Recreational cannabis legalizations associated with reductions in prescription drug utilization among Medicaid enrollees

Abstract

The potential substitution of cannabis for prescription medication has attracted a substantial amount of attention within the context of medical cannabis laws (MCLs). However, much less is known about the association between recreational cannabis laws (RCLs) and prescription drug use. With recent evidence supporting substitution of cannabis for prescription drugs following MCLs, it is reasonable to ask what effect RCLs may have on those outcomes. We use quarterly data for all Medicaid prescriptions from 2011 to 2019 to investigate the effect of state‐level RCLs on prescription drug utilization. We estimate this effect with a series of two‐way fixed effects event study models. We find significant reductions in the volume of prescriptions within the drug classes that align with the medical indications for pain, depression, anxiety, sleep, psychosis, and seizures. Our results suggest substitution away from prescription drugs and potential cost savings for state Medicaid programs.

Recreational cannabis and opioid distribution

“…Our results are broadly consistent with prior economic studies finding reductions in opioid prescribing following MCL and RCL adoption (Abouk et al., 2021; McMichael et al., 2020; Ozluk, 2017; Raman & Bradford, 2022; Shi et al., 2019; Wen et al., 2021; Wen & Hockenberry, 2018). We contribute to this literature by identifying that reductions in opioid dispensing due to RCLs are driven by reductions in codeine dispensing at retail pharmacies.…”

“…An emerging literature suggests RCLs also may reduce demand for prescription opioids. Post-RCL adoption, opioid prescriptions decline among Medicaid enrollees (Raman & Bradford, 2022;Wen & Hockenberry, 2018), Medicare beneficiaries (Abouk et al, 2021), and those with employer-sponsored insurance (Wen et al, 2021). Using a database of public and private payers, McMichael et al (2020) and Abouk et al (2021) and find that opioid prescriptions filled in retail pharmacies decline post-RCL.…”

Association of Recreational Cannabis Legalization With Alcohol Use Among Adults in the US, 2010 to 2019

“…However, cannabis use also has costs and benefits regarding substances that people may use more of or less of when using cannabis (ie, complements and substitutes). An expanding literature suggests, albeit not conclusively, that cannabis legalization may reduce opioid use and associated risks . However, our findings suggest that these gains may need to be considered against the increased costs of alcohol use among young adults and men.…”

“…An expanding literature suggests, albeit not conclusively, that cannabis legalization may reduce opioid use and associated risks. 44 , 45 However, our findings suggest that these gains may need to be considered against the increased costs of alcohol use among young adults and men. As more data from the postlegalization period becomes available, cost-benefit analyses would be immensely informative to the debate surrounding cannabis legalization, as would additional studies on the relationship between RCLs and alcohol use.…”

Pain Management and Work Capacity: Evidence From Workers’ Compensation and Marijuana Legalization

“…Studies show that patients substitute marijuana for prescription medications, in particular pain medications (Bednarek et al., 2022; Carrieri et al., 2020; McMichael et al., 2020; Raman & Bradford, 2022; Raman et al., in press; Wen & Hockenberry, 2018; Wen et al., 2021). Wen and Hockenberry (2018) document that, post‐RML, prescriptions for chronic pain medications decline by 6 percent among Medicaid enrollees.…”