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The Effect of Medical Marijuana on Sickness Absence
Abstract
Utilizing the Current Population Survey, the study identifies that absences due to sickness decline following the legalization of medical marijuana. The effect is stronger in states with 'lax' medical marijuana regulations, for full-time workers, and for middle-aged males, which is the group most likely to hold medical marijuana cards. Copyright © 2016 John Wiley & Sons, Ltd.
... Older studies using survey data have typically identified negative associations between cannabis use and health-and-productivity-related outcomes (Van Ours, 2007;Hanson et al., 2010;Van Ours et al., 2013;Volkow et al., 2014;Williams and Van Ours, 2020;Winward et al., 2014;Kaestner, 1994;Register and Williams, 1992;Irons et al., 2014), or no association (MacDonald and Pudney, 2000). More recent studies of medical cannabis legalization indicate potential positive health and productivity effects, often through substitution away from more harmful substances (Ullman, 2017;Nicholas and Maclean, 2019;Bonn-Miller et al., 2007;Vigil et al., 2017;Doremus et al., 2019;Bradford et al., 2018;Bradford and Bradford, 2018;Anderson et al., 2018Anderson et al., , 2014Chu, 2015;Baggio et al., 2018;Anderson et al., 2013;Choi et al., 2019). ...
... The limited literature on how medical marijuana laws (MMLs) affect labor supply shows mixed results as well. On the one hand, medical cannabis dispensaries' entry may have potential positive employment and earnings effects, at least in older populations (Nicholas and Maclean, 2019), and for more extreme outcomes, such as workplace deaths (Anderson et al., 2014), workers' compensation claims (Ghimire and Maclean, 2020), and job absences (Ullman, 2017). On the other hand, Sabia and Nguyen (2018) find a small decrease in wages among males aged 20-39 years. ...
... 6 Furthermore, studies have found that legal medical cannabis lowers rates of workplace fatalities for workers aged 25-44 years (Anderson et al., 2018), decreases job absences by 8.4%-8.7% among workers aged 15-65 years (Ullman, 2017), and reduces suicide rates among young men aged 20-39 years (Anderson et al., 2014). These outcomes could be associated with increases in labor productivity, which, in competitive labor markets, should lead to higher wages. ...
Recreational cannabis markets possibly increase labor demand through investments in facilities for growing, processing, and retail sales of cannabis, as well as through other industries such as manufacturing, leisure, and hospitality. However, this increase in labor demand may vary substantially across counties within a state as most states with legal recreational cannabis allow individual counties to ban commercial cannabis sales. Meanwhile, labor supply may change through positive and negative effects from cannabis use. Using county-level Colorado data from 2011 to 2018 and exploiting variation across counties in the existence and timing of the start of dispensary sales, we test for changes in the unemployment rate, employment, and wages, overall and by industry subsector. Consistent with an increase in labor demand, we estimate that the sale of recreational cannabis through dispensaries is associated with a 0.7 percentage point decrease in the unemployment rate with no effect on the size of the labor force. We also find a 4.5% increase in the number of employees, with the strongest effects found in manufacturing. We find no effect on wages. Given the lack of a reduction in labor force participation or wages, negative effects on labor supply are likely limited, in line with the existing literature. The decrease in unemployment, coupled with an increase in the number of employees, indicates that labor demand effects likely dominate effects on labor supply. Our results suggest that policymakers considering recreational access to cannabis should anticipate a possible increase in employment.
... However, the equilibrium effects of recreational cannabis dispensary entry on local communities and surrounding areas are less clear. The health effects of cannabis are ambiguous, with older studies using survey data typically identifying negative associations between cannabis use and health and productivity outcomes (Hanson et al., 2010;Van Ours, 2007;Van Ours, Williams, Fergusson, & Horwood, 2013;Volkow, Baler, Compton, & Weiss, 2014), while more recent studies of medical cannabis legalization indicate potential positive health and productivity effects (Li et al., 2019;Nicholas & Maclean, 2019;Ullman, 2017). ...
... to 8.7 percent among workers 15 to 65 (Ullman, 2017), and reduces suicide rates among young men ages 20 to 39 (Anderson, Rees, & Sabia, 2014). These outcomes could be associated with increases in labor productivity, which, in competitive markets, should lead to higher wages. ...
Recreational access to cannabis may have a positive effect on labor demand due to investments in growing, processing and retail cannabis facilities, and spillovers to interconnected industries such as manufacturing, and leisure and hospitality. Using county-level Colorado data from 2011-2018 and exploiting the variation in the timing of commencement of sale of dispensaries, we test for changes in the unemployment rate, employment and wages, overall as well as in manufacturing, construction, and services. Consistent with an increase in labor demand, we estimate that the sale of recreational cannabis through dispensaries is associated with a 0.7 percentage point decrease in the unemployment rate with no effect on total labor force participation. We also find a 4.5 percent increase in the overall number of employees, with effects concentrated in manufacturing and services. We do not find an effect on average weekly wages overall or by sector. Given the lack of a reduction in labor force participation or wages, negative effects on labor supply are likely limited, in line with the existing literature. The decrease in the unemployment rate, coupled with an increase in the number of employees, indicates that labor demand effects are likely to dominate. Our results suggest that policymakers considering recreational access to cannabis should account for increased employment as a possible outcome.
From Cal Poly Working Paper Series. To cite: https://EconPapers.repec.org/RePEc:cpl:wpaper:2001
... With regard to externalities, the literature reports a multitude of effects (see Anderson and Rees, 2023 for an overview of the public health effects of legalising marijuana); for example, 2 In a supplementary specification, Sabia et al. (2017) test potential mechanisms for the effect on physical health and find a beneficial effect of MMLs on mental health. However, they do not examine heterogeneous treatment effects on mental health conditional on differences in the law, consumption motive or health status. the literature reports decreased absenteeism from work (Ullman, 2017), negative environmental impact of local cultivation (Carah et al., 2015), tax revenues and a decrease in crime-related drug trafficking (Gavrilova et al., 2019). Furthermore, several studies report systematic relationships between MMLs and the rate of traffic fatalities, highlighting the potential substitution of alcohol with marijuana (e.g. ...
