Aggregate Effects of Marijuana Legalization on Health Outcomes

Austin J Dyami Adams

I. Introduction
The effects of cannabis on health have been widely studied with inconclusive, and sometimes
confounding, results. As soon as one study is published making a claim about the safety of the drug,
another is often published warning of the exact opposite. For example, a recent study led by Aditi
Kalla found that using cannabis was associated with a 26% increased risk of stroke and a 10%
increased risk of developing heart failure (Kalla, 2017). While the study was given high attention for
its large sample and robustness, it contradicted the findings of two equally acclaimed publications,
both of which found no association between stroke and cannabis use (Falkstedt, 2016; Reis 2017).
This problem seems to exist because of two major limitations past studies have faced.
The first limitation often faced is the inability to run controlled experiments. Marijuana is
considered a Schedule 1 drug under federal regulations, meaning it is considered to have no
currently accepted medical use and a high potential for abuse (DEA, n.d). Because of this
distinction, researchers often cannot access cannabis easily and in a way that allows them to study its
effects in a controlled trial experiment, thus rendering any research on cannabis unable to meet the
gold standard. This often leads to researchers relying on self-reported information from low quality
survey populations.
A second limitation of cannabis studies is that the quality and characteristics of commercial
marijuana do not seem to match what is used in research. Since the 1960s, the federal government
has mandated that all marijuana used in research must come through the federal government (The
Washington Post, n.d). Sue Sisley, a researcher in the marijuana field, was conducting a study on the
efficacy of medical cannabis for military veterans with PTSD. Upon receiving the product from the
government, she noticed that it was quite different from what she’d known cannabis to be. In testing
this product, she found that it only contained 8% THC, as opposed to the average of 20% in
commercial products. Further, the product was stringy, filled with stems, and light in color, in
contrast to the natural appearance of being dark green, chunky, and sticky (The Washington Post,
n.d). It seems then that researchers able to obtain cannabis through the government for experiments
inevitably end up working with low-quality marijuana that is not comparable to what is found in the
marketplace, thus limiting the generalizability of many studies.
With these limitations, it is evident that individual, micro-level analysis is relatively unreliable in
understanding the health outcomes associated with cannabis consumption. This analysis thus
observes health outcomes at state level, before and after the implementation of marijuana
legalization laws. The analysis will observe trends in both positive and negative health outcomes that
have been claimed to be associated with marijuana consumption. This level of analysis is important
because it allows for observation of the effects of marijuana that is commercial-standard through the
marketplace and accessible to anyone over the legal age limit for consumption.
II. Policy Background
Because cannabis has been shown in many studies to improve health in a variety of ways,
many states began legalizing marijuana for medicinal use, as early as 1996 in California (CA Prop
215). In recent years, stigma has been widely reduced regarding marijuana use, and many states have
passed laws decriminalizing and/or legalizing cannabis for medical and sometimes recreational use.
Today, 21 states have some form of legalized medical marijuana, and eight have legalized or
decriminalized the recreational use of marijuana, meaning that 58% of states have some form of
legal leniency towards marijuana (State Marijuana Laws, n.d).
The legal leniency towards marijuana has changed drastically throughout the past century, and
has changed quite rapidly in recent years. By 1933, the prohibition on cannabis peaked with 29 states
having criminalized its use (Labate, 2014). After decades of slow decriminalization, states began
rapidly adopting medical marijuana policies throughout the 2000s. Colorado and Washington
became the first two states to legalize marijuana for recreational use in 2012 (Coffman, 2012). Just
six years later in 2018, Vermont became the first state to legalize recreational cannabis by way of
legislature, marking a new political shift towards marijuana that has aligned closer with public
opinion and ballot measure outcomes (Wilson, 2018). While many states have taken action towards
marijuana, the accessibility of the drug varies widely across the country for two main reasons.
First, the decriminalization of marijuana permits less access than legalization. Decriminalizing
the drug means that someone caught with it in their possession may just face fines, as opposed to
going to jail for carrying a federally listed Schedule 1 drug. However, unlike decriminalization,
legalization involves no punishment for possession. More importantly, legalization also allows
