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Background: Several have claimed that the overreliance on benzodiazepines for many approved and off-label uses poses substantial human and social consequences comparable to those observed with the opioid epidemic. In light of these problems, alternatives are required to properly manage patients. Numerous states now permit the use of medical cannabis to treat conditions, such as chronic pain, that were traditionally treated with benzodiazepines, opioids, or both. As patients and physicians seek alternative treatments, little is known about whether the presence of cannabis laws helps to alleviate the burdens caused by these more traditional medications owing to the displacement of benzodiazepines and/or opioids toward cannabis. Methods: Using data from multiple years of the National Survey on Drug Use and Health (2017, 2018, 2019), the effect of Medical Marijuana Laws (MMLs) on benzodiazepine and/or opioid use and misuse is examined while controlling for a variety of demographic characteristics. Supplemental analysis also is performed including the 2020 and 2021 survey years. Results: MMLs did not affect lone, legitimate benzodiazepine usage, but lower use of opioids and combinations of benzodiazepines and opioids was observed. MMLs appear to help attenuate benzodiazepine and/or opioid misuse to a substantial degree. Additional results suggest that the presence of an MML was related to annual, varying decreases in the use and misuse of benzodiazepines, opioids, and their combination across the years of data evaluated. Conclusions: MMLs may serve to attenuate the consequences of benzodiazepine, opioid, and their combined use and/or misuse to varying degrees. [ABSTRACT FROM AUTHOR]

The criminal justice system underwent two revolutionary developments over the past twenty years--the legalization of medical marijuana at the state level, which provides criminal immunity protections for qualifying patients, and the exponential rise of drug treatment courts as alternatives to incarceration. Traditionally, offenders serving probationary sentences are generally prohibited from using drugs as one condition of probation. But courts are now increasingly confronted with challenges to probationary conditions prohibiting the use of medical marijuana in states where it has been legalized. The trend among courts permits the medicinal use of marijuana during probationary sentences and invalidates conditions prohibiting such use for therapeutic purposes. Drug treatment courts are a form of probation that offer intensive treatment services for offenders with substance abuse disorders. Most drug treatment courts across the country operate on an abstinence-based model. While to date there have been no reported challenges to prohibiting the use of medical marijuana by participants in drug treatment court programs, the legal and practical issues are brimming just below the surface, and it is only a matter of time before a clash occurs between criminal immunity provisions under state medical marijuana laws and their consequential applicability in the drug treatment court landscape. This Article takes a forward-looking approach by foreshadowing this seemingly straightforward, but complicated question: How will criminal immunity provisions under state medical marijuana laws and the judicial protections afforded to offenders on regular probation be construed by appellate courts when inevitably challenged by drug treatment court participants? This is the first scholarly article to address the knotty legal and practical issues underlying this inquiry. The purpose of this contribution then is to provide future scholars, appellate courts, drug treatment courts, legal actors, and drug treatment court professionals with a robust foundation to draw upon in thinking about the adaptability of medical marijuana use in the drug treatment court domain. [ABSTRACT FROM AUTHOR]

The article discusses the case Cease v. Housing Authority to examine the use of Pennsylvania's medical marijuana act to the eligibility requirements of the federally-funded section 8 housing program for low-income tenants. Also cited are the provisions of the Quality Housing and Work Responsibility Act (QHWRA) regarding the admission to and termination from the program, and the state's Medical Marijuana Act (MMA) that legalize the use of marijuana.