The consequences of legal access to medical marijuana for individuals' well-being are controversially assessed. We contribute to the discussion by evaluating the impact of the introduction of medical marijuana laws across US states on self-reported mental health considering different motives for cannabis consumption. Our analysis is based on BRFSS survey data from close to eight million respondents between 1993 and 2018 that we combine with information from the NSDUH to estimate individual consumption propensities. We find that eased access to marijuana through medical marijuana laws reduce the reported number of days with poor mental health for individuals with a high propensity to consume marijuana for medical purposes and for those individuals who likely suffer from frequent pain.
... Considering these arguments, the North-American accommodative models have a clear benefit since they allow access to a large variety of herbal cannabis and hence maximize the potentialities of medical cannabis. They also have demonstrated more general health, social and economic benefits, such as a reduction in opioid-related harms (Powell et al., 2018), cigarette consumption (Choi et al., 2019), sickness absence (Ullman, 2017) and an increase in older adult labor supply (Nicholas and Maclean, 2019), without increasing use prevalence among minors (Sarvet et al., 2018). However, these schemes also increase the risk of accidental poisoning (Wang et al., 2016) as well as diverted recreational use (Pacula et al., 2015) and initiation (Wen et al., 2015). ...
Over the past decades, the cannabis policy paradigm has been changing with most Western countries allowing its medical use and few jurisdictions where any adults can legally purchase it. The basic question is no longer whether countries should legalize cannabis, but which policy should be adopted in order to maximize social welfare. While a basic legal guidance emerged from the experience of other addictive substances, cannabis regulation is a more complex policy challenge, given its product heterogeneity and the differential harms caused by its consumption across different types of users. When over-consumed, it can inflict harm to the users and others, whereas when is used as a medicine, it can improve the quality of life. In the midst of these extreme purposes, there is the spectrum of wellness and the industrial uses of potential economic and environmental interest. The thesis explores a major distinctive feature which characterizes the legal framework of cannabis distribution : the existence of multiple interrelated markets operating with different regulations, but that can often satisfy consumer demand interchangeably. Based on the expected purpose of use, analogous cannabis-based products arc supplied in different distributional channels characterized by substantially different transaction costs for consumers. It is the first attempt to systematically examine cannabis markets comprehensively and to consider how supply architecture and taxation (or subsidies) of one market can affect the others creating market distortions. Its contribution will extend to the institutionalization of other commodities with intoxicating potential, such as other forms of herbal medicine.
... Since all states which have legalized cannabis for adult use have previously legalized cannabis for medical use, the effects of both policies are relevant to our study. Ullman (2017) finds that medical cannabis laws (MCLs) reduce the number of absences due to sickness, while Sabia and Nguyen (2018) employ a synthetic control approach and find "no evidence that [MCLs] affect employment, hours, or wages among working-age adults, " Nicholas and Maclean (2019) find evidence that MCLs "lead to increases in older adult labor supply, with effects concentrated on the intensive margin" and Ghimire and Maclean (2020) provide evidence that workers' compen- (2022) 4:42 Page 3 of 51 sation claims fall following the adoption of MCLs. On the adult-use side, Maclean et al. (2021) argue that RCLs increase Social Security disability claims, while Abouk et al. (2021) find that workers' compensation benefits decline after RCL adoption. ...
Background
Over the past several years, cannabis has become legal for recreational use in many US states and jurisdictions around the world. The opening of these markets has led to the establishment of hundreds of cannabis production and retail firms with accompanying demand for labor, leading to concerns about spillover effects on wages from incumbents.
Methods
We study the markets for agricultural and retail labor in Washington and Colorado from 2000 to 2019 using differences-in-differences with synthetic controls. We employ employment data from the Quarterly Census of Employment and Wages, state-level demographic data from the US Census Bureau, and agricultural data from the National Agricultural Statistics Service. We use the least absolute shrinkage and selection operator (LASSO) for variable selection and classification and regression trees (CART) for chained imputation of missing values.
Results
We find little-to-no evidence of a significant difference in weekly wages per worker generated by cannabis legalization: the log of the weekly wage per worker decreases by 0.013 in Washington’s agricultural sector ( p value 0.091) and increases by 0.059 in Washington’s retail sector ( p value 0.606). Results in Colorado are qualitatively similar. These results are limited in part by the short post-legalization period of the data.
Conclusions
Cannabis legalization is unlikely to negatively impact incumbent agriculture or retail firms through the labor market channel.
... Fortunately, the large sample size of the CPS (125,510 workermonth observations for March to June 2020) provided us a unique opportunity to examine SAs. Prior research has used the same measure in the CPS to analyze health-related topics, including seasonal influenza patterns (Groenewold et al. 2019) and the health consequences of marijuana legalizations (Ullman 2017). There is evidence that lockdown and social-distancing measures introduced to combat COVID-19 also decreased other respiratory infections, such as influenza and the common cold (Jones 2020), and so far as this is the case, comparing absences in 2020 to prior years likely underestimates the effect of COVID-19 illnesses on occupational health. ...
Pandemic frontline occupations consist of disproportionately low socioeconomic status and racial minority workers. Documenting occupational health disparities is therefore crucial for understanding COVID-19-related health inequalities in the United States. This study uses Current Population Survey microdata to estimate occupational differences in sickness-related absences (SAs) from work in March through June 2020 and their contribution to educational, racial-ethnic, and nativity health disparities. We find that there has been an unprecedented rise in SAs concentrated in transportation, food-related, and personal care and service occupations. SA rates were 6 times higher in these occupations than in non-health-care professions. The greatest increases were in occupations that are unsuitable for remote work, require workers to work close to others, pay low wages, and rarely provide health insurance. Workers in these occupations are disproportionately Black, Hispanic, indigenous, and immigrants. Occupation contributes 41% of the total of Black/white differences and 54% of educational differences in SAs.
