{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:45:49Z","timestamp":1790729149513,"version":"4.1.0"},"reference-count":45,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Mental health disorders are prevalent yet undertreated health conditions in the US. Given perceptions about the potential effect of cannabis on individuals with mental health disorders, there is a need to understand the association of cannabis laws with psychotropic use.<\/jats:p><\/jats:sec>Objective<\/jats:title>To investigate the association of medical and recreational cannabis laws and dispensary openings with the dispensing of psychotropic medications used to treat mental health disorders in the US.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This cross-sectional study of 10\u202f013\u202f948 commercially insured patients used a synthetic control method to examine the association of cannabis policies with prescribing. Data on all patients dispensed prescriptions for each of the 5 classes of psychotropic medications from January 1, 2007, to December 31, 2020, were extracted from Optum\u2019s deidentified Clinformatics Data Mart Database. Statistical analysis was performed from September 2022 to November 2023.<\/jats:p><\/jats:sec>Exposures<\/jats:title>The 4 exposure variables measured were whether medical or recreational cannabis laws were in effect and whether medical or recreational cannabis dispensaries were open in each state and calendar quarter.<\/jats:p><\/jats:sec>Main Outcome and Measures<\/jats:title>One measure of the extensive margins of dispensing and 2 measures of the intensive margins of dispensing were constructed for 5 medication classes (benzodiazepines, antidepressants, antipsychotics, barbiturates, and sleep medications).<\/jats:p><\/jats:sec>Results<\/jats:title>The primary sample (the benzodiazepine sample) included 3\u202f848\u202f721 patients (mean [SD] age, 46.1 [11.4] years; 65.4% women; 53.7% aged 35-54 years). Medical cannabis laws were associated with a 12.4% reduction in the benzodiazepine fill rate (average treatment effect on the treated [ATT], \u201327.4; 95% CI, \u201314.7 to 12.0; P<\/jats:italic>\u2009=\u2009.001), recreational cannabis laws were associated with a 15.2% reduction in the fill rate (ATT, \u221232.5; 95% CI, \u221224.4 to 20.1; P<\/jats:italic>\u2009=\u2009.02), and medical cannabis laws were associated with a 1.3% reduction in the mean number of benzodiazepine fills per patient (ATT, \u20130.02; 95% CI, \u22120.02 to 0.02; P<\/jats:italic>\u2009=\u2009.04). Medical dispensaries were associated with a 3.9% reduction in mean days\u2019 supply per benzodiazepine fill (ATT, \u22121.7; 95% CI, \u22120.8 to 0.6; P<\/jats:italic>\u2009=\u2009.001), while recreational dispensaries were associated with a 6.2% reduction (ATT, \u22122.4; 95% CI, \u22121.0 to 0.9; P<\/jats:italic>\u2009&amp;lt;\u2009.001). Medical cannabis laws were associated with a 3.8% increase in antidepressant fills (ATT, 27.2; 95% CI, \u221233.5 to 26.9; P<\/jats:italic>\u2009=\u2009.048), and medical dispensaries were associated with an 8.8% increase (ATT, 50.7; 95% CI, \u221232.3 to 28.4; P<\/jats:italic>\u2009=\u2009.004). The mean number of antipsychotic medication fills per patient increased by 2.5% (ATT, 0.06; 95% CI, \u22120.04 to 0.05; P<\/jats:italic>\u2009=\u2009.02) after medical cannabis laws and by 2.5% (ATT, 0.06; 95% CI, \u22120.04 to 0.04; P<\/jats:italic>\u2009=\u2009.02) after medical dispensary openings. Findings for the other drug classes showed substantial heterogeneity by state and direction of association.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>This cross-sectional study of commercially insured patients suggests that there may have been meaningful heterogeneous associations between cannabis policy and state and between cannabis policy and drug class (eg, decreases in dispensing of benzodiazepines but increases in dispensing of antidepressants and antipsychotics). This finding suggests additional clinical research is needed to understand the association between cannabis use and mental health. The results have implications for patient substance use and mental health\u2013related outcomes.