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Most studies have examined the relationship using state-level data, missing important sub-state variation in cannabis access.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Objective<\/jats:title>\n                <jats:p>To examine cannabis legalization on opioid use at the county level, using Colorado as a case study. Colorado allowed recreational cannabis stores in January 2014. Local communities could decide whether to allow dispensaries, creating variation in the level of exposure to cannabis outlets.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Design<\/jats:title>\n                <jats:p>Observational, quasi-experimental design exploiting county-level variation in allowance of recreational dispensaries.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Subjects<\/jats:title>\n                <jats:p>Colorado residents<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Measures<\/jats:title>\n                <jats:p>We use licensing information from the Colorado Department of Revenue to measure county-level exposure to cannabis outlets. We use the state\u2019s Prescription Drug Monitoring Program (2013\u20132018) to construct opioid-prescribing measures of number of 30-day fills and total morphine equivalents, both per county resident per quarter. We construct outcomes of opioid-related inpatient visits (2011\u20132018) and emergency department visits (2013\u20132018) with Colorado Hospital Association data. We use linear models in a differences-in-differences framework that accounts for the varying exposure to medical and recreational cannabis over time. There are 2048 county-quarter observations used in the analysis.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>We find mixed evidence of cannabis exposure on opioid-related outcomes at the county level. We find increasing exposure to recreational cannabis is associated with a statistically significant decrease in number of 30-day fills (coefficient: \u2212117.6, <jats:italic>p<\/jats:italic>-value&lt;0.01) and inpatient visits (coefficient: \u22120.8, <jats:italic>p<\/jats:italic>-value: 0.03), but not total MME nor ED visits. Counties with no medical exposure prior to recreational legalization experience greater reductions in the number of 30-day fills and MME than counties with prior medical exposure (<jats:italic>p<\/jats:italic>=0.02 for both).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>Our mixed findings suggest that further increases in cannabis beyond medical access may not always reduce opioid prescribing or opioid-related hospital visits at a population level.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s11606-023-08195-3","type":"journal-article","created":{"date-parts":[[2023,6,20]],"date-time":"2023-06-20T16:01:47Z","timestamp":1687276907000},"page":"2726-2733","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Impact of Recreational Cannabis Legalization on Opioid Prescribing and Opioid-Related Hospital Visits in Colorado: an Observational Study"],"prefix":"10.1007","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4993-2581","authenticated-orcid":false,"given":"Christine","family":"Buttorff","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George Sam","family":"Wang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asa","family":"Wilks","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory","family":"Tung","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amii","family":"Kress","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Schwam","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rosalie Liccardo","family":"Pacula","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2023,6,20]]},"reference":[{"key":"8195_CR1","unstructured":"CDC. 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