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. 2025 Apr;40(5):1030-1038.
doi: 10.1007/s11606-024-09053-6. Epub 2024 Oct 1.

The Combined Relationship of Prescription Drug Monitoring Program Enactment and Medical Cannabis Laws with Chronic Pain-Related Healthcare Visits

Zachary L Mannes  1   2 , Molly Nowels  3 , Christine Mauro  4 , Sharon Cook  3 , Katherine Wheeler-Martin  5   6 , Sarah Gutkind  2 , Emilie Bruzelius  2 , Samantha M Doonan  5   6 , Stephen Crystal  3   7   8 , Corey S Davis  5   9 , Hillary Samples  3 , Deborah S Hasin  2   10   11 , Katherine M Keyes  2 , Kara E Rudolph  2 , Magdalena Cerdá  5   6 , Silvia S Martins  12
Affiliations

The Combined Relationship of Prescription Drug Monitoring Program Enactment and Medical Cannabis Laws with Chronic Pain-Related Healthcare Visits

Zachary L Mannes et al. J Gen Intern Med. 2025 Apr.

Abstract

Background: U.S. state electronic prescription drug monitoring programs (PDMPs) are associated with reduced opioid dispensing among people with chronic pain and may impact use of other chronic pain treatments. In states with medical cannabis laws (MCLs), patients can use cannabis for chronic pain management, reducing their need for chronic-pain related treatment visits and moderating effects of PDMP laws.

Objective: Given high rates of chronic pain among Medicaid enrollees, we examined associations between PDMP enactment in the presence or absence of MCL on chronic pain-related outpatient and emergency department (ED) visits.

Design: We created annual cohorts of Medicaid enrollees with chronic pain diagnoses using national Medicaid claims data from 2002-2013 and 2016. Negative binomial hurdle models produced adjusted odds ratios (aOR) for the likelihood of any chronic pain-related outpatient or ED visit and incident rate ratios (IRR) for the rate of visits among patients with ≥ 1 visit.

Participants: Medicaid enrollees aged 18-64 years with chronic pain (N = 4,878,462).

Main measures: A 3-level state-year variable with the following categories: 1) no PDMP, 2) PDMP enactment in the absence of MCL, or 3) PDMP enactment in the presence of MCL. Healthcare codes for chronic pain-related outpatient and ED visits each year.

Key results: The sample was primarily female (67.2%), non-Hispanic White (51.2%), and ages 40-55 years (37.2%). Compared to no-PDMP states, PDMP enactment in the absence of MCL was not associated with chronic pain-related outpatient visits but PDMP enactment in the presence of MCL was associated with lower odds of chronic pain-related outpatient visits (aOR = 0.81, 95% CI:0.71-0.92). PDMP enactment was not associated with ED visits, irrespective of MCL.

Conclusions: During a period of PDMP and MCL expansion, our findings suggest treatment shifts for persons with chronic pain away from outpatient settings, potentially related to increased use of cannabis for chronic pain management.

Keywords: chronic pain; healthcare utilization; medical cannabis laws; prescription drug monitoring programs.

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Conflict of interest statement

Declarations:. Conflicts of Interest:: KMK provides expert testimony for various law firms in the US. DSH receives funding from Syneos Health for an unrelated project on the measurement of opioid use disorder among patients with chronic pain.

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