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Kalbfuss J, Odermatt R, Stutzer A. Medical marijuana laws and mental health in the United States. Health Econ Policy Law 2024:1-16. [PMID: 38562089 DOI: 10.1017/s1744133124000033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
The consequences of legal access to medical marijuana for individuals' well-being are controversially assessed. We contribute to the discussion by evaluating the impact of the introduction of medical marijuana laws across US states on self-reported mental health considering different motives for cannabis consumption. Our analysis is based on BRFSS survey data from close to eight million respondents between 1993 and 2018 that we combine with information from the NSDUH to estimate individual consumption propensities. We find that eased access to marijuana through medical marijuana laws reduce the reported number of days with poor mental health for individuals with a high propensity to consume marijuana for medical purposes and for those individuals who likely suffer from frequent pain.
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Affiliation(s)
- Jörg Kalbfuss
- Faculty of Economics, University of Cambridge, Cambridge, UK
| | - Reto Odermatt
- Faculty of Business and Economics, Center for Research in Economics and Well-Being (CREW), University of Basel, Basel, Switzerland
| | - Alois Stutzer
- Faculty of Business and Economics, Center for Research in Economics and Well-Being (CREW), University of Basel, Basel, Switzerland
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Wen J, Wen H, Butler JS, Talbert JC. The impact of medical and recreational marijuana laws on opioid prescribing in employer-sponsored health insurance. Health Econ 2021; 30:989-1000. [PMID: 33624387 PMCID: PMC8237244 DOI: 10.1002/hec.4237] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 12/18/2020] [Accepted: 01/10/2021] [Indexed: 05/16/2023]
Abstract
Using data from Truven Health MarketScan Commercial Claims and Encounters Database between 2009 and 2015, we studied the effects of medical and recreational marijuana laws on opioid prescribing in employer-sponsored health insurance. We used a differences-in-differences (DD) approach and found that the implementation of medical marijuana laws (MMLs) and recreational marijuana laws (RMLs) reduced morphine milligram equivalents per enrollee by 7% and 13%, respectively. The reduction associated with MMLs was predominately in people aged 55-64, whereas the reduction associated with RMLs was largely in people aged 35-44 and aged 45-54. Our findings suggest that both MMLs and RMLs have the potential to reduce opioid prescribing in the privately insured population, especially for the middle-aged population.
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Affiliation(s)
- Jiebing Wen
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Hefei Wen
- Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - J. S. Butler
- Martin School of Public Policy and Administration, University of Kentucky, 473 Patterson Office Tower, Lexington, Kentucky, USA
| | - Jeffery C. Talbert
- Institute of Biomedical Informatics, College of Medicine and Department of Pharmacy Practice and Science, College of Pharmacy, University of Kentucky, 725 Rose St, Lexington, Kentucky, USA
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Abstract
INTRODUCTION The opioid epidemic has resulted in the deaths of millions of Americans and was declared a public health emergency in 2017. In response, many states have enacted policies and analyzed various interventions for harm reduction and overdose prevention, which have embraced limited success. With more states legalizing medical marijuana, another intervention of interest in pain management, much research has since focused on the potential for medical marijuana laws (MMLs) to curb the opioid epidemic. Nonetheless, marijuana legalization and its use for medical purposes has been a polarizing debate from ethical, social, and clinical perspectives. AREAS COVERED We examine evidence on the merits of medical marijuana to address its potential as a diversion from prescription painkillers. Additionally, we review the impact of MMLs on opioid-related outcomes. Furthermore, we provide multi-layered recommendations for future directions in the evaluation of medical marijuana and MMLs as potential mitigators of the opioid epidemic. EXPERT OPINION Despite limited and mixed evidence of efficacy, medical marijuana may still play an important role in addressing the opioid epidemic in the United States. Furthermore, we believe coordinated responses among the federal government, states, researchers, and patients are crucial in producing more robust evaluations of medical marijuana and MMLs.
