Association for Public Policy Analysis & Management

Panel: Impacts of State-Level Substance Abuse Policies on Individual Health and Health Care Costs

(Health Policy)

There is significant variation across US states in the types and strength of policies that restrict and regulate substance use. This session contains four papers that focus on the effects of various state-level substance use and abuse policies on individual health outcomes Each of the studies use the naturally occurring, arguably exogenous, variation in state policies across time to identify the effects of alcohol, marijuana, other illicit drug use. The first two studies focus on state-level medical marijuana legislation. Using the 1994-2010 surveys of the Behavioral Risk Factor Surveillance System, the first paper examines if the passing of a medical marijuana law affects cigarette use. Preliminary results suggest that probability of smoking increases for adult men, particularly in states that allow dispensaries and in-home cultivation of medical marijuana. The second paper compares changes in physician prescription behavior in states with and without medical marijuana laws using Medicare Part D enrollee data. The existing literature has paid close attention to downstream negative externalities associated with medical marijuana laws, but no studies to-date have examined whether proximal clinical behaviors are significantly impacted in states with medical marijuana laws. The third and fourth papers use the Healthcare and Cost Utilization Project (HCUP) data to examine the effects of illicit drug use and alcohol policies on hospital-related outcomes and costs. The third paper focuses on the criminalization of prenatal substance use. There is substantial variation among states with respect to how the law defines prenatal substance abuse, whether prenatal substance abuse is a criminal offense, and the consequences. This variation across time is used to identify the effects of prenatal substance abuse on outcomes for both mothers and their infants. The final paper focuses on the American College of Surgeons Committee on Trauma mandate announced in 2007 that required all Level I trauma centers must provide routine screening and brief intervention for risky alcohol use. Using data from Arizona, the mandate was associated with a large and statistically significant reduction in the probability of a reduction and a negligible impact on health care costs. Combined, these four studies present evidence on how state-level substance abuse policies can impact public health. Given the significant internal and external costs associated with substance abuse, the extent to which state-level actions affect individual behaviors is an important policy question. Understanding the benefits, costs, and unintended consequences associated with existing state-level substance use policies supports the dissemination of effective policies to other states and informs future federal policy debates on alcohol, medical marijuana, and other illicit drug regulation.