IDPH Medical Cannabis and Older Persons Survey

The goal of this research project is to close gaps in what is known about older persons who are participating in the state of Illinois’ medical cannabis program. We will field a survey of more than 2,600 program participants over the age of 60 to learn about what motivates cannabis use, describe how cannabis is used for medical purposes, and identify both positive and negative outcomes of cannabis use. We also will learn more how older adults interact with the Illinois Medical Cannabis Program.

Background:

Since the Illinois Department of Public Health (IDPH) started accepting applications for the medical cannabis program, older adults have been disproportionally represented. Individuals over the of age of 60 have accounted for nearly 25% of program participants while persons under the age of 30 make up less than 10%. According to the IDPH, the most common diagnosable medical conditions experienced by older adults include cancer, glaucoma, cachexia, pain, and nausea—conditions that all are considered amendable to medical cannabis. The IDPH also reported that cancer and fibromyalgia are among the most common reasons individuals are qualified for the cannabis program (note: the state currently does not extend participation for the management of pain, nausea and other related symptoms).

We expect the use of medical cannabis by older adults will increase substantially in the next decade. However, like most other state medical cannabis programs, the state of Illinois does not collect the kind of data that can further illuminate the motives, patterns and outcomes of cannabis use. For example, how do older adults first learn about the Illinois program and what drives their decision to participate. Several knowledge gaps also exist about outcomes most relevant to older adults, and there is a lack of data to chart the pathways leading to these outcomes. Moreover, we have few insights about the operation of the Illinois program. Are older persons able to find a medical doctor to approve their application? How much counseling is provided to those who take medical cannabis? What are the financial barriers to program participation?

Research Objectives:

With the support of the IDPH, we propose to reach the following objectives:

1) Create a reliable and valid online survey instrument, and with the assistance of the IDPH, invite all older program participants to complete the survey;

2) Using survey answers, conduct multivariable statistical analysis to:

  • identify the antecedents of cannabis use among older participants;
  • describe patterns of use in terms of frequency and methods;
  • explicate both negative (e.g., falls) and positive (e.g., pain control) outcomes associated with using cannabis for medical purposes.

3)   Analyze survey responses to identify strengths and weaknesses pertaining to the operation of the Illinois Medical Cannabis Pilot Program, and identify viable alternatives for improvement and/or expansion.


IDPH Opioid Alternative Pilot Program

The goal of this research project is to evaluate the state of Illinois’ Opioid Alternative Pilot Program (OAPP). We reach this goal by: (a) fielding separate surveys of program participants, certifying physicians, and dispensary directors; (b) analyzing key features of the OAPP including program participation, operations, and outcomes; and (c) identifying strengths and weaknesses of the OAPP, and recommending viable alternatives to improve and expand the program.

Background:

The OAPP was established within the context of a nationwide epidemic of fatal opioid-related drug overdoses. Between 1999 and 2016, opioid-related overdose deaths in Illinois increased from 3.9 per 100,000 persons to 15.3 per 100,000 persons. The use and misuse of opioids also varies considerably across the state. In 2017, while the state-wide opioid prescribing rate was 51.1 prescriptions per 100 persons, some Illinois counties reported prescribing rates over twice that average with the highest being 203.0 prescriptions per 100 persons (https://www.cdc.gov/drugoverdose/maps/rxcounty2017.html). Meanwhile, researchers had observed that states (including Illinois) offering legal access to cannabis had lower rates of prescription opioid use and suggested individuals were substituting cannabis for opioid prescriptions (Bradford & Bradford, 2016). Indeed, soon after establishing the Medical Cannabis Pilot Program in 2015, the Illinois Department of Public Health (IDPH) recognized that creating a program for individuals to substitute cannabis for opioid prescriptions may correspond with several public health benefits.   

Pursuant to the Alternative to Opioids Act approved in August of 2018, the IDPH launched the OAPP on January 31, 2019 (http://www.dph.illinois.gov/topics-services/prevention-wellness/medical-...). The goal of the OAPP is to curtail the opioid epidemic in Illinois by permitting access to medical cannabis for individuals age 21 and older who have been (or could be) prescribed a pharmaceutical opioid by a licensed Illinois physician. Illinois is the first state to establish a program like the OAPP.

Given the program novelty and potential impact on curtailing over-prescribing or misuse of opioids, the formal evaluation of the OAPP constitutes a critical endeavor. What are the motives of individual OAPP participants? What challenges occur when these individuals enroll in the program? What are the outcomes, positive and negative, reported by these individuals? There also is a need to evaluate “supply-side” factors of the OAPP. What types of physicians are most likely to certify individuals to participate? What sort of preparations did medical cannabis dispensaries make before implementing the program? How efficient is the OAPP enrollment system used by cannabis dispensaries?  Upon gaining a better understanding of these individual parts, the OAPP should be evaluated in terms of over-all level of knowledge and understanding among program participants and providers, program access and enrollment, and regional differences in program operations and outcomes. Such a thorough evaluation can illuminate strengths and weaknesses of this evolving program and may provide a blueprint for other states to consider.     

Research Objectives:

With the support of the IDPH, we propose to reach the following objectives:

  1. Field three reliable and valid online surveys among

  • as many as 500 OAPP participants,
  • as many as 100 certifying physicians,
  • as many as 40 directors of participating medical dispensaries.

2. Analyze survey answers provided by participants, providers and dispensaries:

  • Describe key characteristics of survey respondents (e.g., average age, level of knowledge about the OAPP).
  • Assess program operations (e.g., ease of access to medical dispensary, average length of time for participant approval).
  • Examine state-wide system performance (e.g., supply of participating physicians, average distance between participants and dispensaries).

3. Prepare a report that identifies strengths and weaknesses of the OAPP, and proposes viable alternatives for improvement and expansion focusing on:

  • information, education and training needs; 
  • increasing efficiencies and effectiveness of program operations;
  • resolving regional variations in program access and outcomes.