... Nicholas and Maclean (2019) focus on adults 50 and older in the Health and Retirement Study and document that passage of an MML leads to an increase in the probability of working full-time and the number of hours worked per week among those participating in paid employment. Ullman (2017) finds that increased marijuana consumption due to MML adoption reduces work absences as measured in the CPS. Anderson, Rees, and Tekin (2018) show that workplace fatalities fall following MML passage among workers 25 to 44 years (coefficient estimates are imprecise for other age groups). ...
... Benefits need to be balanced against the indirect cost of increased use of cannabis locally, quantifiable in terms of economic productivity, loss of years of education, and rates of motor accidents. 17,18 Even a small increase in incidence and prevalence of psychiatric disorders leading to higher service utilization could drain already scarce resources. Accordingly, medical professionals in countries considering liberalizing cannabis legislation are ethically obliged to ''First, do no harm'' (primum non nocere) by inviting the authorities to prioritize the health, physical and mental, of the nation before any other consideration. ...
In April 2020, after decades of discussions and controversy, the Lebanese parliament voted a law legalizing the cultivation, production, and sale of cannabis for medicinal purposes. Although the law leaves several unanswered questions and awaits implementation, the symbolic nature of this step in recognizing a positive role of cannabis in the local economy is significant on a regional level. The Arab world has traditionally been conservative when it comes to all drugs-related policies. Cannabis is largely demonized with heavy sentences served to anyone suspected of using selling, let alone planting cannabis. Despite a few countries considered producers and consumers of substances, governing authorities have remained immune to the liberalization trend encountered in western countries. The social experiment taking place in Lebanon is fraught with risks, given the unstable political situation and chronic economic challenges. The reactions to the law have been mixed with several scientific bodies such as the Lebanese Psychiatric Society criticizing the absence of proper consultation of stakeholders. The absence of consistency in enforcing established drugs policies or seriously debating the decriminalization of cannabis use raises concerns over the establishment of a two-tier approach toward drugs, driven solely by economic imperatives.
... Recent work suggests that RMLs increase medical use of marijuana, displacing standard medications used to manage pain (McMichael, Van Horn, & Viscusi, 2020;Wen & Hockenberry, 2018). Three studies show that work-capacity increases post-MML (Ghimire & Maclean, 2020;Nicholas & Maclean, 2019;Ullman, 2016) suggesting that RMLs, if they promote medical use, could have similar effects. ...
We study the effect of recent legalization of recreational marijuana use laws (RMLs) in the United States on new applications and allowances for Social Security Disability Insurance and Supplemental Security Income over the period 2001–2019. We combine administrative caseload data from the Social Security Administration with state policy changes using two‐way fixed‐effects methods. We find that RML adoption increases applications for both benefits. However, there is no change in allowances post‐RML. We provide suggestive evidence that the observed changes in applications post‐RML are driven by increases in marijuana misuse and selective migration, and decreases in unemployment.
... Furthermore, while the passage of MMLs had no effect on underage drinking or other substance use (Wen et al., 2015), it decreased cocaine and heroin use (Chu, 2015), cigarette smoking (Choi et al., 2018), and alcohol consumption (Anderson et al., 2013), except for binge drinking (Wen et al., 2015), among adults. Studies of labor market outcomes found that MMLs increased labor supply among older adults (Nicholas and Maclean, 2019) and reduced sickness absences (Ullman, 2017), although they also reduced hourly earnings for younger adult males (Sabia and Nguyen, 2018) and decreased college students' educationrelated activities in favor of leisure activities (Chu and Gershenson, 2018). Additionally, the implementation of MMLs has been shown to impact a variety of health outcomes. ...
This paper examines the effects of state-level medical marijuana laws (MMLs) in the U.S. on birth outcomes, including birth weight, length of gestation, and Apgar scores. Using individual-level natality data from the National Center for Health Statistics from 1990 to 2013, we take advantage of the geographic and temporal variation in the implementation of MMLs in a difference-in-differences estimation framework with state and year fixed effects and state-specific time trends. Overall, we find that MMLs have no impact on gestation period or Apgar scores. While MMLs lead to a statistically significant increase in birth weight by 4.4 g (0.13%), this effect is practically small. Furthermore, we find little variation in the effects of MMLs on birth outcomes across different socioeconomic subgroups and observe no lagged negative effects of MMLs on birth outcomes of children born in the MML states in the years following the legalization of medical marijuana.
... Considering these arguments, the North American accommodative models have a clear benefit as they maximize the potential of medical cannabis by allowing access to a large variety of herbal cannabis. They have also demonstrated more generalized health, social and economic benefits, such as a reduction in opioid-related harms [28], cigarette consumption [29], sickness absence [30] and an increase in older adult labor supply [31], without increasing use prevalence among minors [32]. However, these schemes also increase the risk of accidental poisoning [33] as well as diverted recreational use [34] and initiation [35]. ...
France is about to experiment with legal access to medical cannabis. In this short contribution, we propose an analysis of this regulation choice in light of the intrinsic characteristics of medical cannabis and the lessons learned from other countries. More precisely, we argue that scientific evidence for the efficacy of cannabis is limited, which favors restrictive regulation schemes, similar to those found in other European countries. However, since there are strong technical and economic barriers to demonstrating the efficacy of medical cannabis, more accommodative regulatory frameworks such as those found in North America, have advantages, but these are also at risk of excessive or diverted use. In order to keep the best of both systems, it might be possible to design innovative regulatory frameworks based on a dual-distribution system for medical cannabis. Cannabis Social Clubs, for example, could serve as a distribution structure complementary to the conventional healthcare system.
... Five studies explore the effect of MMLs on labor market outcomes, and findings vary across sample and outcome. Days absent from work decline post MML (Ullman, 2017). Anderson, Rees, and Tekin (2018) show that workplace fatalities fall following MML passage. ...
