Cannabis Legalization: Assessing its Impact on Treatment for Substance Use Disorders

大麻合法化：评估其对药物使用障碍治疗的影响

• 批准号: 9980834
• 负责人: Lydia Aletraris
• 金额: $ 55.13万
• 依托单位: UNIVERSITY OF GEORGIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-08-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9980834
• 关键词: 21 year old; Address; Admission activity; Adopted; Adoption; Adult; Affect; Alcohols; Behavior; Cannabis; Characteristics; Client; Communities; Criminal Justice; Data; Data Collection; Data Set; Dependence; Diagnosis; Diffusion of Innovation; Disease; Environment; Evidence based practice; FDA approved; Foundations; Funding; Goals; Health Care Reform; Heroin; Heterogeneity; Home environment; Imprisonment; Individual; Institution; Intervention; Interview; Laws; Lead; Leadership; Legal; Link; Locales; Marketing; Measures; Medical; Medical Marijuana; Methods; National Institute of Drug Abuse; Outcome; Patients; Pattern; Pharmaceutical Preparations; Policies; Primary Health Care; Process; Production; Public Health; Research; Resources; Sampling; Screening procedure; Services; Solid; Source; Statutes and Laws; Substance Use Disorder; Surveys; System; Techniques; Time; Typology; base; court; evidence base; implementation science; innovation; marijuana legalization; marijuana use; marijuana use disorder; novel; off-label drug; off-label use; policy implication; prescription opioid; recruit; response; socioeconomics; stem; substance abuse treatment; theories; treatment center; treatment organization; treatment program; treatment services; trend

Abstract Understanding the impact of recreational cannabis legalization on treatment of substance use disorders (SUD) is the goal of this research. Drawing upon treatment centers recruited in our prior studies, we propose to collect two waves of organization-level data from 350 SUD treatment organizations comprising 3 mutually exclusive groups: (1) centers located in states where recreational cannabis is legal (“legalization states”); (2) centers in states that prohibit recreational cannabis but allow medical cannabis (“medical cannabis states”); and (3) centers in states that prohibit medical and recreational cannabis (“prohibition states”). These three groups are foundational to achieving the project’s Specific Aims, which are (1) to compare cannabis treatment admissions in treatment centers located in legalization states, medical cannabis states, and prohibition states as well as to examine changes in treatment admissions over time; and (2) to examine whether treatment delivery for cannabis use disorder (CUD) is altered in response to legal recreational cannabis availability. Controlling for the organizational, legal, and socioeconomic environment, we will examine admissions for cannabis for adults 21 and older and for individuals under age 21. We will examine heterogeneity in state cannabis laws, including important nuances in policies toward dispensaries, home cultivation, and total production, to assess treatment system impacts of each policy provision as well as to compare impacts of centers in early legalization states (CO and WA) relative to centers in later legalization states. Based on substitution and complementary hypotheses, we will also examine patterns of change in admissions for other SUD diagnoses, such as nonmedical prescription opioids, and in sources of referrals, differentiating between clients with CUD from those presenting due to a court mandate or in lieu of incarceration. Measures will examine changes in inter- organizational relationships between centers and community institutions, such as educational institutions, primary care, and the criminal justice system. Because treatment admissions may be affected by how states are implementing health reform, we will control for state-level approaches to health reform as well as other state-level characteristics. This study will also examine if and how screening tools and treatment practices are adapted or reinvented to fit the needs of patients with cannabis-related problems. Using resource dependence theory, absorptive capacity, and diffusion of innovation theory, we will compare the effects of organizational and external socioeconomic and legal factors on the adoption of treatment practices for CUD, including off- label use of medications. In addition, we will focus on management’s proactive strategizing (or absence thereof) in response to legalization, such as adaptations in marketing campaigns. These innovative findings will assist the SUD treatment field to build a body of evidence-based management strategies related to CUD treatment, and will set the stage for understanding how these strategies are linked to organizational outcomes. Addressing such questions is critical as other states consider cannabis legislation initiatives.

抽象的 了解休闲大麻合法化对治疗物质使用障碍的影响（SUD） 是这项研究的目标。利用先前研究中招募的治疗中心，我们建议收集 来自350个SUD治疗组织的组织级别数据的两波浪潮完成了3个相互排斥 组：（1）位于休闲大麻是合法的州（“合法化国家”）的中心； （2）中心 规定禁止休闲大麻但允许医用大麻的国家（“医用大麻状态”）； （3） 禁止医疗和休闲大麻的州（“禁止状态”）。这三组是 实现该项目的特定目标的基础，这是（1）比较大麻治疗入学 在合法化状态，医用大麻国家和禁令状态的治疗中心以及 随着时间的流逝，检查治疗入院的变化； （2）检查是否要治疗 大麻使用障碍（CUD）因法律娱乐性大麻的可用性而改变。控制 组织，法律和社会经济环境，我们将检查成人大麻的录取21 以及年龄较大的人和21岁以下的个人。我们将研究国家大麻法中的异质性，包括 对药房，家庭种植和总生产的政策的重要细微差别，以评估治疗 每个政策规定的系统影响以及比较早期合法化中心的影响 （CO和WA）相对于后来合法化国家的中心。基于替代和完成 假设，我们还将研究其他SUD诊断的入院变化模式，例如 非医学处方阿片类药物，以及转介的来源，与CUD的客户区分 那些根据法院授权或代替遗产而呈现的人。措施将检查间隔的变化 中心与社区机构之间的组织关系，例如教育机构， 初级保健和刑事司法系统。因为治疗入院可能会受到状态的影响 正在实施健康改革，我们将控制国家级别的卫生改革方法以及其他 州级特征。这项研究还将检查筛查工具和治疗方法是否以及如何 适应或重新发明，以适应与大麻相关问题的患者的需求。使用资源依赖 理论，吸收能力和创新理论的扩散，我们将比较组织的影响 以及外部社会经济和法律因素，用于采用CUD的治疗方法，包括 标签使用药物。此外，我们将专注于管理层的主动策略（或缺席 响应合法化，例如营销活动中的改编。这些创新的发现将 协助SUD治疗领域建立与CUD相关的一系列基于证据的管理策略 治疗，并将为理解这些策略如何与组织成果联系起来奠定基础。 解决此类问题至关重要，因为其他州考虑大麻立法计划。