The development of anxiety disorders and post-traumatic stress disorder (PTSD) is complex. Both delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are of potential therapeutic use. Evidence suggests that cannabis has a beneficial effect on neural circuitry involved in fear regulation. In the United States, cannabis is considered either medical or recreational and can contain pure THC or CBD or any combination thereof. The numerous cannabis compounds of various administration routes, with variable pharmacokinetics, further affect the cannabis conundrum. Despite being federally unregulated, medical cannabis has received increased attention socially, and at present, 37 states, four territories, and the District of Columbia have legalized medical cannabis for use in specific health conditions. Patients are increasingly inquiring about cannabis, and clinicians must educate themselves with reliable cannabinoid information for patient education. In adults with anxiety disorders and PTSD, evidence supports a relatively safe profile for medical cannabis; however, conclusive scientific evidential support of its therapeutic properties is limited, resulting in a lack of standardization and Food and Drug Administration approval. [ABSTRACT FROM AUTHOR]

Deregulation of cannabis use has raised concerns regarding its potential effects on health, particularly in adolescents and young adults. Here, we extracted data from the Global Burden of Disease database to estimate the long-term effect (> 5 years) of medical marijuana laws (MML) on 2019 cannabis use disorders Disability Adjusted Life Years (2019 CUD DALYs) in US male and female adolescents (15–19 years old) and young adults (20–24 years old). Socio-cultural, demographic and economic characteristics were used as baseline covariates. To improve the robustness of estimation, we took advantage of machine learning techniques. We found no significant effect of MML on 2019 CUD DALYS in each of our four age/sex groups. Estimates from a marginal structural model taking into account age and sex strata in the same model were also non-significant. Our findings suggest that MML may have a negligible effect (if any) on cannabis use disorders in this population group. [ABSTRACT FROM AUTHOR]

Introduction State legalization of marijuana for medical purposes could increase illicit marijuana use among young people. Medical marijuana laws may boost the availability of marijuana and reduce perceptions of its harmfulness, leading more young people to try it. Prior studies report little evidence that these laws are impacting marijuana consumption by young Americans, and none have systematically compared developmentally distinct age groups. Methods We performed multilevel, serial cross-sectional analyses on ten annual waves of U.S. National Survey on Drug Use and Health, from 2004 to 2013, comparing young people in states with and without medical marijuana laws. Disaggregated analyses compared multiple measures of marijuana use across approximately 450,300 individuals in early adolescence (12-14 years), late adolescence (15-17 years) and young adulthood (18-25 years). Results Dwelling in a state that had legalized medical marijuana was not associated with marijuana consumption in the past month among early adolescents, late adolescents or young adults. However, young adults living in medical marijuana states were significantly more likely to have initiated first use in the past year. Conclusions Medical marijuana laws increase the likelihood that young adults will start using marijuana but do not affect more vulnerable developmental groups in early and late adolescence. Delaying the age of first use into young adulthood can reduce the risk of a drug use disorder later in life. Young adults are in the peak years of engagement with illicit drugs and state medical marijuana laws appear to be leading larger numbers to try the drug.

The trend of legalizing medical cannabis is related to its increased illicit use worldwide. In Taiwan, cannabis has become the fifth most used illicit substance, with continuous increases in its use since 2018; yet, the potential risk of adverse mental health due to cannabis use has not been sufficiently emphasized. In this study, we present the findings from a case series of six patients with cannabis-induced psychosis. Two of them had prior psychotic disorders in remission. Four patients showed violent behaviors, and other two showed lethal suicidal behaviors under the influence of cannabis. Two of the six patients were hospitalized for more than 2 weeks owing to the prolonged psychotic state. Clinicians, patients with psychosis, and cannabis users in Eastern countries should pay more attention to the complex models of cannabis use and the public risk of related violent behaviors exhibited by patients under psychosis. [ABSTRACT FROM AUTHOR]

The World Anti‐Doping Agency now allows cannabidiol (CBD) to be taken in elite sport, but has retained all other cannabinoids on its banned list. This, together with liberalisation of cannabis laws, has led to an increasing interest in its use in sport. This includes commercial sponsorship of sporting events and highlights the need for accurate information to be readily available to athletes and their advisers. This narrative review confirms that CBD and tetrahydrocannabinol (THC) do not enhance performance. CBD possesses anti‐inflammatory and analgesic properties that have not been adequately evaluated in the area of sport. Some formulations of CBD contain THC or other cannabinoids that may result in a positive drug test. [ABSTRACT FROM AUTHOR]

