精神健康障碍是美国普遍存在但治疗不足的健康状况。鉴于人们对大麻对精神健康障碍患者的潜在影响的看法,有必要了解大麻法律与精神药物使用的关联。
■调查医疗和娱乐性大麻法律和药房开口与分配用于治疗美国精神健康障碍的精神药物的关联。
■这项对10013948名商业保险患者的横断面研究使用了一种合成对照方法来检查大麻政策与处方的关联。从2007年1月1日至2020年12月31日,所有患者为5类精神药物中的每一种分配处方的数据都是从Optum的去识别的临床形式学数据集市数据库中提取的。统计分析于2022年9月至2023年11月进行。
■测量的4个暴露变量是医疗或休闲大麻法律是否有效,以及医疗或休闲大麻药房是否在每个州和日历季度开放。
■针对5种药物类别(苯二氮卓类药物,抗抑郁药,抗精神病药,巴比妥酸盐,和睡眠药物)。
■主要样本(苯二氮卓类药物样本)包括3848721名患者(平均[SD]年龄,46.1[11.4]岁;65.4%为女性;53.7%为35-54岁)。医用大麻法律与苯二氮卓填充率降低12.4%相关(对治疗的[ATT]的平均治疗效果,-27.4;95%CI,-14.7至12.0;P=.001),休闲大麻法与填充率降低15.2%相关(ATT,-32.5;95%CI,-24.4至20.1;P=0.02),和医用大麻法律与每名患者的苯二氮卓类药物平均填充数量减少1.3%相关(ATT,-0.02;95%CI,-0.02至0.02;P=.04)。医疗药房与每次苯二氮卓填充的平均供应天数减少3.9%相关(ATT,-1.7;95%CI,-0.8至0.6;P=.001),而娱乐性药房则减少了6.2%(ATT,-2.4;95%CI,-1.0至0.9;P<.001)。医用大麻法律与抗抑郁药填充量增加3.8%相关(ATT,27.2;95%CI,-33.5至26.9;P=.048),和医疗药房增加了8.8%(ATT,50.7;95%CI,-32.3至28.4;P=.004)。每位患者服用抗精神病药物的平均数量增加了2.5%(ATT,0.06;95%CI,-0.04至0.05;P=0.02),在医用大麻法律之后,按2.5%(ATT,0.06;95%CI,-0.04至0.04;P=.02)医疗药房开放后。其他药物类别的研究结果表明,根据关联的状态和方向,存在很大的异质性。
■这项对商业保险患者的横断面研究表明,大麻政策与州之间以及大麻政策与药物类别之间可能存在有意义的异质关联(例如,减少苯二氮卓类药物的分配,但增加抗抑郁药和抗精神病药的分配)。这一发现表明,需要更多的临床研究来了解大麻使用与心理健康之间的关系。结果对患者物质使用和心理健康相关的结果有影响。
UNASSIGNED: Mental health disorders are prevalent yet undertreated health conditions in the US. Given perceptions about the potential effect of cannabis on individuals with mental health disorders, there is a need to understand the association of cannabis laws with psychotropic use.
UNASSIGNED: To investigate the association of medical and recreational cannabis laws and dispensary openings with the dispensing of psychotropic medications used to treat mental health disorders in the US.
UNASSIGNED: This cross-sectional study of 10 013 948 commercially insured patients used a synthetic control method to examine the association of cannabis policies with prescribing. Data on all patients dispensed prescriptions for each of the 5 classes of psychotropic medications from January 1, 2007, to December 31, 2020, were extracted from Optum\'s deidentified Clinformatics Data Mart Database. Statistical analysis was performed from September 2022 to November 2023.
UNASSIGNED: The 4 exposure variables measured were whether medical or recreational cannabis laws were in effect and whether medical or recreational cannabis dispensaries were open in each state and calendar quarter.
UNASSIGNED: One measure of the extensive margins of dispensing and 2 measures of the intensive margins of dispensing were constructed for 5 medication classes (benzodiazepines, antidepressants, antipsychotics, barbiturates, and sleep medications).
UNASSIGNED: The primary sample (the benzodiazepine sample) included 3 848 721 patients (mean [SD] age, 46.1 [11.4] years; 65.4% women; 53.7% aged 35-54 years). Medical cannabis laws were associated with a 12.4% reduction in the benzodiazepine fill rate (average treatment effect on the treated [ATT], -27.4; 95% CI, -14.7 to 12.0; P = .001), recreational cannabis laws were associated with a 15.2% reduction in the fill rate (ATT, -32.5; 95% CI, -24.4 to 20.1; P = .02), and medical cannabis laws were associated with a 1.3% reduction in the mean number of benzodiazepine fills per patient (ATT, -0.02; 95% CI, -0.02 to 0.02; P = .04). Medical dispensaries were associated with a 3.9% reduction in mean days\' supply per benzodiazepine fill (ATT, -1.7; 95% CI, -0.8 to 0.6; P = .001), while recreational dispensaries were associated with a 6.2% reduction (ATT, -2.4; 95% CI, -1.0 to 0.9; P < .001). Medical cannabis laws were associated with a 3.8% increase in antidepressant fills (ATT, 27.2; 95% CI, -33.5 to 26.9; P = .048), and medical dispensaries were associated with an 8.8% increase (ATT, 50.7; 95% CI, -32.3 to 28.4; P = .004). The mean number of antipsychotic medication fills per patient increased by 2.5% (ATT, 0.06; 95% CI, -0.04 to 0.05; P = .02) after medical cannabis laws and by 2.5% (ATT, 0.06; 95% CI, -0.04 to 0.04; P = .02) after medical dispensary openings. Findings for the other drug classes showed substantial heterogeneity by state and direction of association.
UNASSIGNED: This cross-sectional study of commercially insured patients suggests that there may have been meaningful heterogeneous associations between cannabis policy and state and between cannabis policy and drug class (eg, decreases in dispensing of benzodiazepines but increases in dispensing of antidepressants and antipsychotics). This finding suggests additional clinical research is needed to understand the association between cannabis use and mental health. The results have implications for patient substance use and mental health-related outcomes.