Cannabis use and health outcomes among opioid-using people who inject drugs in the context of cannabis legalization

大麻合法化背景下注射吸毒的阿片类药物使用者的大麻使用和健康结果

• 批准号: 10057377
• 负责人: Ricky N Bluthenthal
• 金额: $ 58.32万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-01 至 2022-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10057377
• 关键词: Address; Adult; Alcohols; California; Cannabis; Child; Colorado; Communities; Data; Data Collection; Dose; Drug usage; Economics; Epidemic; Epidemiology; Event; Failure; Fentanyl; Frequencies; Goals; Growth; Health; Heroin; Hospitalization; Individual; Ingestion; Injecting drug user; Injections; Intentional injury; Interview; Lead; Legal; Longitudinal cohort; Los Angeles; Marijuana; Measures; Medical Marijuana; Methods; Modeling; Motivation; Naloxone; Opioid; Opioid Rotation; Outcome; Overdose; Pain Measurement; Participant; Patients; Pattern; Pharmaceutical Preparations; Prevalence; Prevention program; Price; Prospective cohort study; Psychology; Public Health; Public Policy; Publishing; Reporting; Research Project Grants; Risk; Risk Factors; Route; Sales; Sample Size; Sampling; Site; Sociology; Special Population; Statistical Data Interpretation; Techniques; Testing; Time; United States; Vulnerable Populations; base; behavioral outcome; design; ethnic diversity; heroin use; innovation; marijuana legalization; marijuana use; multidisciplinary; opioid overdose; opioid use; opioid user; overdose death; overdose risk; polysubstance use; prescription opioid; programs; prospective; racial and ethnic; rate of change; recruit

Project Summary We propose a longitudinal, prospective cohort study to determine if changes in cannabis use frequency are associated with changes in frequency of opioid use and drug-use related health outcomes among opioid- using (both heroin and prescription opiates) people who inject drugs (PWID) in two states with legal adult cannabis sales and use. State-level legalization of adult cannabis sales and use is likely to lead to greater cannabis use and cannabis-related health problems among vulnerable populations. However, increases in cannabis sales and use might have unanticipated consequences for PWID. Preliminary studies suggest substitution of cannabis for opioids among medicinal cannabis patients and community recruited PWID. Ecological studies have found that medical marijuana legalization is associated with lower rates of opioid- related overdose and hospitalization, outcomes that might be observable for legal adult use cannabis. Based on these findings, we theorize that cannabis use may reduce opioid use and thereby lower the risk for opioid- related drug harms such as nonfatal overdose events. Therefore, we propose the following aims: AIM 1: To determine whether changes in cannabis use are associated with changes in frequency of opioid use among opioid-using PWID while adjusting for confounders. Hypothesis 1 (H1): The rate of change in cannabis use over time will be inversely associated with the rate of change in opioid use during the same period. AIM 2: To determine whether changes in cannabis use among opioid-using PWID is associated with changes in non-fatal overdose events while adjusting for confounders. H2: The rate of change in cannabis use will be inversely associated with the rate of change in the number of non-fatal overdose events. To achieve these aims, we propose to recruit, interview, and follow at baseline, 6 and 12 months a prospective, longitudinal cohort of 1,000 opioid-using PWID in Denver, CO (N=500) and Los Angeles, CA (N=500). Opioid-using PWID will be recruited using targeted sampling methods. Multiple observation periods and large sample size will permit the use of cutting edge statistical techniques such as latent growth modelling and finite mixture modelling to rigorously test our hypotheses. Our two sites allow us to observe drug use patterns and health outcomes among racially/ethnically diverse PWID. The prevalence of non-fatal overdoses has increased in recent years. In our 2016/17 sample of Los Angeles PWID (n=472), 21% reported a non-fatal overdose in the last 6 months, meaning the proposed sample should have sufficient non-fatal overdoses events to permit statistical analyses of changes over time as proposed here. Findings will advance drug use epidemiology and may inform new prevention programs for the reduction of drug-related harms. Our study team is multidisciplinary (economics [Pacula], epidemiology [Corsi, Kral], psychology [Booth & Huh], and sociology [Bluthenthal]) and well-prepared to conduct this significant, innovative, and rigorous 4-year research project.

项目摘要 我们提出了一项纵向，前瞻性队列研究，以确定大麻使用频率是否变化 与阿片类药物的使用频率和药物使用相关的健康结果的变化有关 使用（海洛因和处方鸦片）的人在两个州中注入毒品（PWID） 大麻销售和使用。成人大麻销售和使用的州级合法化可能会导致更大 弱势群体中的大麻使用和与大麻相关的健康问题。但是，增加 大麻销售和使用可能会对PWID产生意外的后果。初步研究表明 在药用大麻患者和社区招募的PWID中，大麻代替阿片类药物。 生态研究发现，医用大麻合法化与阿片类药物的率较低有关 相关的过量服用和住院，可能可观察到的成人大麻的结果。基于 在这些发现中，我们认为大麻使用可以减少阿片类药物的使用，从而降低阿片类药物的风险 相关药物会损害非致命过量事件等。因此，我们提出以下目的： 目标1：确定使用大麻的变化是否与阿片类药物使用频率的变化有关 在调整混杂因子时使用阿片类药物的PWID。假设1（H1）：大麻的变化率 随着时间的流逝，使用将与同一时期的阿片类药物使用变化率成反比。 目的2：确定阿片类药物使用PWID中使用大麻使用的变化是否与变化有关 在非致命过量事件中，在调整混杂因素的同时。 H2：大麻使用的变化率将是 与非致命过量事件数量的变化率成反比。 为了实现这些目标，我们建议在基线，6和12个月招募，面试和遵循 丹佛（N = 500）和加利福尼亚州洛杉矶的前瞻性，1,000个阿片类药物的纵向队列 （n = 500）。使用目标采样方法募集阿片类药物的PWID。多个观察期 大型样本量将允许使用前沿统计技术，例如潜在生长建模 和有限混合物建模以严格测试我们的假设。我们的两个站点允许我们观察吸毒 种族/种族多样的PWID的模式和健康结果。非致命性过量的患病率 近年来有所增加。在我们的2016/17洛杉矶PWID样本（n = 472）中，有21％的人报告了非致命的 在过去6个月中过量用药，这意味着所提出的样品应具有足够的非致命性过量 事件允许此处提出的随着时间的变化进行统计分析。调查结果将推动吸毒 流行病学，并可能为减少与药物有关的危害的新预防计划提供信息。我们的研究 团队是多学科（经济学[Pacula]，流行病学[Corsi，Kral]，心理学[Booth＆Huh]和 社会学[Bluthenthal]），并准备好进行这项重要，创新和严格的4年研究 项目。