Accessible Requires Authentication Published by De Gruyter October 16, 2019

The Impact of Medical Marijuana Laws and Dispensaries on Self-Reported Health

Elena Andreyeva and Benjamin Ukert ORCID logo

Abstract

Growing evidence suggests that medical marijuana laws have harm reduction effects across a variety of outcomes related to risky health behaviors. This study investigates the impact of medical marijuana laws on self-reported health using data from the Behavioral Risk Factor Surveillance System from 1993 to 2013. In our analyses we separately identify the effect of a medical marijuana law and the impact of subsequent active and legally protected dispensaries. Our main results show surprisingly limited improvements in self-reported health after the legalization of medical marijuana and legally protected dispensaries. Subsample analyses reveal strong improvements in health among non-white individuals, those reporting chronic pain, and those with a high school degree, driven predominately by whether or not the state had active and legally protected dispensaries. We also complement the analysis by evaluating the impact on risky health behaviors and find that the aforementioned demographic groups experience large reductions in alcohol consumption after the implementation of a medical marijuana law.

Appendix

Figure 4: Event Study Results on the Impact of Protected and Active Marijuana Dispensaries on Self-Reported Health only among states with a Medical Marijuana Law.

Figure 4:

Event Study Results on the Impact of Protected and Active Marijuana Dispensaries on Self-Reported Health only among states with a Medical Marijuana Law.

Table 8:

Effective Dates of Medical Marijuana Laws and Protected and Active Dispensaries.

StateMedical MJ effective dateDispensary legally protected & active
Alaska3/4/1999N/A
Arizona11/29/2010Dec 2012
California11/6/1996Jan 2004
Colorado12/28/2000June 2010
Connecticut10/1/2012Aug 2014
Delaware5/13/2011N/A
Washington DC7/27/2010Apr 2013
Hawaii6/16/2000N/A
Illinois1/1/2014N/A
Maine12/23/1999Mar 2011
Maryland10/2/2003N/A
Massachusetts1/1/2013N/A
Michigan12/4/2008N/A
Minnesota5/30/2014N/A
Montana11/2/2004N/A
Nevada10/1/2001Mar 2015
New Hampshire7/23/2013N/A
New Jersey6/1/2010Dec 2012
New Mexico7/1/2007July 2009
New York7/5/2014N/A
Oregon12/3/1998Mar 2014
Rhode Island1/3/2006Apr 2013
Vermont7/1/2004June 2013
Washington12/3/1998N/A
Table 9:

Summary Statistics for Control Variables by State MML Status.

Full sampleAdopted MMLDid not adopt MML
Age 25–290.086 (0.281)0.088 (0.283)0.085 (0.279)
Age 30–340.101 (0.301)0.103 (0.303)0.100 (0.300)
Age 35–390.097 (0.296)0.100 (0.300)0.095 (0.293)
Age 40–440.103 (0.303)0.104 (0.305)0.102 (0.302)
Age 45–490.090 (0.286)0.091 (0.288)0.089 (0.284)
Age 50–540.087 (0.283)0.088 (0.282)0.087 (0.282)
Age 55–590.070 (0.266)0.070 (0.255)0.070 (0.255)
Age 60–640.061 (0.240)0.060 (0.237)0.062 (0.242)
Age 65+0.054 (0.226)0.052 (0.221)0.056 (0.230)
Black0.100 (0.300)0.043 (0.202)0.118 (0.322)
Hispanic0.116 (0.320)0.036 (0.186)0.082 (0.274)
Other race/ethnicity0.058 (0.233)0.036 (0.187)0.038 (0.191)
Student0.047 (0.211)0.049 (0.217)0.044 (0.205)
High school degree0.304 (0.460)0.277 (0.448)0.328 (0.470)
Some college0.273 (0.446)0.277 (0.448)0.269 (0.443)
College graduate0.292 (0.454)0.320 (0.466)0.266 (0.443)
Household size2.250 (1.289)2.249 (1.300)2.251 (1.278)
One child0.125 (0.331)0.128 (0.334)0.123 (0.328)
Two children0.053 (0.226)0.056 (0.229)0.053 (0.223)
Three children0.018 (0.133)0.019 (0.135)0.017 (0.130)
Four children or more0.009 (0.093)0.009 (0.094)0.009 (0.092)
Married0.584 (0.493)0.567 (0.495)0.600 (0.490)
Women0.516 (0.499)0.515 (0.500)0.518 (0.500)
Unemployed0.057 (0.231)0.062 (0.241)0.052 (0.222)
Unemployment rate6.141 (2.056)6.450 (2.169)5.816 (1.888)
Poverty level13.328 (3.125)12.795 (3.056)13.814 (3.108)
Income 10k to less than 15k0.061 (0.238)0.060 (0.237)0.061 (0.240)
Income 15k to less than 20k0.081 (0.274)0.074 (0.262)0.088 (0.283)
Income 20k to less than 25k0.099 (0.298)0.088 (0.283)0.108 (0.310)
Income 25k to less than 35k0.138 (0.345)0.127 (0.333)0.149 (0.356)
Income 35k to less than 50k0.167 (0.373)0.160 (0.367)0.174 (0.378)
Income 50k to less than 75k0.167 (0.372)0.172 (0.377)0.162 (0.369)
Income more than 75k0.221 (0.415)0.252 (0.434)0.193 (0.394)
Health insurance0.847 (0.360)0.858 (0.349)0.836 (0.369)
Medicaid expansion0.090 (0.286)0.154 (0.361)0.032 (0.175)
Must access PDMPs0.018 (0.131)0.011 (0.103)0.024 (0.152)