BACKGROUND: The presence of contaminants in cannabis presents a potential health hazard to recreational users and susceptible patients with medical conditions. Because of the federally illegal status of cannabis, there are no unified regulatory guidelines mitigating the public health risk of cannabis contaminants. OBJECTIVE: To inform further research and provide solutions to the public health risk of cannabis contaminants at a national level, we examined the current landscape of state-level contaminant regulations, and cannabis contaminants of concern, as well as patient populations susceptible to contaminants. METHODS: We examined the regulatory documents for medical and recreational cannabis in all legalized U.S. jurisdictions and compiled a complete list of regulated contaminants, namely, pesticides, inorganics, solvents, microbes, and mycotoxins. We data mined the compliance testing records of 5,654 cured flower and 3,760 extract samples that accounted for ~6% of California's legal cannabis production in 2020-2021. We also reviewed the publicly available medical cannabis use reports to tabulate the susceptible patient populations. RESULTS: As of 18 May 2022, 36 states and the District of Columbia listed a total of 679 cannabis contaminants as regulated in medical or recreational cannabis, including 551 pesticides, 74 solvents, 12 inorganics, 21 microbes, 5 mycotoxins, and 16 other contaminants. Different jurisdictions showed significant variations in regulated contaminants and action levels ranging up to four orders of magnitude. A failure rate of 2.3% was identified for flowers and 9.2% for extracts in the California samples. Insecticides and fungicides were the most prevalent categories of detected contaminants, with boscalid and chlorpyrifos being the most common. The contaminant concentrations fell below the regulatory action levels in many legalized jurisdictions, indicating a higher risk of contaminant exposure. Cannabis use reports indicated usage in several patient populations susceptible to contamination toxicity, including cancer (44,318) and seizure (21,195) patients. DISCUSSION: Although individual jurisdictions can implement their policies and regulations for legalized cannabis, this study demonstrates the urgent need to mitigate the public health risk of cannabis contamination by introducing national-level guidelines based on conventional risk assessment methodologies and knowledge of patients' susceptibility in medical use. [ABSTRACT FROM AUTHOR]

Background The purpose of this paper is to discuss the history of cannabis, its benefits, risks and the federal re-legalization of cannabis for medical use in the USA. Methods Thirty-six states have legalized cannabis as a medicinal substance. Cannabis is a Schedule I drug, an illegal and controlled substance, making research on the substance challenging. Both the American Medical Association and the American Nurses Association have called for the re-scheduling of marijuana, so that research can be conducted, its benefits and risks discovered. Results Data are demonstrating that medical marijuana may be beneficial as a step-down drug, decreasing the use of opioids and benzodiazepines, as well as deaths related to their overdose. Studies have indicated that cannabis is a low-risk substance, when compared to alcohol and opioids. There appear to be specific conditions in which cannabis provides relief of symptoms which no other medications can provide. There is also evidence of cannabis's negative effects on the developing brain. Conclusion Cannabis should be rescheduled and researched, so that its risks and benefits can be identified. Its medicinal use should be monitored, and its availability protected in children, pregnant women and pets. [ABSTRACT FROM AUTHOR]

This article examines the nature of and controversies within southwest Michigan's unique cannabis community during the state's imposition of a new regulatory model for medical cannabis businesses. These transformations occurred at the same time voters in the state struck down prohibition in 2018, arguably facilitating an even more anomic environment for medical cannabis patients and stakeholders. Data presented here comes from an eclectic mix of key informant interviews (n = 9), focus groups of cannabis patients (n = 21), informal researcher observations, and news reports. These are combined to create a case study that illuminates a variety of tensions during a transformational time. Results are then broken down between two overarching themes—How new regulations favoring big businesses made medical cannabis scarce for patients, and how the inclusion of caregivers in the new regulatory system may have prevented such a scarcity. Following the results is a discussion which synthesizes the literature on medical cannabis social movements and the cannabis subculture with the tensions and controversies documented in Michigan. The article concludes with implications and practical strategies for regulatory bodies as both medical and adult-use cannabis moves from the underground and into the formal economy. [ABSTRACT FROM AUTHOR]

The article discusses the ruling in the case Harrisburg Area Community College v. Pennsylvania Human Relations Commission to analyze the complications with the scope of protection against possible discrimination and lack of mandatory accommodations of the Pennsylvania Medical Marijuana Act (MMA). Also cited is how the case featured the statutory inconsistencies between the MMA, the Pennsylvania Human Relations Act (PHRA), and the Pennsylvania Fair Educational Opportunities Act (PFEOA).

