美国继续努力解决阿片类药物过量危机。每年有500-800万美国人使用处方阿片类药物治疗慢性疼痛，而涉及处方阿片类药物的用药过量为17 000例。新出现的证据表明，医用大麻(MC)可能减少某些个体使用阿片类药物治疗疼痛，并可能对阿片类药物相关药物过量产生影响。然而，在采用和未采用医用大麻的州之间可能存在其它重要差异。本研究评价了1999-2017年间，医用大麻合法销售后美国阿片类药物相关过量死亡（校正人群）的差异。与之前的研究相反，2012-2017年间药物过量死亡在采用医用大麻的州显著较高。有关作者对研究结果的解释，欢迎阅读Thieme药理学期刊 Pharmacopsychiatry 2021年第2期的主编推荐论文。
Opioid Mortality Following Implementation of Medical Cannabis Programs in the United States
Kaufman DE et al.
Introduction The United States is in the midst of an opioid overdose epidemic. Emerging evidence suggests that medical cannabis (MC) may reduce use of opioids for pain in some individuals, with potential impacts on opioid-related overdose. However, there may be other important differences between states that did, and did not, adopt MC.
Methods This study evaluated differences following legal MC sales on US opioid-related overdose deaths, corrected for population, from 1999 to 2017 using an interrupted time series. Comparisons by MC status were also made for Medicaid expansion and the Centers for Disease Control death certificate reporting quality (0: <good, 1: good, 2: excellent).
Results Overdose deaths were significantly higher in MC states from 2012–2017. Overdose death slopes over time increased in states with (pre=1.46±0.46, post=2.90±0.58, p<0.05) and without (pre =0.20±.10, post=1.04±0.22, p<0.005) MC. Post-legalization slopes were significantly higher in MC states (p<0.01). Two states without (11.1%) as compared to 11 states with (91.7%) MC expanded Medicaid by 2014 (χ2[1]=19.03, p<0.0005). MC states (1.50±0.23) had higher death certificate reporting quality relative to states without MC (0.78±0.22, p<0.05).
Discussion MC states had higher rates of opioid overdoses. Although there was no decrease in association with MC introduction, these results were confounded by states without MC having lower overdose reporting quality. Medicaid expansion was also more common in states with MC. Finally, the potency of fentanyl analogues may have obscured any protective effects of MC against illicit opioid harms.
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