In states where medical and recreational marijuana are legal, fewer patients are taking medications to treat anxiety. This is the key finding of my recent study published in the journal JAMA Network Open.
I am an applied policy researcher studying the economics of risky behavior and substance use within the United States. My collaborators and I wanted to understand how medical and recreational cannabis laws and the opening of cannabis dispensaries affect prescription rates of anti-anxiety medications among patients with private health insurance.
These include:
Benzodiazepines work by increasing levels of gamma-aminobutyric acid (GABA), a neurotransmitter that produces sedation by reducing nervous system activity. This category includes the sedatives Valium, Xanax and Ativan, among others.
Antipsychotics, a class of drugs that address symptoms of psychosis in a variety of ways.
Antidepressants relieve symptoms of depression by affecting neurotransmitters such as serotonin, norepinephrine, and dopamine. The best-known examples of these are selective serotonin reuptake inhibitors (SSRIs).
We also add barbiturate sedatives and sleep medications (sometimes called "Z drugs"), both of which are used to treat insomnia. We did not estimate any policy implications for these two drugs compared with the other three drug classes.
We found consistent evidence that increases in cannabis access are associated with decreases in benzodiazepine prescriptions. "Number of prescriptions" refers to the number of prescriptions received by patients, not the number of prescriptions issued by doctors. This is based on calculating the rate of individual patients who fill prescriptions in a state, the average number of days of supply per prescription, and the average prescription filled per patient.
Notably, we found that not all national policies resulted in similar changes in prescription dispensing patterns.
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why this is important
In 2021, nearly 23% of U.S. adults reported having a diagnosable mental health disorder. However, only 65.4% of them reported receiving treatment within the past year. Lack of treatment may exacerbate current mental health disorders, leading to an increased risk of other chronic conditions.
Access to cannabis introduces alternative treatments to traditional prescription drugs, potentially providing easier access for some patients. Medical laws in many states allow medical marijuana use by patients with mental health disorders such as post-traumatic stress disorder (PTSD), while recreational laws expand access to all adults.
Our findings have important implications for insurance systems, prescribers, policymakers, and patients. Like opioid use, benzodiazepine use can be dangerous for patients, especially when the two classes of drugs are used together. Given the high proportion of opioid poisonings that also involve benzodiazepines (these drugs accounted for 14% of total opioid overdose deaths in 2020), our findings provide a strong basis for substituting cannabis in situations of potential abuse. Drugs provide insights.
Don't know what yet
Our study does not elucidate whether changes in dispensing patterns lead to measurable changes in patient outcomes.
There is some evidence that cannabis can be effective in treating anxiety disorders. If this is the case, switching from benzodiazepines (which can have serious side effects) to cannabis may improve patient outcomes.
This finding is critical given that approximately 5% of the U.S. population takes benzodiazepines. Alternatives to marijuana have the potential to reduce negative side effects nationwide, but it's unclear whether marijuana is equally effective in treating anxiety.
Our study also found a small, albeit less significant, increase in the dispensing of antipsychotics and antidepressants. But it's unclear whether marijuana use, especially recreational use, increases the incidence of mental disorders and depression.
While we found that, overall, marijuana use was associated with increased use of antidepressants and antipsychotics, some states saw decreases in use.
The details of state marijuana laws vary widely, some of which may contribute to these meaningful differences in results. I think the variation in state results is an important finding for policymakers who might want to tailor laws to specific goals.
A research profile is a short introduction to interesting academic work.