We study the effect of state medical marijuana laws (MMLs) on workers' compensation (WC) claiming among adults. Medical marijuana is plausibly related to WC claiming by allowing improved symptom management, and thus reduced need for the benefit, among injured or ill workers. We use data on claiming drawn from the Annual Social and Economic supplement to the Current Population Survey over the period 1989 to 2012, coupled with a differences‐in‐differences design to provide the first evidence on this relationship. Our estimates show that, post MML, WC claiming declines, both the propensity to claim and the level of income from WC. These findings suggest that medical marijuana can allow workers to better manage symptoms associated with workplace injuries and illnesses and, in turn, reduce need for WC. However, the reductions in WC claiming post MML are very modest in size.
... Anderson, Rees, and Sabia (2014) document that MML passage leads to a decline in completed suicides among men aged 20 to 39 years, but not for other demographic groups. Ullman (2017) shows that passage of an MML reduces work absences by 8.4 to 8.7 percent among workers aged 15 to 65 in the Current Population Survey (CPS), although effects are somewhat sensitive to specification for workers ages 50 to 65. Anderson and coauthors find that state MMLs lead to lower rates of workplace fatalities for workers age 25 to 44, but no differences for other age groups. In contrast to these beneficial health effects, Abouk and Adams (2018) show that cardiovascular deaths increase by 2.3 percent among men and 1.2 percent among women following state MMLs. ...
Older adults are at elevated risk of reducing labor supply due to poor health, partly because of high rates of symptoms that may be alleviated by medical marijuana. Yet, surprisingly little is known about how this group responds to medical marijuana laws (MMLs). We quantify the effects of state medical marijuana laws on the health and labor supply of adults age 51 and older, focusing on the 55 percent with one or more medical conditions with symptoms that may respond to medical marijuana. We use longitudinal data from the Health and Retirement Study to estimate event study and differences‐in‐differences regression models. Three principle findings emerge from our analysis. First, active state medical marijuana laws lead to lower pain and better self‐assessed health among older adults. Second, state medical marijuana laws lead to increases in older adult labor supply, with effects concentrated on the intensive margin. Third, the effects of MMLs are largest among older adults with a health condition that would qualify for legal medical marijuana use under current state laws. Findings highlight the role of health policy in supporting work among older adults and the importance of including older adults in assessments of state medical marijuana laws.
This study explores how the frequency of employee cannabis use moderates the relationships between mental health and legal status of cannabis in predicting employee sickness absence. Analyzing a sample of 1,199 employed young adults in the United States from the most recent wave of the Panel Study of Income Dynamics (PSID): Transition into Adulthood Supplement (TAS), this study estimates zero-inflated Poisson regressions to predict the number of sickness absences employees reported over the past year. The results indicated that the legal status of cannabis interacted with frequency of cannabis use and depression to predict employee sickness absence. However, supplemental analyses examining sex indicated that the legal status of cannabis interacted with the frequency of cannabis use and anxiety to predict sickness absence. Our study contributes to the literature by moving beyond the main effects of substance use on sickness absence to explore how individual and environmental characteristics interact with frequency of cannabis use to predict sickness absence, using a nationally representative sample of recent data.
Background
Globally, cannabis laws and regulations are rapidly changing. Countries are increasingly permitting access to cannabis under various decriminalization, medicalization, and legalization laws. With strong economic, public health, and social justice incentives driving these domestic cannabis policy reforms, liberalization trends are bound to continue. However, despite a large and growing body of interdisciplinary research addressing the policy‐relevant health, safety, and socioeconomic consequences of cannabis liberalization, there is a lack of robust primary and systematic research that comprehensively investigates the consequences of these reforms.
Objectives
This evidence and gap map (EGM) summarizes the empirical evidence on cannabis liberalization policies. Primary objectives were to develop a conceptual framework linking cannabis liberalization policies to relevant outcomes, descriptively summarize the empirical evidence, and identify areas of evidence concentration and gaps.
Search Methods
We comprehensively searched for eligible English‐language empirical studies published across 23 academic databases and 11 gray literature sources through August 2020. Additions to the pool of potentially eligible studies from supplemental sources were made through November 2020.
Selection Criteria
The conceptual framework for this EGM draws upon a legal epidemiological perspective highlighting the causal effects of law and policy on population‐level outcomes. Eligible interventions include policies that create or expand access to a legal or decriminalized supply of cannabis: comprehensive medical cannabis laws (MCLs), limited medical cannabidiol laws (CBDLs), recreational cannabis laws (RCLs), industrial hemp laws (IHLs), and decriminalization of cultivations laws (DCLs). Eligible outcomes include intermediate responses (i.e., attitudes/behaviors and markets/environments) and longer‐term consequences (health, safety, and socioeconomic outcomes) of these laws.
Data Collection and Analysis
Both dual screening and dual data extraction were performed with third person deconfliction. Primary studies were appraised using the Maryland Scientific Methods Scale and systematic reviews were assessed using AMSTAR 2.
Main Results
The EGM includes 447 studies, comprising 438 primary studies and nine systematic reviews. Most research derives from the United States, with little research from other countries. By far, most cannabis liberalization research focuses on the effects of MCLs and RCLs. Studies targeting other laws—including CBDLs, IHLs, and DCLs—are relatively rare. Of the 113 distinct outcomes we documented, cannabis use was the single most frequently investigated. More than half these outcomes were addressed by three or fewer studies, highlighting substantial evidence gaps in the literature. The systematic evidence base is relatively small, comprising just seven completed reviews on cannabis use (3), opioid‐related harms (3), and alcohol‐related outcomes (1). Moreover, we have limited confidence in the reviews, as five were appraised as minimal quality and two as low quality.
Authors’ Conclusions
More primary and systematic research is needed to better understand the effects of cannabis liberalization laws on longer‐term—and arguably more salient—health, safety, and socioeconomic outcomes. Since most research concerns MCLs and RCLs, there is a critical need for research on the societal impacts of industrial hemp production, medical CBD products, and decriminalized cannabis cultivation. Future research should also prioritize understanding the heterogeneous effects of these laws given differences in specific provisions and implementation across jurisdictions.