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Affiliation(s)
- Delaney D Ding
- Clinical Research Coordinator, Medical Practice Evaluation Center, Massachusetts General Hospital , Boston, MA, USA
| | - Rajesh Balkrishnan
- University of Virginia School of Medicine, Clinical Professor, University of Virginia School of Nursing , Charlottesville, VA, USA
| | - Vakaramoko Diaby
- Department of Pharmaceutical Outcomes and Policy (POP), College of Pharmacy, University of Florida , Gainesville, FL, USA
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Meinhofer A, Witman A, Murphy SM, Bao Y. Medical marijuana laws are associated with increases in substance use treatment admissions by pregnant women. Addiction 2019; 114:1593-1601. [PMID: 31106499 PMCID: PMC6684381 DOI: 10.1111/add.14661] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/15/2019] [Accepted: 05/10/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Between 2002 and 2014, past-month marijuana use among pregnant women in the United States increased 62%, nearly twice the growth of the general population. This growth coincides with the proliferation of state medical marijuana laws (MMLs) authorizing physicians to recommend marijuana for approved conditions. We estimated the association between MMLs and substance use treatment utilization among pregnant and non-pregnant women of reproductive age. We also examined whether the association varied across MML provisions, age groups and treatment referral sources to clarify potential pathways. DESIGN Nation-wide administrative data from the 2002-14 Treatment Episodes Data Set Admissions, and a difference-in-differences design that exploited the staggered implementation of MMLs to compare changes in outcomes before and after implementation between MML and non-MML states. SETTING Twenty-one MML and 27 non-MML US states. PARTICIPANTS Pregnant and non-pregnant women aged 12-49 admitted to publicly funded specialty substance use treatment facilities. MEASUREMENTS The primary outcome variable was the number of treatment admissions per 100 000 women aged 12-49, aggregated at the state-year level (n = 606). Admissions for marijuana, alcohol, cocaine and opioids were considered. The primary independent variable was an indicator of MML implementation in a state. FINDINGS Among pregnant women, the rate of marijuana treatment admissions increased by 4.69 [95% confidence interval (CI) = 1.32, 8.06] in MML states relative to non-MML states. This growth was accompanied by increases in treatment admissions involving alcohol (β = 3.19; 95% CI = 0.97, 5.410 and cocaine (β = 2.56; 95% CI = 0.34, 4.79), was specific to adults (β = 5.50; 95% CI = 1.52, 9.47) and was largest in states granting legal protection for marijuana dispensaries (β = 6.37; 95% CI = -0.97, 13.70). There was no statistically significant association between MMLs and treatment admissions by non-pregnant women. CONCLUSIONS Medical marijuana law implementation in US states has been associated with greater substance use treatment utilization by pregnant adult women, especially in states with legally protected dispensaries.
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Affiliation(s)
- Angélica Meinhofer
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
| | - Allison Witman
- Cameron School of Business, University of North Carolina Wilmington, Wilmington, NC
| | - Sean M. Murphy
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
| | - Yuhua Bao
- Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY
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Chen X, Yu B, Stanton B, Cook RL, Chen DG(D, Okafor C. Medical Marijuana Laws and Marijuana Use Among U.S. Adolescents: Evidence From Michigan Youth Risk Behavior Surveillance Data. J Drug Educ 2018; 48:18-35. [PMID: 30296851 PMCID: PMC6551305 DOI: 10.1177/0047237918803361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Research findings are inconsistent regarding a positive association between the passage of state medical marijuana laws (MML) and adolescent access and use marijuana. We utilized a novel analytical approach to examine this issue with multi-year data from the 1997–2013 Youth Risk Behavior Surveillance System (YRBSS) of the State of Michigan. After controlling for the historically declining trend in marijuana use prior to the passages of MML in Michigan, we found that marijuana use among adolescents had increased subsequent to the passage of state MML. Study findings suggest the need for considering the increased risk of marijuana use among adolescents as the number of states with laws permitting marijuana use is increasing.