suppliers to grow, transport, and sell cannabis as a taxable entity with taxable employees (T.W,
2014). Because of this new marketplace, marijuana accessibility is likely to be higher, which is
relatively unattainable under decriminalization.
Second, legalization of marijuana, particularly of medical cannabis, does not necessarily lead to
higher accessibility. In cases where the policy is too strict, and thus forces a lower demand than
natural, prices of medical cannabis may be high relative to illegally cultivated and purchased
marijuana. Because of this price difference, some states have found that many who qualify for
medical cannabis do not take up the offer, as it costs them more money (Associated Press St Paul,
MN, 2015). In this situation, accessibility is limited because the new medical product that has
entered the market is deemed unreasonably high, and therefore is not consumed. In order to
observe the effects of marijuana on health, it is important to examine states with relatively high and
similar accessibility. If the drug is inaccessible and therefore not widely used, we would not expect
any changes in health trends to reflect marijuana use. For example, in low-accessibility states like
Minnesota, we should not expect to observe health changes associated with marijuana use if legal
consumption has not changed much at all. For this reason, states with decriminalization laws and
medical legalization laws with low access were not selected for analysis given their relatively low
accessibility to marijuana. Using states with high accessibility and therefore higher use makes
legalization more akin to use in general.
III. Research
Overview
For the analysis, nine states were chosen: three of which have legalized recreational and
therefore also medical marijuana (CA, CO, ME), three of which have only legalized medical cannabis
(NM, VT, MT), and three of which do not allow at all for the legal consumption of marijuana (ID,
TX, VA) (State Marijuana Laws in 2018, 2018). Outcomes can be compared across these states to
understand the health effects of recreational legalization versus medical legalizaiton relative to the
three states with no legalization. Four health outcomes, cancer, drug overdose mortality, obesity, and
stroke mortality, are observed in each of these states. Each graph displays trends for both the
specified state and the US average for comparison.
For states with legalization policies, a vertical line has been placed to mark the year of
legalization. Note that states with recreational policies had first passed medical use policies, and so
these states have two vertical lines, indicating the year for each policy. Further note that data
limitations have disallowed showing some years where states passed these policies. For states where
legalization happened before data begins, vertical lines are placed over the y-axis. For states where
legalizaiton happened after data ends, vertical lines are excluded, as they have no implications for the
data shown.
Cancer
The first health outcome observed is cancer. Some have argued marijuana is likely to cause
some forms of cancer due to similar compounds found in tobacco, which is problematic because
cancer patients often find success in limiting naseua and increasing appetite through cannabis use
(American Drug Association, n.d). In contradicting studies, certain cannabis compounds have been
found to shrink certain cancer cells (Scott, 2013). In this analysis, five major forms of cancer were
observed: Prostate cancer, Breast cancer, Lung cancer, Colon cancer, and Melanoma. Rates for each
form of cancer are reported by the Center for Disease Control and Prevention (United States Cancer
Statistics, n.d).
For each state that legalized cannabis, neither recreational or medicinal legalization seemed
to change the overall trend that existed prior to the policy. When comparing these states to those
where cannabis is illegal, the trends between these states are remarkably similar as well. Thus
oberving trends across these forms of cancer shows little evidence that marijuana legalization
(recreational or medical) has any effect on cancer prevelance, assuming the claimed cancer-causing
effects and cancer-curing effects are not offsetting one another. There are, however, some notable
states worth observing more closely.
After medical legalization in 2004, Vermont saw a spike in lung cancer rates up to 2006.
However, by 2008, cancer rates dropped back again to align with the overarching trend.
Additionally, a single state that offered compelling evidence that cannabis legalizaiton may increase
cancer rates is that of Montana. Prior to legalization, Montana experienced a decline in Melanoma
rates, dropping below the national average in 2004. In 2004, medical cannabis was legalized, and we
see that, from then on, Melanoma rates rose considerably, distancing itself from the national
average. Despite these two cases, the overall trend seems to suggest cannabis legalization has no
short-term effects on the forms of cancer studied.
Drug Overdose Mortality
The second health outcome observed is drug overdose rates. Some studies have found
evidence to suggest that, given the option, many will substitute opioids and other heavy prescription