Background:
To evaluate the impact of medical cannabis laws (MCLs) on health insurance premiums. We study whether cannabis legalization significantly impacts aggregate health insurer premiums in the individual market. Increases in utilization could have spillover effects to patients in the form of higher health insurance premiums.
Methods:
We use 2010-2021 state-level U.S. private health insurer financial data from the National Association of Insurance Commissioners. We examined changes to individual market health insurance premiums after the implementation of medical cannabis laws. We employed a robust difference-in-differences estimator that accounted for variation in policy timing to exploit temporal and geographic variation in state-level medical cannabis legalization.
Results:
Seven years after the implementation of Medical Cannabis laws, we observe lower health insurer premiums in the individual market. Starting seven years post-MCL implementation, we find a reduction of $-1662.7 (95% confidence interval [CI -2650.1, -605.7]) for states which implemented MCLs compared to the control group, a reduction of -$1541.8 (95% confidence interval [CI 2602.1, -481.4]) in year 8, and a reduction of $-1625.8, (95% confidence interval [CI -2694.2, -557.5]) in year 9. Due to the nature of insurance pooling and community rating, these savings are appreciated by cannabis users and non-users alike in states that have implemented MCLs.
Conclusions:
The implementation of MCLs lowers individual-market health insurance premiums. Health insurance spending, including premiums, comprises between 16% and 34% of household budgets in the United States. As healthcare costs continue to rise, our findings suggest that households that obtain their health insurance on the individual (i.e., not employer sponsored) market in states with MCLs appreciate significantly lower premiums.
Thirty-six states have legalized medical marijuana and 18 states have legalized the use of marijuana for recreational purposes. In this paper, we review the literature on the public health consequences of legalizing marijuana, focusing on studies that have appeared in economics journals as well as leading public policy, public health, and medical journals. Among the outcomes considered are: youth marijuana use, alcohol consumption, the abuse of prescription opioids, traffic fatalities, and crime. For some of these outcomes, there is a near consensus in the literature regarding the effects of medical marijuana laws (MMLs). As an example, leveraging geographic and temporal variation in MMLs, researchers have produced little credible evidence to suggest that legalization promotes marijuana use among teenagers. Likewise, there is convincing evidence that young adults consume less alcohol when medical marijuana is legalized. For other public health outcomes such as mortality involving prescription opioids, the effect of legalizing medical marijuana has proven more difficult to gauge and, as a consequence, we are less comfortable drawing firm conclusions. Finally, it is not yet clear how legalizing marijuana for recreational purposes will affect these and other important public health outcomes. We will be able to draw stronger conclusions when more posttreatment data are collected in states that have recently legalized recreational marijuana. (JEL I12, I18, K32, K42, R41)
We study whether the work capacity of the older working population responds to improved pain management therapy access. We use the adoption of state recreational marijuana laws (RMLs) as a large policy shock to access to a non‐pharmaceutical pain management option. We focus on workers’ compensation cash benefit receipt as a measure of work capacity, finding that receipt declines in response to RML adoption. Workers’ compensation cash benefits are awarded to workers who require time away from work to recover from an injury, which arguably captures a policy‐relevant aspect of work capacity. We observe similar shifts in complementary proxies for work capacity, including work‐limiting disability rates. After considering a range of alternative mechanisms, the evidence suggests that the primary driver of the reductions in workers’ compensation benefits is improvements in work capacity. This article is protected by copyright. All rights reserved
The newly emerged pandemic poses several socioeconomic crises as globally. Among social crisis drug overdose is increased during pandemic COVID-19 in different parts of the world. These paper reviewed issue related to the effect of corona virus on increament of opoid overdose mortality. Although the health consequences of the pandemic remain unclear evidence suggests there have been challenges in maintaining substance use disorder treatment and a recent content review of COVID-19 and addiction suggests risk of increases in prevalence of withdrawal symptoms and addictive behaviors including relapse. A quick action to prevent the crisis should be implemented as globally.
Significant support exists in the United States for legalization of marijuana/cannabis. As of 2021, 36 states and four territories approved the legalization of medical cannabis via medical marijuana laws (MMLs), and 15 states and District of Columbia (DC) have adopted recreational marijuana laws (RMLs). We performed structured and systematic searches of articles published from 2010 through September 2021. We assess the literature pertaining to adolescent marijuana use; opioid use and opioid-related outcomes; alcohol use; tobacco use; illicit and other drug use; marijuana growing and cultivation; employment, earnings, and other workplace outcomes; academic achievement and performance; criminal activity; perceived harmfulness; traffic and road safety; and suicide and sexual activity. Overall, 113 articles satisfied our inclusion criteria. Except for opioids, studies on use of other substances (illicit drugs, tobacco, and alcohol) were inconclusive. MMLs and RMLs do not generate negative outcomes in the labor market, lead to greater criminal activity, or reduce traffic and road safety.
We use the staggered roll out of medical marijuana laws (MMLs) as a plausibly exogenous shock to individuals’ marijuana used to identify the effect of marijuana on labour-market outcomes. While our analysis largely confirms that MMLs do not affect labour market outcomes, we find two results that are not seen in the prior literature. We find that MMLs increase the probability that a 30–39 year-old woman is in the labour force, and decrease the time that unemployed 20–29 year-old men spend looking for a job. While both results are imprecisely estimated, they are generally robust to a large number of robustness checks we employ.
Legalizing marijuana for medical purposes is a longstanding debate. However, evidence of marijuana's health effects is limited, especially for young adults. We estimate the health impacts of medical marijuana laws (MML) in the U.S. among young adults aged 18–29 years using the difference-in-differences method and data from the Behavioral Risk Factors Surveillance System. We find that having MMLs with strict regulations generate health gains, but not in states with lax regulations. Our heterogeneity analysis results indicate that individuals with lower education attainments, with lower household income and without access to health insurance coverage gain more health benefits from MML with strict regulations than from MML with lax regulations. The findings suggest greater net health gains under strict controls concerning marijuana supply and access.