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.32021","type":"journal-article","created":{"date-parts":[[2024,9,5]],"date-time":"2024-09-05T15:49:13Z","timestamp":1725551353000},"page":"e2432021","source":"Crossref","is-referenced-by-count":9,"title":["Cannabis Laws and Utilization of Medications for the Treatment of Mental Health Disorders"],"prefix":"10.1001","volume":"7","author":[{"given":"Ashley C.","family":"Bradford","sequence":"first","affiliation":[{"name":"School of Public Policy, Georgia Institute of Technology, Atlanta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe","family":"Lozano-Rojas","sequence":"additional","affiliation":[{"name":"Department of Public Administration and Policy, University of Georgia, School of Public & International Affairs, Athens"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailemichael Bekele","family":"Shone","sequence":"additional","affiliation":[{"name":"Paul H. O\u2019Neill School of Public and Environmental Affairs, Indiana University, Bloomington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. David","family":"Bradford","sequence":"additional","affiliation":[{"name":"Department of Public Administration and Policy, University of Georgia, School of Public & International Affairs, Athens"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda J.","family":"Abraham","sequence":"additional","affiliation":[{"name":"Department of Public Administration and Policy, University of Georgia, School of Public & International Affairs, Athens"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2024,9,5]]},"reference":[{"issue":"3","key":"zoi240962r2","first-page":"168","article-title":"Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization\u2019s World Mental Health Survey Initiative.","volume":"6","author":"Kessler","year":"2007","journal-title":"World Psychiatry"},{"key":"zoi240962r3","doi-asserted-by":"publisher","DOI":"10.26633\/RPSP.2018.165","article-title":"Mental health in the Americas: an overview of the treatment gap.","volume":"42","author":"Kohn","year":"2018","journal-title":"Rev Panam Salud Publica"},{"issue":"2","key":"zoi240962r5","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1377\/hlthaff.2018.05266","article-title":"Qualifying conditions of medical cannabis license holders in the United States.","volume":"38","author":"Boehnke","year":"2019","journal-title":"Health Aff (Millwood)"},{"issue":"20","key":"zoi240962r7","doi-asserted-by":"publisher","first-page":"2433","DOI":"10.1001\/archinte.163.20.2433","article-title":"Depression and pain comorbidity: a literature review.","volume":"163","author":"Bair","year":"2003","journal-title":"Arch Intern Med"},{"issue":"1","key":"zoi240962r8","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1037\/0033-2909.119.1.95","article-title":"Explaining high rates of depression in chronic pain: a diathesis-stress framework.","volume":"119","author":"Banks","year":"1996","journal-title":"Psychol Bull"},{"issue":"2","key":"zoi240962r9","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1037\/a0021263","article-title":"A different kind of co-morbidity: understanding posttraumatic stress disorder and chronic pain.","volume":"3","author":"Beck","year":"2011","journal-title":"Psychol Trauma"},{"key":"zoi240962r10","doi-asserted-by":"publisher","DOI":"10.1155\/2013\/174728","article-title":"Conceptualizing and Treating Comorbid Chronic Pain and PTSD.","volume":"2013","author":"Bosco","year":"2013","journal-title":"Pain Res Treat"},{"issue":"5","key":"zoi240962r11","doi-asserted-by":"publisher","first-page":"397","DOI":"10.1682\/JRRD.2003.09.0397","article-title":"An examination of the relationship between chronic pain and post-traumatic stress disorder.","volume":"40","author":"Otis","year":"2003","journal-title":"J Rehabil Res Dev"},{"issue":"3","key":"zoi240962r12","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1007\/s10865-015-9628-3","article-title":"Chronic pain and comorbid mental health conditions: independent associations of posttraumatic stress disorder and depression with pain, disability, and quality of life.","volume":"38","author":"Outcalt","year":"2015","journal-title":"J Behav Med"},{"issue":"11","key":"zoi240962r13","doi-asserted-by":"publisher","first-page":"3069","DOI":"10.1111\/add.v116.11","article-title":"The associations between prenatal cannabis use disorder and neonatal outcomes.","volume":"116","author":"Shi","year":"2021","journal-title":"Addiction"},{"issue":"5","key":"zoi240962r14","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1001\/jamainternmed.2018.0266","article-title":"Association between US state medical cannabis laws and opioid prescribing in the Medicare Part D population.","volume":"178","author":"Bradford","year":"2018","journal-title":"JAMA Intern Med"},{"issue":"5","key":"zoi240962r15","doi-asserted-by":"publisher","first-page":"673","DOI":"10.1001\/jamainternmed.2018.1007","article-title":"Association