大麻合法化和阿片类药物使用障碍退伍军人卫生管理局患者患者
Zachary L Mannes1,2, Melanie M Wall3, Daniel M Alschuler3
1Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York.
JAMA health forum
|June 13, 2025
概括
国家医用大麻法律 (MCL) 和娱乐大麻法律 (RCL) 与退伍军人中阿片类药物使用障碍 (OUD) 患病率的增加有关. 这些法律不支持大麻合法化作为在阿片类药物危机期间减少OUD的战略.
科学领域:
- 公共卫生 公共卫生
- 流行病学 流行病学
- 卫生政策 卫生政策
背景情况:
- 美国阿片类药物危机需要识别影响阿片类药物使用障碍 (OUD) 患病率的因素,以有效预防和治疗.
- 国家医用大麻法 (MCL) 和娱乐大麻法 (RCL) 是影响OUD率的潜在因素.
研究的目的:
- 调查MCL和RCL颁布与退伍军人中OUD患病率变化之间的关联.
- 为了确定这些关联是否因患者的年龄或慢性疼痛的存在而有所不同.
主要方法:
- 使用的退伍军人卫生管理局电子健康记录 (2005-2022) 适用于18-75岁的患者.
- 雇佣分阶段采用差异分析以估计大麻法律颁布和OUD流行之间的关系,控制共变量.
- 根据ICD-9-CM/ICD-10-CM诊断计算每年调整的OUD患病率.
主要成果:
- 在MCL颁布后,OUD患病率增加了0.06%,在RCL颁布后增加了0.07%.
- 在中年和老年人 (35-75岁) 中,这种关联更强烈,特别是在RCL颁布后的老年人中 (0.12%).
- 慢性疼痛患者在MCL (0.08%) 和RCL (0.13%) 实施后表现出更大的OUD增加,在RCL (0.23%) 实施后,慢性疼痛的老年人中最显著的增加是RCL (0.23%).
结论:
- 在VHA患者中,MCL和RCL的起效与OUD患病率的增加有关.
- 调查结果表明,州大麻合法化并没有有效地减少OUD的负担.
- 具体的患者子组,包括老年人和慢性疼痛患者,在大麻法律实施后,OUD的增加最为明显.
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