title: Medical marijuana policies and hospitalizations related to marijuana and opioid pain reliever.
abstract: Twenty-eight states in the U.S have legalized medical marijuana, yet its impacts on severe health consequences such as hospitalizations remain unknown. Meanwhile, the prevalence of opioid pain reliever (OPR) use and outcomes has increased dramatically. Recent studies suggested unintended impacts of legalizing medical marijuana on OPR, but the evidence is still limited. This study examined the associations between state medical marijuana policies and hospitalizations related to marijuana and OPR.
  
  
  
  State-level annual administrative records of hospital discharges during 1997-2014 were obtained from the State Inpatient Databases (SID). The outcome variables were rates of hospitalizations involving marijuana dependence or abuse, opioid dependence or abuse, and OPR overdose in 1000 discharges. Linear time-series regressions were used to assess the associations of implementing medical marijuana policies to hospitalizations, controlling for other marijuana- and OPR-related policies, socioeconomic factors, and state and year fixed effects.
  
  
  
  Hospitalizations related to marijuana and OPR increased sharply by 300% on average in all states. Medical marijuana legalization was associated with 23% (p=0.008) and 13% (p=0.025) reductions in hospitalizations related to opioid dependence or abuse and OPR overdose, respectively; lagged effects were observed after policy implementation. The operation of medical marijuana dispensaries had no independent impacts on OPR-related hospitalizations. Medical marijuana polices had no associations with marijuana-related hospitalizations.
  
  
  
  Medical marijuana policies were significantly associated with reduced OPR-related hospitalizations but had no associations with marijuana-related hospitalizations. Given the epidemic of problematic use of OPR, future investigation is needed to explore the causal pathways of these findings.
authors.affiliation: Department of Family Medicine and Public Health, University of California, San Diego, CA, USA. Electronic address: yus001@ucsd.edu.
authors.forename: Yuyan
authors.initials: Y
authors.lastname: Shi
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D062787:Drug Overdose / Q000453:epidemiology*; D005260:Female; D006291:Health Policy / Q000331:legislation & jurisprudence* / Q000639:trends*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology*; D064086:Medical Marijuana / Q000009:adverse effects* / Q000627:therapeutic use*; D009294:Narcotics / Q000009:adverse effects* / Q000627:therapeutic use*; D014481:United States
chemical_list: D064086:Medical Marijuana; D009294:Narcotics
keywords: Hospitalization; Law; Marijuana; Medical marijuana; Opioid; Overdose