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Affiliation(s)
- Xinguang Chen
- Department of Epidemiology, University of Florida, Gainesville, FL, 32610
| | - Bin Yu
- Department of Epidemiology, University of Florida, Gainesville, FL, 32610
| | - Bonita Stanton
- School of Medicine, Wayne State University, Detroit, MI, 48201
| | - Robert L. Cook
- Department of Epidemiology, University of Florida, Gainesville, FL, 32610
| | - Ding-Geng (Din) Chen
- School of Social Work, and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA 27599
- Department of Statistics, University of Pretoria, South Africa
| | - Chukwuemeka Okafor
- Department of Epidemiology, University of Florida, Gainesville, FL, 32610
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Williams AR, Santaella-Tenorio J, Mauro CM, Levin FR, Martins SS. Loose regulation of medical marijuana programs associated with higher rates of adult marijuana use but not cannabis use disorder. Addiction 2017; 112:1985-1991. [PMID: 28600874 PMCID: PMC5735415 DOI: 10.1111/add.13904] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Revised: 02/27/2017] [Accepted: 06/06/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND AIMS Most US states have passed medical marijuana laws (MMLs), with great variation in program regulation impacting enrollment rates. We aimed to compare changes in rates of marijuana use, heavy use and cannabis use disorder across age groups while accounting for whether states enacted medicalized (highly regulated) or non-medical mml programs. DESIGN Difference-in-differences estimates with time-varying state-level MML coded by program type (medicalized versus non-medical). Multi-level linear regression models adjusted for state-level random effects and covariates as well as historical trends in use. SETTING Nation-wide cross-sectional survey data from the US National Survey of Drug Use and Health (NSDUH) restricted use data portal aggregated at the state level. PARTICIPANTS Participants comprised 2004-13 NSDUH respondents (n ~ 67 500/year); age groups 12-17, 18-25 and 26+ years. States had implemented eight medicalized and 15 non-medical MML programs. MEASUREMENTS Primary outcome measures included (1) active (past-month) marijuana use; (2) heavy use (> 300 days/year); and (3) cannabis use disorder diagnosis, based on DSM-IV criteria. Covariates included program type, age group and state-level characteristics throughout the study period. FINDINGS Adults 26+ years of age living in states with non-medical MML programs increased past-month marijuana use 1.46% (from 4.13 to 6.59%, P = 0.01), skewing towards greater heavy marijuana by 2.36% (from 14.94 to 17.30, P = 0.09) after MMLs were enacted. However, no associated increase in the prevalence of cannabis use disorder was found during the study period. Our findings do not show increases in prevalence of marijuana use among adults in states with medicalized MML programs. Additionally, there were no increases in adolescent or young adult marijuana outcomes following MML passage, irrespective of program type. CONCLUSIONS Non-medical marijuana laws enacted in US states are associated with increased marijuana use, but only among adults aged 26+ years. Researchers and policymakers should consider program regulation and subgroup characteristics (i.e. demographics) when assessing for population level outcomes. Researchers and policymakers should consider program regulation and subgroup characteristics (i.e. demographics) when assessing for population level outcomes.
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Sabia JJ, Swigert J, Young T. The Effect of Medical Marijuana Laws on Body Weight. Health Econ 2017; 26:6-34. [PMID: 26602324 DOI: 10.1002/hec.3267] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 06/14/2015] [Accepted: 09/08/2015] [Indexed: 06/05/2023]
Abstract
This study is the first to examine the effects of medical marijuana laws (MMLs) on body weight, physical wellness, and exercise. Using data from the 1990 to 2012 Behavioral Risk Factor Surveillance System and a difference-in-difference approach, we find that the enforcement of MMLs is associated with a 2% to 6% decline in the probability of obesity. We find some evidence of age-specific heterogeneity in mechanisms. For older individuals, MML-induced increases in physical mobility may be a relatively important channel, while for younger individuals, a reduction in consumption of alcohol, a substitute for marijuana, appears more important. These findings are consistent with the hypothesis that MMLs may be more likely to induce marijuana use for health-related reasons among older individuals, and cause substitution toward lower-calorie recreational 'highs' among younger individuals. Our estimates suggest that MMLs induce a $58 to $115 per-person annual reduction in obesity-related medical costs. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Joseph J Sabia
- Department of Economics, San Diego State University, San Diego, CA, USA
| | - Jeffrey Swigert
- Department of Policy Analysis and Management, Cornell University, Ithaca, NY, USA
| | - Timothy Young
- Department of Economics, San Diego State University, San Diego, CA, USA
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Hall W, Lynskey M. Evaluating the public health impacts of legalizing recreational cannabis use in the United States. Addiction 2016; 111:1764-73. [PMID: 27082374 DOI: 10.1111/add.13428] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/01/2016] [Accepted: 04/14/2016] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND AIMS Since 2012 four US states have legalized the retail sale of cannabis for recreational use by adults, and more are likely to follow. This report aimed to (1) briefly describe the regulatory regimes so far implemented; (2) outline their plausible effects on cannabis use and cannabis-related harm; and (3) suggest what research is needed to evaluate the public health impact of these policy changes. METHOD We reviewed the drug policy literature to identify: (1) plausible effects of legalizing adult recreational use on cannabis price and availability; (2) factors that may increase or limit these effects; (3) pointers from studies of the effects of legalizing medical cannabis use; and (4) indicators of cannabis use and cannabis-related harm that can be monitored to assess the effects of these policy changes. RESULTS Legalization of recreational use will probably increase use in the long term, but the magnitude and timing of any increase is uncertain. It will be critical to monitor: cannabis use in household and high school surveys; cannabis sales; the number of cannabis plants legally produced; and the tetrahydrocannabinol (THC) content of cannabis. Indicators of cannabis-related harms that should be monitored include: car crash fatalities and injuries; emergency department presentations; presentations to addiction treatment services; and the prevalence of regular cannabis use among young people in mental health services and the criminal justice system. CONCLUSIONS Plausible effects of legalizing recreational cannabis use in the United States include substantially reducing the price of cannabis and increasing heavy use and some types of cannabis-related harm among existing users. In the longer term it may also increase the number of new users.