Studies on the effect of marijuana on domestic violence often suffer from endogeneity issues. To examine the effect of marijuana decriminalization and medical marijuana legalization on serious domestic assaults, we conducted a difference-in-differences analysis on a panel dataset on NIBRS-reported assaults in 24 states over the 12 years between 2005 and 2016. Assaults disaggregated according to situation and extent of injury were employed as dependent variables. We found that while the total number of assaults did not change, decriminalization reduced domestic assaults involving serious injuries by 18%. From a harm reduction perspective, these results suggest that while the extensive margin of violence did not change, the intensive margin measured by the seriousness of assaults were substantially affected by decriminalization. This result may be partially explained by reductions in offender alcohol intoxication and weapon-involved assault. [ABSTRACT FROM AUTHOR]

The article focuses on endometriosis that is an oestrogen-dependent, chronic inflammatory condition characterized by the presence of endometrial-like tissue outside of the uterus. Topics include considered several percentage of women and those assigned female at birth have a diagnosis of endometriosis by the age of 44 years.

Cannabis use among adolescents may have detrimental effects and use among this age group is increasing. It is important to understand how expansion of laws permitting cannabis sales may impact adolescent use. Much of the current research has explored how state-level policy decisions may impact adolescents' use behaviors; however, there is a gap in the understanding of how differences in local jurisdictional policies may also influence underage cannabis use. Procedures: The present study cross-sectionally assesses local variation in cannabis policies to explore the potential effects of local policy on underage use behaviors. Data were collected from (N = 1,573) adolescents representing 120 different localities across California, collected as a part of Project Cal Teens. Linear regression models were used to assess associations between local jurisdiction's allowance of retail sale of cannabis for adult-use and past 30-day use of non-medical (adult use) cannabis and perceived access to cannabis products. Local policy allowing cannabis retail was associated with adolescents' significantly higher past 30-day use of cannabis (β = 0.25 95% CI = 0.08, 0.42) and perceived access (β = 0.60 95% CI = 0.27, 0.94). Results highlight the impact of local cannabis policies on adolescent cannabis use and perception. Considering the effects of cannabis use on adolescent development, this is an important public health concern because 14 states have already legalized recreational retail sales and growing numbers of local jurisdictions are allowing the retail sale of recreational cannabis. [ABSTRACT FROM AUTHOR]

The legalization of medical marijuana in states of the United States is currently a controversial topic. Despite conflict with the federal government, 33 states have legalized medical marijuana and other states are currently considering adopting the law by the year 2019. Why do some US states adopt medical marijuana laws (MMLs) and others do not? This study examines the diffusion of MMLs by analysing policy adoption from morality and economic development policy perspectives. This study finds that the morality perspectives of states – religious groups, citizens' liberal ideology, and a ballot initiative process – have a significant effect on the adoption of medical marijuana laws. Economic indicators – fiscal capacity growth, incarceration, and the cost of the justice system – also have a significant effect on adoption. Marijuana users and the state regulatory environment are also important predictors of the diffusion. Overall, this study finds that the adoption and diffusion of MMLs is mainly determined by the opinions of citizens rather than the political ideology of elected officials or the government's fiscal health conditions. In addition, the study finds that the multidimensional policy model provides a better explanation for this than either of the single policy perspective models. [ABSTRACT FROM AUTHOR]

