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Importance The rate of opioid-related emergency department (ED) visits and inpatient hospitalizations has increased rapidly in recent years. Medicaid expansions have the potential to reduce overall opioid-related hospital events by improving access to outpatient treatment for opioid use disorder. Objective To examine the association between Medicaid expansions and rates of opioid-related ED visits and inpatient hospitalizations. Design, Setting, and Participants A difference-in-differences observational design was used to compare changes in opioid-related hospital events in US nonfederal, nonrehabilitation hospitals in states that implemented Medicaid expansions between the first quarter of 2005 and the last quarter of 2017 with changes in nonexpansion states. All-payer ED and hospital discharges from 45 states in the Healthcare Cost and Utilization Project FastStats were included. Exposures State implementation of Medicaid expansions between 2005 and 2017. Main Outcomes and Measures Rates of all opioid-related ED visits and inpatient hospitalizations, measured as the quarterly numbers of treat-and-release ED discharges and hospital discharges related to opioid abuse, dependence, and overdose, per 100 000 state population. Results In the 46 states and District of Columbia included in the study, 1524 observations of emergency department data and 2219 observations of opioid-related inpatient hospitalizations were analyzed. The post-2014 Medicaid expansions were associated with a 9.74% (95% CI, −18.83% to −0.65%) reduction in the rate of opioid-related inpatient hospitalizations. There appeared to be no association between the pre-2014 or post-2014 Medicaid expansions and the rate of opioid-related ED visits (post-2014 Medicaid expansions, −3.98%; 95% CI, −14.69% to 6.72%; and pre-2014 Medicaid expansions, 1.02%; 95% CI, −5.25% to 7.28%). Conclusions and Relevance Medicaid expansion appears to be associated with meaningful reductions in opioid-related hospital use, possibly attributable to improved care for opioid use disorder in other settings.

Importance Overprescribing of opioids is considered a major driving force behind the opioid epidemic in the United States. Marijuana is one of the potential nonopioid alternatives that can relieve pain at a relatively lower risk of addiction and virtually no risk of overdose. Marijuana liberalization, including medical and adult-use marijuana laws, has made marijuana available to more Americans. Objective To examine the association of state implementation of medical and adult-use marijuana laws with opioid prescribing rates and spending among Medicaid enrollees. Design, Setting, and Participants This cross-sectional study used a quasi-experimental difference-in-differences design comparing opioid prescribing trends between states that started to implement medical and adult-use marijuana laws between 2011 and 2016 and the remaining states. This population-based study across the United States included all Medicaid fee-for-service and managed care enrollees, a high-risk population for chronic pain, opioid use disorder, and opioid overdose. Exposures State implementation of medical and adult-use marijuana laws from 2011 to 2016. Main Outcomes and Measures Opioid prescribing rate, measured as the number of opioid prescriptions covered by Medicaid on a quarterly, per-1000-Medicaid-enrollee basis. Results State implementation of medical marijuana laws was associated with a 5.88% lower rate of opioid prescribing (95% CI, −11.55% to approximately −0.21%). Moreover, the implementation of adult-use marijuana laws, which all occurred in states with existing medical marijuana laws, was associated with a 6.38% lower rate of opioid prescribing (95% CI, −12.20% to approximately −0.56%). Conclusions and Relevance The potential of marijuana liberalization to reduce the use and consequences of prescription opioids among Medicaid enrollees deserves consideration during the policy discussions about marijuana reform and the opioid epidemic.