Pediatric Health Care Utilization and Financial Impact Following Recreational Marijuana Legalization in Michigan: A Retrospective Single-Center Study

The expansion of recreational marijuana legalization across the United States has coincided with rising cannabis exposures among children and adolescents. However, limited data exist on the downstream clinical and economic effects within pediatric healthcare systems. This study aims to evaluate changes in clinical care patterns, hospital resource utilization, and financial implications associated with pediatric marijuana-related visits before and after recreational legalization of marijuana in Michigan.

A retrospective chart review was conducted for patients <18 years old treated at a freestanding, urban, tertiary children’s hospital between January 1, 2015 and January 1, 2025. Cannabis related encounters were identified using ICD-10 codes and stratified into pre-legalization (2015–2018) and post-legalization (2019–2024) cohorts. Variables analyzed included demographics, diagnosis, triage acuity, disposition, length of stay, disposition, resource utilization, and cost metrics.

Of 276 cases, 53 (19.2%) occurred pre-legalization and 223 (80.8%) post-legalization. Average annual hospital encounters nearly doubled post-legalization (19/year vs 36/year). Geographic distribution broadened post-legalization, with cases arising from a wider range of ZIP codes (36 vs 52). Fewer high-acuity triage scores (ESI 1–2) were observed post-legalization (68.0% to 40.9%, p=0.003), with a corresponding rise in lower-acuity cases ESI 3 (24.5% to 49.1%). Inpatient admissions increased (3.8% to 29.6%, p=0.002), and emergency department discharges decreased (73.6% to 49.3%). Mean LOS rose from 10.9 to 30.6 hours (p<0.001). IV fluid use increased (45.3% to 76.2%, p<0.001), while urine drug screening (92.5% to 74.4%, p=0.004) declined. Mean hospital costs rose significantly ($509.43 to $1,346.71, p<0.001).

Following recreational marijuana legalization in Michigan, pediatric cannabis related hospital encounters increased substantially with broader geographic distribution, shifts in healthcare resource utilization, and marked rise in hospital-associated costs. These findings highlight the need for targeted public education, regulatory safeguards, and healthcare system preparedness to address rising pediatric cannabis exposures.