Association for Public Policy Analysis & Management

The use and abuse of prescription and illegal opioids has contributed to tens of thousands of overdose deaths each year, and states have responded to the crisis with prescription drug monitoring laws, Good Samaritan laws, Naloxone liability laws, additional law enforcement, and treatment programs. Separately and typically not in response to the opioid crisis, thirty-three states have adopted medical or recreational cannabis laws since 1996. Some argue that marijuana use could be a gateway to opioid drugs, but others suggest that it could be a pain relief alternative that could reduce opioid use or abuse. Further, marijuana does not affect the opioid receptors in the brain, and marijuana use is not affected by Vivitrol, a drug that blocks opioid receptors and is often used after drug detox, treatment, or release from prison. Some evidence suggests that states with medical or recreational cannabis laws may experience reduced opioid overdose death rates. Using CDC Wonder data for opioid overdose death rates for the states from 1999 to 2016, we test models that include state variation in prescription drug monitoring laws, Good Samaritan laws, Naloxone liability laws, law enforcement, Medicaid spending, treatment programs, demographics and economic factors. Further, the models test the variation in state cannabis laws, such as the implementation of recreational and medical cannabis laws, but also differences in the allowance of the number of plants that can cultivated, regulations on growers, possession of usable ounces of cannabis, whether smoking of cannabis is allowed, licenses for dispensaries, whether dispensaries must be nonprofit, a minimum age of 21 for dispensary ownership, restrictions on sales to out-of-state residents, and local government restrictions. The results suggest that the type of cannabis policy regime matters as those states allowing cultivation and those with stricter dispensary regulation experience greater reductions in opioid overdose death rates.