Globally cannabis regulations are rapidly changing. In recent years social and political pressure, not science, has driven this change. Experience from jurisdictions that have implemented regulatory change, although relatively new, should be used to inform future policy development for other jurisdictions, assisting in addressing the wicked problem that cannabis regulations present. This review aimed to elicit underlying themes from a broad range of literature exploring the effects of regulatory change relating to cannabis. To achieve this a meta-narrative theoretical approach using inductive constant comparative analysis was used to synthesize data until thematic saturation was reached. Following a systematic literature search, 92 papers were analyzed before thematic saturation was complete. Five super-ordinate themes emerged that observed the societal and health effects following legislative and regulatory change: Normalization; Economics; Gatekeeping; Community and Health. These themes, empirically derived through a formal qualitative approach, were considered regarding cultural contexts, providing an understanding of how cannabis regulation is changing the social landscape. Consideration of the themes during future research may provide a focus point for the discussion of legislation and policy, not only relating to cannabis, but also other broad-ranging areas such as social policy, welfare, education and health.
Using US panel data on young workers, we demonstrate that those who receive performance pay are more likely to consume alcohol and illicit drugs. Recognizing that this likely reflects worker sorting, we first control for risk, ability, and personality proxies. We further mitigate sorting concerns by introducing worker fixed effects, worker-employer match fixed effects, and worker-employer-occupation match fixed effects. Finally, we present fixed effect IV estimates. All of these estimates continue to indicate a greater likelihood of substance use when a worker receives performance pay. The results support conjectures that stress and effort increase with performance pay and that alcohol and drug use is a coping mechanism for workers.
In August 2012, the Arizona Department of Health Services conducted a lottery to allocate licenses for the state's first medical marijuana dispensaries. The lottery randomly selected an applicant within each of 69 contested Community Health Analysis Areas to open a dispensary. By comparing 36 zip codes with winning applications to 48 zip codes with losing applications and weighting using propensity scores based on the true probability of winning, we estimate the causal effect of the allocation of a dispensary on the emergency room visits of residents of that zip code. Outcomes of interest are emergency room visits for acute symptoms caused by cannabis, opioids, alcohol, and cocaine. Using emergency room discharge data from 2010 to 2016, we find evidence of an increase in visits for acute cannabis‐related causes for the winning set of zip codes and weak evidence of an increase in visits for opioid‐related causes. The results indicate that in the four years following the lottery, emergency room visits for acute cannabis causes rose by approximately 45% in allocated zip codes relative to non‐allocated zip codes. Because of the high likelihood of spillovers to neighboring zip codes, these effects are likely underestimates.
We use retail scanner data on purchases of alcoholic beverages across US counties for 2006 to 2015 to study the link between medical marijuana laws (MMLs) and alcohol consumption. To do this, we exploit differences in the timing of marijuana laws among states and find that they are substitutes. We show that unlike traditional national‐level analysis, focusing on contiguous‐border county pairs provides unbiased estimates of the effect of MMLs on alcohol sales. Specifically, alcohol sales in counties located in MML states decreased by 12.4%. Results are robust to including placebo effective dates for MMLs in treated states.
Résumé
Marijuana et alcool: analyse transfrontalière et données relatives à la vente au détail. Afin d’étudier la corrélation entre les lois sur la marijuana médicale (LMM) et la consommation d’alcool, nous nous sommes appuyés sur les données de vente au détail de boissons alcoolisées dans différents comtés des États‐Unis entre 2005 et 2016. À cette fin, nous avons d’abord exploité le décalage dans le temps des mises en œ uvre des LMM dans les états concernés, et avons découvert qu’alcool et marijuana se substituaient l’un à l’autre. Nous montrons également qu’une analyse réalisée sur des paires de comtés transfrontaliers, contrairement à une étude traditionnelle réalisée à l’échelle nationale, permettait de fournir des évaluations fiables relativement à l’incidence des LMM sur les ventes d’alcool. Plus précisément, le volume mensuel des ventes d’alcool dans les comtés situés dans des états ayant passé des lois sur la marijuana médicale a diminué de 12, 4 %. Les résultats restent robustes même en intégrant de fausses dates de mise en œ uvre des LLM dans les états étudiés.
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.
This study contributes to recent work on the relationship between minimum wages and health by examining potential underlying mechanisms. Specifically, the roles of health insurance, health care access and utilization are explored. By analyzing Current Population Survey data for the years 1989–2009 and by estimating DD models, I find that higher minimum wages increase health insurance coverage, in particular individually purchased insurance, among low-educated individuals. By estimating data from the Behavioral Risk Factor Surveillance System for the same period, I furthermore provide evidence for improvements in health care access/affordability and increased health care utilization following minimum wage increases.
This study is the first to estimate the impact of state medical marijuana laws (MMLs) on labor market outcomes. First, using data from the National Survey of Drug Use and Health, we document that MMLs are associated with an increase in marijuana consumption among younger and older adult males, consistent with increases in use for both recreational and medicinal purposes. Then, using data from the Current Population Survey Outgoing Rotation Groups, we find no evidence that MMLs affect employment, hours, or wages among working-age adults, including among demographic groups whose marijuana consumption is most impacted by MMLs. Medical marijuana laws that provide access to open marijuana dispensaries only moderately depress wages among young men. We conclude that the labor market effects of MMLs are small.
We use retail scanner data on purchases of alcoholic beverages across US counties for 2006-2015 to study the link between medical marijuana laws (MMLs) and alcohol consumption. To do this we first exploit differences in the timing of marijuana laws among states and find that they are substitutes. We show that unlike traditional national-level analysis, focusing on contiguous border county-pairs provides unbiased estimates of the effect of MMLs on alcohol sales. Specifically, counties located in MML states reduced monthly alcohol sales by 12.4 percent. Results are robust to including placebo effective dates for MMLs in treated states.
