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BMJ Open. 2019 May 15;9(5):e027432. doi: 10.1136/bmjopen-2018-027432.

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

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Medicine (Cardiology), University of California, San Francisco, California, USA.
Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
Medicine, Oregon Health & Science University, Portland, Oregon, USA.



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).


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.


Population-based, inpatient.


HCUP state-wide data comprising over 28 million individuals and over 16 million hospitalisations across three states.


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.


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).


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.


cannabis legalization; health policy; healthcare utilization

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