The Effect of Medical Marijuana on Sickness Absence

Medical marijuana laws and mental health in the United States

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.

Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map

Background

Globally, cannabis laws and regulations are rapidly changing. Countries are increasingly permitting access to cannabis under various decriminalization, medicalization, and legalization laws. With strong economic, public health, and social justice incentives driving these domestic cannabis policy reforms, liberalization trends are bound to continue. However, despite a large and growing body of interdisciplinary research addressing the policy-relevant health, safety, and socioeconomic consequences of cannabis liberalization, there is a lack of robust primary and systematic research that comprehensively investigates the consequences of these reforms.

Objectives

This evidence and gap map (EGM) summarizes the empirical evidence on cannabis liberalization policies. Primary objectives were to develop a conceptual framework linking cannabis liberalization policies to relevant outcomes, descriptively summarize the empirical evidence, and identify areas of evidence concentration and gaps.

Search Methods

We comprehensively searched for eligible English-language empirical studies published across 23 academic databases and 11 gray literature sources through August 2020. Additions to the pool of potentially eligible studies from supplemental sources were made through November 2020.

Selection Criteria

The conceptual framework for this EGM draws upon a legal epidemiological perspective highlighting the causal effects of law and policy on population-level outcomes. Eligible interventions include policies that create or expand access to a legal or decriminalized supply of cannabis: comprehensive medical cannabis laws (MCLs), limited medical cannabidiol laws (CBDLs), recreational cannabis laws (RCLs), industrial hemp laws (IHLs), and decriminalization of cultivations laws (DCLs). Eligible outcomes include intermediate responses (i.e., attitudes/behaviors and markets/environments) and longer-term consequences (health, safety, and socioeconomic outcomes) of these laws.

Data Collection and Analysis

Both dual screening and dual data extraction were performed with third person deconfliction. Primary studies were appraised using the Maryland Scientific Methods Scale and systematic reviews were assessed using AMSTAR 2.

Main Results

The EGM includes 447 studies, comprising 438 primary studies and nine systematic reviews. Most research derives from the United States, with little research from other countries. By far, most cannabis liberalization research focuses on the effects of MCLs and RCLs. Studies targeting other laws-including CBDLs, IHLs, and DCLs-are relatively rare. Of the 113 distinct outcomes we documented, cannabis use was the single most frequently investigated. More than half these outcomes were addressed by three or fewer studies, highlighting substantial evidence gaps in the literature. The systematic evidence base is relatively small, comprising just seven completed reviews on cannabis use (3), opioid-related harms (3), and alcohol-related outcomes (1). Moreover, we have limited confidence in the reviews, as five were appraised as minimal quality and two as low quality.

Authors’ Conclusions

More primary and systematic research is needed to better understand the effects of cannabis liberalization laws on longer-term-and arguably more salient-health, safety, and socioeconomic outcomes. Since most research concerns MCLs and RCLs, there is a critical need for research on the societal impacts of industrial hemp production, medical CBD products, and decriminalized cannabis cultivation. Future research should also prioritize understanding the heterogeneous effects of these laws given differences in specific provisions and implementation across jurisdictions.

Medical cannabis laws lower individual market health insurance premiums

BACKGROUND

To evaluate the impact of medical cannabis laws (MCLs) on health insurance premiums. We study whether cannabis legalization significantly impacts aggregate health insurer premiums in the individual market. Increases in utilization could have spillover effects to patients in the form of higher health insurance premiums.

METHODS

We use 2010-2021 state-level U.S. private health insurer financial data from the National Association of Insurance Commissioners. We examined changes to individual market health insurance premiums after the implementation of medical cannabis laws. We employed a robust difference-in-differences estimator that accounted for variation in policy timing to exploit temporal and geographic variation in state-level medical cannabis legalization.

