The Combined Relationship of Prescription Drug Monitoring Program Enactment and Medical Cannabis Laws with Chronic Pain-Related Healthcare Visits.
chronic pain
healthcare utilization
medical cannabis laws
prescription drug monitoring programs
Journal
Journal of general internal medicine
ISSN: 1525-1497
Titre abrégé: J Gen Intern Med
Pays: United States
ID NLM: 8605834
Informations de publication
Date de publication:
01 Oct 2024
01 Oct 2024
Historique:
received:
13
02
2024
accepted:
17
09
2024
medline:
3
10
2024
pubmed:
3
10
2024
entrez:
1
10
2024
Statut:
aheadofprint
Résumé
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. 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. 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. Medicaid enrollees aged 18-64 years with chronic pain (N = 4,878,462). 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
METHODS
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
METHODS
Medicaid enrollees aged 18-64 years with chronic pain (N = 4,878,462).
MAIN MEASURES
METHODS
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
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
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.
Identifiants
pubmed: 39354252
doi: 10.1007/s11606-024-09053-6
pii: 10.1007/s11606-024-09053-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NIDA NIH HHS
ID : 5R01DA045872
Pays : United States
Organisme : NIDA NIH HHS
ID : 5T32DA031099
Pays : United States
Organisme : NCCIH NIH HHS
ID : 1K01AT012205
Pays : United States
Informations de copyright
© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.
Références
Yong RJ, Mullins PM, Bhattacharyya N. Prevalence of chronic pain among adults in the United States. Pain. 2022;163(2):e328-e332. https://doi.org/10.1097/j.pain.0000000000002291 .
doi: 10.1097/j.pain.0000000000002291
Zajacova A, Grol-Prokopczyk H, Zimmer Z. Pain trends among American adults, 2002-2018: Patterns, disparities, and correlates. Demography. 2021;58(2):711-738. https://doi.org/10.1215/00703370-8977691 .
doi: 10.1215/00703370-8977691
Oliveira CB, Maher CG, Franco MR, Kamper SJ, Williams CM, Silva FG, Pinto RZ. Co-occurrence of Chronic Musculoskeletal Pain and Cardiovascular Diseases: A systematic review with meta-analysis. Pain Med. 2020;21(6):1106-1121. https://doi.org/10.1093/pm/pnz217 .
doi: 10.1093/pm/pnz217
Feldman DE, Nahin RL. Disability among persons with chronic severe back pain: Results from a nationally representative population-based sample. J Pain. 2022;23(12):2144-2154. https://doi.org/10.1016/j.jpain.2022.07.016 .
doi: 10.1016/j.jpain.2022.07.016
Gaskin DJ, Richard P. The economic costs of pain in the United States. J Pain. 2012;13(8):715-24. https://doi.org/10.1016/j.jpain.2012.03.009 .
doi: 10.1016/j.jpain.2012.03.009
Skelly AC, Chou R, Dettori JR, Turner JA, Friedly JL, Rundell SD, Fu R, Brodt ED, Wasson N, Kantner S, Ferguson AJR. Noninvasive nonpharmacological treatment for chronic pain: A systematic review update [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2020. Report No.: 20-EHC009.
Groenewald CB, Murray CB, Battaglia M, Scaini S, Quinn PD. Prevalence of pain management techniques among adults with chronic pain in the United States, 2019. JAMA Netw Open. 2022 Feb 1;5(2):e2146697. https://doi.org/10.1001/jamanetworkopen.2021.46697 . Erratum in: JAMA Netw Open. 2022;5(4):e228840. https://doi.org/10.1001/jamanetworkopen.2022.8840 .
doi: 10.1001/jamanetworkopen.2021.46697
Dowell D, Ragan KR, Jones CM, Baldwin GT, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain - United States, 2022. MMWR Recomm Rep. 2022;71(3):1–95. https://doi.org/10.15585/mmwr.rr7103a1 .