drugs with medical cannabis (Bradford, 2016). Given these results, many have argued that
legalization may lead to a decline in drug abuse and overdose. To observe this relationship, drug
overdose rates are sourced from the Center for Disease Control and Prevention (National Center
for Health Statistics, n.d).
Evidence surrounding drug overdose rates seems to suggest that medical legalizaiton has no
substantial effects on overdoses. The data is limited in that recreational policies are very new, so it is
difficult to conclude whether recreational legalization has an effect on drug overdoses. Both Maine
and California have legalizaiton dates at the end of the available overdose data. However, Colorado
seems to show that recreational legalization lowered overdose rates. Prior to legalization, Colorado’s
overdose mortality trend was quite similar to the US average. Upon recreational legalization, the
rates in Colorado drop, falling below the national average. Overall, these trends seem to show that
legalization has little-to-no-effect on overdose mortality rates, as trends remain fairly constant across
states across time.
Obesity
The third health outcome obersved in this study is obesity. Research has suggested that acute
marijuana use stimulates appetite, while other studies have shown that frequent users of the drug
have lower body mass indexes on average (Sansone, 2014). For this state-level analysis, data was
collected from the State of Obesity, a project of the Trust for America’s Health and the Robert
Wood Johnson Foundation (Adult Obesity in the United States, n.d).
In observing data on adult obesity, while all states observed had lower obesity rates than the
US average, it seems that the margin between US average and state numbers is slightly larger than
for those states with no legalization laws, which may support mentioned findings that marijuana
users tend to have lower BMIs. However, the holistic trends for each state at the individual level
appear to be unchanged by the legalization policy. Thus, it appears unlikely from these states that
marijuana consumption has a positive or negative direct impact on obesity rates.
Stroke Mortality
The final health outcome observed is stroke mortality rates. Particularly, this study observes
instances of Ischemic stroke, as they account for nearly 90% of strokes and deal directly with oxygen
blockage to the brain, opposed to hemorrhaging and mini-strokes (TIAs) (Mozzafarian, 2016). As
reported at the American Stroke Association’s International Stroke Conference, some have found
marijuana use to increase risk of stroke (Szalavitz, 2013). Data used to analyze this claim at a state
level was collected from the Center of Disease Control and Prevention (Interactive Atlas of Heart
Disease and Stroke, n.d).
The stroke data seems to suggest that marijuana legalization has no impact on stroke
mortality from Ischemic strokes. States with legalized marijuana (recreational or medical) tend to
have lower rates than the US average, while states with no legalization policies have higher rates than
the national average. Further, there is no individual state that shows a shift from the holistic trend
after legalization, which suggests further that marijuana legalization does not increase the risk of
stroke.
IV. Conclusion
To analyze the effects marijuana may have on health without traditional limitations, this
analysis has examined health outcome trends across time at a state level, allowing us to examine the
effects of market-quality cannabis on larger, more randomized populations.
This paper analyzed four health outcomes, cancer, drug overdose mortality, obesity, and
Ischemic stroke mortality. While there were a couple of states that indicated a relationship between
marijuana legalization and cancer, the overall analysis suggests no significant relationship between
the two across five reported forms of cancer: prostate, breast, lung, colon, and melanoma. While
impacts of recreational legalization were unobservable in the drug overdose mortality data for two
states, Colorado seems to show that recreational legalization may decrease overdose mortality rates.
Overall, medical legalization had no significant effects. States with legalization policies tended to
have obesity rates lower than the national average, while non-legalization states did now. However,
there was not an individual state to legalize marijuana that experienced a significant change in the
overall trend in obesity rate after the year of legalization. Finally, there appears to be no impact on
stroke mortality following the legalization of cannabis (medical or recreational), suggesting marijuana
consumption does not increase the risk of stroke.
This study is limited by how recently some states have passed their policies, as well as by
how far back in time accessible data has been collected. Future studies of this kind should analyze a
larger number of states overall and with other health outcomes that have been reportedly linked to
cannabis consumption.
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V. Appendix
Cancer
Prostate Recreational States
PROSTATE CANCER RATE ME
Prostate ME Prostate US Linear (Prostate ME) Linear (Prostate US)

