The Effect of Medical Cannabis Laws on Health Care Use in Insured Populations with Pain-S1

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Project Summary The COVID-19 pandemic has substantially disrupted routine healthcare and exacerbated existing barriers to healthcare access for the population. Our proposal will provide new evidence on the impact of the COVID-19 pandemic for a particularly vulnerable population: postpartum women. Approximately two-thirds of women report pain that interferes with Activities of Daily Living at 24 hours postpartum; 6 to 18% of women experience chronic pain after delivery. Thus, disruption to routine healthcare has the potential to substantially worsen pain and subsequent health for postpartum women. Our proposed study will examine the effect of the COVID-19 pandemic on postpartum women’s pain-related healthcare utilization, with specific focus on the prescription of opioid analgesics at hospital discharge after delivery and during the subsequent six-month postpartum period. In addition, we will examine the extent to which the impact of the pandemic differed systematically for women with versus without access to recreational or medical cannabis, thus building on preliminary evidence that there is substitution away from opioid analgesic prescriptions in states that implement recreational and medical cannabis laws. Our analyses will leverage data from two large secondary data sources: Optum claims data and HealthJump electronic medical records data, in conjunction with data on active cannabis dispensaries and U.S. Census data. We will employ a patient-level panel data approach to examine changes in healthcare utilization that coincided with the start of the COVID-19 pandemic, controlling for individual patient characteristics, state and county time-varying characteristics, and state fixed effects. In addition, we will interact our measure of pandemic exposure with measures of access to legal cannabis and conduct sub-analyses in which we allow for potential differential effects by delivery type (vaginal or Cesarean), by prior opioid use, and by urban versus rural residence. These novel analyses will provide the first longitudinal, patient-level analysis of the relationship between COVID-19 and pain-related healthcare utilization for postpartum women, as well as the first evidence on the interaction between legal cannabis access and utilization of prescription pain medication among postpartum women. Understanding these relationships is essential in order to optimize public policies and to provide guidance to clinical practitioners on mitigation of long-run impacts of the COVID-19 pandemic.