Heyward J, Jones CM, Compton WM, Lin DH, Losby JL, Murimi IB, Baldwin GT, Ballreich JM, Thomas DA, Bicket MC, Porter L, Tierce JC, Alexander GC. Coverage of nonpharmacologic treatments for low back pain among US Public and private insurers. JAMA Netw Open. 2018;1(6):e183044. https://doi.org/10.1001/jamanetworkopen.2018.3044 .
doi: 10.1001/jamanetworkopen.2018.3044
Dépelteau A, Racine-Hemmings F, Lagueux É, Hudon C. Chronic pain and frequent use of emergency department: A systematic review. Am J Emerg Med. 2020;38(2):358-363. https://doi.org/10.1016/j.ajem.2019.158492 .
doi: 10.1016/j.ajem.2019.158492
Giusti GD, Reitano B, Gili A. Pain assessment in the Emergency Department. Correlation between pain rated by the patient and by the nurse. An observational study. Acta Biomed. 2018;89(4-S):64-70. https://doi.org/10.23750/abm.v89i4-S.7055 .
doi: 10.23750/abm.v89i4-S.7055
Phelan MP, Thompson NR, Ahmed Z, Lapin B, Udeh B, Anderson E, Katzan I, Walker LE. Emergency department utilization among patients who receive outpatient specialty care for headache: A retrospective cohort study analysis. Headache. 2023;63(4):472-483. https://doi.org/10.1111/head.14456 .
doi: 10.1111/head.14456
Bernard SA, Chelminski PR, Ives TJ, Ranapurwala SI. Management of pain in the United States-A brief history and implications for the opioid epidemic. Health Serv Insights. 2018;11:1178632918819440. https://doi.org/10.1177/1178632918819440 .
doi: 10.1177/1178632918819440
Centers for Disease Control and Prevention. Atlanta, GA: CDC, National Center for Health Statistics. Available at http://wonder.cdc.gov . 2020. Accessed 12 November 2022.
D’Souza RS, Lang M, Eldrige JS. Prescription drug monitoring program. 2022 Jun 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022.
Holmgren AJ, Botelho A, Brandt AM. A history of prescription drug monitoring programs in the United States: Political Appeal and Public Health Efficacy. Am J Public Health. 2020;110(8):1191-1197. https://doi.org/10.2105/AJPH.2020.305696 .
doi: 10.2105/AJPH.2020.305696
Horwitz JR, Davis C, McClelland L, Fordon R, Meara E. The importance of data source in prescription drug monitoring program research. Health Serv Res. 2021;56(2):268-274. https://doi.org/10.1111/1475-6773.13548 .
doi: 10.1111/1475-6773.13548
Smith N, Martins SS, Kim J, Rivera-Aguirre A, Fink DS, Castillo-Carniglia A, Henry SG, Mooney SJ, Marshall BDL, Davis C, Cerdá M. A typology of prescription drug monitoring programs: a latent transition analysis of the evolution of programs from 1999 to 2016. Addiction. 2019;114(2):248-258. https://doi.org/10.1111/add.14440 .
doi: 10.1111/add.14440
Puac-Polanco V, Chihuri S, Fink DS, Cerdá M, Keyes KM, Li G. Prescription drug monitoring programs and prescription opioid-related outcomes in the United States. Epidemiol Rev. 2020;42(1):134-153. https://doi.org/10.1093/epirev/mxaa002 .
doi: 10.1093/epirev/mxaa002
American Medical Association. Chicago, IL. Total opioid prescriptions has decreased by more than 44% between 2011–2020. Available at https://end-overdose-epidemic.org/wp-content/uploads/2021/09/IQVIA-opioid-prescription-trends-chart-Sept-2021-FINAL.pdf . 2021. Accessed 14 November 2022.
Keyhani S, Steigerwald S, Ishida J, Vali M, Cerdá M, Hasin D, Dollinger C, Yoo SR, Cohen BE. Risks and benefits of marijuana use: A National Survey of U.S. Adults. Ann Intern Med. 2018;169(5):282-290. https://doi.org/10.7326/M18-0810 .
doi: 10.7326/M18-0810
Dai H, Richter KP. A national survey of marijuana use among US adults with medical conditions, 2016-2017. JAMA Netw Open. 2019;2(9):e1911936. https://doi.org/10.1001/jamanetworkopen.2019.11936 .
doi: 10.1001/jamanetworkopen.2019.11936
Matson TE, Carrell DS, Bobb JF, Cronkite DJ, Oliver MM, Luce C, Ghitza UE, Hsu CW, Campbell CI, Browne KC, Binswanger IA, Saxon AJ, Bradley KA, Lapham GT. Prevalence of medical cannabis use and associated health conditions documented in electronic health records among primary care patients in Washington State. JAMA Netw Open. 2021;4(5):e219375. https://doi.org/10.1001/jamanetworkopen.2021.9375 .
doi: 10.1001/jamanetworkopen.2021.9375
Marijuana Policy Project. State-by-state language allowing severe pain. https://www.mpp.org/issues/medical-marijuana/state-state-language-allowing-severe-pain/ . Accessed on 22 May 2024.