Medical marijuana legalization (MML) has become more prevalent in the United States. This study examined the association between medical marijuana legalization and sources of obtaining marijuana among adults in the United States. Adult participants (age ≥ 18) from the 2018 wave of the National Survey on Drug Use and Health (NSDUH) were analyzed (n = 42,669, weighted N = 247,247,786). We used two multinomial regression models to estimate the association. The first model controlled for sociodemographic variables, and the second model additionally included an interaction effect of participants' race with MML. In the first model, participants residing in states with MML were positively associated with reporting lifetime marijuana use (but did not use in the past 12 months), buying marijuana, receiving marijuana for free or sharing with others, and growing marijuana on their own (all p <.01). With the interaction of participants' race, nonwhites residing in states with MML were negatively associated with reporting lifetime marijuana use and receiving marijuana for free or sharing marijuana with others (all p <.05). Policy makers should be aware of the sources of obtaining marijuana in the states with legalization of medical marijuana. [ABSTRACT FROM AUTHOR]

Background: Legalization of cannabis use and the evidence base supporting both risks and benefits of cannabinoids are expanding, but our understanding of health care professionals' (HCPs) knowledge about cannabis for medical purposes is limited. Understanding of the knowledge base and knowledge gaps about medical cannabis use is critical to advanced practice registered nurses (APRNs) because they are increasingly called on to manage patients taking multiple drugs, including prescribed and unprescribed cannabis and prescription cannabinoids. Purpose: The purpose of this study was to examine HCPs' knowledge of clinical cannabis, including laws and regulations; risks and harms; pharmacology; and effects on pain, multiple sclerosis spasticity, and seizures as assessed with written tests before an in-person, continuing medical education program. Methods: Total scores and differences among professions and topics were compared. Results: A total of 178 of the 226 program attendees completed the test (79%) (107 [47%] physicians, 30 [13%] APRNs, and 18 [8%] registered nurses). The mean test score was 63.2% (SD = 12.7%) without significant differences among professions (F (3, 174) = 1.53; p =.21) but with significant differences among topics (χ2(7, 1068) = 201.13; p <.001). The score was lowest for effects on seizures (43.8%) and with scores below 70% for all other areas except laws and regulations (85.7%). Implications for practice: There are substantial gaps in HCPs' knowledge about the clinical effects of cannabis, especially about risks and harms, pharmacology, and the effects on pain, multiple sclerosis spasticity, and seizures. Further education may help HCPs to understand the risks and benefits of cannabis and cannabinoids across conditions. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Medical cannabis programs across the country vary and differ in their qualifying conditions for medical cannabis use. This has led to a gap in knowledge regarding the specific needs of cannabis patients, including the most common reason patients seek medical cannabis. The purpose of this study was to examine the current needs of medical cannabis patients in order to better inform future research, and to evaluate potential needs in policy changes in states with more restrictive qualifying conditions for medical cannabis use. Methods: A cross-sectional survey study was administered (n = 207) at a Laurel Harvest Labs dispensary in Pennsylvania. Participants were qualified medical cannabis users and were recruited as a convenience sample when entering the dispensary. The survey asked questions regarding participant demographics, medical cannabis qualifying conditions, usage, methods of administration, adverse effects, tolerance, and impact of medical cannabis on medication, alcohol, and tobacco use. Chi-squared or Fisher's exact tests were conducted for analyses involving categorical data. Results: The mean age of respondents was 36.7 years (SD = 12.8), and the majority were male (61.4%) and white (84.7%). Respondents self-reported that anxiety disorder was the most common qualifying medical condition and the most common comorbid condition (50.1%; 69.3%) for medical cannabis use. Additionally, approximately 95% of users reported having no adverse effects from using medical cannabis, and 90% of users preferred inhalation through vaporization as the preferred method of consumption. More than 50% of participants reported an improvement in their symptoms where only 20% of users reported being tolerant to their current dose. More than 70% of respondents reported that obtaining medical cannabis was "easy" and 54% of users reported that the cost of medical cannabis was not a barrier to access. Conclusions: Anxiety disorder is a prevalent condition for which medical cannabis is used; however, many states do not recognize anxiety disorder as a qualifying condition for medical cannabis. Further research on medical cannabis use for anxiety disorders is needed to evaluate proper dosing and responses to treatment. [ABSTRACT FROM AUTHOR]