250

200
INCIDENCE PER 100,000

150

100

50

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

PROSTATE CANCER RATE CO

Prostate CO Prostate US Linear (Prostate CO) Linear (Prostate US)
200
180
160
INCIDENCE PER 100,000

140
120
100
80
60
40
20
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

PROSTATE CANCER RATE CA

Prostate CA Prostate US Linear (Prostate CA) Linear (Prostate US)
200
180
160
INCIDENCE PER 100,000

140
120
100
80
60
40
20
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR
 Prostate Medical States
PROSTATE CANCER RATE NM
Prostate NM Prostate US Linear (Prostate NM) Linear (Prostate US)
200
180
160
INCIDENCE PER 100,000

140
120
100
80
60
40
20
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

PROSTATE CANCER RATE MT

Prostate MT Prostate US Linear (Prostate MT) Linear (Prostate US)
250

200
INCIDENCE PER 100,000

150

100

50

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

PROSTATE CANCER RATE VT

Prostate VT Prostate US Linear (Prostate VT) Linear (Prostate US)
200
180
160
INCIDENCE PER 100,000

140
120
100
80
60
40
20
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR
 Prostate Illegal States
PROSTATE CANCER RATE ID
Prostate ID Prostate US Linear (Prostate ID) Linear (Prostate US)
200
180
160
INCIDENCE PER 100,000

140
120
100
80
60
40
20
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

PROSTATE CANCER RATE TX

Prostate TX Prostate US Linear (Prostate TX) Linear (Prostate US)
200
180
160
INCIDENCE PER 100,000

140
120
100
80
60
40
20
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

PROSTATE CANCER RATE VA

Prostate VA Prostate US Linear (Prostate VA) Linear (Prostate US)
200
180
160
INCIDENCE PER 100,000

140
120
100
80
60
40
20
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR
 Breast Recreational States
BREAST CANCER RATE ME
Breast ME Breast US Linear (Breast ME) Linear (Breast US)
145

140
INCIDENCE PER 100,000

135

130

125

120

115

110
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

BREAST CANCER RATE CO

Breast CO Breast US Linear (Breast CO) Linear (Breast US)
160
140
120
INCIDENCE PER 100,000

100
80
60
40
20
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

BREAST CANCER RATE CA

Breast CA Breast US Linear (Breast CA) Linear (Breast US)
140

135

130
INCIDENCE PER 100,000

125

120

115

110

105
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR
 Breast Medical States

BREAST CANCER RATE NM

Breast NM Breast US Linear (Breast NM) Linear (Breast US)
160
140
INCIDENCE PER 100,000

120
100
80
60
40
20
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR .
BREAST CANCER RATE MT
Breast MT Breast US Linear (Breast MT) Linear (Breast US)
160
140
120
INCIDENCE PER 100,000

100
80
60
40
20
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

BREAST CANCER RATE VT

Breast VT Breast US Linear (Breast VT) Linear (Breast US)
160
140
120
INCIDENCE PER 100,000

100
80
60
40
20
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR
 Breast Illegal States
BREAST CANCER RATE ID
Breast ID Breast US Linear (Breast ID) Linear (Breast US)
160
140
120
INCIDENCE PER 100,000

100
80
60
40
20
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

BREAST CANCER RATE TX

Breast TX Breast US Linear (Breast TX) Linear (Breast US)
160
140
120
INCIDENCE [ER 100,000

