Browsing by Subject "Medical cannabis"

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    The Effect of Cannabis Laws on Access to Pain Medications among Commercially Insured Patients in the United States
    (Elsevier, 2022-12-11) Lozano-Rojas, Felipe; Abraham, Amanda; Gupta, Sumedha; Bradford, David; School of Public and Environmental Affairs
    Chronic pain is a major trigger for opioid prescribing in the U.S. Further, 35 U.S. states and the District of Columbia have adopted medical cannabis laws (MCLs), and chronic pain is the most common condition qualifying for medical cannabis access. Little is known about how legal access to medical cannabis has changed prescribing patterns for commercially insured Americans. In this article, we estimate a series of state-by-state synthetic control case-studies (29 cases, across 22 states in two policy levers for which observable pre-and post- policy timeframe comply with our eligibility criteria), using data from a nationwide comprehensive commercial claims database with approximately 15 – 20 million patients per year. We assess changes in patterns of opioid analgesic and non-opioid pain medications dispensed, capturing both intensive and extensive margins. The methodology allows us to construct a stable counterfactual in the pre-policy period for each case and to accommodate heterogeneity across treated units and their treatment timing. In all except two of the 22 examined states we find reductions in the rate of patients receiving any dispensed prescriptions of opioids (extensive margin) following the implementation of an MCL, the majority of which are statistically significant at conventional levels. We also find a marginally significant reduction in the intensive margin, measured as both the average daily supply of dispensed prescriptions and as the average number of dispensed prescriptions per patient. When we focus on other non-opioid pain medications, we do not find such a clear pattern, with very few significant effects emerging following the introduction of MCLs. Our study highlights the large variation in positive spillovers of MCLs on prescription opioid utilization among commercially insured Americans across U.S. states. Findings suggest that cannabis may offer an alternative for pain management with opioid analgesics. Thus, policymakers should consider MCLs as an alternative tool for pain management, specifically when other policies that constrain supply of opioids might push some Americans to more harmful substances.
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    Three Essays in Health Economics: Policy and Natural Shocks in Healthcare Provision and Patient Outcomes
    (2022-11) Shone, Hailemichael Bekele; Gupta, Sumedha; Royalty, Anne Beeson; Simon, Kosali; Tennekoon, Vidhura; Boukai, Ben
    Policy and natural shocks are exogenous factors, which may disrupt patients’ ability to access recommended health care. My dissertation investigates the effect of recent natural and policy shocks in health care provision on different patient outcomes. The first chapter studies the effect of the 2014 Ebola virus epidemic in West Africa on maternal health care utilization and infant health in Sierra Leone. The Epidemic resulted in the diversion of the limited health care resource away from other services to care for Ebola patients. It also led to maternal stress from fear of infection and community breakdown. The results show the outbreak led to significant decline in maternal health care utilization and infant birth weight. The second chapter examines whether physician practices that are vertically integrated with hospitals provide healthcare at higher costs than non-integrated practices in a Medicare patient population. The degree of integration is exogenously assigned to a patient following a geographical move. The study finds that switching to integrated practice increases health care utilization and spending. Although integration may increase quality of care, the increase in spending suggests the need for a continuing attention to policies and incentives that are associated with integration. Finally, the third chapter documents the impact of the recent changes in state medical and recreational cannabis access laws in the United States on health care utilization. The liberalization of access to cannabis may enable patients to substitute cannabis for another prescription and non-prescription health care services. The results show a significant decline in the utilization of emergency and outpatient services among patients with chronic pain for the states that legalized cannabis. The effect is mainly due to medical cannabis laws, whereas the effect of recreational cannabis is ambiguous. The three chapters, taken together, show that exogenous shocks, such as natural shocks and government policy, affect health care utilization and the health of individuals. Health policies should, therefore, target developing a resilient health care system that withstands natural shocks and promote policies that provide better treatment alternatives.