Gaps in Identification, Referral and Treatment of Cannabis Use in VA Primary Care

退伍军人事务部初级保健中大麻使用识别、转诊和治疗方面的差距

• 批准号: 10634475
• 负责人: Carolyn Gibson
• 金额: --
• 依托单位: VETERANS AFFAIRS MED CTR SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-06-01 至 2028-05-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10634475
• 关键词: Accident and Emergency department; Address; Adult; Age; Alcohol consumption; Alcohols; Anxiety; Area; Behavior; Behavior Therapy; Cannabis; Caring; Characteristics; Chronic; Cognitive Therapy; Confusion; Data; Drug Screening; Drug usage; Ensure; Feeling suicidal; Foundations; Frequencies; Health; Hospitalization; Individual; Intervention; Interview; Malignant Neoplasms; Marijuana Smoking; Marketing; Measures; Medical Records; Mental Depression; Mental Health; Methodology; Monitor; Motivation; Needs Assessment; Outcome; Patients; Pattern; Pharmaceutical Preparations; Polypharmacy; Population; Populations at Risk; Post-Traumatic Stress Disorders; Prevalence; Primary Care; Provider; Psychoses; Reporting; Respiratory Signs and Symptoms; Risk; Sampling; Sleeplessness; Smoking; Subgroup; Substance Use Disorder; Symptoms; Telephone; Tobacco; Tobacco use; Treatment outcome; United States; Urine; Validation; Veterans; Women' s Health; adverse outcome; aged; brief intervention; cannabis use behavior; cannabis withdrawal; cohort; comorbidity; effective therapy; experience; functional disability; gabapentin; high risk; improved; innovation; marijuana use; marijuana use disorder; marijuana user; middle age; military veteran; motivational enhancement therapy; opioid use; physical conditioning; primary care patient; primary care provider; primary care setting; prospective; psychologic; racial minority; screening; sexual minority; telephone based; treatment services

Background: Cannabis use and cannabis use disorder (CUD) are increasing in the US population, and adults aged 50 and older are among the fastest growing groups of cannabis users. While cannabis use is increasing, it is often perceived as harmless and marketed to patients as helpful for several conditions despite a lack of evidence. There is no data on past month cannabis use, daily cannabis use, and CUD among Veterans using primary care, but there is evidence that cannabis use is common in specific Veteran subgroups (11% to 25%) and that CUD identified using administrative data is increasing. Significance: There are reasons to be concerned about the potential under-identification of cannabis use among Veterans. Smoking cannabis is the most common form of cannabis use among Veterans, and there is evidence that cannabis use is associated with respiratory symptoms and cancer. Comorbid mental health conditions are prevalent among Veterans, and these conditions are commonly reported as motivation for regular cannabis use. Cannabis use negatively impacts treatment outcomes of Veterans with anxiety, depression, and post-traumatic stress disorder (PTSD), and use is associated with psychosis and suicidal ideation. Symptoms of cannabis withdrawal can frequently be confused with symptoms of mental health conditions by patients which can perpetuate use. Finally, there are effective behavioral treatments available for CUD and several medications that have shown benefit in treatment of CUD and withdrawal from cannabis in trials. It is important to identify cannabis users to ensure access to effective therapies. Innovation and Impact: This proposal will address important gaps in the priority areas of women’s health, substance use disorders, and mental health. This proposal will lay the foundation for the validation of a simple, frequency-based screening measure for cannabis use that could be feasible in the primary care setting. Specific Aims: We propose to improve our understanding of at-risk populations and determine whether cannabis treatment services in the Veteran population are being underused. We also propose to determine if certain use patterns are associated with adverse mental and physical health outcomes, placing individuals at higher risk. Such individuals (if identified) may also require brief intervention, referral, and/or treatment. Aim 1: To examine the patterns of cannabis use (past month use, daily use, CUD, persistent use), behaviors (e.g., alcohol use) associated with use, and characteristics associated with use among a nationally representative sample of Veterans 50 and older who receive VA primary care. Aim 2a: To determine whether Veterans discuss cannabis use with their providers and whether providers document use and/or intervene upon use or CUD. Aim 2b: To explore provider experiences assessing cannabis use and initiating CUD-related treatment and referrals in the primary care setting. Aim 3: Using the cohort created in Aim 1, we will prospectively examine the association of cannabis use with depression, anxiety, PTSD, insomnia, emergency department use, and all-cause hospitalization. Methodology: We will construct a nationally representative cohort of Veterans 50 and older using VA data, chart review and phone interviews. We will conduct qualitative interviews with primary care providers to understand gaps in care. Next Steps/Implementation: As with alcohol and tobacco, regular cannabis use may be effectively monitored and managed with identification and brief intervention. This proposal will improve our understanding of the prevalence of unidentified cannabis use and gaps in care in the primary care setting, the need for screening, and improve our understanding of the harms associated with use. This proposal will lay the foundation for addressing gaps in care related to cannabis use and CUD among older Veterans.

