Impact of Recreational and Medical Marijuana legalization on cannabis use disorders, serious mental illness, and mortality outcomes among Medicaid enrolled youth

娱乐和医用大麻合法化对参加医疗补助计划的青少年大麻使用障碍、严重精神疾病和死亡率结果的影响

• 批准号: 10675915
• 负责人: Cynthia Ann Fontanella
• 金额: $ 73.94万
• 依托单位: RESEARCH INST NATIONWIDE CHILDREN'S HOSP
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-08-01 至 2028-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10675915
• 关键词: Achievement; Adolescent; Adolescent and Young Adult; Adult; Affect; Age; American; Behavior; Cannabis; Cannabis policy; Cessation of life; Classification; Data; Development; District of Columbia; Drug Prescriptions; Emergency department visit; Enrollment; Exhibits; Goals; Health; Health Benefit; Heterogeneity; High Prevalence; Hospitalization; Individual; Intervention; Knowledge; Laws; Legal; Mediating; Medicaid; Medical; Medical Marijuana; Mental Health; Mental Health Services; Modeling; National Institute of Drug Abuse; Occupations; Outcome; Outpatients; Pattern; Perception; Pharmaceutical Preparations; Policies; Policy Maker; Policy Making; Population; Positioning Attribute; Prevalence; Privatization; Public Health; Public Policy; Quasi-experiment; Records; Recreation; Research; Residential Treatment; Risk; Risk Taking; Sales; Sampling; Science; Substance Use Disorder; Suicide; Taxonomy; Teenagers; US State; Vulnerable Populations; Work; Youth; aged; clinical care; experience; illicit drug use; indexing; interest; marijuana legalization; marijuana use; marijuana use disorder; mortality; multilevel analysis; opioid overdose; outcome disparities; overdose death; peer; physical conditioning; poor health outcome; population health; programs; severe mental illness; study population; substance use; substance use treatment; vehicular accident; young adult

ABSTRACT Adolescent cannabis use is a major public health crisis. Marijuana laws (ML) carries significant health impli- cations for American youth. Decriminalization, medicalization, and legalization of cannabis by a majority of US states over the past 25 years has dramatically shifted societal perceptions and adult use patterns. How mariju- ana policy changes have affected population-wide health of US youth and the downstream public health impli- cations of ML remain topics of significant debate. Cannabis is the most commonly used illicit drug by US ado- lescents and the main drug for which US teens obtain substance use (SU) treatment. Adolescent cannabis use is associated with negative long-term consequences on mental health outcomes, risk-taking behaviors (eg, motor vehicle accidents: MVA), and academic/job achievement. Currently, 36 states and the District of Colum- bia (DC) have enacted medical ML (MML); of these, 18 states and DC have enacted recreational ML (RML). While studies have assessed the association between MML and marijuana use in youth, little is known about the impact of ML on mental health outcomes for American youth. No studies to date have evaluated the impact of MML and RML enactment on youth mental health or mortality outcomes. This represents a major knowledge gap in research that, if answered, will provide critical information to guide ML policymaking. The overarching goal of this NIDA RFA-DA-22-037 application is to characterize the effects of state-level MML and RML, including degree of ML restrictiveness and the effect of varying provisions, on changes in can- nabis use disorder (CUD), serious mental illness (SMI), non-cannabis substance use disorder (NCSUD), sui- cide-related outcomes (SROs), all-cause mortality (ACM), and treatment utilization for SU and MH services, including prescription medication, in American youth. Our central hypothesis is that ML will increase CUD, SMI, NCSUD, SROs, and ACM, with less restrictive ML being associated with worse health outcomes. To achieve study objectives, a difference in difference (DID) quasi-experimental design will be implemented. The main in- tervention of interest is ML, specifically, enactment of MML and RML. We will use national Medicaid data from all 50 states and DC for the period 1/1/2008 to 12/31/2020 merged with the National Death Index data. The study population will include a 20% random sample of all US adolescents (12-17 years) and young adults (18- 25 years) (N=55 million). Medicaid-enrolled adolescents and young adults have higher prevalence rates of mental health and substance use disorders and poorer physical and mental health outcomes compared to age matched peers; thus, they are a large and vulnerable population in whom MML and RML effects are unknown. Multilevel models will be fit to obtain estimates of before vs. after changes among adolescents and young adults in states enacting MML and RML compared to changes in other states, controlling for Individual and state-level covariates.

抽象的 青少年吸食大麻是一个重大的公共卫生危机。大麻法 (ML) 对健康有重大影响 美国青年的阳离子。美国大多数人将大麻非刑事化、医疗化和合法化 过去 25 年里，各州已经极大地改变了社会观念和成人使用模式。怎么大麻- ana 政策的变化影响了美国青少年的全民健康以及下游的公共卫生影响 机器学习的阳离子仍然是备受争议的话题。大麻是美国青少年最常用的非法药物 以及美国青少年接受药物滥用 (SU) 治疗的主要药物。青少年吸食大麻 与心理健康结果、冒险行为（例如， 机动车事故：MVA），以及学术/工作成就。目前，36 个州和哥伦比亚特区 bia (DC) 颁布了医学 ML (MML)；其中，18 个州和华盛顿特区颁布了娱乐性 ML (RML)。 虽然研究评估了 MML 与青少年吸食大麻之间的关联，但人们对这方面知之甚少。 机器学习对美国青少年心理健康结果的影响。迄今为止还没有研究评估其影响 MML 和 RML 颁布对青少年心理健康或死亡率结果的影响。这代表了一个主要知识点 研究中的差距，如果得到解答，将为指导机器学习决策提供关键信息。 NIDA RFA-DA-22-037 应用程序的总体目标是表征州级的影响 MML 和 RML，包括 ML 限制性程度以及不同条款对可变更的影响 大麻使用障碍 (CUD)、严重精神疾病 (SMI)、非大麻物质使用障碍 (NCSUD)、 死亡相关结局 (SRO)、全因死亡率 (ACM) 以及 SU 和 MH 服务的治疗利用率， 包括美国年轻人的处方药。我们的中心假设是 ML 将增加 CUD、SMI、 NCSUD、SRO 和 ACM，限制较少的 ML 与较差的健康结果相关。达到 研究目标，将实施差异中的差异（DID）准实验设计。主要在- 感兴趣的干预是 ML，特别是 MML 和 RML 的制定。我们将使用来自以下国家的国家医疗补助数据： 2008 年 1 月 1 日至 2020 年 12 月 31 日期间所有 50 个州和特区均与国家死亡指数数据合并。这 研究人群将包括所有美国青少年（12-17 岁）和年轻人（18-17 岁）的 20% 随机样本 25 年）（N=5500 万）。参加医疗补助的青少年和年轻人的患病率较高 与年龄相比，心理健康和物质使用障碍以及较差的身心健康结果 匹配的同伴；因此，他们是一个庞大而脆弱的人群，MML 和 RML 的影响尚不清楚。 多层次模型将适合获得青少年和年轻人前后变化的估计 与其他州的变化相比，颁布 MML 和 RML 的州的成年人，控制了个人和 州级协变量。