of medical and adult-use marijuana laws with opioid prescribing for Medicaid enrollees.","volume":"178","author":"Wen","year":"2018","journal-title":"JAMA Intern Med"},{"issue":"5","key":"zoi240962r16","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1377\/hlthaff.2016.1135","article-title":"Medical marijuana laws may be associated with a decline in the number of prescriptions for Medicaid enrollees.","volume":"36","author":"Bradford","year":"2017","journal-title":"Health Aff (Millwood)"},{"issue":"7","key":"zoi240962r17","doi-asserted-by":"publisher","first-page":"1230","DOI":"10.1377\/hlthaff.2015.1661","article-title":"Medical marijuana laws reduce prescription medication use in Medicare Part D.","volume":"35","author":"Bradford","year":"2016","journal-title":"Health Aff (Millwood)"},{"issue":"3","key":"zoi240962r18","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1086\/699620","article-title":"The impact of medical cannabis legalization on prescription medication use and costs under Medicare Part D.","volume":"61","author":"Bradford","year":"2018","journal-title":"J Law Econ"},{"issue":"7","key":"zoi240962r20","doi-asserted-by":"publisher","first-page":"1513","DOI":"10.1002\/hec.v31.7","article-title":"Recreational cannabis legalizations associated with reductions in prescription drug utilization among Medicaid enrollees.","volume":"31","author":"Raman","year":"2022","journal-title":"Health Econ"},{"issue":"6","key":"zoi240962r21","doi-asserted-by":"publisher","first-page":"588","DOI":"10.1176\/appi.ajp.2015.15070907","article-title":"Prevalence and correlates of DSM-5 cannabis use disorder, 2012-2013: findings from the National Epidemiologic Survey on Alcohol and Related Conditions\u2013III.","volume":"173","author":"Hasin","year":"2016","journal-title":"Am J Psychiatry"},{"issue":"10","key":"zoi240962r22","doi-asserted-by":"publisher","first-page":"1447","DOI":"10.1017\/S0033291706008361","article-title":"Cannabis use disorders in the USA: prevalence, correlates and co-morbidity.","volume":"36","author":"Stinson","year":"2006","journal-title":"Psychol Med"},{"key":"zoi240962r23","doi-asserted-by":"publisher","DOI":"10.1136\/bmj-2022-072348","article-title":"Balancing risks and benefits of cannabis use: umbrella review of meta-analyses of randomised controlled trials and observational studies.","volume":"382","author":"Solmi","year":"2023","journal-title":"BMJ"},{"issue":"9","key":"zoi240962r24","doi-asserted-by":"publisher","first-page":"736","DOI":"10.1016\/S2215-0366(22)00161-4","article-title":"Association of cannabis potency with mental ill health and addiction: a systematic review.","volume":"9","author":"Petrilli","year":"2022","journal-title":"Lancet Psychiatry"},{"key":"zoi240962r25","doi-asserted-by":"publisher","journal-title":"Subst Use Misuse","DOI":"10.1080\/10826084.2017.1416407"},{"key":"zoi240962r26","doi-asserted-by":"publisher","journal-title":"J Gen Intern Med","DOI":"10.1007\/s11606-018-4628-y"},{"key":"zoi240962r27","doi-asserted-by":"publisher","journal-title":"JAMA Pediatr","DOI":"10.1001\/jamapediatrics.2019.4878"},{"key":"zoi240962r28","doi-asserted-by":"publisher","journal-title":"Health Aff (Millwood)","DOI":"10.1377\/hlthaff.2018.0512"},{"key":"zoi240962r29","doi-asserted-by":"publisher","journal-title":"J Health Econ","DOI":"10.1016\/j.jhealeco.2020.102397"},{"key":"zoi240962r30","doi-asserted-by":"publisher","journal-title":"JAMA Netw Open","DOI":"10.1001\/jamanetworkopen.2021.16860"},{"issue":"2","key":"zoi240962r31","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1016\/j.jeconom.2021.03.014","article-title":"Difference-in-differences with variation in treatment timing.","volume":"225","author":"Goodman-Bacon","year":"2021","journal-title":"J Econom"},{"issue":"2","key":"zoi240962r32","doi-asserted-by":"publisher","first-page":"200","DOI":"10.1016\/j.jeconom.2020.12.001","article-title":"Difference-in-differences with multiple time periods.","volume":"225","author":"Callaway","year":"2021","journal-title":"J Econom"},{"issue":"490","key":"zoi240962r33","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1198\/jasa.2009.ap08746","article-title":"Synthetic control methods for comparative case studies: estimating the effect of California\u2019s tobacco control program.","volume":"105","author":"Abadie","year":"2010","journal-title":"J Am Stat Assoc"},{"issue":"2","key":"zoi240962r34","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1257\/jel.20191450","article-title":"Using