Kilmer B. How will cannabis legalization affect health, safety, and social equity outcomes? It largely depends on the 14 Ps. Am J Drug Alcohol Abuse. 2019;45(6):664-672. https://doi.org/10.1080/00952990.2019.1611841 .
doi: 10.1080/00952990.2019.1611841
Boehnke KF, Gangopadhyay S, Clauw DJ, Haffajee RL. Qualifying conditions of medical cannabis license holders in the United States. Health Aff (Millwood). 2019;38(2):295-302. https://doi.org/10.1377/hlthaff.2018.05266 . Erratum in: Health Aff (Millwood). 2019 Mar;38(3):511. https://doi.org/10.1377/hlthaff.2019.00175 . Erratum in: Health Aff (Millwood). 2019 Nov;38(11):1953. https://doi.org/10.1377/hlthaff.2019.01452 .
doi: 10.1377/hlthaff.2018.05266
Bradford AC, Bradford WD, Abraham A, Bagwell Adams G. Association between US State medical cannabis laws and opioid prescribing in the medicare part D population. JAMA Intern Med. 2018;178(5):667-672. https://doi.org/10.1001/jamainternmed.2018.0266 .
doi: 10.1001/jamainternmed.2018.0266
Wen H, Hockenberry JM. Association of medical and adult-use marijuana laws with opioid prescribing for medicaid enrollees. JAMA Intern Med. 2018;178(5):673-679. https://doi.org/10.1001/jamainternmed.2018.1007 .
doi: 10.1001/jamainternmed.2018.1007
Shah A, Hayes CJ, Lakkad M, Martin BC. Impact of medical marijuana legalization on opioid use, chronic opioid use, and high-risk opioid use. J Gen Intern Med. 2019;34(8):1419-1426. https://doi.org/10.1007/s11606-018-4782-2 .
doi: 10.1007/s11606-018-4782-2
McMichael BJ, Van Horn RL, Viscusi WK. The impact of cannabis access laws on opioid prescribing. J Health Econ. 2020;69:102273. https://doi.org/10.1016/j.jhealeco.2019.102273 .
doi: 10.1016/j.jhealeco.2019.102273
Bicket MC, Stone EM, McGinty EE. Use of cannabis and other pain treatments among adults with chronic pain in US States with medical cannabis programs. JAMA Netw Open. 2023;6(1):e2249797. https://doi.org/10.1001/jamanetworkopen.2022.49797 .
doi: 10.1001/jamanetworkopen.2022.49797
McGinty EE, Tormohlen KN, Seewald NJ, Bicket MC, McCourt AD, Rutkow L, White SA, Stuart EA. Effects of U.S. State medical cannabis laws on treatment of chronic noncancer pain. Ann Intern Med. 2023;176(7):904-912. https://doi.org/10.7326/M23-0053 .
doi: 10.7326/M23-0053
Dahlhamer J, Lucas J, Zelaya C, Nahin R, Mackey S, DeBar L, Kerns R, Von Korff M, Porter L, Helmick C. Prevalence of chronic pain and high-impact chronic pain among adults - United States, 2016. MMWR Morb Mortal Wkly Rep. 2018;67(36):1001-1006. https://doi.org/10.15585/mmwr.mm6736a2 .
