Medical Cannabis Laws Combined with Prescription Monitoring Reduced Chronic Pain Outpatient Visits

Prescription drug monitoring programs alone were not associated with changes in chronic pain outpatient visits. However, in states where medical cannabis laws were also present, patients had 19% lower odds of chronic pain-related outpatient visits (aOR = 0.81, 95% CI: 0.71-0.92). Neither policy combination was associated with changes in emergency department visits for chronic pain.

Researchers created annual cohorts of Medicaid enrollees with chronic pain diagnoses using national Medicaid claims data from 2002-2013 and 2016. Negative binomial hurdle models compared three state-level conditions: no PDMP, PDMP without MCL, and PDMP with MCL. The sample of nearly 4.9 million patients was primarily female (67.2%) and ages 40-55.

As states have simultaneously tightened opioid prescribing (through PDMPs) and expanded cannabis access, patients with chronic pain are navigating both policy shifts. The reduction in outpatient visits where both policies exist may indicate patients are self-managing pain with cannabis rather than seeking conventional treatment.

This study captures a critical period in U.S. drug policy when prescription monitoring programs were expanding alongside medical cannabis access. The shift away from outpatient pain management in MCL states raises both possibilities and concerns: patients may be finding effective relief through cannabis, or they may be losing connection with clinical pain management.

Medicaid claims data cannot determine whether reduced visits reflect improved self-management or disengagement from care. The study period (2002-2016) precedes the major wave of recreational legalization. Cannabis use itself was not directly measured, only inferred from state-level policy.