  1. Standard deviations in parentheses.

Table 10:

The Heterogenous Impact of MML on State with MML and Protected and Active Dispensaries vs. only MML.

Very good/excellent healthExcellent healthDays Not in Good Physical HealthDays Not in Good Mental HealthDays with Health-Related Limitations
MML states only
 MML effect0.006* (0.003)0.004 (0.005)0.030 (0.060)−0.016 (0.098)0.046* (0.025)
States with MML and dispensary
 MML effect0.020* (0.008)0.012 (0.006)−0.098* (0.038)−0.147** (0.048)−0.102* (0.042)
 Active + legal dispensaries−0.011** (0.004)−0.002 (0.002)−0.042 (0.050)0.032 (0.052)−0.035 (0.047)
 Combined effect of MML and dispensaries0.010 (0.006)0.010 (0.006)−0.139* (0.070)−0.115 (0.070)−0.136 (0.080)

  1. Standard errors, heteroscedasticity-robust and clustered by state, are in parentheses. ***Indicates statistically significant at 0.1% level; **1% level; *5% level. BRFSS sampling weights are used. All regressions include state and year fixed effects as well as the controls. The first row displays the impact of a MML among states that passed a MML compared to states without a MML on self-reported health. The bottom rows display the results of states that passed a MML and had protected and active dispensary compared to states who never passed a MML.

Table 11:

Robustness Checks on the Impact of MML on Very Good or Better Health.

Drop late MML expandersLimit sample period up to 2010Exclude 2008–2009 year of deep recessionExclude Medicaid Expansion states Drop 18–24-year oldsDrop those aged above 64Drop cell phone sample
MML0.017* (0.008)0.016 (0.009)0.019* (0.008)0.022** (0.008)0.015** (0.006)0.017* (0.009)0.015* (0.007)
Active + legal dispensaries−0.012** (0.004)−0.028*** (0.005)−0.009* (0.004)−0.014*** (0.003)−0.010*** (0.002)−0.011** (0.003)−0.018*** (0.004)
Combined effect of MML and dispensaries0.005 (0.006)−0.015 (0.013)0.099 (0.065)0.008 (0.008)0.005 (0.005)0.006 (0.007)−0.003 (0.006)
Sample size4,979,4543,397,4264,273,4163,957,5934,725,5623,760,8644,414,923

  1. Standard errors, heteroscedasticity-robust and clustered by state, are in parentheses. ***Indicates statistically significant at 0.1% level; **1% level; *5% level. BRFSS sampling weights are used. All regressions include state and year fixed effects as well as the controls. The effect of a MML, dispensaries, and the combined effect of having a MML and active and legal dispensaries are reported.

Table 12:

Robustness Checks on the Impact of MML on Excellent Health.

Drop late MML expandersLimit sample period up to 2010Exclude 2008–2009 year of deep recessionExclude medicaid expansion states Drop 18–24-year oldsDrop those aged above 64Drop cell phone sample
MML0.010 (0.005)0.010 (0.008)0.012* (0.006)0.013 (0.007)0.010* (0.005)0.011* (0.006)0.009 (0.005)
Active + legal dispensaries−0.003 (0.002)−0.011* (0.004)−0.003 (0.002)−0.004 (0.003)0.001 (0.003)−0.003 (0.002)−0.006* (0.003)
Combined effect of MML and dispensaries0.007 (0.005)−0.001 (0.011)0.009 (0.006)0.009 (0.009)0.010 (0.007)0.008 (0.006)0.003 (0.005)
Sample size4,414,9233,397,4264,273,4163,957,5934,725,5623,760,8644,414,923

  1. Standard errors, heteroscedasticity-robust and clustered by state, are in parentheses. ***Indicates statistically significant at 0.1% level; **1% level; *5% level. BRFSS sampling weights are used. All regressions include state and year fixed effects as well as the controls. The effect of a MML, dispensaries, and the combined effect of having a MML and active and legal dispensaries are reported.

