 0.02；P = .04）。医疗大麻药房与平均苯二氮䓬类药物配药天数减少 3.9%相关（ATT，-1.7；95%CI，-0.8 至 0.6；P = .001），而娱乐用大麻药房与配药天数减少 6.2%相关（ATT，-2.4；95%CI，-1.0 至 0.9；P < .001）。医疗大麻法规与抗抑郁药配药量增加 3.8%相关（ATT，27.2；95%CI，-33.5 至 26.9；P = .048），医疗大麻药房与配药量增加 8.8%相关（ATT，50.7；95%CI，-32.3 至 28.4；P = .004）。每位患者的抗精神病药物配药量增加 2.5%（ATT，0.06；95%CI，-0.04 至 0.05；P = .02），这是在医疗大麻法规生效后出现的情况，在医疗大麻药房开业后也出现了 2.5%的增长（ATT，0.06；95%CI，-0.04 至 0.04；P = .02）。其他药物类别的发现显示出州和药物类别的关联存在实质性异质性。
这项对商业保险患者的横断面研究表明，大麻政策与州之间以及大麻政策与药物类别之间可能存在有意义的混杂关联（例如，苯二氮䓬类药物的配药减少，但抗抑郁药和抗精神病药的配药增加）。这一发现表明需要进一步进行临床研究，以了解大麻使用与心理健康之间的关联。结果对患者的物质使用和与心理健康相关的结果有影响。