100
80
60
40
20
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

BREAT CANCER RATE VA

Breast VA Breast US Linear (Breast VA) Linear (Breast US)
140

135
INCIDENCE PER 100,000

130

125

120

115

110
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR
 Lung Recreational States
LUNG CANCER RATE ME
Lung ME Lung US Linear (Lung ME) Linear (Lung US)
90
80
70
INCIDENCE PER 100,000

60
50
40
30
20
10
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

LUNG CANCER RATE CO

Lung CO Lung US Linear (Lung CO) Linear (Lung US)
80

70

60
INCIDENCE PER 100,000

50

40

30

20

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

LUNG CANCER RATE CA

Lung CA Lung US Linear (Lung CA) Linear (Lung US)
80
70
60
INCIDENCE PER 100,000

50
40
30
20
10
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR
 Lung Medical States
LUNG CANCER RATE NM
Lung NM Lung US Linear (Lung NM) Linear (Lung US)
80
INCIDENCE PER 100,000 70
60
50
40
30
20
10
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

LUNG CANCER RATE MT

Lung MT Lung US Linear (Lung MT) Linear (Lung US)
80

70

60
INCIDENCE PER 100,000

50

40

30

20

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

LUNG CANCER RATE VT

Lung VT Lung US Linear (Lung VT) Linear (Lung US)
90
80
70
INCIDENCE PER 100,000

60
50
40
30
20
10
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR
 Lung Illegal States
LUNG CANCER RATE ID
Lung ID Lung US Linear (Lung ID) Linear (Lung US)
80
INCIDENCER PER 100,000 70
60
50
40
30
20
10
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

LUNG CANCER RATE TX

Lung TX Lung US Linear (Lung TX) Linear (Lung US)
80
70
60
INCIDENCE PER 100,000

50
40
30
20
10
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

LUNG CANCER RATE VA

Lung VA Lung US Linear (Lung VA) Linear (Lung US)
80
70
60
INCIDENCE PER 100,000

50
40
30
20
10
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR
 Colon Recreational States

COLON CANCER RATE ME

Colon ME Colon US Linear (Colon ME) Linear (Colon US)
70

60
INCIDENCE PER 100,000

50

40

30

20

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

COLON CANCER RATE CO

Colon CO Colon US Linear (Colon CO) Linear (Colon US)
70

60
INCIDENCE PER 100,000

50

40

30

20

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

COLON CANCER RATE CA

Colon CA Colon US Linear (Colon CA) Linear (Colon US)
70

60
INCIDENCE PER 100,000

50

40

30

20

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR
 Colon Medical States

COLON CANCER RATE NM

Colon NM Colon US Linear (Colon NM) Linear (Colon US)
70

60
INCIDENCE PER 100,000

50

40

30

20

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

COLON CANCER RATE MT

Colon MT Colon US Linear (Colon MT) Linear (Colon US)
70

60
INCIDENCE PER 100,000

50

40

30

20

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

COLON CANCER RATE VT

Colon VT Colon US Linear (Colon VT) Linear (Colon US)
70

60
INCIDENCE PER 100,000

50

40

30

20

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR
 Colon Illegal States

COLON CANCER RATE ID

Colon ID Colon US Linear (Colon ID) Linear (Colon US)
70

60
INCIDENCE PER 100,000

50

40

30

20

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

COLON CANCER RATE TX

Colon TX Colon US Linear (Colon TX) Linear (Colon US)
70

60
INCIDENCE PER 100,000

50

40

30

20

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

COLON CANCER RATE VA

Colon VA Colon US Linear (Colon VA) Linear (Colon US)
70

60
INCIDENCE PER 100,000

50

40

30

20

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR
 Melanoma Recreational States

MELANOMA RATE ME
Melanoma ME Melanoma US Linear (Melanoma ME) Linear (Melanoma US)

30

25
INCIDENCE PER 100,000

20

15

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

MELANOMA RATE CO
Melanoma CO Melanoma US Linear (Melanoma CO) Linear (Melanoma US)