RESULTS

Seven years after the implementation of Medical Cannabis laws, we observe lower health insurer premiums in the individual market. Starting seven years post-MCL implementation, we find a reduction of $-1662.7 (95% confidence interval [CI -2650.1, -605.7]) for states which implemented MCLs compared to the control group, a reduction of -$1541.8 (95% confidence interval [CI 2602.1, -481.4]) in year 8, and a reduction of $-1625.8, (95% confidence interval [CI -2694.2, -557.5]) in year 9. Due to the nature of insurance pooling and community rating, these savings are appreciated by cannabis users and non-users alike in states that have implemented MCLs.

CONCLUSIONS

The implementation of MCLs lowers individual-market health insurance premiums. Health insurance spending, including premiums, comprises between 16% and 34% of household budgets in the United States. As healthcare costs continue to rise, our findings suggest that households that obtain their health insurance on the individual (i.e., not employer sponsored) market in states with MCLs appreciate significantly lower premiums.

Watching the grass grow: does recreational cannabis legalization affect retail and agricultural wages?

Background

Over the past several years, cannabis has become legal for recreational use in many US states and jurisdictions around the world. The opening of these markets has led to the establishment of hundreds of cannabis production and retail firms with accompanying demand for labor, leading to concerns about spillover effects on wages from incumbents.

Methods

We study the markets for agricultural and retail labor in Washington and Colorado from 2000 to 2019 using differences-in-differences with synthetic controls. We employ employment data from the Quarterly Census of Employment and Wages, state-level demographic data from the US Census Bureau, and agricultural data from the National Agricultural Statistics Service. We use the least absolute shrinkage and selection operator (LASSO) for variable selection and classification and regression trees (CART) for chained imputation of missing values.

Results

We find little-to-no evidence of a significant difference in weekly wages per worker generated by cannabis legalization: the log of the weekly wage per worker decreases by 0.013 in Washington’s agricultural sector (p value 0.091) and increases by 0.059 in Washington’s retail sector (p value 0.606). Results in Colorado are qualitatively similar. These results are limited in part by the short post-legalization period of the data.

Conclusions

Cannabis legalization is unlikely to negatively impact incumbent agriculture or retail firms through the labor market channel.

Occupations and Sickness-Related Absences during the COVID-19 Pandemic

Pandemic frontline occupations consist of disproportionately low socioeconomic status and racial minority workers. Documenting occupational health disparities is therefore crucial for understanding COVID-19-related health inequalities in the United States. This study uses Current Population Survey microdata to estimate occupational differences in sickness-related absences (SAs) from work in March through June 2020 and their contribution to educational, racial-ethnic, and nativity health disparities. We find that there has been an unprecedented rise in SAs concentrated in transportation, food-related, and personal care and service occupations. SA rates were 6 times higher in these occupations than in non-health-care professions. The greatest increases were in occupations that are unsuitable for remote work, require workers to work close to others, pay low wages, and rarely provide health insurance. Workers in these occupations are disproportionately Black, Hispanic, indigenous, and immigrants. Occupation contributes 41% of the total of Black/white differences and 54% of educational differences in SAs.

Heterogeneous health effects of medical marijuana legalization: Evidence from young adults in the United States

Legalizing marijuana for medical purposes is a longstanding debate. However, evidence of marijuana's health effects is limited, especially for young adults. We estimate the health impacts of medical marijuana laws (MML) in the U.S. among young adults aged 18-29 years using the difference-in-differences method and data from the Behavioral Risk Factors Surveillance System. We find that having MMLs with strict regulations generate health gains, but not in states with lax regulations. Our heterogeneity analysis results indicate that individuals with lower education attainments, with lower household income and without access to health insurance coverage gain more health benefits from MML with strict regulations than from MML with lax regulations. The findings suggest greater net health gains under strict controls concerning marijuana supply and access.