背景：美国人口和成年人中的大麻使用和大麻使用障碍（CUD）正在增加 50 岁及以上的大麻使用者是增长最快的群体之一。 尽管缺乏治疗方法，但它通常被认为是无害的，并且向患者推销，认为它对多种疾病有帮助。 没有关于退伍军人过去一个月的大麻使用情况、每日大麻使用情况和 CUD 的数据。 初级保健，但有证据表明大麻使用在特定退伍军人亚组中很常见（11% 至 25%） 并且使用行政数据确定的 CUD 正在增加。 意义：有理由担心大麻使用的潜在识别不足 退伍军人中吸食大麻是退伍军人中最常见的大麻使用形式。 有证据表明大麻的使用与呼吸道症状和癌症相关。 这些情况在退伍军人中很普遍，并且这些情况通常被报告为动机 经常使用大麻对患有焦虑症的退伍军人的治疗结果产生负面影响， 抑郁症和创伤后应激障碍 (PTSD)，并且使用与精神病和自杀有关 大麻戒断症状经常与心理健康症状相混淆。 最后，还有有效的行为疗法可供使用。 CUD 和几种在治疗 CUD 和戒除大麻方面显示出益处的药物 重要的是要确定大麻使用者以确保获得有效的治疗。 创新和影响：该提案将解决妇女健康等优先领域的重要差距， 该提案将为验证一个简单的、 基于频率的大麻使用筛查措施在初级保健机构中可能是可行的。 具体目标：我们建议提高对高危人群的了解，并确定是否 我们还建议确定退伍军人群体中的大麻治疗服务是否得到充分利用。 某些使用模式与不良的心理和身体健康结果相关，使个人处于 此类个人（如果已确定）也可能需要简短的干预、转诊和/或治疗。 目标 1：检查大麻使用模式（过去一个月使用、日常使用、CUD、持续使用）， 与使用相关的行为（例如，饮酒）以及与全国范围内的使用相关的特征 接受 VA 初级护理的 50 岁及以上退伍军人的代表性样本。 目标 2a：确定退伍军人是否与其提供者讨论大麻的使用以及提供者是否 文件使用和/或对使用或 CUD 进行干预。 目标 2b：探索提供者评估大麻使用和启动 CUD 相关治疗的经验 以及初级保健机构的转诊。 目标 3：利用目标 1 中创建的队列，我们​​将前瞻性地研究大麻使用的关联 抑郁、焦虑、创伤后应激障碍、失眠、急诊室使用和全因住院。 方法：我们将使用 VA 数据构建一个具有全国代表性的 50 岁及以上退伍军人队列， 我们将与初级保健提供者进行图表审查和电话访谈。 了解护理方面的差距。 后续步骤/实施：与酒精和烟草一样，可以有效监测定期使用大麻 并通过识别和简短干预进行管理，该提案将提高我们对这一问题的理解。 不明大麻使用的普遍性和初级保健机构护理方面的差距、筛查的必要性、 并提高我们对使用相关危害的了解。该提案将为以下方面奠定基础： 解决老年退伍军人中与大麻使用和 CUD 相关的护理差距。