This study investigates whether minimum wage increases impact worker health in the United States. We consider self-reported measures of general, mental, and physical health. We use data on lesser-skilled workers from the 1993 to 2014 Behavioral Risk Factor Surveillance Survey. Among men, we find no evidence that minimum wage increases improve health; instead, we find that such increases lead to worse health outcomes, particularly among unemployed men. We find both worsening general health and improved mental health following minimum wage increases among women. These findings broaden our understanding of the full impacts of minimum wage increases on lesser-skill workers. (JEL I1, I11, I18)
To date, 16 states have passed medical marijuana laws, yet very little is known about their effects. Using state-level data, we examine the relationship between medical marijuana laws and a variety of outcomes. Legalization of medical marijuana is associated with increased use of marijuana among adults, but not among minors. In addition, legalization is associated with a nearly 9 percent decrease in traffic fatalities, most likely to due to its impact on alcohol consumption. Our estimates provide strong evidence that marijuana and alcohol are substitutes.
One way to avoid detection of law enforcement officials if you are engaging in illegal activities is to wear a seatbelt. Therefore, an unintended consequence of laws allowing people to possess marijuana for medical purposes is that seatbelt use may decline among groups whose possession of marijuana is now legal. We find a decrease in seatbelt use among middle-aged males, providing evidence that drivers use seatbelts as a means to avoid police interaction. We find no such reduction in seatbelt use among those less likely to possess medical marijuana cards. Our evidence supports the contention that drivers use seatbelts more if they fear interaction with law enforcement officials, which is consistent with evidence of heightened seatbelt use among drunk drivers. These findings are important in understanding how to best design traffic safety laws and enforce them.
Using a large representative data set for Germany, this study contrasts absenteeism of self-employed individuals and paid employees by estimating hurdle models. We find that absence from work is clearly less prevalent among the self-employed than among paid employees. Only to a small extent, this difference can be traced back to differences in health status and job satisfaction. Furthermore, the gap in absenteeism does not seem to be driven by different behaviour in case of sickness as we find no clear difference in the prevalence of presenteeism between the two groups. We suspect that different behaviour in case of healthiness plays a role, highlighting potential shirking and moral hazard problems in paid employment.
To date, 19 states have passed medical marijuana laws, yet very little is known about their effects. The current study examines the relationship between the legalization of medical marijuana and traffic fatalities, the leading cause of death among Americans ages 5–34. The first full year after coming into effect, legalization is associated with an 8–11 percent decrease in traffic fatalities. The impact of legalization on traffic fatalities involving alcohol is larger and estimated with more precision than its impact on traffic fatalities that do not involve alcohol. Legalization is also associated with sharp decreases in the price of marijuana and alcohol consumption, which suggests that marijuana and alcohol are substitutes. Because alternative mechanisms cannot be ruled out, the negative relationship between legalization and alcohol-related traffic fatalities does not necessarily imply that driving under the influence of marijuana is safer than driving under the influence of alcohol.
The possible medicinal uses of cannabis are growing, yet research on how patients use medical cannabis facility services remains scarce. This article reports on the Cannabis Care Study, in which 130 medical cannabis patients at seven facilities in the San Francisco Bay Area were surveyed to gather information about demographics, personal health practices, health outcomes, service use, and satisfaction with medical cannabis facilities. The study was modeled after Andersen's Behavioral Model of Health Services Use. Results show that patients tend to be males older than 35, identify with multiple ethnicities, and report variable symptom duration and current health status. Nearly half the sample reported substituting cannabis for alcohol and illegal drugs; 74% reported substituting it for prescription drugs. Satisfaction did not differ across study sites and was significantly higher than nationally reported satisfaction with health care. Implications for the medical cannabis community and the greater system of health and social care are discussed.
For more than a decade, medical marijuana has been at the forefront of the marijuana policy debate in the United States. Fourteen states allow physicians to recommend marijuana or provide a legal defense for patients and physicians if prosecuted in state courts; however, little is known about those individuals using marijuana for medicinal purposes and the symptoms they use it for. This study provides descriptive information from 1,655 patients seeking a physician's recommendation for medical marijuana, the conditions for which they seek treatment, and the diagnoses made by the physicians. It conducts a systematic analysis of physician records and patient questionnaires obtained from consecutive patients being seen during a three month period at nine medical marijuana evaluation clinics belonging to a select medical group operating throughout the State of California. While this study is not representative of all medical marijuana users in California, it provides novel insights about an important population being affected by this policy.
This research examines absence as a response to a non-optimal labor market equilibrium. Its basic premise is that workers may be using absenteeism to move themselves closer to an optimal equilibrium in situations where, due to greater than desired work hours, the worker's marginal rate of substitution of income for leisure (MRS) is less than the wage rate for the last hour worked. This notion is tested for a sample of workers using Tobit analysis with individual data from company records on absence and wages and an empirical measure of each worker's MRS. The results indicate a significant positive relationship between absence and the difference between a worker's MRS and wage.
The aim was to study the extent and type of health service utilisation, medication habits, and sickness absence due to the primary headaches.
This was a cross sectional epidemiological survey of headache disorders in a general population. Headache was diagnosed according to a structured interview and a neurological examination using the criteria of the International Headache Society.
A random sample of 25-64 year-old individuals was drawn from the Danish National Central Person Registry. All subjects were living in the Copenhagen County.
740 subjects participated (76% of the sample); 119 had migraine and 578 had tension type headache.
Among subjects with migraine 56% had, at some time, consulted their general practitioner because of the migraine. The corresponding percentage among subjects with tension type headache was 16. One or more specialists had been consulted by 16% of migraine sufferers and by 4% of subjects with tension type headache. The consultation rates of chiropractors and physiotherapists were 5-8%. Hospital admissions and supplementary laboratory investigations due to headache were rare (< 3%). Half of the migraine sufferers and 83% of subjects with tension type headache in the previous year had managed with at least one type of drug in the current year. Acetylsalicylic acid preparations and paracetamol were the most commonly used analgesics. Prophylaxis of migraine was used by 7%. In the preceding year 43% of employed migraine sufferers and 12% of employed subjects with tension type headache had missed one or more days of work because of headache. Most common was 1-7 days off work. The total loss of workdays per year due to migraine in the general population was estimated at 270 days per 1000 persons. For tension type headache the corresponding figure was 820. Women were more likely to consult a practitioner than men, whereas no significant sex difference emerged as regards absenteeism from work.