Table 13:

Robustness Checks on the Impact of MML on Number of Days with Physical Health Problems in the Last Month.

Drop late MML expandersLimit sample period up to 2010Exclude 2008–2009 year of deep recessionExclude medicaid expansion states Drop 18–24-year oldsDrop those aged above 64Drop cell phone sample
MML−0.071 (0.045)−0.134 (0.082)−0.092 (0.046)−0.120* (0.056)−0.074 (0.055)−0.031 (0.033)−0.076 (0.051)
Active + legal dispensaries−0.038 (0.043)−0.103* (0.051)−0.059 (0.045)−0.088* (0.042)−0.048 (0.057)−0.030 (0.033)−0.036 (0.046)
Combined effect of MML and dispensaries−0.108 (0.071)−0.238 (0.119)−0.151* (0.073)−0.208* (0.078)−0.121 (0.010)−0.061 (0.047)0.112 (0.081)
Sample size4,800,5373,241,6424,102,0633,819,7364,556,8363,636,2384,243,070

  1. Standard errors, heteroscedasticity-robust and clustered by state, are in parentheses. ***Indicates statistically significant at 0.1% level; **1% level; *5% level. BRFSS sampling weights are used. All regressions include state and year fixed effects as well as the controls. The effect of a MML, dispensaries, and the combined effect of having a MML and active and legal dispensaries are reported.

Table 14:

Robustness Checks on the Impact of MML on Number of Days with Mental Health Problems in the Last Month.

Drop late MML expandersLimit sample period up to 2010Exclude 2008–2009 year of deep recessionExclude medicaid expansion states Drop 18–24-year oldsDrop those aged above 64Drop cell phone sample
MML−0.115* (0.050)−0.131 (0.080)−0.128* (0.064)−0.186*** (0.046)−0.123* (0.049)−0.114* (0.050)−0.126** (0.047)
Active + legal dispensaries0.010 (0.053)0.015 (0.059)0.001 (0.058)0.001 (0.045)0.046 (0.054)−0.003 (0.058)0.005 (0.043)
Combined effect of MML and dispensaries−0.105 (0.072)−0.116 (0.120)−0.127 (0.083)−0.186** (0.066)−0.077 (0.071)−0.117 (0.087)−0.121 (0.061)
Sample size4,811,7403,246,3724,111,0723,829,4064,567,9533,633,5784,252,705

  1. Standard errors, heteroscedasticity-robust and clustered by state, are in parentheses. ***Indicates statistically significant at 0.1% level; **1% level; *5% level. BRFSS sampling weights are used. All regressions include state and year fixed effects as well as the controls. The effect of a MML, dispensaries, and the combined effect of having a MML and active and legal dispensaries are reported.

Table 15:

Robustness Checks on the Impact of MML on Number of Days with Health-Related Limitations in the Last Month.

Drop late MML expandersLimit sample period up to 2010Exclude 2008–2009 year of deep recessionExclude medicaid expansion states Drop 18–24-year oldsDrop those aged above 64Drop cell phone sample
MML−0.068 (0.045)−0.179 (0.095)−0.084 (0.049)−0.130** (0.047)−0.061 (0.047)−0.081 (0.049)−0.083 (0.047)
Active + legal dispensaries−0.038 (0.043)−0.160*** (0.043)−0.073 (0.053)−0.098*** (0.018)−0.036 (0.052)−0.025 (0.043)−0.045 (0.049)
Combined effect of MML and dispensaries−0.106 (0.074)−0.340* (0.133)−0.157 (0.091)−0.227*** (0.049)−0.097 (0.085)−0.106 (0.075)−0.128 (0.083)
Sample size4,836,2183,263,9024,132,7813,849,2754,591,3873,651,6564,274,815

  1. Standard errors, heteroscedasticity-robust and clustered by state, are in parentheses. ***Indicates statistically significant at 0.1% level; **1% level; *5% level. BRFSS sampling weights are used. All regressions include state and year fixed effects as well as the controls. The effect of a MML, dispensaries, and the combined effect of having a MML and active and legal dispensaries are reported.

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Published Online: 2019-10-16

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