# State Medical Cannabis Laws, Chronic Pain, and Opioids: A Mixed-Methods Approach

> **NIH NIH R01** · JOHNS HOPKINS UNIVERSITY · 2021 · $727,940

## Abstract

ABSTRACT
Thirty-three states and D.C. have enacted medical cannabis laws allowing patients with chronic non-cancer
pain to use cannabis, when recommended by a physician, to manage their condition. Policymakers are
increasingly considering state medical cannabis laws as a potential solution to the U.S. opioid crisis, with the
idea that some patients may substitute cannabis in place of prescription opioids for treatment of chronic non-
cancer pain and reduce rates of opioid use disorder and overdose as a result. However, rigorous evidence is
lacking: no studies have examined the effects of state medical cannabis laws on opioid-related outcomes
among a cohort of patients with chronic non-cancer pain. Further, no existing research has examined how
state medical cannabis laws affect chronic non-cancer pain patients’ receipt of guideline-concordant non-opioid
pain treatments or how such laws affect cannabis use disorder and poisoning among those with chronic non-
cancer pain conditions like low back pain or arthritis. Critically, no prior studies have considered how the
considerable variation in provisions and implementation across state medical cannabis laws, and within states
over time as states amend their laws and change implementation rules, affect outcomes for chronic pain
patients. Our study uses a mixed-methods approach incorporating quasi-experimental difference-in-differences
analyses; qualitative interviews with state policy and healthcare leaders; and representative surveys of
physicians who treat and patients who experience chronic non-cancer pain to fill these research gaps. Using
50-state data sources including Medicare and Optum UnitedHealthcare administrative claims data, we will
examine the effects of state medical cannabis laws on receipt of prescription opioid and guideline-concordant
non-opioid pharmacologic (e.g., anticonvulsants) and non-pharmacologic (e.g., physical therapy) pain
treatments (Aim 1). We will also use these data to examine the effects of state medical cannabis laws on
receipt of treatment for opioid use disorder, opioid overdose, cannabis use disorder, and cannabis poisoning
among patients with chronic non-cancer pain (Aim 2). We will conduct qualitative interviews with state policy
and healthcare system leaders to characterize implementation of state medical cannabis laws for treatment of
chronic non-cancer pain (Aim 3). Finally, we will conduct representative surveys with primary care physicians,
pain specialists, and patients with chronic non-cancer pain in states with medical cannabis laws. Surveys will
capture key attitudes and reported behaviors related to medical cannabis laws, including the degree to which
physicians report recommending and patients report using cannabis in place of opioids for treatment of chronic
non-cancer pain (Aim 4). In all Aims, we will consider how differences in law provisions and implementation
influence chronic pain treatment. Results will yield information needed by state decis...

## Key facts

- **NIH application ID:** 10199994
- **Project number:** 5R01DA049789-02
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Emma Elizabeth McGinty
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $727,940
- **Award type:** 5
- **Project period:** 2020-07-01 → 2024-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10199994

## Citation

> US National Institutes of Health, RePORTER application 10199994, State Medical Cannabis Laws, Chronic Pain, and Opioids: A Mixed-Methods Approach (5R01DA049789-02). Retrieved via AI Analytics 2026-05-22 from https://api.ai-analytics.org/grant/nih/10199994. Licensed CC0.

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