Lira Marlene C, Pacula Rosalie Liccardo, Smart Rosanna, Pessar Seema Choksy, Blanchette Jason, Naimi Timothy S
Workit Labs, Workit Health, Ann Arbor, Michigan; DrPH Program, Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Leonard D. Schaeffer Center for Health Policy & Economics, University of Southern California, Los Angeles, California; Department of Health Policy and Management, Sol Price School of Public Policy, University of Southern California, Los Angeles, California.
Am J Prev Med. 2025 Mar;68(3):475-484. doi: 10.1016/j.amepre.2024.11.009. Epub 2024 Nov 28.
Suicides and deaths of undetermined intent frequently involve cannabis or opioids, yet the relationships between cannabis and opioids, and cannabis policies and cannabis or opioid involvement in these deaths, are not well-characterized. Additionally, although there have been substantial changes to cannabis policies, there have been conflicting findings on relationships between changing cannabis policies and cannabis-involved or opioid-involved deaths.
This was a repeated, cross-sectional study of decedents using restricted access data from the National Violent Death Reporting System from 2003 to 2018 and the Cannabis Policy Scale. The following associations were assessed among decedents from suicide and deaths of undetermined intent using mixed effects logistic regression: (1) relationships between cannabis involvement and opioid involvement; (2) relationships between cannabis policies and cannabis involvement; and (3) relationships between cannabis policies and opioid involvement. Analyses were conducted from 2021 to 2022.
States contributing to National Violent Death Reporting System increased in number from 7 to 41 throughout the study period, and the final sample included 68,924 decedents of suicide and undetermined intent. Cannabis involvement was associated with increased odds of opioid involvement (AOR=1.29, 95% CI=1.22, 1.37). A 10% increase in Cannabis Policy Scale, representing a more restrictive cannabis policy environment, was associated with reduced odds of cannabis involvement (AOR=0.87, 95% CI=0.84, 0.90) and opioid involvement (AOR=0.88, 95% CI=0.85, 0.91).
These findings do not support the idea that cannabis policy liberalization and/or cannabis use are likely to be useful strategies to reduce cannabis or opioid involvement in deaths of suicide and undetermined intent.
自杀和意图不明的死亡事件常常涉及大麻或阿片类药物，但大麻与阿片类药物之间的关系，以及大麻政策与这些死亡事件中涉及大麻或阿片类药物的情况，目前尚未得到充分描述。此外，尽管大麻政策发生了重大变化，但关于不断变化的大麻政策与涉及大麻或阿片类药物的死亡之间的关系，研究结果却相互矛盾。
这是一项对死者进行的重复横断面研究，使用了2003年至2018年国家暴力死亡报告系统的受限访问数据以及大麻政策量表。通过混合效应逻辑回归评估了自杀和意图不明死亡的死者中以下关联：（1）大麻使用与阿片类药物使用之间的关系；（2）大麻政策与大麻使用之间的关系；（3）大麻政策与阿片类药物使用之间的关系。分析于2021年至2022年进行。
在整个研究期间，向国家暴力死亡报告系统提供数据的州数量从7个增加到41个，最终样本包括68924名自杀和意图不明死亡的死者。大麻使用与阿片类药物使用的几率增加相关（调整后比值比[AOR]=1.29，95%置信区间[CI]=1.22，1.37）。大麻政策量表增加10%，代表更严格的大麻政策环境，与大麻使用几率降低相关（AOR=0.87，95%CI=0.84，0.90）以及阿片类药物使用几率降低相关（AOR=0.88，95%CI=0.85，0.91）。
这些发现不支持大麻政策自由化和/或大麻使用可能是减少自杀和意图不明死亡事件中涉及大麻或阿片类药物的有用策略这一观点。