synthetic controls: feasibility, data requirements, and methodological aspects.","volume":"59","author":"Abadie","year":"2021","journal-title":"J Econ Lit"},{"issue":"5","key":"zoi240962r36","doi-asserted-by":"publisher","first-page":"1549","DOI":"10.1162\/REST_a_00413","article-title":"Catastrophic natural disasters and economic growth.","volume":"95","author":"Cavallo","year":"2013","journal-title":"Rev Econ Stat"},{"issue":"1","key":"zoi240962r37","doi-asserted-by":"publisher","first-page":"190","DOI":"10.1016\/j.jeconom.2019.04.011","article-title":"Placebo inference on treatment effects when the number of clusters is small.","volume":"213","author":"Hagemann","year":"2019","journal-title":"J Econom"},{"key":"zoi240962r40","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2022.115047","article-title":"Risk of depressive disorders associated with medical cannabis authorization: a propensity score matched cohort study.","volume":"320","author":"Yana","year":"2023","journal-title":"Psychiatry Res"},{"issue":"6","key":"zoi240962r43","doi-asserted-by":"publisher","first-page":"555","DOI":"10.1001\/archgenpsychiatry.2011.5","article-title":"Cannabis use and earlier onset of psychosis: a systematic meta-analysis.","volume":"68","author":"Large","year":"2011","journal-title":"Arch Gen Psychiatry"},{"issue":"1","key":"zoi240962r45","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1080\/15504263.2019.1674991","article-title":"Cannabis use and the risk for psychosis and affective disorders.","volume":"16","author":"Sideli","year":"2020","journal-title":"J Dual Diagn"},{"key":"zoi240962r6","volume-title":"The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research","author":"National Academies of Sciences, Engineering, and Medicine","year":"2017"},{"key":"zoi240962r1","unstructured":"Mental illness. National Institutes of Health; National Institute of Mental Health. Accessed February 15, 2024. https:\/\/www.nimh.nih.gov\/health\/statistics\/mental-illness#part_2541"},{"key":"zoi240962r4","unstructured":"ProCon.org. State-by-state medical marijuana laws. Accessed February 15, 2024. https:\/\/medicalmarijuana.procon.org\/ legal-medical-marijuana-states-and-dc\/"},{"key":"zoi240962r19","doi-asserted-by":"crossref","unstructured":"Lozano-Rojas F, Abraham AJ, Gupta S, Bradford WD. The effect of cannabis laws on access to pain medications among commercially insured patients in the United States. SSRN. Preprint posted online December 19, 2022. doi:10.2139\/ssrn.4299449","DOI":"10.2139\/ssrn.4299449"},{"key":"zoi240962r35","doi-asserted-by":"crossref","unstructured":"Hollingsworth? A, Wing? C. Tactics for design and inference in synthetic control studies: an applied example using high-dimensional data. SSRN. Preprint posted online June 1, 2020. doi:10.2139\/ssrn.3592088","DOI":"10.2139\/ssrn.3592088"},{"key":"zoi240962r38","unstructured":"Chernozhukov? V, Wuthrich? K, Zhu? Y. A t-test for synthetic controls. arXiv. Preprint posted online December 27, 2018. doi:10.48550\/arXiv.1812.10820?"},{"key":"zoi240962r39","unstructured":"Borbely? D, Lenhart? O, Norris? J, Romiti? A. Marijuana legalization and mental health. IZA Discussion Papers. 2022. Accessed November 1, 2023. https:\/\/docs.iza.org\/dp15729.pdf"},{"key":"zoi240962r41","unstructured":"National Institute on Drug Abuse; National Institutes of Health. Drug overdose death rates. 2022. Accessed June 3, 2021. https:\/\/nida.nih.gov\/research-topics\/trends-statistics\/overdose-death-rates"},{"key":"zoi240962r42","unstructured":"Drug Enforcement Administrations; Department of Justice. Drug fact sheet: marijuana\/cannabis. Accessed July 8, 2024. https:\/\/www.dea.gov\/sites\/default\/files\/2020-06\/Marijuana-Cannabis-2020_0.pdf"},{"key":"zoi240962r44","unstructured":"National Institute on Drug Abuse; National Institutes of Health. Cannabis (Marijuana) DrugFacts. Accessed July 8, 2024. https:\/\/nida.nih.gov\/publications\/drugfacts\/cannabis-marijuana"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2823248\/bradford_2024_oi_240962_1724862696.78434.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,5]],"date-time":"2024-09-05T15:49:21Z","timestamp":1725551361000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2823248"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,5]]},"references-count":45,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2024,9,3]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2024.32021","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,5]]}}}