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Substance Use, Health, and Mental Health Outcomes in States with and without Medical Marijuana Laws

Cristiana Nelise de Paula Araujo
University of Florida

Co-Authors: JeeWon Cheong1, Ali M. Yurasek1
1University of Florida

Many states within the US have enacted medical marijuana laws (MML). However, how MML may impact the prevalence of marijuana, other substance use, and mental health conditions remains unclear. The purpose of this study was to examine differences in substance use, general health, and mental health outcomes in states with and without MML.

This study was a secondary data analysis of the Behavioral Risk Factor Surveillance System (BRFSS) publicly available data collected in 2020 by the Centers for Disease Control and Prevention (CDC). Of 22 states that elected the marijuana use module, 14 states had passed MML (n = 143,151) and 8 states had not (n = 67,744). We used ordinary least squares (OLS) multiple regression analyses for continuous outcome variables and logistic regression analyses for the binary outcomes. For count data outcome variables (e.g., the number of days using marijuana), we used generalized linear modeling with zero-inflated negative binomial distribution in SAS.

People living in states with MML were more likely to be marijuana users (p < .001) and have higher levels of marijuana use (p < .05), compared to those in non-MML states. Similarly, those living in MML states were more likely to be cigarette smokers and have used e-cigarettes (ps < .01). However, residents in MML states were more likely to be non-drinkers, non-binge drinkers, and less likely to drive under the influence (ps < .01), compared to those in non-MML states. Although those in MML states reported experiencing better general health (p < .001), they reported significantly worse mental health, including more days feeling stressed, depressed or having emotional problems, having depressive disorder, and having fewer hours of sleep (ps < .001).

Residents of MML states may be at increased risk to use marijuana and cigarettes as well as experience more mental health symptoms. Although it is unclear if MML influenced those health outcomes or if those with more negative health outcomes are more likely to live in MML states, the findings suggest that MML states should ensure adequate access to substance use and mental health treatment beyond medical marijuana.

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