Does cannabis legalisation change healthcare utilisation? A population-based study using the healthcare cost and utilisation project in Colorado, USA

Francesca N. Delling, Eric Vittinghoff, Thomas Dewland, Mark J. Pletcher, Jeffrey E. Olgin, Gregory Nah, Kirstin Aschbacher, Christina D. Fang, Emily S. Lee, Shannon M. Fan, Dhruv S. Kazi, Gregory M. Marcus

Research output: Contribution to journalArticle

Abstract

Objective To assess the effect of cannabis legalisation on health effects and healthcare utilisation in Colorado (CO), the first state to legalise recreational cannabis, when compared with two control states, New York (NY) and Oklahoma (OK). Design We used the 2010 to 2014 Healthcare Cost and Utilisation Project (HCUP) inpatient databases to compare changes in rates of healthcare utilisation and diagnoses in CO versus NY and OK. Setting Population-based, inpatient. Participants HCUP state-wide data comprising over 28 million individuals and over 16 million hospitalisations across three states. Main outcome measures We used International Classification of Diseases-Ninth Edition codes to assess changes in healthcare utilisation specific to various medical diagnoses potentially treated by or exacerbated by cannabis. Diagnoses were classified based on weight of evidence from the National Academy of Science (NAS). Negative binomial models were used to compare rates of admissions between states. Results In CO compared with NY and OK, respectively, cannabis abuse hospitalisations increased (risk ratio (RR) 1.27, 95% CI 1.26 to 1.28 and RR 1.16, 95% CI 1.15 to 1.17; both p<0.0005) post-legalisation. In CO, there was a reduction in total admissions but only when compared with OK (RR 0.97, 95% CI 0.96 to 0.98, p<0.0005). Length of stay and costs did not change significantly in CO compared with NY or OK. Post-legalisation changes most consistent with NAS included an increase in motor vehicle accidents, alcohol abuse, overdose injury and a reduction in chronic pain admissions (all p<0.05 compared with each control state). Conclusions Recreational cannabis legalisation is associated with neutral effects on healthcare utilisation. In line with previous evidence, cannabis liberalisation is linked to an increase in motor vehicle accidents, alcohol abuse, overdose injuries and a decrease in chronic pain admissions. Such population-level effects may help guide future decisions regarding cannabis use, prescription and policy.

Original languageEnglish (US)
Article numbere027432
JournalBMJ open
Volume9
Issue number5
DOIs
StatePublished - May 1 2019

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Cannabis
Health Care Costs
Delivery of Health Care
Population
Odds Ratio
Motor Vehicles
Chronic Pain
Alcoholism
Accidents
Inpatients
Hospitalization
Marijuana Abuse
Wounds and Injuries
Statistical Models
International Classification of Diseases
Prescriptions
Length of Stay
Outcome Assessment (Health Care)
Databases
Weights and Measures

Keywords

  • Cannabis legalization
  • Health policy
  • Healthcare utilization

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Does cannabis legalisation change healthcare utilisation? A population-based study using the healthcare cost and utilisation project in Colorado, USA. / Delling, Francesca N.; Vittinghoff, Eric; Dewland, Thomas; Pletcher, Mark J.; Olgin, Jeffrey E.; Nah, Gregory; Aschbacher, Kirstin; Fang, Christina D.; Lee, Emily S.; Fan, Shannon M.; Kazi, Dhruv S.; Marcus, Gregory M.

In: BMJ open, Vol. 9, No. 5, e027432, 01.05.2019.

Research output: Contribution to journalArticle

Delling, FN, Vittinghoff, E, Dewland, T, Pletcher, MJ, Olgin, JE, Nah, G, Aschbacher, K, Fang, CD, Lee, ES, Fan, SM, Kazi, DS & Marcus, GM 2019, 'Does cannabis legalisation change healthcare utilisation? A population-based study using the healthcare cost and utilisation project in Colorado, USA', BMJ open, vol. 9, no. 5, e027432. https://doi.org/10.1136/bmjopen-2018-027432
Delling, Francesca N. ; Vittinghoff, Eric ; Dewland, Thomas ; Pletcher, Mark J. ; Olgin, Jeffrey E. ; Nah, Gregory ; Aschbacher, Kirstin ; Fang, Christina D. ; Lee, Emily S. ; Fan, Shannon M. ; Kazi, Dhruv S. ; Marcus, Gregory M. / Does cannabis legalisation change healthcare utilisation? A population-based study using the healthcare cost and utilisation project in Colorado, USA. In: BMJ open. 2019 ; Vol. 9, No. 5.
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abstract = "Objective To assess the effect of cannabis legalisation on health effects and healthcare utilisation in Colorado (CO), the first state to legalise recreational cannabis, when compared with two control states, New York (NY) and Oklahoma (OK). Design We used the 2010 to 2014 Healthcare Cost and Utilisation Project (HCUP) inpatient databases to compare changes in rates of healthcare utilisation and diagnoses in CO versus NY and OK. Setting Population-based, inpatient. Participants HCUP state-wide data comprising over 28 million individuals and over 16 million hospitalisations across three states. Main outcome measures We used International Classification of Diseases-Ninth Edition codes to assess changes in healthcare utilisation specific to various medical diagnoses potentially treated by or exacerbated by cannabis. Diagnoses were classified based on weight of evidence from the National Academy of Science (NAS). Negative binomial models were used to compare rates of admissions between states. Results In CO compared with NY and OK, respectively, cannabis abuse hospitalisations increased (risk ratio (RR) 1.27, 95{\%} CI 1.26 to 1.28 and RR 1.16, 95{\%} CI 1.15 to 1.17; both p<0.0005) post-legalisation. In CO, there was a reduction in total admissions but only when compared with OK (RR 0.97, 95{\%} CI 0.96 to 0.98, p<0.0005). Length of stay and costs did not change significantly in CO compared with NY or OK. Post-legalisation changes most consistent with NAS included an increase in motor vehicle accidents, alcohol abuse, overdose injury and a reduction in chronic pain admissions (all p<0.05 compared with each control state). Conclusions Recreational cannabis legalisation is associated with neutral effects on healthcare utilisation. In line with previous evidence, cannabis liberalisation is linked to an increase in motor vehicle accidents, alcohol abuse, overdose injuries and a decrease in chronic pain admissions. Such population-level effects may help guide future decisions regarding cannabis use, prescription and policy.",
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AU - Olgin, Jeffrey E.

