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 青少年大麻的使用是主要的公共卫生危机。大麻法（ML）具有重大健康状况 美国青年的阳离子。我们大多数人将大麻的非刑事化，医疗化和合法化 在过去的25年中，各州急剧改变了社会观念和成人使用模式。大麻如何 ANA政策的变化影响了美国青年和下游公共卫生的整个人口健康 ML的阳离子仍然是重大辩论的主题。大麻是美国最常用的非法药物 美国青少年获得药物使用（SU）治疗的患者和主要药物。青少年大麻的使用 与对心理健康结果的负面影响，冒险行为有关（例如， 汽车事故：MVA）和学术/工作成就。目前，36个州和科鲁姆地区 - BIA（DC）已制定医疗ML（MML）；其中，有18个州和DC制定了休闲ML（RML）。 尽管研究评估了MML和大麻在青年中使用的关联，但对 ML对美国青年的心理健康成果的影响。迄今为止尚无研究评估影响 关于青年心理健康或死亡率成果的MML和RML颁布。这代表了主要知识 研究中的差距，如果回答，将提供关键信息来指导ML决策。 该NIDA RFA-DA-22-037应用程序的总体目标是表征状态级别的影响 MML和RML，包括ML限制性程度以及各种规定的影响，对可能的变化 NABIS使用障碍（CUD），严重的精神疾病（SMI），非大道药物使用障碍（NCSUD），Sui- 与CIDE相关的结果（SRO），全因死亡率（ACM）和SU和MH服务的治疗利用， 包括处方药，在美国青年中。我们的中心假设是ML将增加CUD，SMI， NCSUD，SRO和ACM，限制性较低的ML与健康结果差有关。实现 研究目标，差异（DID）将实现差异（DID）。主要的 兴趣的关注是ML，特别是MML和RML的颁布。我们将使用国家医疗补助数据 2008年1月1日至12/31/2020的所有50个州和DC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）和年轻人的20％随机样本（18-- 25年）（n = 5500万）。医疗补助注册的青少年和年轻人的患病率较高 与年龄相比 匹配的同龄人；因此，它们是一个较大且脆弱的人群，其中MML和RML效应未知。 多级模型将适合在青少年和年轻人之间变化之后获得估计。 与其他州的变化相比 州级协变量。