HJAR Nov/Dec 2021

HEALTHCARE JOURNAL OF ARKANSAS I  NOV / DEC 2021 37 Joseph W. Thompson, MD, MPH President and Chief Executive Officer Arkansas Center for Health Improvement with decreases or increases in: • Utilization of traditional healthcare, including prescription drugs. • Healthcare costs. • Claims related to mental health diagnoses. • Claims related to substance abuse diagnoses. • Motor vehicle accidents. The project also will consider the impacts of the COVID-19 pandemic on theArkansas medical marijuana program. Although Ar- kansans have never been under a formal stay-at-home order during the pandemic, many businesses were temporarily re- quired to close, and many clinics and pro- viders temporarily ceased seeing patients in person. Medical marijuana dispensaries, however, were considered essential busi- nesses and never closed. We will examine how the pandemic impacted aspects of the medical marijuana program such as changes in cardholder requests, product purchases, healthcare utilization and adverse events. We also will consider connections be- tween medical marijuana use and opioid use. This is an important issue in light of the national opioid overdose epidemic, and it is especially important inArkansas, which has the second-highest opioid prescribing rate in the country. 2 Some have argued that legalizing medical marijuana could lead to decreases in opioid deaths and opioid prescribing, but that is far from an estab- lished fact. A 2019 literature review and meta-analysis found a statistically nonsig- nificant 8% reduction in opioid overdose mortality in states with legalized medical marijuana and a 7% reduction in prescrip- tion opioids dispensed in those states. 3 Our study will go farther by observing changes in opioid prescriptions and opioid-related adverse events among individual medical Research — and I will serve as co-principal investigators on the project. Our study, titled “Population-BasedAnal- yses of Healthcare Utilization and Outcomes in Users of Medical Marijuana,” will be a first-of-its-kind population health analysis of the medical marijuana program, combin- ing eligible consumers’ cannabis purchase information with insurance claims records and other data sources to gain a more com- prehensive understanding of the effects of cannabis on medical care. Arkansas is the ideal place for this groundbreaking research to take place, thanks to the existence of the Arkansas Healthcare Transparency Initiative, which ACHI oversees. The Arkansas General As- sembly created the initiative in 2015 to bring increased transparency to healthcare and healthcare costs in the state. Initially, the Arkansas Healthcare Trans- parency Initiative Act required insurers to submit claims data to a single database, the All-Payer Claims Database. Lawmakers later amended the act to require the collection of several additional types of data, including medical marijuana patient registry data, data from the Arkansas Department of Health’s medical marijuana patient registry, medical marijuana cardholder data, birth and death certificate data, and hospital emergency de- partment records. Our medical marijuana study will draw on all of the above, along with Arkansas State Police motor vehicle crash data. The Transparency Initiative links data across these different datasets at the individual level, removing all personal identifiers to protect patient confidentiality. Access to these data will enable us to examine in an unprecedented way the ex- periences, both positive and negative, with medical marijuana. We will be able to ex- plore whether marijuana use is associated marijuana cardholders, not just among the general populations of states with legalized medical marijuana. This project will contribute to the knowl- edge of societal impact of medical marijuana, elucidate its benefits and adverse outcomes and help to inform federal and state policy decisions, clinical therapeutic strategies and insurance coverage decisions. This is an exciting opportunity, not just for ACHI and UAMS but for our state and the country. n REFERENCES 1 National Academies of Sciences, Engineering, and Medicine. “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.” Wash- ington (DC): National Academies Press, Jan. 12, 2017: sec. 16, Recommendations to Support and Improve the Cannabis Research Agenda. https:// www.ncbi.nlm.nih.gov/books/NBK425745/. 2 Centers for Disease Control and Prevention. U.S. State Opioid Dispensing Rates, 2019. Last reviewed Dec. 7, 2020. https://www.cdc.gov/ drugoverdose/rxrate-maps/state2019.html. 3 Chihuri, S and Li, G. “State marijuana laws and opioid overdose mortality.” Injury Epidemiology. Vol. 6, Art. 38 (2019). https://doi.org/10.1186/ s40621-019-0213-z. “Our study … will be a first-of-its-kind population health analysis of the medical marijuana program, combining eligible consumers’ cannabis purchase information with insurance claims records and other data sources to gain a more comprehensive understanding of the effects of cannabis on medical care.”