ARTHUR R WILLIAMS (2018-09-01 to 2020-08-31) Medical Marijuana Program Participation and Changes in Controlled Substance Use. Amount: $238049

医用大麻计划参与和受控物质使用的变化

Abstract

Project Summary:  The United States is experiencing an unprecedented rate of opioid-related overdose death following a dramatic rise in opioid painkiller use over the past 20 years. In response, the CDC, several states, and professional organizations have promoted prescriber guidelines for managing pain with non-opioid alternatives (i.e., anti-inflammatories, anti-depressants). Additional emphasis has focused on reducing the impact of concomitant use of sedating medications (i.e. benzodiazepines) and other controlled substances (i.e. hypnotics, muscle relaxants) that synergistically increase risk of fatal overdose, especially in medically compromised individuals. Recent reports suggest that states with medical marijuana programs have lower rates of opioid overdose death. Possible mechanisms for lower rates of overdose include reductions in opioid use and/or the use of sedating medications due to symptomatic relief of comorbid anxiety or insomnia. However, little is known about the relationship between medical marijuana program participation among patients with pain conditions and changes in use patterns of controlled substance use. Even less is known about the differential impact of specific cannabinoid products medically dispensed (such as high tetrahydrocannabinol [THC] versus high cannabidiol [CBD] products).  The New York State medical marijuana program (implemented January 2016) is one of the most highly regulated and medicalized programs in operation in the United States. State-licensed dispensaries must be staffed with licensed pharmacists and demonstrate that they dispense products with consistent cannabinoid ratios (including high-THC, high-CBD, and 1:1 THC:CBD products). New York State is therefore an ideal setting for a rigorous analysis of medical cannabis program participation and the impact of cannabinoid products with varying THC:CBD ratios on controlled substance use over time among chronic pain patients. We propose to partner with the largest medical marijuana provider in New York (> 10,000 participants enrolled as of October 2017). Participant activity is tracked through an electronic health record with de-identified patient characteristics at baseline (demographics, qualifying condition and symptoms, concomitant medications) that is linked to data containing 12-month controlled substance prescription history through the state?s prescription drug monitoring program (PDMP). The analysis of these de-identified, compiled records is a highly innovative and cost-effective method for better understanding the potential mechanisms of how participation in medical marijuana programs influences controlled substance use and overdose risk among patients with pain conditions receiving opioids and sedative-hypnotics and can inform subsequent prospective study designs.

项目摘要：在过去20年阿片类药物止痛药使用量急剧增加之后，美国正在经历前所未有的阿片类药物相关过量死亡率。作为回应，疾病预防控制中心，几个州和专业组织已经推广了使用非阿片类药物替代品（即抗炎药，抗抑郁药）治疗疼痛的处方指南。另外强调的重点是减少同时使用镇静药物（即苯二氮卓类药物）和其他受控物质（即催眠药，肌肉松弛剂）的影响，这些物质协同增加致命过量的风险，特别是在医学上受损的个体。最近的报告表明，拥有医用大麻计划的州的阿片类药物过量死亡率较低。降低过量服用率的可能机制包括减少阿片类药物的使用和/或使用镇静药物，因为症状缓解共患焦虑症或失眠症。然而，对于疼痛状况患者的医用大麻计划参与与受控物质使用的使用模式的变化之间的关系知之甚少。人们对于医学上分配的特定大麻素产品（如高四氢大麻酚[THC]与高大麻酚[CBD]产品）的不同影响知之甚少。纽约州医用大麻计划（2016年1月实施）是美国最受监管和医疗化程度最高的计划之一。国家许可的药房必须配备有执照的药剂师，并证明他们分配的产品具有一致的大麻素比例（包括高THC，高CBD和1：1 THC：CBD产品）。因此，纽约州是一个理想的环境，可以严格分析医疗大麻计划的参与情况以及大麻素产品对慢性疼痛患者随时间控制物质使用的不同THC：CBD比率的影响。我们建议与纽约最大的医用大麻供应商合作（截至2017年10月登记的参与人数超过10,000人）。参与者活动通过电子健康记录进行跟踪，该记录在基线（人口统计学，合格条件和症状，伴随药物）中通过州的处方药监测计划与包含12个月控制物质处方历史的数据相关联的去识别患者特征（PDMP）。对这些去除已识别的汇编记录的分析是一种高度创新且具有成本效益的方法，可以更好地理解参与医用大麻计划如何影响受控物质使用和接受阿片类药物和镇静催眠药的疼痛状况患者过量风险的潜在机制并可以通知随后的前瞻性研究设计。

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