Societal Costs and Outcomes of Medical and Recreational Marijuana Policies in the United States: A Systematic Review

Significant support exists in the United States for legalization of marijuana/cannabis. As of 2021, 36 states and four territories approved the legalization of medical cannabis via medical marijuana laws (MMLs), and 15 states and District of Columbia (DC) have adopted recreational marijuana laws (RMLs). We performed structured and systematic searches of articles published from 2010 through September 2021. We assess the literature pertaining to adolescent marijuana use; opioid use and opioid-related outcomes; alcohol use; tobacco use; illicit and other drug use; marijuana growing and cultivation; employment, earnings, and other workplace outcomes; academic achievement and performance; criminal activity; perceived harmfulness; traffic and road safety; and suicide and sexual activity. Overall, 113 articles satisfied our inclusion criteria. Except for opioids, studies on use of other substances (illicit drugs, tobacco, and alcohol) were inconclusive. MMLs and RMLs do not generate negative outcomes in the labor market, lead to greater criminal activity, or reduce traffic and road safety.

Marijuana legalization and disability claiming

We study the effect of recent legalization of recreational marijuana use laws (RMLs) in the United States on new applications and allowances for Social Security Disability Insurance and Supplemental Security Income over the period 2001-2019. We combine administrative caseload data from the Social Security Administration with state policy changes using two-way fixed-effects methods. We find that RML adoption increases applications for both benefits. However, there is no change in allowances post-RML. We provide suggestive evidence that the observed changes in applications post-RML are driven by increases in marijuana misuse and selective migration, and decreases in unemployment.

Legalizing Medical Cannabis in Lebanon: the Complex Interface Between Medicine, Law, Ethics, and Economics

In April 2020, after decades of discussions and controversy, the Lebanese parliament voted a law legalizing the cultivation, production, and sale of cannabis for medicinal purposes. Although the law leaves several unanswered questions and awaits implementation, the symbolic nature of this step in recognizing a positive role of cannabis in the local economy is significant on a regional level. The Arab world has traditionally been conservative when it comes to all drugs-related policies. Cannabis is largely demonized with heavy sentences served to anyone suspected of using selling, let alone planting cannabis. Despite a few countries considered producers and consumers of substances, governing authorities have remained immune to the liberalization trend encountered in western countries. The social experiment taking place in Lebanon is fraught with risks, given the unstable political situation and chronic economic challenges. The reactions to the law have been mixed with several scientific bodies such as the Lebanese Psychiatric Society criticizing the absence of proper consultation of stakeholders. The absence of consistency in enforcing established drugs policies or seriously debating the decriminalization of cannabis use raises concerns over the establishment of a two-tier approach toward drugs, driven solely by economic imperatives.

A lottery test of the effect of dispensaries on emergency room visits in Arizona

In August 2012, the Arizona Department of Health Services conducted a lottery to allocate licenses for the state's first medical marijuana dispensaries. The lottery randomly selected an applicant within each of 69 contested Community Health Analysis Areas to open a dispensary. By comparing 36 zip codes with winning applications to 48 zip codes with losing applications and weighting using propensity scores based on the true probability of winning, we estimate the causal effect of the allocation of a dispensary on the emergency room visits of residents of that zip code. Outcomes of interest are emergency room visits for acute symptoms caused by cannabis, opioids, alcohol, and cocaine. Using emergency room discharge data from 2010 to 2016, we find evidence of an increase in visits for acute cannabis-related causes for the winning set of zip codes and weak evidence of an increase in visits for opioid-related causes. The results indicate that in the four years following the lottery, emergency room visits for acute cannabis causes rose by approximately 45% in allocated zip codes relative to non-allocated zip codes. Because of the high likelihood of spillovers to neighboring zip codes, these effects are likely underestimates.

Medical marijuana and workers' compensation claiming

We study the effect of state medical marijuana laws (MMLs) on workers' compensation (WC) claiming among adults. Medical marijuana is plausibly related to WC claiming by allowing improved symptom management, and thus reduced need for the benefit, among injured or ill workers. We use data on claiming drawn from the Annual Social and Economic supplement to the Current Population Survey over the period 1989 to 2012, coupled with a differences-in-differences design to provide the first evidence on this relationship. Our estimates show that, post MML, WC claiming declines, both the propensity to claim and the level of income from WC. These findings suggest that medical marijuana can allow workers to better manage symptoms associated with workplace injuries and illnesses and, in turn, reduce need for WC. However, the reductions in WC claiming post MML are very modest in size.

