Policy-Driven Changes in Medical Marijuana Routes of Administration and Patient Health Outcomes: Evidence from Florida

• In Event: What Happens After Legalization?: The Role of Cannabis Policy in Markets, Policing, Youth, and Patient Health

Abstract

State medical marijuana programs are expanding rapidly, with 40 states now permitting medical cannabis use. Yet these programs vary substantially in which routes of administration (ROAs) patients may use, and states continue to adjust these rules over time. ROA is clinically meaningful: smoking produces rapid onset and peak intoxication, while edibles produce delayed, prolonged effects with dosing unpredictability. These differences have implications for patient safety, prescription medication use, and acute health events. Despite this, existing research rarely distinguishes between ROAs, which may obscure differential risks. To our knowledge, no study has linked patient-level, ROA-specific data to longitudinal health outcomes in a population-based medical marijuana registry.

This study leverages the Medical Marijuana Clinical Outcomes Research Data Repository (MEMORY) from the Consortium for Medical Marijuana Outcomes Research at the University of Florida. MEMORY is a novel linked data infrastructure that connects Florida's Medical Marijuana Use Registry (which contains patient-level information on certifications, qualifying conditions, and authorized ROAs) with Medicaid and Medicare claims, controlled substances tracking, and adverse event reports. This linkage enables researchers to follow individual patients across their medical marijuana use, prescription medication history, and clinical encounters over time, providing a level of detail on ROA-specific utilization and outcomes that has not been available in prior research.

Florida's medical marijuana program, launched in 2017) initially restricted ROAs to vaping, oral, suppository, sublingual, or topical products. Smoked flower became allowable in March 2019 and edibles in August 2020. Preliminary descriptive results indicate that medical marijuana certifications increased substantially following the introduction of smoking and edibles, suggesting these policy changes meaningfully expanded program participation and shifted utilization patterns. Building on these findings, this study will: 1) characterize ROA utilization patterns before and after each policy change; 2) examine associations between patient-level ROA utilization patterns and prescription medication use, including opioids, benzodiazepines, and sedative-hypnotics, as well as potentially risky co-use; and 3) examine associations between ROA patterns and acute clinical outcomes plausibly related to ROA differences. We will use longitudinal models with individual fixed effects, comparison-group analyses, and event-study specifications, examining heterogeneity across demographics, qualifying conditions, and medication profiles.

This study will generate actionable, ROA-specific evidence for policymakers designing medical marijuana regulations, health systems managing patient safety, and clinicians counseling high-risk populations.

Author

• Danielle Atkins, Florida State University
  Presenting Author