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Affiliation(s)
- Wayne Hall
- Centre for Youth Substance Abuse Research, The University of Queensland, Herston, Queensland, Australia. .,National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Strand, London, WC2R 2LS, UK.
| | - Michael Lynskey
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Strand, London, WC2R 2LS, UK
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Cerdá M, Wall M, Keyes KM, Galea S, Hasin D. Medical marijuana laws in 50 states: investigating the relationship between state legalization of medical marijuana and marijuana use, abuse and dependence. Drug Alcohol Depend 2012; 120:22-7. [PMID: 22099393 PMCID: PMC3251168 DOI: 10.1016/j.drugalcdep.2011.06.011] [Citation(s) in RCA: 321] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Revised: 06/08/2011] [Accepted: 06/11/2011] [Indexed: 01/20/2023]
Abstract
BACKGROUND Marijuana is the most frequently used illicit substance in the United States. Little is known of the role that macro-level factors, including community norms and laws related to substance use, play in determining marijuana use, abuse and dependence. We tested the relationship between state-level legalization of medical marijuana and marijuana use, abuse, and dependence. METHODS We used the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a national survey of adults aged 18+ (n=34,653). Selected analyses were replicated using the National Survey on Drug Use and Health (NSDUH), a yearly survey of ∼68,000 individuals aged 12+. We measured past-year cannabis use and DSM-IV abuse/dependence. RESULTS In NESARC, residents of states with medical marijuana laws had higher odds of marijuana use (OR: 1.92; 95% CI: 1.49-2.47) and marijuana abuse/dependence (OR: 1.81; 95% CI: 1.22-2.67) than residents of states without such laws. Marijuana abuse/dependence was not more prevalent among marijuana users in these states (OR: 1.03; 95% CI: 0.67-1.60), suggesting that the higher risk for marijuana abuse/dependence in these states was accounted for by higher rates of use. In NSDUH, states that legalized medical marijuana also had higher rates of marijuana use. CONCLUSIONS States that legalized medical marijuana had higher rates of marijuana use. Future research needs to examine whether the association is causal, or is due to an underlying common cause, such as community norms supportive of the legalization of medical marijuana and of marijuana use.
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Affiliation(s)
- Magdalena Cerdá
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W168th St, Room 527, New York, NY, 10032-3727, Phone: 212-305-2570; Fax: 212-342-5168;
| | - Melanie Wall
- Department of Biostatistics, Mailman School of Public Health, Columbia University, 722 W168th St, New York, NY, 10032-3727
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W168th St, Room 527, New York, NY, 10032-3727, Phone: 212-305-2570; Fax: 212-342-5168;
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032
| | - Sandro Galea
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W168th St, Room 527, New York, NY, 10032-3727, Phone: 212-305-2570; Fax: 212-342-5168;
| | - Deborah Hasin
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W168th St, Room 527, New York, NY, 10032-3727, Phone: 212-305-2570; Fax: 212-342-5168;
- New York State Psychiatric Institute, 1051 Riverside Drive, New York, NY, 10032
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, NY, 10032
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