30

25
INCIDENCE PER 100,000

20

15

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

COLON CANCER RATE CA

Colon CA Colon US Linear (Colon CA) Linear (Colon US)
70

60
INCIDENCE PER 100,000

50

40

30

20

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR
 Melanoma Medical States

MELANOMA RATE NM
Melanoma NM Melanoma US Linear (Melanoma NM) Linear (Melanoma US)
25

20
INCIDENCE PER 100,000

15

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

MELANOMA RATE MT
Melanoma MT Melanoma US Linear (Melanoma MT) Linear (Melanoma US)
30

25
INCIDENCE PER 100,000

20

15

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

MELANOMA RATE VT
Melanoma VT Melanoma US Linear (Melanoma VT) Linear (Melanoma US)
40
35
30
ICIDENCE PER 100,000

25
20
15
10
5
0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR
 Melanoma Illegal States

MELANOMA RATE ID
Melanoma ID Melanoma US Linear (Melanoma ID) Linear (Melanoma US)
30

25
INCIDENCE PER 100,000

20

15

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

MELANOMA RATE TX
Melanoma TX Melanoma US Linear (Melanoma TX) Linear (Melanoma US)
25

20
INCIDENCE PER 100,000

15

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR

MELANOMA RATE VA
Melanoma VA Melanoma US
25 Linear (Melanoma VA) Linear (Melanoma US)

20

15
INCIDENCE PER 100,000

10

0
1999 2000 2002 2004 2006 2008 2010 2012 2014
YEAR
 Drug Overdose
Recreational States
DRUG OVERDOSE RATE ME
OD ME OD US Linear (OD ME) Linear (OD US)
35

30

25
DEATHS PER 100,000

20

15

10

0
1999 2005 2014 2015 2016
YEAR

DRUG OVERDOSE RATE CO

OD CO OD US Linear (OD CO) Linear (OD US)
25

20
DEATHS PER 100,000

15

10

0
1999 2005 2014 2015 2016
YEAR

DRUG OVERDOSE RATE CA

OD CA OD US Linear (OD CA) Linear (OD US)
25

20
DEATHS PER 100,000

15

10

0
1999 2005 2014 2015 2016
YEAR
 Medical States
DRUG OVERDOSE RATE NM
OD NM OD US Linear (OD NM) Linear (OD US)
30

25
DEATHS PER 100,000

20

15

10

0
1999 2005 2014 2015 2016
YEAR

DRUG OVERDOSE RATE MT

OD MT OD US Linear (OD MT) Linear (OD US)
25

20
DEATHS PER 100,000

15

10

0
1999 2005 2014 2015 2016
YEAR

DRUG OVERDOSE RATE VT

OD VT OD US Linear (OD VT) Linear (OD US)
25

20
DEATHS PER 100,000

15

10

0
1999 2005 2014 2015 2016
YEAR
 Illegal States
DRUG OVERDOSE RATE ID
OD ID OD US Linear (OD ID) Linear (OD US)
25

20
DEATHS PER 100,000

15

10

0
1999 2005 2014 2015 2016
YEAR

DRUG OVERDOSE RATE TX

OD TX OD US Linear (OD TX) Linear (OD US)
25

20
DEATHS PER 100,000

15

10

0
1999 2005 2014 2015 2016
YEAR

DRUG OVERDOSE RATE VA

OD VA OD US Linear (OD VA) Linear (OD US)
25

20
DEATHS PER 100,000

15

10

0
1999 2005 2014 2015 2016
YEAR
 Obesity
Recreational States
OBESITY RATE ME
Obese ME Obese US Linear (Obese ME) Linear (Obese US)
40
35
30
INCIDENCE PER 100,000

25
20
15
10
5
0
2000 2004 2006 2008 2010 2012 2014
YEAR

OBESISTY RATE CO
Obese CO Obese US Linear (Obese CO) Linear (Obese US)
40
35
30
INCIDENCE PER 100,000

25
20
15
10
5
0
2000 2004 2006 2008 2010 2012 2014
YEAR
.
OBESITY RATE CA
Obese CA Obese US Linear (Obese CA) Linear (Obese US)
40
35
30
INCIDENCE PER 100,000

