Behavioral Economic Analysis of Medical Marijuana Use in HIV+ Patients

HIV 患者使用医用大麻的行为经济学分析

• 批准号: 8228758
• 负责人: Mark K Greenwald
• 金额: $ 52.68万
• 依托单位: WAYNE STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8228758
• 关键词: AIDS/HIV problem; Acute; Address; Alcohol or Other Drugs use; Alcohols; Alternative Therapies; Area; Behavior; Behavioral; Biometry; Cannabis; Caring; Certification; Characteristics; Cigarette; Clinic; Clinical; Clinical Data; Complement; Criminal Justice; Cross-Sectional Studies; Data; Diagnosis; Disease; Dose; Double-Blind Method; Economics; Elasticity; Environment; Epidemiology; Evaluation; Failure; Frequencies; Goals; Gold; HIV; Health; Health behavior outcomes; High Prevalence; Income; Interview; Knowledge; Laboratories; Laws; Life; Marijuana; Marijuana Smoking; Measures; Medical; Mental Health; Methods; Michigan; Monitor; Moods; Opioid; Outcome; Patient Self-Report; Patients; Pattern; Persons; Pharmaceutical Preparations; Pharmacotherapy; Placebo Control; Policies; Policy Developments; Population; Positioning Attribute; Prevalence; Price; Primary Health Care; Probability; Procedures; Provider; Psychopharmacology; Public Health; Reporting; Research; Risk; Risk Behaviors; Sampling; Self Medication; Signs and Symptoms; Simulate; Smoking; Societies; Subgroup; Substance abuse problem; Surveys; Symptoms; Tetrahydrocannabinol; Therapeutic; Therapeutic Uses; Urinalysis; base; health care service utilization; marijuana user; metropolitan; physical conditioning; programs; prospective; psychopharmacologic; response; service utilization; simulation; socioeconomics; transmission process

DESCRIPTION (provided by applicant): State laws that allow medical marijuana use, including the Michigan Medical Marihuana Program (MMMP), create policy tension due to a paucity of scientific data about factors that influence: marijuana use patterns, abuse potential, decisions to seek/renew medical certification, impact of marijuana use on HIV risk behaviors, and health outcomes. This proposal will address these knowledge gaps by studying marijuana-using persons living with HIV/AIDS (PLWHAs) in Michigan's largest HIV primary care clinic (Detroit, 1700 patients) with a prospective mixed-method approach, as described in these Specific Aims: Aim 1. In 120 marijuana-using PLWHAs (certified medical users, non-certified therapeutic users, and recreational users; 40/group), we will (A) use behavioral economic simulations to evaluate marijuana demand sensitivity to experimental manipulation of unit price and income; and (B) determine whether marijuana price elasticity, cross-price elasticity with other drugs/therapies, and income elasticity differ across marijuana user groups. Aim 2. In a subset of 36 marijuana-using PLWHAs (certified medical, non-certified therapeutic, and recreational users; 12/group from Aim 1), conduct a laboratory-based, double blind, placebo-controlled, marijuana smoking evaluation (cumulative 0, 4, 8 and 12 puffs from 3.5% delta 9-THC cigarettes). We will (A) determine whether marijuana dose-effect profiles for symptom relief and abuse liability differ between marijuana-using groups; (B) compare smoked marijuana demand across groups; and (C) compare intensity of experimental ("gold standard") and naturalistic smoking effects. Aim 3. In the same 120 marijuana-using PLWHAs as Aim 1, use chart review, urinalysis, and interviews to measure prospectively at baseline, and at quarterly intervals for one year, clinical factors that are hypothesized to influence marijuana use and medical certification: socioeconomic changes, physical and mental health, substance use, criminal justice involvement, acute care utilization, HIV risk-transmission behaviors, and reasons for marijuana use. We will use clinical data alone and combined with simulated marijuana demand (Aim 1) and smoked marijuana responses (Aim 2) to predict longitudinal patterns of marijuana and alternative therapy use. Aim 4. Determine whether prevalence of certified medical marijuana use, non-certified therapeutic use, and recreational use in the 120-patient prospective sample generalizes to the entire HIV clinic. We will survey a random sample of 300 PLWHAs to (A) determine whether marijuana use patterns are representative within this large urban clinic located in the area with disproportionally high HIV prevalence, and (B) compare characteristics of this sample to prior cross-sectional survey data. At the conclusion of this project, we anticipate that (1) these data will reveal distinct patterns within this population; (2) we will have achieved a more sophisticated understanding of medical marijuana use, and (3) we will be able to predict which subsets of HIV patients are likely to benefit or be harmed. These findings will be disseminated to patients, providers and society to promote public health and informed policy debate. PUBLIC HEALTH RELEVANCE: Implementation of state laws that allow medical marijuana use - including the Michigan Medical Marihuana Program (MMMP) - create a significant policy problem because we lack systematic scientific data concerning factors that influence: marijuana use patterns, abuse potential, decisions to seek or renew medical certification, impact of marijuana use on HIV transmission behaviors, and health outcomes. The overall goal of this proposal is to address these knowledge gaps by studying subgroups of marijuana-using HIV patients (certified medical users, non-certified therapeutic users and recreational users) in Michigan's largest HIV primary care clinic (Detroit) with a prospective mixed-method approach that uses behavioral-economic simulations of marijuana demand, laboratory-based psychopharmacological assessment, longitudinal health monitoring, and probability survey procedures.

