ArticleBMJ open2019
Does cannabis legalisation change healthcare utilisation? A population-based study using the healthcare cost and utilisation project in Colorado, USA.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers, 4 of them syntheses that pooled it.
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Who cites it
21 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- The impact of cannabis legalization and decriminalization on acute poisoning: A systematic review.Addiction (Abingdon, England) · 2023Pooled it
- Effects of Cannabis Legalization on Road Safety: A Literature Review.International journal of environmental research and public health · 2023Pooled it
- The clouded debate: A systematic review of comparative longitudinal studies examining the impact of recreational cannabis legalization on key public health outcomes.Frontiers in psychiatry · 2022Pooled it
- A Mapping Literature Review of Medical Cannabis Clinical Outcomes and Quality of Evidence in Approved Conditions in the USA from 2016 to 2019.Medical cannabis and cannabinoids · 2021Pooled it
- Change of substance-related hospitalisation in adolescents after cannabis legalisation in Thailand in 2022.Addiction (Abingdon, England) · 2026Article
- Development of a Decision Aid to Support Shared Decision-Making on Cannabis Use for Arthritis: Protocol for a Multiphase Study.JMIR research protocols · 2026Article
- The prevalence of cannabis use pre-versus post-cannabis legalization in Canada by mental health status: findings from national repeat cross-sectional surveys.Lancet regional health. Americas · 2026Article
- Review
- Effects of Cannabis Exposure on Adolescent Health and Development: A Narrative Review.Current drug research reviews · 2025Review
- Changes in cannabis involvement in emergency department visits for anxiety disorders after cannabis legalization: a repeated cross-sectional study.Lancet regional health. Americas · 2024Article
- Germany's cannabis act: a catalyst for European drug policy reform?The Lancet regional health. Europe · 2024Review
- Health, safety, and socioeconomic impacts of cannabis liberalization laws: An evidence and gap map.Campbell systematic reviews · 2023Article
- Association of Recreational Cannabis Legalization With Alcohol Use Among Adults in the US, 2010 to 2019.JAMA health forum · 2022Article
- Changes in Traffic Crash Rates After Legalization of Marijuana: Results by Crash Severity.Journal of studies on alcohol and drugs · 2022Article
- Non-medical cannabis use: international policies and outcomes overview. An outline for Portugal.Trends in psychiatry and psychotherapy · 2022Article
- Relationships of Cannabis Policy Liberalization With Alcohol Use and Co-Use With Cannabis: A Narrative Review.Alcohol research : current reviews · 2022Review
- The Endocannabinoid System and Cannabidiol: Past, Present, and Prospective for Cardiovascular Diseases.Pharmaceuticals (Basel, Switzerland) · 2021Review
- Effect of pharmaceutical regulatory policy on health impact.British journal of clinical pharmacology · 2020Article
- Facing the option for the legalisation of cannabis use and supply in New Zealand: An overview of relevant evidence, concepts and considerations.Drug and alcohol review · 2020Review
- Assessing the public health impacts of legalizing recreational cannabis use: the US experience.World psychiatry : official journal of the World Psychiatric Association (WPA) · 2020Article
Corrections and comments
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo 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).
designWe 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.
settingPopulation-based, inpatient.
participantsHCUP state-wide data comprising over 28 million individuals and over 16 million hospitalisations across three states.
main outcome measuresWe 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.
resultsIn 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).
conclusionsRecreational 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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