25
20
15
10
5
0
2000 2004 2006 2008 2010 2012 2014
YEAR
 Medical States
OBESITY RATE NM
Obese NM Obese US Linear (Obese NM) Linear (Obese US)
40
35
30
INCIDENCE PER 100,000

25
20
15
10
5
0
2000 2004 2006 2008 2010 2012 2014
YEAR

OBESITY RATE MT
Obese MT Obese US Linear (Obese MT) Linear (Obese US)
40
35
30
INCIDENCE PER 100,000

25
20
15
10
5
0
2000 2004 2006 2008 2010 2012 2014
YEAR

OBESITY RATE VT
Obese VT Obese US Linear (Obese VT) Linear (Obese US)
40
35
30
INCIDENCE PER 100,000

25
20
15
10
5
0
2000 2004 2006 2008 2010 2012 2014
YEAR
 Illegal States
OBESITY RATE ID
Obese ID Obese US Linear (Obese ID) Linear (Obese US)
40
35
30
INCIDENCE PER 100,000

25
20
15
10
5
0
2000 2004 2006 2008 2010 2012 2014
YEAR

OBESITY RATE TX
Obese TX Obese US Linear (Obese TX) Linear (Obese US)
40
35
30
INCIDENCE PER 100,000

25
20
15
10
5
0
2000 2004 2006 2008 2010 2012 2014
YEAR

OBESITY RATE VA
Obese VA Obese US Linear (Obese VA) Linear (Obese US)
40
35
30
INCIDENCE PER 100,000

25
20
15
10
5
0
2000 2004 2006 2008 2010 2012 2014
YEAR
 Stroke Mortality
Recreational States
STROKE MORTALITY ME
Stroke ME Stroke US Linear (Stroke ME) Linear (Stroke US)
30

25
DEATHS PER 100,000

20

15

10

0
2006 2007 2008 2009 2010 2011 2012 2013 2014
YEAR

STROKE MORTALITY CO
Stroke CO Stroke US Linear (Stroke CO) Linear (Stroke US)
30

25
DEATHS PER 100,000

20

15

10

0
2006 2007 2008 2009 2010 2011 2012 2013 2014
YEAR

STROKE MORTALITY CA
Stroke CA Stroke US Linear (Stroke CA) Linear (Stroke US)
30

25
DEATHS PER 100,000

20

15

10

0
2006 2007 2008 2009 2010 2011 2012 2013 2014
YEAR
 Medical States
STROKE MORTALITY NM
Stroke NM Stroke US Linear (Stroke NM) Linear (Stroke US)
30

25
DEATHS PER 100,000

20

15

10

0
2006 2007 2008 2009 2010 2011 2012 2013 2014
YEAR

STROKE MORTALITY MT
Stroke MT Stroke US Linear (Stroke MT) Linear (Stroke US)
30

25
DEATHS PER 100,000

20

15

10

0
2006 2007 2008 2009 2010 2011 2012 2013 2014
YEAR

STOKE MORTALITY VT
Stroke VT Stroke US Linear (Stroke VT) Linear (Stroke US)
30

25
DEATHS PER 100,000

20

15

10

0
2006 2007 2008 2009 2010 2011 2012 2013 2014
YEAR
 Illegal States
STROKE MORTALITY ID
Stroke ID Stroke US Linear (Stroke ID) Linear (Stroke US)
35

30

25
DEATHS PER 100,000

20

15

10

0
2006 2007 2008 2009 2010 2011 2012 2013 2014
YEAR

STROKE MORTALITY TX
Stroke TX Stroke US Linear (Stroke TX) Linear (Stroke US)
35

30

25
DEATHS PER 100,000

20

15

10

0
2006 2007 2008 2009 2010 2011 2012 2013 2014
YEAR

STROKE MORTALITY VA
Stroke VA Stroke US Linear (Stroke VA) Linear (Stroke US)
35

30

25
DEATHS PER 100,000

20

15

10

0
2006 2007 2008 2009 2010 2011 2012 2013 2014
YEAR