Association for Public Policy Analysis & Management

By July 2019, cannabis legalization had spread across the United States with medical cannabis legally available through dispensaries in the majority of states, recreational cannabis use legalized in eleven, and recreational dispensaries operating in four of those eleven. Increasing levels of legalization have dramatically lowered the acquisition and consumption costs associated with cannabis use with two possible effects. One, decreasing costs might differentially increase access among patients with particularly high costs of access, e.g., the very sick or risk averse, or it might bring in patients with lower expected benefits for whom the net benefits have now turned positive due to the decrease in costs. Using a panel fixed effects regression model and data on more than 70,000 mobile software app-tracked medicinal cannabis use sessions completed by almost 3,000 cannabis users, we find evidence of both effects. Medical legalization increases the average starting symptom level by 2.5 points (on a 1-10 scale, p<0.01) and extends documented symptom relief by -2.5 points (range [-10,9], p<0.01) among women, a typically risk averse population, while medical dispensaries in particular provide a sicker population access, with effects strongest among novice cannabis users (1.33 points, p<0.01) and men (0.96 points, p<0.01). Medical dispensaries do not appear to increase the benefits of cannabis use, in terms of symptom relief, relative to medical legalization alone. Recreational legalization (without or prior to dispensary entry) extenuates the effect of medical legalization, again driven by women. Recreational dispensaries, however, lead to use for less severe conditions (-0.85 points, p<0.01) with reduced benefits experienced (1.11 points, p<0.05). Users in states where cannabis is illegal or where recreational dispensaries exist are the most likely to report feeling “high” while consuming cannabis medicinally.

These results suggest that medical and recreational cannabis laws remove barriers to treatment for patients with higher costs of entry, in terms of legal risk and symptom severity, with these effects driven by females, a typically more risk averse population. Medical dispensaries may further remove important barriers to access for sicker users, particularly novice male users. Recreational dispensaries, on the other hand, appear to so significantly lower barriers to medicinal cannabis use that these users are not only less sick but also document lower levels of symptom relief and are more likely to report feeling “high.” Our results suggest that cannabis legalization and medical dispensary access significantly benefit some patients, while recreational cannabis dispensaries extend use to less severe medical conditions with reduced therapeutic benefit from its use.