doi: 10.15585/mmwr.mm6736a2
Fillingim RB, Bruehl S, Dworkin RH, Dworkin SF, Loeser JD, Turk DC, Widerstrom-Noga E, Arnold L, Bennett R, Edwards RR, Freeman R, Gewandter J, Hertz S, Hochberg M, Krane E, Mantyh PW, Markman J, Neogi T, Ohrbach R, Paice JA, Porreca F, Rappaport BA, Smith SM, Smith TJ, Sullivan MD, Verne GN, Wasan AD, Wesselmann U. The ACTTION-American Pain Society Pain Taxonomy (AAPT): an evidence-based and multidimensional approach to classifying chronic pain conditions. J Pain. 2014;15(3):241-9. https://doi.org/10.1016/j.jpain.2014.01.004 .
doi: 10.1016/j.jpain.2014.01.004
Mayhew M, DeBar LL, Deyo RA, Kerns RD, Goulet JL, Brandt CA, Von Korff M. Development and assessment of a crosswalk between ICD-9-CM and ICD-10-CM to identify patients with common pain conditions. J Pain. 2019;20(12):1429-1445. https://doi.org/10.1016/j.jpain.2019.05.006 .
doi: 10.1016/j.jpain.2019.05.006
Tian TY, Zlateva I, Anderson DR. Using electronic health records data to identify patients with chronic pain in a primary care setting. J Am Med Inform Assoc. 2013;20(e2):e275-80. https://doi.org/10.1136/amiajnl-2013-001856 .
doi: 10.1136/amiajnl-2013-001856
Pagé MG, Fortier M, Ware MA, Choinière M. As if one pain problem was not enough: prevalence and patterns of coexisting chronic pain conditions and their impact on treatment outcomes. J Pain Res. 2018;11:237-254. https://doi.org/10.2147/JPR.S149262 .
doi: 10.2147/JPR.S149262
Mun CJ, Ruehlman L, Karoly P. Examining the adjustment patterns of adults with multiple chronic pain conditions and multiple pain sites: More pain, no gain. J Pain. 2020;21(1-2):108-120. https://doi.org/10.1016/j.jpain.2019.06.002 .
doi: 10.1016/j.jpain.2019.06.002
Feng CX. A comparison of zero-inflated and hurdle models for modeling zero-inflated count data. J Stat Distrib Appl. 2021;8(1):8. https://doi.org/10.1186/s40488-021-00121-4 .
doi: 10.1186/s40488-021-00121-4
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on the Health Effects of Marijuana: An Evidence Review and Research Agenda. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research. Washington (DC): National Academies Press (US); 2017.
Rikard SM, Strahan AE, Schmit KM, Guy GP Jr. Chronic pain among adults - United States, 2019-2021. MMWR Morb Mortal Wkly Rep. 2023;72(15):379-385. https://doi.org/10.15585/mmwr.mm7215a1 .
doi: 10.15585/mmwr.mm7215a1
Livne O, Budney A, Borodovsky J, Shmulewitz D, Walsh C, Struble CA, Habib M, Aharonovich E, Hasin DS. Age differences in patterns of cannabis use among an online US sample of adults who consume cannabis frequently. Am J Drug Alcohol Abuse. 2024;50(2):242-251. https://doi.org/10.1080/00952990.2024.2309340 .
doi: 10.1080/00952990.2024.2309340
Dagnino APA, Campos MM. Chronic Pain in the Elderly: Mechanisms and Perspectives. Front Hum Neurosci. 2022;16:736688. https://doi.org/10.3389/fnhum.2022.736688 .
doi: 10.3389/fnhum.2022.736688
Yang KH, Kaufmann CN, Nafsu R, Lifset ET, Nguyen K, Sexton M, Han BH, Kim A, Moore AA. Cannabis: An emerging treatment for common symptoms in older adults. J Am Geriatr Soc. 2021;69(1):91-97. https://doi.org/10.1111/jgs.16833 .
doi: 10.1111/jgs.16833
Bradford AC, Bradford WD. Medical marijuana laws reduce prescription medication use in medicare Part D. Health Aff (Millwood). 2016;35(7):1230-6. https://doi.org/10.1377/hlthaff.2015.1661 .
doi: 10.1377/hlthaff.2015.1661
Gupta R, Boehmer S, Giampetro D, Gupta A, DeFlitch CJ. Effect of a prescription drug monitoring program on Emergency Department opioid prescribing. West J Emerg Med. 2021;22(3):756-762. https://doi.org/10.5811/westjem.2021.1.49652 .
doi: 10.5811/westjem.2021.1.49652
Hämäläinen J, Kvist T, Kankkunen P. Acute pain assessment inadequacy in the Emergency Department: Patients' Perspective. J Patient Exp. 2022;9:23743735211049677. https://doi.org/10.1177/23743735211049677 .
doi: 10.1177/23743735211049677
Baharuddin KA, Mohamad N, Nik Abdul Rahman NH, Ahmad R, Nik Him NA. Assessing patient pain scores in the emergency department. Malays J Med Sci. 2010;17(1):17-22.
