The Combined Relationship of Prescription Drug Monitoring Program Enactment and Medical Cannabis Laws with Chronic Pain-Related Healthcare Visits.

Autor: Mannes ZL; Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA., Nowels M; Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA., Mauro C; Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY, USA., Cook S; Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA., Wheeler-Martin K; Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.; Department of Population Health, Grossman School of Medicine, NYU Langone Health, New York, NY, USA., Gutkind S; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA., Bruzelius E; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA., Doonan SM; Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.; Department of Population Health, Grossman School of Medicine, NYU Langone Health, New York, NY, USA., Crystal S; Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA.; Department of Health Behavior, Society and Policy, School of Public Health, Rutgers University, New Brunswick, NJ, USA.; School of Social Work, Rutgers University, New Brunswick, NJ, USA., Davis CS; Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.; Network for Public Health Law, Los Angeles, CA, USA., Samples H; Center for Pharmacoepidemiology and Treatment Science, Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA., Hasin DS; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, USA.; New York State Psychiatric Institute, New York, NY, USA., Keyes KM; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA., Rudolph KE; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA., Cerdá M; Center for Opioid Epidemiology and Policy, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA.; Department of Population Health, Grossman School of Medicine, NYU Langone Health, New York, NY, USA., Martins SS; Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA. ssm2183@cumc.columbia.edu.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2024 Oct 01. Date of Electronic Publication: 2024 Oct 01.
DOI: 10.1007/s11606-024-09053-6
Abstrakt: Background: U.S. state electronic prescription drug monitoring programs (PDMPs) are associated with reduced opioid dispensing among people with chronic pain and may impact use of other chronic pain treatments. In states with medical cannabis laws (MCLs), patients can use cannabis for chronic pain management, reducing their need for chronic-pain related treatment visits and moderating effects of PDMP laws.
Objective: Given high rates of chronic pain among Medicaid enrollees, we examined associations between PDMP enactment in the presence or absence of MCL on chronic pain-related outpatient and emergency department (ED) visits.
Design: We created annual cohorts of Medicaid enrollees with chronic pain diagnoses using national Medicaid claims data from 2002-2013 and 2016. Negative binomial hurdle models produced adjusted odds ratios (aOR) for the likelihood of any chronic pain-related outpatient or ED visit and incident rate ratios (IRR) for the rate of visits among patients with ≥ 1 visit.
Participants: Medicaid enrollees aged 18-64 years with chronic pain (N = 4,878,462).
Main Measures: A 3-level state-year variable with the following categories: 1) no PDMP, 2) PDMP enactment in the absence of MCL, or 3) PDMP enactment in the presence of MCL. Healthcare codes for chronic pain-related outpatient and ED visits each year.
Key Results: The sample was primarily female (67.2%), non-Hispanic White (51.2%), and ages 40-55 years (37.2%). Compared to no-PDMP states, PDMP enactment in the absence of MCL was not associated with chronic pain-related outpatient visits but PDMP enactment in the presence of MCL was associated with lower odds of chronic pain-related outpatient visits (aOR = 0.81, 95% CI:0.71-0.92). PDMP enactment was not associated with ED visits, irrespective of MCL.
Conclusions: During a period of PDMP and MCL expansion, our findings suggest treatment shifts for persons with chronic pain away from outpatient settings, potentially related to increased use of cannabis for chronic pain management.
(© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.)
Databáze: MEDLINE
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