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Washington State Institute for Public Policy

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Publications

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The Impact of Cannabis Retail Availability on Cannabis and Mental Health Outcomes Among Medicaid Recipients in Washington State

Open Publication PDF

Amani Rashid, Helen Ippolito - September 2025

In November 2012, Washington State voters passed Initiative 502 (I-502), which legalized limited possession, private use, and commercial sales of cannabis for adults. In this study, we explore the relationship between licensed cannabis retail availability in Washington State and healthcare outcomes related to cannabis use disorder (CUD) and mental health disorders, including depression, anxiety, bipolar, and psychotic disorders.

Using claims and encounter data on Medicaid enrollees aged 12-64, we find that residence near a cannabis retailer predicts higher rates of CUD, CUD-related hospitalization, and CUD-related inpatient SUD treatment. Furthermore, we find that living near a retailer predicts higher rates of co-occurring CUD and mental health disorder diagnoses. Last, we find that living near a retailer is associated with an increase in the probability of having a mental health disorder diagnosis following a CUD diagnosis. Evidence suggests that impacts are generally largest in neighborhoods with multiple active retailers nearby.

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