Table 1 Aim 1–2 hypotheses related to state cannabis law implementation rules

Hypotheses related to specific state medical cannabis policy implementation rules (aims 1–2)

1. Medicalization: Relative to less medicalized laws, laws with a higher degree of medicalization—shown to decrease medical cannabis program enrollment—will have a lesser effect on aim 1–2 outcomes.

2. Non-specific chronic pain provisions: Laws that include broad “non-specific” chronic pain qualifying criteria will have greater effects on outcomes relative to laws with narrower criteria, e.g., a requirement of a headache specifically.

3. Dry-leaf provisions: Laws allowing dry-leaf cannabis (the cheapest form) will have greater effects on outcomes.

4. Opioid substitution provisions: Laws with provisions allowing substitution of cannabis for opioid prescriptions will increase the pool of chronic pain patients eligible to use cannabis and have greater effects on outcomes relative to laws without such provisions.

5. Opioid use disorder provisions: Relative to laws without such provisions, laws that make opioid use disorder a qualifying condition will be associated with reduced use of non-cannabis treatment for opioid use disorder and increased treatment utilization for cannabis use disorder and poisoning, among patients with co-occurring chronic pain and opioid use disorder (aim 2 only).

6. Registration fees: Medical cannabis laws implemented without registration fees or with low-income subsidies will have greater effects on outcomes among patients with chronic non-cancer pain, which is disproportionately prevalent in low-income individuals.

7. Dispensary limits: Relative to states with no limits, states with dispensary limits will have lesser effects on outcomes.

8. Local dispensary prohibitions: Laws’ effects on outcomes will be stronger when localities allow dispensaries.

9. Dispensary proximity: Medical cannabis laws’ effects will be stronger among patients who live near a dispensary.

10. Physician proximity: Laws’ effects will be stronger among patients who live near a physician registered to recommend cannabis to patients.