The impact of the headache disorders on work performance in the general population is substantial, and the disorders merit increased attention.
The regulation of alcohol availability has the potential to influence worker productivity. This paper uses legislative changes in bar opening hours to provide a potential quasi-natural experiment of the effect of alcohol availability on working effort, focusing on worker absenteeism. We examine two recent policy changes, one in England/Wales and one in Spain that increased and decreased opening hours respectively. We demonstrate a robust positive causal link between opening hours and absenteeism, although short-lived for Spain. The effect is long lasting for the UK where we provide evidence which suggests that increased alcohol consumption is a key mechanism.
We estimate the effect of medical marijuana laws (MMLs) in ten states between 2004 and 2012 on adolescent and adult use of marijuana, alcohol, and other psychoactive substances. We find increases in the probability of current marijuana use, regular marijuana use and marijuana abuse/dependence among those aged 21 or above. We also find an increase in marijuana use initiation among those aged 12-20. For those aged 21 or above, MMLs further increase the frequency of binge drinking. MMLs have no discernible impact on drinking behavior for those aged 12-20, or the use of other psychoactive substances in either age group.
Copyright © 2015 Elsevier B.V. All rights reserved.
Government influence on labor supply behavior through taxation and transfer policies is well understood. However, they also act to regulate the timing and extent of leisure activity. This has the potential to influence labor-leisure decisions. Legislative changes in bar opening hours provide a potential quasi-natural experiment of the effect of government regulation on working effort. This paper examines two recent policy changes, one in England/Wales and one in Spain that increased and decreased opening hours, respectively. A robust positive causal link between opening hours and absence is demonstrated. This indicates that alcohol policy has the potential to influence workforce productivity., seminar participants at the University of Wisconsin-Milwaukee and participants at the 4 th Annual Meeting on the Economics of Risky Behaviors, the 11 th IZA/SOLE Transatlantic Meetings, the 2012 EEA meetings in Malaga and the 2012 EALE meetings in Bonn for helpful comments. María Navarro gratefully acknowledges financial support from the Spanish CYCIT Research Project ECO2008-06395-C05-03/ECON.
Cannabis is the most popular illegal drug. Its legal status is typically justified on the grounds that cannabis use has harmful consequences. Empirically investigating this issue has been a fertile topic for research in recent times. We provide an overview of this literature, focusing on studies which seek to establish the causal effect of cannabis use on health, education, and labor market success. We conclude that there do not appear to be serious harmful health effects of moderate cannabis use. Nevertheless, there is evidence of reduced mental well-being for heavy users who are susceptible to mental health problems. While there is robust evidence that early cannabis use reduces educational attainment, there remains substantial uncertainty as to whether using cannabis has adverse labor market effects.
Objectives:
We estimated the association between legalizing medical marijuana and suicides.
Methods:
We obtained state-level suicide data from the National Vital Statistics System's Mortality Detail Files for 1990-2007. We used regression analysis to examine the association between medical marijuana legalization and suicides per 100 000 population.
Results:
After adjustment for economic conditions, state policies, and state-specific linear time trends, the association between legalizing medical marijuana and suicides was not statistically significant at the .05 level. However, legalization was associated with a 10.8% (95% confidence interval [CI] = -17.1%, -3.7%) and 9.4% (95% CI = -16.1%, -2.4%) reduction in the suicide rate of men aged 20 through 29 years and 30 through 39 years, respectively. Estimates for females were less precise and sensitive to model specification.
Conclusions:
Suicides among men aged 20 through 39 years fell after medical marijuana legalization compared with those in states that did not legalize. The negative relationship between legalization and suicides among young men is consistent with the hypothesis that marijuana can be used to cope with stressful life events. However, this relationship may be explained by alcohol consumption. The mechanism through which legalizing medical marijuana reduces suicides among young men remains a topic for future study.
This paper develops a model of dual labor markets based on employers' need to motivate workers. In order to elicit effort from their workers, employers may find it optimal to pay more than the going wage. This changes fundamentally the character of labor markets. The model is applied to a wide range of labor market phenomena. It provides a coherent framework for understanding the claims of industrial policy advocates. It also can provide the basis for a theory of occupational segregation and discrimination that will not be eroded by market forces. Finally, the model provides the basis for a theory of involuntary unemployment. Copyright 1986 by University of Chicago Press.
Previous studies suggest that problem drinkers have markedly increased sickness absence. However, it is not clear how more moderate alcohol consumption and abstinence relate to sickness absence. As part of the Whitehall II study the relationship between different drinking patterns and sickness absence is examined. A total of 10,314 male and female civil servants completed a baseline questionnaire about their drinking habits--the amount of alcohol consumed over the past 7 days and the frequency of drinking over the past 12 months. All sickness absence has been recorded prospectively. Drinking patterns and sickness absence are examined for short spells (< or = 7 days) and long spells (> 7 days) adjusting for other causes of sickness absence: age, grade of employment, smoking, work characteristics and baseline health. Alcohol consumption was strongly related to employment grade, the lower the grade the higher proportion of men and women reporting no alcohol consumption. For men the relation of alcohol intake to short spells of sickness absence (< or = 7 days) appeared to be U-shaped, for long spells (> 7 days) increased rates of absence were found only in frequent drinkers. There was no clear relationship for women, however higher rates of sickness absence were found in non-drinkers.
Marijuana and Medicine: Assessing the Science Base
- J E Joy
Joy, J. E., et al. 1999. Marijuana and Medicine: Assessing the Science Base. National Academies
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The Effect of Medical Marijuana Laws on Marijuana, Alcohol, and Hard Drug Use
- Wen
Play Hard, Shirk Hard?
- Green CP
Absence from work of the self-employed: a comparison with paid employees
- Lechmannds