Availability of medical cannabis dispensaries and cannabis abuse/dependence-related hospitalizations in California

Abstract

Aims: To estimate associations between both current- and prior-year medical cannabis dispensary densities and hospitalizations for cannabis use disorder in California, USA between 2013 and 2016.

Design: Spatial analysis of ZIP code-level hospitalization discharge data using Bayesian Poisson hierarchical space-time models over 4 years.

Setting and cases: California, USA from 2013 to 2016 (6832 space-time ZIP code units).

Measurements: We assessed associations of annual hospitalizations for cannabis use disorder [assignment of a primary or secondary code for cannabis abuse and/or dependence using ICD-9-CM or ICD-10-CM (outcome)] with the total number of medical cannabis dispensaries per square mile in a ZIP code as well as dispensary temporal and spatial lags (primary exposures). Other exposure covariates included alcohol outlet densities, manual labor and retail sales densities and ZIP code-level economic and demographic conditions.

Findings: One additional dispensary per square mile was associated with a median risk ratio of 1.021 (95% credible interval 1.001, 1.041). Prior-year dispensary density did not appear to be associated with hospitalizations (median risk ratio = 1.006, 95% CrI = 0.986, 1.026). Higher median household income, higher unemployment, greater off-premises alcohol outlet density and lower on-premises alcohol outlet density and poverty were all associated with decreased ZIP code-level risk of cannabis abuse/dependence hospitalizations.

Conclusions: In California, USA, the increasing density of medical cannabis dispensaries appears to be positively associated with same-year but not next-year hospitalizations for cannabis use disorder.

Keywords: Cannabis abuse; cannabis dependence; cannabis use disorder; hospital discharge data; medical cannabis dispensaries; spatial analysis.