# Marijuana policy change impact on patterns of marijuana and other harmful substance use among people living with HIV: A mixed methods evaluation

> **NIH NIH R21** · UNIVERSITY OF WASHINGTON · 2020 · $194,375

## Abstract

Project Summary/Abstract
This project will use mixed methods (qualitative and quantitative) to evaluate the impact of
marijuana policy changes on patterns of use of marijuana and other harmful substances among
people living with HIV (PLWH). PLWH are a key population given their high prevalence of
marijuana use and potential for marijuana-related adverse outcomes. We will analyze the rich
data available through the Centers for AIDS Research Network of Integrated Clinical Systems
(CNICS) study, a large, geographically and racially diverse cohort of >32,000 PLWH in care in 8
regions across the U.S. CNICS' comprehensive clinical data includes laboratory data (CD4, HIV
RNA levels), medications, diagnoses (substance use disorders, mental health disorders),
patient-reported outcomes (PROs) with >70,000 comprehensive substance use assessments,
and health care utilization such as primary care visits and missed visits. Ongoing longitudinal
substance use assessments combined with geographic diversity including areas like San Diego,
Seattle, and Boston with recent regulatory changes and areas like Baltimore and Birmingham
without regulatory changes will enable this project. We will examine marijuana use among
PLWH using joint longitudinal and survival models to estimate associations with
policy/regulation. We will also evaluate the association between marijuana use changes and risk
behaviors, such as binge drinking, among PLWH. We will additionally employ qualitative
methods including focus groups and structured interviews to evaluate changing usage patterns,
beliefs, and health behaviors over periods experiencing regulatory changes. We expect that the
majority of increases in marijuana use will be explained by current users increasing frequency
rather than non-users becoming users. Furthermore, post-legalization, PLWH reporting current
marijuana use will a) describe a diversification of product use and means of ingestion, b) report
increased access to marijuana, c) describe an increase in use of marijuana in social settings
and in public spaces, d) report marijuana as a cue for use of other substances in certain
settings, e) describe decreased stigma associated with marijuana use, and f) and lower rates of
alcohol and tobacco use. The findings of this proposal will likely enable several future studies
exploring the intersection of marijuana policy, substance use, and health outcomes among
PLWH. Further, we expect that data gleaned from this project will have ramifications not only for
the clinical care of PLWH but for public health and marijuana legislation in general.

## Key facts

- **NIH application ID:** 9868293
- **Project number:** 5R21DA047891-02
- **Recipient organization:** UNIVERSITY OF WASHINGTON
- **Principal Investigator:** Heidi M. Crane
- **Activity code:** R21 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $194,375
- **Award type:** 5
- **Project period:** 2019-02-15 → 2022-01-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9868293

## Citation

> US National Institutes of Health, RePORTER application 9868293, Marijuana policy change impact on patterns of marijuana and other harmful substance use among people living with HIV: A mixed methods evaluation (5R21DA047891-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/9868293. Licensed CC0.

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