States with cannabis laws saw lower benzodiazepine use but higher antidepressant prescriptions
Medical and recreational cannabis laws were associated with a 12-15% reduction in benzodiazepine fills but increases in antidepressant and antipsychotic prescriptions among commercially insured patients.
Quick Facts
What This Study Found
Medical cannabis laws were associated with a 12.4% reduction in benzodiazepine fill rates, and recreational laws with a 15.2% reduction. Meanwhile, medical cannabis laws were associated with a 3.8% increase in antidepressant fills, and medical dispensary openings with an 8.8% increase.
Key Numbers
3.85 million patients in the primary benzodiazepine sample. 12.4% reduction in benzo fill rate with medical cannabis laws. 15.2% reduction with recreational laws. 3.8% increase in antidepressant fills with medical laws. 8.8% increase with medical dispensary openings. 65.4% of the benzodiazepine sample were women.
How They Did This
Cross-sectional analysis of 10 million commercially insured patients from 2007-2020 using Optum claims data. A synthetic control method compared prescribing patterns across states with different cannabis policy timelines, examining medical/recreational laws and dispensary openings.
Why This Research Matters
The finding that cannabis laws may shift prescribing patterns away from benzodiazepines (which carry overdose risk) while increasing antidepressant use suggests cannabis policy may have complex, drug-class-specific effects on mental health treatment.
The Bigger Picture
This adds to growing evidence that cannabis legalization does not simply add substance use on top of existing medication patterns. Instead, it appears to reshape prescribing in ways that vary by drug class, potentially reflecting substitution effects or changes in how patients and clinicians approach mental health treatment.
What This Study Doesn't Tell Us
Cross-sectional design cannot establish causation. Commercially insured patients may not represent Medicaid or uninsured populations. The study cannot determine whether patients who reduced benzodiazepine use actually substituted cannabis. State-level heterogeneity was substantial.
Questions This Raises
- ?Are patients actively substituting cannabis for benzodiazepines, or are clinicians prescribing differently?
- ?Why did antidepressant prescriptions increase with cannabis laws?
- ?Do these prescribing shifts translate to better or worse patient outcomes?
Trust & Context
- Key Stat:
- 12.4% reduction in benzodiazepine fills with medical cannabis laws
- Evidence Grade:
- Large dataset of 10 million patients with synthetic control methodology, though the cross-sectional design limits causal conclusions and state-level variation was considerable.
- Study Age:
- Published in 2024 in JAMA Network Open, covering data through 2020.
- Original Title:
- Cannabis Laws and Utilization of Medications for the Treatment of Mental Health Disorders.
- Published In:
- JAMA network open, 7(9), e2432021 (2024)
- Authors:
- Bradford, Ashley C(2), Lozano-Rojas, Felipe(3), Shone, Hailemichael Bekele(2), Bradford, W David, Abraham, Amanda J
- Database ID:
- RTHC-05155
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Did cannabis laws reduce all psychiatric medication use?
No. Benzodiazepine fills decreased, but antidepressant and antipsychotic fills increased. The effects varied by drug class, suggesting cannabis policy does not uniformly reduce psychiatric prescribing.
Does this mean people are replacing benzos with cannabis?
The study found an association but cannot confirm direct substitution. Other explanations include changes in clinician prescribing behavior or shifts in how patients seek mental health treatment after cannabis becomes available.
How large was this study?
It analyzed data from over 10 million commercially insured patients across the US from 2007 to 2020, making it one of the largest studies on cannabis policy and prescription medication patterns.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-05155APA
Bradford, Ashley C; Lozano-Rojas, Felipe; Shone, Hailemichael Bekele; Bradford, W David; Abraham, Amanda J. (2024). Cannabis Laws and Utilization of Medications for the Treatment of Mental Health Disorders.. JAMA network open, 7(9), e2432021. https://doi.org/10.1001/jamanetworkopen.2024.32021
MLA
Bradford, Ashley C, et al. "Cannabis Laws and Utilization of Medications for the Treatment of Mental Health Disorders.." JAMA network open, 2024. https://doi.org/10.1001/jamanetworkopen.2024.32021
RethinkTHC
RethinkTHC Research Database. "Cannabis Laws and Utilization of Medications for the Treatme..." RTHC-05155. Retrieved from https://rethinkthc.com/research/bradford-2024-cannabis-laws-and-utilization
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.