Marijuana Legalization and Suicide Among Older Adults

With Sara Markowitz [Forthcoming - Health Economics]

Suicides rates among older adults have been rising over time in the United States. At the same time, more individuals have been suffering with chronic pain and illness, which are often underlying risk factors for suicide. As self-medication with marijuana has become common, we ask whether access to legal marijuana for medical and recreational purposes reduces suicide rates among older individuals. We find that suicide rates among older age groups decline following the opening of recreational marijuana dispensaries, especially among older Whites, men, and those with low levels of education. 

The Critical Access Hospital (CAH) program, established under the Balanced Budget Act of 1997, provides cost-based Medicare reimbursement to small rural hospitals in exchange for limits on inpatient capacity and service scope. We estimate the effects of CAH designation on hospital finances, capacity, and organizational outcomes using a synthetic difference-in-differences design that exploits the staggered 1999--2002 rollout of state-level CAH availability. CAH designation has no detectable effect on operating margins, as net patient revenue and total operating expenses both decline by similar magnitudes, consistent with proportional financial contraction as hospitals downsize to meet eligibility requirements. The primary effect is a reduction in operational scale, with significant declines in total beds, obstetric capacity, and nursing staff. At the same time, CAH designation reduces hospital closures, with no meaningful effect on mergers. These results point to a ``survival versus scale'' tradeoff wherein designation-based subsidies preserve hospital presence, but primarily through continued operation at a smaller scale rather than by maintaining pre-designation capacity.

In this paper, I investigate whether the relaxation of marijuana legislation is associated with changes in health, healthcare utilization, and labor market outcomes in individuals aged 50 and older. Since 1970, states have been decriminalizing and legalizing medical and recreational marijuana. In conjunction with the changing legal landscape is a rise in marijuana use among older adults. I explore these simultaneous trends to determine if marijuana decriminalization and legalization have changed older adults’ pain, health status, and other related health and labor outcomes. Leveraging restricted data from the Health and Retirement Study, I use difference-in-differences methods to estimate the effect of decriminalization, medical, and recreational marijuana legalization on pain, health status, hours worked, work status, and other health and labor outcomes. I also use duration models to explore the time in which individuals remain in a state of pain or poor health status and instrumental variables to understand the spillover effects marijuana’s complex relationship with health has on labor market participation. I find that health and labor outcomes improve in states after they legalize medical and recreational marijuana. These findings are consistent with previous research showing that the legalization of medical marijuana is associated with a decrease in pain and an increase in better health status. These findings hold significance for policymakers, especially in light of the ongoing legislative efforts to reschedule marijuana following the acknowledgment of marijuana's medicinal benefits from the Department of Health and Human Services.

Marijuana policies have become a crucial topic of discussion due to their economic, health, and social effects. While the literature on marijuana is expanding, most of it focuses on the general population, leaving a gap in understanding how it affects older adults. Many older adults use marijuana as an alternative pain reliever, but there is little information about how changes in marijuana access influence their use. This paper looks at how medical marijuana access and decriminalization affect marijuana demand among older adults.

To explore this, I analyze data from the National Survey on Drug Use and Health (NSDUH) Marijuana Trend tables between 2002 and 2014. My findings show that after a medical marijuana dispensary opens, the percentage of older adults who report using marijuana in the past month increases. This suggests that access to medical marijuana could play a big role in whether older adults choose to consume cannabis. As more states consider marijuana legalization, these findings add to the conversation about how different groups, particularly older adults who may use marijuana for pain management, are impacted by these policy changes.