AU - Nah, Gregory

AU - Aschbacher, Kirstin

AU - Fang, Christina D.

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N2 - Objective To assess the effect of cannabis legalisation on health effects and healthcare utilisation in Colorado (CO), the first state to legalise recreational cannabis, when compared with two control states, New York (NY) and Oklahoma (OK). Design We used the 2010 to 2014 Healthcare Cost and Utilisation Project (HCUP) inpatient databases to compare changes in rates of healthcare utilisation and diagnoses in CO versus NY and OK. Setting Population-based, inpatient. Participants HCUP state-wide data comprising over 28 million individuals and over 16 million hospitalisations across three states. Main outcome measures We used International Classification of Diseases-Ninth Edition codes to assess changes in healthcare utilisation specific to various medical diagnoses potentially treated by or exacerbated by cannabis. Diagnoses were classified based on weight of evidence from the National Academy of Science (NAS). Negative binomial models were used to compare rates of admissions between states. Results In CO compared with NY and OK, respectively, cannabis abuse hospitalisations increased (risk ratio (RR) 1.27, 95% CI 1.26 to 1.28 and RR 1.16, 95% CI 1.15 to 1.17; both p<0.0005) post-legalisation. In CO, there was a reduction in total admissions but only when compared with OK (RR 0.97, 95% CI 0.96 to 0.98, p<0.0005). Length of stay and costs did not change significantly in CO compared with NY or OK. Post-legalisation changes most consistent with NAS included an increase in motor vehicle accidents, alcohol abuse, overdose injury and a reduction in chronic pain admissions (all p<0.05 compared with each control state). Conclusions Recreational cannabis legalisation is associated with neutral effects on healthcare utilisation. In line with previous evidence, cannabis liberalisation is linked to an increase in motor vehicle accidents, alcohol abuse, overdose injuries and a decrease in chronic pain admissions. Such population-level effects may help guide future decisions regarding cannabis use, prescription and policy.

AB - Objective To assess the effect of cannabis legalisation on health effects and healthcare utilisation in Colorado (CO), the first state to legalise recreational cannabis, when compared with two control states, New York (NY) and Oklahoma (OK). Design We used the 2010 to 2014 Healthcare Cost and Utilisation Project (HCUP) inpatient databases to compare changes in rates of healthcare utilisation and diagnoses in CO versus NY and OK. Setting Population-based, inpatient. Participants HCUP state-wide data comprising over 28 million individuals and over 16 million hospitalisations across three states. Main outcome measures We used International Classification of Diseases-Ninth Edition codes to assess changes in healthcare utilisation specific to various medical diagnoses potentially treated by or exacerbated by cannabis. Diagnoses were classified based on weight of evidence from the National Academy of Science (NAS). Negative binomial models were used to compare rates of admissions between states. Results In CO compared with NY and OK, respectively, cannabis abuse hospitalisations increased (risk ratio (RR) 1.27, 95% CI 1.26 to 1.28 and RR 1.16, 95% CI 1.15 to 1.17; both p<0.0005) post-legalisation. In CO, there was a reduction in total admissions but only when compared with OK (RR 0.97, 95% CI 0.96 to 0.98, p<0.0005). Length of stay and costs did not change significantly in CO compared with NY or OK. Post-legalisation changes most consistent with NAS included an increase in motor vehicle accidents, alcohol abuse, overdose injury and a reduction in chronic pain admissions (all p<0.05 compared with each control state). Conclusions Recreational cannabis legalisation is associated with neutral effects on healthcare utilisation. In line with previous evidence, cannabis liberalisation is linked to an increase in motor vehicle accidents, alcohol abuse, overdose injuries and a decrease in chronic pain admissions. Such population-level effects may help guide future decisions regarding cannabis use, prescription and policy.

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