State Cannabis Legalization and Cannabis Use Disorder in the US Veterans Health Administration, 2005 to 2019

被引:18
|
作者
Hasin, Deborah S. [1 ,2 ]
Wall, Melanie M. [1 ,2 ]
Choi, C. Jean [3 ]
Alschuler, Daniel M. [3 ]
Malte, Carol [4 ,5 ]
Olfson, Mark [1 ,2 ]
Keyes, Katherine M. [1 ]
Gradus, Jaimie L. [6 ]
Cerda, Magdalena [7 ]
Maynard, Charles C. [8 ,9 ]
Keyhani, Salomeh [10 ,11 ]
Martins, Silvia S. [1 ]
Fink, David S. [2 ]
Livne, Ofir [1 ]
Mannes, Zachary [1 ]
Sherman, Scott [7 ,12 ]
Saxon, Andrew J. [8 ,9 ]
机构
[1] Columbia Univ, 1051 Riverside Dr,Box 123, New York, NY 10032 USA
[2] New York State Psychiat Inst & Hosp, 1051 Riverside Dr,Box 123, New York, NY 10032 USA
[3] New York State Psychiat Inst & Hosp, Mental Hlth Data Sci, New York, NY USA
[4] Vet Affairs VA Puget Sound Hlth Care Syst, Seattle Ctr Innovat Vet Ctr & Value Driven Care, Hlth Serv Res & Dev HSR&D, Seattle, WA USA
[5] VA Puget Sound Hlth Care Syst, Ctr Excellence Subst Addict Treatment & Educ, Seattle, WA USA
[6] Boston Univ, Boston, MA USA
[7] NYU, New York, NY USA
[8] VA Puget Sound Hlth Care Syst, Seattle, WA USA
[9] Univ Washington, Seattle, WA USA
[10] San Francisco VA Hlth Syst, San Francisco, CA USA
[11] Univ Calif San Francisco, San Francisco, CA USA
[12] VA Manhattan Harbor Healthcare, New York, NY USA
关键词
SUBSTANCE USE DISORDERS; MEDICAL MARIJUANA LAWS; UNITED-STATES; DRUG-USE; PREVALENCE; EPIDEMIOLOGY;
D O I
10.1001/jamapsychiatry.2023.0019
中图分类号
R749 [精神病学];
学科分类号
100205 ;
摘要
IMPORTANCE Cannabis use disorder (CUD) is increasing among US adults. Few national studies have addressed the role of medical cannabis laws (MCLs) and recreational cannabis laws (RCLs) in these increases, particularly in patient populations with high rates of CUD risk factors. OBJECTIVE To quantify the role of MCL and RCL enactment in the increases in diagnosed CUD prevalence among Veterans Health Administration (VHA) patients from 2005 to 2019. DESIGN, SETTING, AND PARTICIPANTS Staggered-adoption difference-in-difference analyses were used to estimate the role of MCL and RCL in the increases in prevalence of CUD diagnoses, fitting a linear binomial regression model with fixed effects for state, categorical year, time-varying cannabis law status, state-level sociodemographic covariates, and patient age group, sex, and race and ethnicity. Patients aged 18 to 75 years with 1 or more VHA primary care, emergency department, or mental health visit and no hospice/palliative care within a given calendar year were included. Time-varying yearly state control covariates were state/year rates from American Community Survey data: percentage male, Black, Hispanic, White, 18 years or older, unemployed, income below poverty threshold, and yearly median household income. Analysis took place between February to December 2022. MAIN OUTCOMES AND MEASURES As preplanned, International Classification of Diseases, Clinical Modification, ninth and tenth revisions, CUD diagnoses from electronic health records were analyzed. RESULTS The number of individuals analyzed ranged from 3 234 382 in 2005 to 4 579 994 in 2019. Patientswere largely male (94.1% in 2005 and 89.0% in 2019) and White (75.0% in 2005 and 66.6% in 2019), with a mean (SD) age of 57.0 [14.4] years. From 2005 to 2019, adjusted CUD prevalences increased from 1.38% to 2.25% in states with no cannabis laws (no CLs), 1.38% to 2.54% in MCL-only enacting states, and 1.39% to 2.56% in RCL-enacting states. Difference-in-difference results indicated that MCL-only enactmentwas associated with a 0.05% (0.05-0.06) absolute increase in CUD prevalence, ie, that 4.7% of the total increase in CUD prevalence in MCL-only enacting states could be attributed to MCLs, while RCL enactment was associated with a 1.12%(95% CI, 0.10-0.13) absolute increase in CUD prevalence, ie, that 9.8% of the total increase in CUD prevalence in RCL-enacting states could be attributed to RCLs. The role of RCL in the increases in CUD prevalencewas greatest in patients aged 65 to 75 years, with an absolute increase of 0.15%(95% CI, 0.13-0.17) in CUD prevalence associated with RCLs, ie, 18.6% of the total increase in CUD prevalence in that age group. CONCLUSIONS AND RELEVANCE In this study of VHA patients, MCL and RCL enactment played a significant role in the overall increases in CUD prevalence, particularly in older patients. However, consistent with general population studies, effect sizes were relatively small, suggesting that cumulatively, laws affected cannabis attitudes diffusely across the country or that other factors played a larger role in the overall increases in adult CUD. Results underscore the need to screen for cannabis use and CUD and to treat CUD when it is present.
引用
收藏
页码:380 / 388
页数:9
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