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.
K E Y W O R D Smedical marijuana laws, pain management, prescription opioids, recreational marijuana laws
| INTRODUCTIONThe opioid epidemic in the United States has reached a crisis level. The economic cost of the crisis was estimated at $504 billion in 2015, or 2.8% of the total gross domestic product (GDP; The Council of Economic Advisers, 2017). Excessive prescribing of opioids for pain management is viewed as a major driver of the ongoing opioid epidemic in the United States (
The opioid epidemic in the United States has accelerated during the COVID-19 pandemic. Over 81,000 drug overdose deaths occurred between June 2019 and May 2020-the highest ever recorded in a one-year period (The Centers for Disease Control and Prevention, 2020). Meanwhile, 17 states have legalized recreational cannabis. Over a third of the U.S. population now lives in a state with a recreational cannabis law (RCL) (ProCon.Org, 2021; U.S. Census Bureau, 2021).RCLs were not originally adopted to mitigate the opioid epidemic, though they may have the potential to reduce opioid use. Recent empirical evidence suggests cannabis is a substitute for prescription opioids in pain management (Shi et al., 2019;Wen & Hockenberry, 2018;Wen et al., 2021). In addition, there is some clinical evidence suggesting cannabis may mitigate opioid withdrawal symptoms (Wiese & Wilson-Poe, 2018). These findings are promising because RCLs, unlike medical cannabis laws (MCLs), make cannabis available to the entire population and thus have a larger imspact on cannabis use (Hollingsworth et al., 2020). However, cannabis does not directly treat the symptoms of opioid use disorder, for which medications for opioid use disorder are the only clinically effective treatment.
Precollege outreach programs improve college access for underrepresented students; however, information on foster youth engagement in precollege programs is virtually nonexistent. This chapter describes the impact of a precollege program on two‐ and four‐year college enrollment and completion rates.
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