De Vita MJ, Moskal D, Maisto SA, Ansell EB. Association of cannabinoid administration with experimental pain in healthy adults: A systematic review and meta-analysis. JAMA Psychiatry. 2018;75(11):1118-1127. https://doi.org/10.1001/jamapsychiatry.2018.2503 .
doi: 10.1001/jamapsychiatry.2018.2503
Stockings E, Campbell G, Hall WD, Nielsen S, Zagic D, Rahman R, Murnion B, Farrell M, Weier M, Degenhardt L. Cannabis and cannabinoids for the treatment of people with chronic noncancer pain conditions: a systematic review and meta-analysis of controlled and observational studies. Pain. 2018;159(10):1932-1954. https://doi.org/10.1097/j.pain.0000000000001293 .
doi: 10.1097/j.pain.0000000000001293
Pritchard KT, Baillargeon J, Lee WC, Raji MA, Kuo YF. Trends in the use of opioids vs nonpharmacologic treatments in adults with pain, 2011-2019. JAMA Netw Open. 2022;5(11):e2240612. https://doi.org/10.1001/jamanetworkopen.2022.40612 .
doi: 10.1001/jamanetworkopen.2022.40612
Gorfinkel LR, Hasin D, Saxon AJ, Wall M, Martins SS, Cerdá M, Keyes K, Fink DS, Keyhani S, Maynard CC, Olfson M. Trends in prescriptions for non-opioid pain medications among U.S. adults with moderate or severe pain, 2014-2018. J Pain. 2022;23(7):1187-1195. https://doi.org/10.1016/j.jpain.2022.01.006 .
doi: 10.1016/j.jpain.2022.01.006
Bohnert ASB, Guy GP Jr, Losby JL. Opioid prescribing in the United States before and after the centers for disease control and prevention's 2016 opioid guideline. Ann Intern Med. 2018;169(6):367-375. https://doi.org/10.7326/M18-1243 .
doi: 10.7326/M18-1243
Hansen B, Miller K, Weber C. Federalism, partial prohibition, and cross-border sales: Evidence from recreational marijuana. J Public Econ. 2020;187:104159.
doi: 10.1016/j.jpubeco.2020.104159
Mannes ZL, Malte CA, Olfson M, Wall MM, Keyes KM, Martins SS, Cerdá M, Gradus JL, Saxon AJ, Keyhani S, Maynard C, Livne O, Fink DS, Gutkind S, Hasin DS. Increasing risk of cannabis use disorder among U.S. veterans with chronic pain: 2005–2019. Pain. 2023. https://doi.org/10.1097/j.pain.0000000000002920 .
Jeffers AM, Glantz S, Byers AL, Keyhani S. Association of cannabis use with cardiovascular outcomes among US adults. J Am Heart Assoc. 2024;13(5):e030178. https://doi.org/10.1161/JAHA.123.030178 .
doi: 10.1161/JAHA.123.030178
Hasin DS, Borodovsky J, Shmulewitz D, Walsh C, Livne O, Struble CA, Aharonovich E, Fink DS, Budney A. Use of highly-potent cannabis concentrate products: More common in U.S. states with recreational or medical cannabis laws. Drug Alcohol Depend. 2021;229(Pt B):109159. https://doi.org/10.1016/j.drugalcdep.2021.109159 .
doi: 10.1016/j.drugalcdep.2021.109159
McDonagh MS, Morasco BJ, Wagner J, Ahmed AY, Fu R, Kansagara D, Chou R. Cannabis-based products for chronic pain: A systematic review. Ann Intern Med. 2022;175(8):1143-1153. https://doi.org/10.7326/M21-4520 .
doi: 10.7326/M21-4520