Recreational cannabis dispensary access effects on prescription opioid use and mortality

Abstract

While opioid prescribing rates have fallen since 2012, opioid mortality in the United States (US) climbed to record highs in 2022, per CDC reports. In the last decade, evidence emerged that recreational cannabis legislation (RCL) may help mitigate adverse opioid-related outcomes. Yet, the empirical evidence on the relationship between RCL and opioid misuse as a whole is inconsistent and possibly spurious, given common estimation methods. Studies reporting beneficial associations between RCL and opioid mortality tend to avoid the mechanism of change, often assuming mortality benefits stem from substituting cannabis for opioids. We test this relationship using prescription opioid quantities and access to recreational cannabis in the US state of Oregon. Our approach uses within-state variation in distance to recreational dispensary access generated by RCL and prior volumes of legal opioid use to assess the impact of dispensary access on prescription opioids. Results suggest that communities located closer to recreational dispensaries are associated with lower rates of prescription opioids per capita. We also show that reasonable bounds to our primary specification suggest communities located within a mile from a recreational dispensary have prescription opioid rates per capita that are 1.0–3.9 percent lower than surrounding communities. Despite the reduction, we find no evidence that reducing barriers to cannabis access and subsequent declines in prescription opioids are associated with meaningful changes in opioid mortality.