ImportanceWhether state implementation of medical and recreational cannabis laws is associated with increased cannabis use disorder (CUD) and/or cannabis poisoning among adults is not evident.ObjectiveTo examine state-level medical and recreational cannabis laws’ associations with CUD and cannabis poisoning, overall and by sex and age subgroups.Design, Setting, and ParticipantsIn this longitudinal cohort study, state-level CUD and cannabis poisoning diagnoses from January 2011 to December 2021 were examined across all 50 US states and the District of Columbia before and after the implementation of medical and recreational cannabis laws (MCLs and RCLs, respectively) using a staggered adoption difference-in-differences approach. Event studies were conducted to estimate the magnitude of the association for each year-quarter relative to the time of each policy implementation. This study was conducted among all adults aged 18 to 64 years enrolled in the Merative MarketScan Commercial Claims and Encounters Database, a database of employer-sponsored health insurance enrollees, with 1 year or more of continuous enrollment from 2011 to 2021. Data analysis was performed from January to August 2024.ExposuresState implementation of an MCL, opening a medical cannabis dispensary (MCD), allowing home cultivation of medical cannabis (HC-MC), and passage of an RCL.Main Outcomes and MeasuresCUD and cannabis poisoning diagnoses per 100 000 enrollees per quarter.ResultsThis study included 110 256 536 enrollees, of whom 56 843 030 (52%) were female and the mean (SD) enrollee age was 41.0 (13.5) years. MCLs were associated with significant increases in CUD and cannabis poisoning by 31.09 (95% CI, 20.20-41.99; P < .001) and 0.76 (95% CI, 0.52-1.00; P < .001) diagnoses per 100 000 enrollees per quarter, respectively, and RCLs were associated with a significant increase in cannabis poisoning by 0.34 (95% CI, 0.19-0.48; P < .001) per 100 000 enrollees per quarter in states with RCLs compared to states without these laws. No significant associations were observed for MCDs or HC-MC. Relative increases in CUD associated with MCLs were higher among female enrollees and among enrollees aged 35 to 44 years compared with male enrollees and other age groups, respectively. Sensitivity analysis results of 2011 to 2019 data were consistent with the 2011 to 2021 results.Conclusions and RelevanceIn this longitudinal cohort study, MCLs were associated with increased CUD and cannabis poisoning diagnoses, and RCLs were associated with increased cannabis poisoning in adults aged 18 to 64 years with employer-sponsored health insurance. Communities with increased access to cannabis may experience increased health care use and costs due to increases in cannabis poisoning and CUD, and new clinical and policy interventions are needed to curb these rising diagnoses.

中文翻译：

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州大麻合法化与大麻使用障碍和大麻中毒的关联


重要性各州实施医用和娱乐大麻法律是否与成人大麻使用障碍 （CUD） 和/或大麻中毒增加有关尚不清楚。目的研究州级医疗和娱乐大麻法律与 CUD 和大麻中毒的关联，总体上以及按性别和年龄亚组划分。设计、设置和参与者在这项纵向队列研究中，检查了 2011 年 1 月至 2021 年 12 月美国所有 50 个州和哥伦比亚特区在实施医疗和娱乐大麻法（分别为 MCL 和 RCL）之前和之后的州级 CUD 和大麻中毒诊断使用交错采用双重差分方法。进行了事件研究，以估计每个年季度相对于每个政策实施时间的关联程度。这项研究是在 Merative MarketScan Commercial Claims and Encounters Database 注册的所有 18 至 64 岁的成年人中进行的，该数据库是雇主赞助的健康保险参保者数据库，从 2011 年到 2021 年连续参保 1 年或更长时间。数据分析于 2024 年 1 月至 8 月进行。暴露国家实施 MCL，开设医用大麻药房 （MCD），允许家庭种植医用大麻 （HC-MC），并通过 RCL。主要结果和措施每季度每 100 000 名注册者的 CUD 和大麻中毒诊断。结果本研究包括 110 256 536 名入组者，其中 56 843 030 （52%） 为女性，平均 （SD） 入组者年龄为 41.0 （13.5） 岁。MCL 与 CUD 和大麻中毒的显着增加相关 31.09 （95% CI，20.20-41.99;P < .001） 和 0.76 （95% CI，0.52-1.00;P < .001） 的诊断数和随机对照试验与大麻中毒显著增加 0.34 相关（95% CI，0.19-0.48;P < .001） 与没有这些法律的州相比，有 RCL 的州每季度每 100 000 名注册者。未观察到 MCDs 或 HC-MC 的显著关联。与男性参保者和其他年龄组相比，女性参保者和 35 至 44 岁的参保者与 MCL 相关的 CUD 相对增加更高。2011 年至 2019 年数据的敏感性分析结果与 2011 年至 2021 年的结果一致。结论和相关性在这项纵向队列研究中，MCL 与 CUD 和大麻中毒诊断的增加有关，而 RCL 与拥有雇主赞助的健康保险的 18 至 64 岁成年人的大麻中毒增加有关。由于大麻中毒和 CUD 的增加，获得大麻的机会增加的社区可能会经历更多的医疗保健使用和成本增加，需要新的临床和政策干预措施来遏制这些不断上升的诊断。