The Impact of Medical Marijuana Laws and Dispensaries on Self-Reported Health

Growing evidence suggests that medical marijuana laws have harm reduction effects across a variety of outcomes related to risky health behaviors. This study investigates the impact of medical marijuana laws on self-reported health using data from the Behavioral Risk Factor Surveillance System from 1993 to 2013. In our analyses we separately identify the effect of a medical marijuana law and the impact of subsequent active and legally protected dispensaries. Our main results show surprisingly limited improvements in self-reported health after the legalization of medical marijuana and legally protected dispensaries. Subsample analyses reveal strong improvements in health among non-white individuals, those reporting chronic pain, and those with a high school degree, driven predominately by whether or not the state had active and legally protected dispensaries. We also complement the analysis by evaluating the impact on risky health behaviors and find that the aforementioned demographic groups experience large reductions in alcohol consumption after the implementation of a medical marijuana law.

Medical marijuana laws and workplace fatalities in the United States

AIMS

The aim of this research was to determine the association between legalizing medical marijuana and workplace fatalities.

DESIGN

Repeated cross-sectional data on workplace fatalities at the state-year level were analyzed using a multivariate Poisson regression.

SETTING

To date, 29 states and the District of Columbia have legalized the use of marijuana for medicinal purposes. Although there is increasing concern that legalizing medical marijuana will make workplaces more dangerous, little is known about the relationship between medical marijuana laws (MMLs) and workplace fatalities.

PARTICIPANTS

All 50 states and the District of Columbia for the period 1992-2015.

MEASUREMENTS

Workplace fatalities by state and year were obtained from the Bureau of Labor Statistics. Regression models were adjusted for state demographics, the unemployment rate, state fixed effects, and year fixed effects.

FINDINGS

Legalizing medical marijuana was associated with a 19.5% reduction in the expected number of workplace fatalities among workers aged 25-44 (incident rate ratio [IRR], 0.805; 95% CI, .662-.979). The association between legalizing medical marijuana and workplace fatalities among workers aged 16-24, although negative, was not statistically significant at conventional levels. The association between legalizing medical marijuana and workplace fatalities among workers aged 25-44 grew stronger over time. Five years after coming into effect, MMLs were associated with a 33.7% reduction in the expected number of workplace fatalities (IRR, 0.663; 95% CI, .482-.912). MMLs that listed pain as a qualifying condition or allowed collective cultivation were associated with larger reductions in fatalities among workers aged 25-44 than those that did not.

CONCLUSIONS

The results provide evidence that legalizing medical marijuana improved workplace safety for workers aged 25-44. Further investigation is required to determine whether this result is attributable to reductions in the consumption of alcohol and other substances that impair cognitive function, memory, and motor skills.

Examining the relationship between medical cannabis laws and cardiovascular deaths in the US

BACKGROUND

Several countries and many U.S. states have allowed, for cannabis to be used as therapy to treat chronic conditions or pain., This has increased the use of cannabis, particularly among older people.Because cannabis has been linked to adverse cardiac events in the medical literature, there may be unintended consequences on increased use among older people.

METHODS

We analyze cardiac-related mortality data from the U.S. National Vital Statistics System for 1990-2014. We use difference-in-difference fixed-effects models to assess whether there are increased rates of cardiac-related mortality following passage of medical cannabis programs. We also analyze whether states with more liberal rules on dispensing cannabis show higher mortality rates.

RESULTS

For men, there is a statistically significant 2.3% increase in the rate of cardiac death following passage. For women, there is a 1.3% increase that is also statistically significant. he effects increase or both men and women with age. The effects are also stronger in states with more a lax approach to cannabis dispensing.

CONCLUSION

Policymakers should be aware of a potential unintended consequence of allowing broader use of cannabis, specifically for those more at risk of cardiovascular events.