描述（由申请人提供）：允许使用医用大麻的州法律，包括密歇根医用大麻计划 (MMMP)，由于缺乏有关影响因素的科学数据而造成政策紧张：大麻使用模式、滥用可能性、寻求寻求的决定/更新医疗证明、大麻使用对艾滋病毒危险行为的影响以及健康结果。该提案将通过采用前瞻性混合方法研究密歇根州最大的艾滋病毒初级保健诊所（底特律，1700 名患者）的吸食大麻的艾滋病毒/艾滋病感染者 (PLWHA) 来解决这些知识差距，如这些具体目标中所述： 1. 在 120 名使用大麻的 PLWHA（经过认证的医疗使用者、非认证的治疗使用者和娱乐使用者；40 人/组）中，我们将 (A) 使用行为行为经济模拟评估大麻需求对单价和收入实验操纵的敏感性； (B) 确定大麻价格弹性、与其他药物/疗法的交叉价格弹性以及收入弹性是否因大麻使用者群体而异。目标 2. 在 36 名使用大麻的 PLWHA（经过认证的医疗、未经认证的治疗和娱乐使用者；目标 1 中每组 12 人）的子集中，进行基于实验室、双盲、安慰剂对照的大麻吸烟评估（ 3.5% Delta 9-THC 香烟累计吸 0、4、8 和 12 口）。我们将 (A) 确定大麻使用群体之间症状缓解和滥用倾向的剂量效应是否存在差异； (B) 比较不同群体的吸食大麻需求； (C) 比较实验（“黄金标准”）和自然吸烟效果的强度。目标 3. 在与目标 1 相同的 120 名吸食大麻的 PLWHA 中，使用图表审查、尿液分析和访谈在基线和一年内每季度前瞻性地测量假设影响大麻使用和医疗证明的临床因素：社会经济变化、身心健康、物质使用、刑事司法参与、急症护理利用、艾滋病毒风险传播行为以及吸食大麻的原因。我们将单独使用临床数据并结合模拟大麻需求（目标 1）和吸食大麻反应（目标 2）来预测大麻和替代疗法使用的纵向模式。目标 4. 确定 120 名患者前瞻性样本中经过认证的医用大麻使用、未经认证的治疗用途和娱乐用途大麻的流行情况是否普遍适用于整个 HIV 诊所。我们将对 300 名艾滋病毒感染者进行随机抽样调查，以 (A) 确定大麻使用模式在这家位于艾滋病毒感染率极高的地区的大型城市诊所中是否具有代表性，以及 (B) 将此样本的特征与之前的横断面调查进行比较数据。在该项目结束时，我们预计 (1) 这些数据将揭示该人群中的不同模式； (2)我们将对医用大麻的使用有更深入的了解，(3)我们将能够预测哪些艾滋病毒患者亚群可能受益或受到伤害。这些研究结果将传播给患者、医疗服务提供者和社会，以促进公共卫生和知情政策辩论。 公共卫生相关性：允许使用医用大麻的州法律的实施 - 包括密歇根医用大麻计划 (MMMP) - 造成了一个重大的政策问题，因为我们缺乏有关影响因素的系统科学数据：大麻使用模式、滥用潜力、寻求寻求的决定或更新医疗证明、大麻使用对艾滋病毒传播行为的影响以及健康结果。该提案的总体目标是通过研究密歇根州最大的 HIV 初级保健诊所（底特律）的使用大麻的 HIV 患者亚组（经过认证的医疗用户、非经过认证的治疗用户和娱乐用户）来解决这些知识差距，该诊所具有前瞻性的混合-该方法采用大麻需求的行为经济模拟、基于实验室的精神药理学评估、纵向健康监测和概率调查程序。