Aims: Canada's 2018 Cannabis Act allows youth (age 12–17 years) to possess up to 5 g of dried cannabis (or equivalent) for personal consumption/sharing. This study assessed whether the Cannabis Act was associated with changes in police‐reported cannabis offences among youth in Canada. Design Time series model using national daily criminal incident data from January 1, 2015–December 31, 2018 from the Canadian Uniform Crime Reporting Survey (UCR‐2). Seasonal autoregressive integrated moving average time series models, stratified by sex, assessed the relations between legalization and youth cannabis‐related offences. Setting: Canada, 2015–2018. Cases Police‐reported cannabis‐related offenses among youth age 12–17 years (male, n = 32 178; female, n = 9001). Measurements Outcomes: police‐reported cannabis‐related crimes, property crimes, and violent crimes. Covariate: calendar‐month. Findings For females, legalization was associated with a step‐effect decrease of 4.56 (95% confidence interval [CI] = 3.32, 5.81; P < 0.001) police‐reported cannabis‐related criminal offences per day, an effect equivalent to a 64.6% (standard error [SE] = 33.5%) reduction. For males, legalization was associated with a drop of 12.73 (95% CI = 8.82, 16.64; P < 0.001) cannabis‐related offences per day, equaling a decrease of 57.7% (SE = 22.6%). Results were inconclusive as to whether there were associations between cannabis legalization and patterns of property crimes or violent crimes. Conclusions: Implementation of the Cannabis Act in Canada in 2018 appears to have been associated with decreases of 55%–65% in cannabis‐related crimes among male and female youth. [ABSTRACT FROM AUTHOR]

Background and aim: New Zealand has recently legalized medicinal cannabis and has explored the possibility of legalizing large‐scale recreational cannabis supply. In the process, concerns have emerged regarding whether corporations involved in the large‐scale production and sale of legalized cannabis will invest in tactics of influence with policymakers and the public. This paper aimed to examine the various ways a legalized cannabis industry could seek to influence governments and the public in the New Zealand reform context. Method: Based on the study of industry tactics with alcohol, tobacco and gambling, we applied a three‐chain model of industry influence that breaks tactics into the 'public good', 'knowledge' and 'political' chains. Results: Exploratory analysis of the nascent cannabis industry's activity in New Zealand provided signs of industry influence strategies related to all three chains. The medicinal cannabis industry has associated the establishment of a legal cannabis sector with regional economic development and employment, supported lobbying for recreational law reform, funded NGOs involved in lobbying for law reform, established research partnerships with universities, invited ex‐politicians on advisory boards, and participated in government public sector partnerships. Conclusion: There is emerging evidence that the legal cannabis industry is using strategies to influence the regulatory environment in New Zealand. [ABSTRACT FROM AUTHOR]

At the structural level, medical cannabis laws (MCLs) have been negatively associated with opioid prescribing practices, and sexual minority adults report disproportionately high non-medical prescription opioid use. We examined medical/non-medical prescription opioid use by intersecting sexual identity and gender and explored associations with MCLs using the 2015–2017 National Survey on Drug Use and Health, which captured sexual identity and MCL state residence for adults 18 + years (N = 126,463). Survey-weighted gender-stratified multinomial logistic models estimated adjusted relative risk ratios (aRRR) of medical vs. no prescription opioid use, and any non-medical vs. no prescription opioid use, by sexual identity and MCL, and tested moderation by MCL. Past-year medical prescription opioid use was higher among women than men across sexual identities (e.g., bisexual: 38.5% women vs. 30.2% men). Non-medical prescription opioid use was lower among women than men, except for bisexual adults (12.4% women vs. 7.6% men). MCL was associated with lower medical prescription opioid vs. no use among heterosexual women (aRRR = 0.86, 95% confidence interval [CI] = 0.81–0.91), bisexual women (aRRR = 0.74, 95% CI = 0.62–0.89), and heterosexual men (aRRR = 0.91, 95% CI = 0.85–0.97). Living in an MCL state was associated with lower non-medical vs. no use among heterosexual and bisexual women, but not among men or lesbian/gay women. MCL status did not moderate associations between sexual identity and prescription opioid outcomes. Future studies should assess whether implementing MCLs could particularly affect bisexual women who reported the highest prescription opioid use and may need targeted services. [ABSTRACT FROM AUTHOR]

