1999-2010 年美国医用大麻法律与阿片类镇痛药过量死亡率
Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010.
机构信息
Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, Pennsylvania2Robert Wood Johnson Foundation Clinical Scholars Program, University of Pennsylvania, Philadelphia3Leonard Davis Institute of Health.
Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia4Robert Wood Johnson Health and Society Scholars Program, University of Pennsylvania, Philadelphia.
出版信息
JAMA Intern Med. 2014 Oct;174(10):1668-73. doi: 10.1001/jamainternmed.2014.4005.
IMPORTANCE
Opioid analgesic overdose mortality continues to rise in the United States, driven by increases in prescribing for chronic pain. Because chronic pain is a major indication for medical cannabis, laws that establish access to medical cannabis may change overdose mortality related to opioid analgesics in states that have enacted them.
OBJECTIVE
To determine the association between the presence of state medical cannabis laws and opioid analgesic overdose mortality.
DESIGN, SETTING, AND PARTICIPANTS: A time-series analysis was conducted of medical cannabis laws and state-level death certificate data in the United States from 1999 to 2010; all 50 states were included.
EXPOSURES
Presence of a law establishing a medical cannabis program in the state.
MAIN OUTCOMES AND MEASURES
Age-adjusted opioid analgesic overdose death rate per 100 000 population in each state. Regression models were developed including state and year fixed effects, the presence of 3 different policies regarding opioid analgesics, and the state-specific unemployment rate.
RESULTS
Three states (California, Oregon, and Washington) had medical cannabis laws effective prior to 1999. Ten states (Alaska, Colorado, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, Rhode Island, and Vermont) enacted medical cannabis laws between 1999 and 2010. States with medical cannabis laws had a 24.8% lower mean annual opioid overdose mortality rate (95% CI, -37.5% to -9.5%; P = .003) compared with states without medical cannabis laws. Examination of the association between medical cannabis laws and opioid analgesic overdose mortality in each year after implementation of the law showed that such laws were associated with a lower rate of overdose mortality that generally strengthened over time: year 1 (-19.9%; 95% CI, -30.6% to -7.7%; P = .002), year 2 (-25.2%; 95% CI, -40.6% to -5.9%; P = .01), year 3 (-23.6%; 95% CI, -41.1% to -1.0%; P = .04), year 4 (-20.2%; 95% CI, -33.6% to -4.0%; P = .02), year 5 (-33.7%; 95% CI, -50.9% to -10.4%; P = .008), and year 6 (-33.3%; 95% CI, -44.7% to -19.6%; P < .001). In secondary analyses, the findings remained similar.
CONCLUSIONS AND RELEVANCE
Medical cannabis laws are associated with significantly lower state-level opioid overdose mortality rates. Further investigation is required to determine how medical cannabis laws may interact with policies aimed at preventing opioid analgesic overdose.
重要性
在美国，由于慢性疼痛的处方增加，阿片类镇痛药过量死亡率继续上升。由于慢性疼痛是医用大麻的主要适应证，因此制定了医用大麻获取法的州可能会改变与阿片类镇痛药相关的过量死亡率。
目的
确定州医用大麻法的存在与阿片类镇痛药过量死亡率之间的关联。
设计、设置和参与者：对美国 1999 年至 2010 年的医用大麻法和州级死亡证明数据进行了时间序列分析；包括所有 50 个州。
暴露
州内存在建立医用大麻计划的法律。
主要结果和措施
每个州每 100000 人年龄调整后的阿片类镇痛药过量死亡率。制定了包括州和年份固定效应、3 种不同阿片类镇痛药政策的存在以及特定州失业率的回归模型。
结果
有 3 个州（加利福尼亚州、俄勒冈州和华盛顿州）在 1999 年之前就有医用大麻法。10 个州（阿拉斯加州、科罗拉多州、夏威夷州、缅因州、密歇根州、蒙大拿州、内华达州、新墨西哥州、罗得岛州和佛蒙特州）在 1999 年至 2010 年期间颁布了医用大麻法。有医用大麻法的州的平均年阿片类药物过量死亡率低 24.8%（95%CI，-37.5%至-9.5%；P=0.003），与没有医用大麻法的州相比。对实施该法后每年医用大麻法与阿片类镇痛药过量死亡率之间的关联进行了检查，结果表明，这种法律与较低的过量死亡率相关，而且这种关联随着时间的推移而增强：第 1 年（-19.9%；95%CI，-30.6%至-7.7%；P=0.002）、第 2 年（-25.2%；95%CI，-40.6%至-5.9%；P=0.01）、第 3 年（-23.6%；95%CI，-41.1%至-1.0%；P=0.04）、第 4 年（-20.2%；95%CI，-33.6%至-4.0%；P=0.02）、第 5 年（-33.7%；95%CI，-50.9%至-10.4%；P=0.008）和第 6 年（-33.3%；95%CI，-44.7%至-19.6%；P<0.001）。在二次分析中，结果仍然相似。
结论和相关性
医用大麻法与州级阿片类药物过量死亡率显著降低相关。需要进一步调查以确定医用大麻法如何与旨在预防阿片类镇痛药过量的政策相互作用。
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