The coronavirus disease 2019 (COVID-19) pandemic has led to increases in felt negative affect for many. This is concerning as individuals at increased risk for mental health issues are often more likely to use substances to cope with stressors. The aim of the current study is to examine whether communities reporting an increased risk for developing mental health issues showed differential patterns of legal cannabis use as the pandemic began. A secondary goal is to examine the feasibility of using anonymized location data to uncover community consumption patterns of potential concern. Anonymized location data from approximately 10% of devices in the United States provided a count of the number of visitors to 3,335 cannabis retail locations (medical and recreational) each day from December 1st 2019 through April 2020. Visitor counts were merged with the average number of mentally unhealthy days (aMUDs) reported in the Federal Information Processing Standard (FIPS) county the retailer was located along with FIPS county population and poverty rate estimates. A Poisson spline regression predicting visitors by day, aMUDs, as well as their interaction was performed, entering population and poverty rate as covariates. As the pandemic began communities reporting a greater aMUDs showed greater visitation to cannabis retailers. These results suggest that the COVID-19 pandemic may have led to increased legal cannabis use in at risk communities. They also highlight the value anonymized location data can provide policymakers and practitioners in uncovering community level trends as they confront an increasingly uncertain landscape. [ABSTRACT FROM AUTHOR]

The consequences of legal access to medical marijuana for individuals' well-being are controversially assessed. We contribute to the discussion by evaluating the impact of the introduction of medical marijuana laws across US states on self-reported mental health considering different motives for cannabis consumption. Our analysis is based on BRFSS survey data from close to eight million respondents between 1993 and 2018 that we combine with information from the NSDUH to estimate individual consumption propensities. We find that eased access to marijuana through medical marijuana laws reduce the reported number of days with poor mental health for individuals with a high propensity to consume marijuana for medical purposes and for those individuals who likely suffer from frequent pain.

Introduction: The recent legalization of cannabis in California has the potential to affect cannabis prevalence in households with children. This eventuality, combined with suboptimal cannabis storage practices, could lead to adverse effects such as unintentional pediatric ingestion, which occurred in Colorado after legalization. Our objective was to assess prevalence and storage practices of cannabis in households with children, and attitudes on use and storage education in a state that has legalized cannabis. Methods: We administered electronic surveys to 401 adults in a pediatric emergency department in California. Participants were excluded if they were not English- or Spanish-speaking or did not live in a household with children <18 years old. They answered questions regarding cannabis use, storage, and attitudes on cannabis storage education. We used convenience sampling and analyzed data using descriptive statistics. Results: Research assistants approached 558 participants of whom 401 completed the survey. Three participants did not respond regarding past or current cannabis use, and 14.5% (58/401) reported cannabis use in their home in the prior six months. Both users and non-users rated safe storage of high importance in homes with children. Only 44.8% of home users (26/58) reported that their cannabis was both locked and hidden. Among home users, the most common source of storage advice was friends and family (21/58, 36.2%), and 45% of home users (26/58) received no storage information whatsoever. Most cannabis users (53/67, 79.1%) and non-users (241/330, 73%) reported that they would feel comfortable receiving cannabis education from their primary care provider. Conclusion: Cannabis is used and stored in homes with children; however, safe storage is not clearly defined in California, and storage education is lacking. Healthcare providers in primary care and the emergency department may play an important role in educating the public about cannabis use and safe storage. [ABSTRACT FROM AUTHOR]

The article presents information opinion summaries, issued by the Legal Ethics Counsel in 2021, as determined by the Advisory Committee to the Supreme Court of Missouri. Topics discussed include duty of confidentiality, medical marijuana, and the use of an outside shredding company to dispose of closed files.

Background and aims: Opening up access to scheduled drugs such as cannabis in the United Kingdom rarely happens, yet on 1 November 2018 the United Kingdom changed the law to allow cannabis‐derived products to be prescribed for medicinal purposes, albeit in tightly controlled circumstances. This followed substantial media interest in the cases of two children with epilepsy. This article focuses upon the role of scandal in bringing about legislative change. Methods: We used political science and social policy theories (punctuated equilibrium theory and scandal theory) to guide a qualitative content analysis of media articles published in 2018 in UK national newspapers. We focused in particular on the 6‐month period prior to the policy change. Results: The concentrated attention by the media given to the suffering of children with epilepsy appears to have prompted the rapid change in policy by the UK government. A variety of strategies were used to develop a highly emotive response to garner support for reform. Media stories emphasized the injustice of two extremely sick children being unable to access the medicine they apparently needed to enable them to have a 'normal' childhood. Three groups of 'claim‐makers' were identified as important in influencing public opinion: families, high‐profile individuals and campaigning groups. Conclusions: The case of medicinal cannabis in the United Kingdom suggests that policy reform can occur when a scandal is successfully manufactured. We must be cautious, however, about over‐emphasizing the role of scandal as a driver of policy change in this context: only a limited set of circumstances will permit a prescription for cannabis‐based medicine to be issued in the United Kingdom. [ABSTRACT FROM AUTHOR]

The article focuses on the history and future of the journal of social work practice in the addictions. Topics discussed include Social Workers and other allied professionals interact with person who use and misuse substances in a variety of settings, whether or not people are seeking specific assistance with their use; and according to the latest published information from the 2019 National Survey on Drug Use and Health or NSDUH.

The article examines the role of the Pennsylvania Medical Marijuana Act in providing implied remedy for patients who are experiencing discrimination from their employers due to their medical marijuana patient status. Topics mentioned include the concept of the implied private right of action, the development of federal law, and the use of the Statutory Construction Act to interpret state statutory language.

Medicinal cannabis is legal in some form in 47 states, 3 United States territories, and the District of Columbia. An estimated three million Americans use cannabis for relief of a variety of illnesses, and this figure is expected to grow based on policy changes. However, cannabis remains illegal at the federal level as a Schedule I drug under the 1970 Controlled Substances Act. Schedule I classification of cannabis has impeded the advancement of research, leaving providers with little evidence-based information to educate their patients. Furthermore, the disparities in individual state laws create significant social and health inequities in gaining access to medicinal cannabis. Conflicting state and federal policies regarding medicinal cannabis create logistical and ethical dilemmas, and all U.S. stakeholders—patients, providers, and health delivery systems—may be impacted by conflicting federal and state policies. This brief addresses the impact of conflicting cannabis policies. [ABSTRACT FROM AUTHOR]

The public is often frustrated when Congress or their state legislature is not responsive to their policy priorities. This was especially true during the effort to legalize marijuana in Massachusetts. The legislature consistently refused to take up the issue despite public support. Legalization advocates ultimately bypassed the legislature by turning to the ballot-initiative process on three occasions: first to decriminalize possession of small amounts of marijuana, then to legalize medical marijuana, and most recently to legalize recreational marijuana. After the electorate legalized recreational marijuana, the legislature further frustrated advocates, first by delaying implementation of key parts of the law and later by making significant changes. Despite the fierce criticism of the legislators for attempting to thwart the will of the people, this Essay argues that the Legislature acted in a responsible and effective manner. By giving a detailed history of the legislative activity during the legalization effort, this Essay attempts to show that the state legislature demonstrated valuable traits, including being appropriately cautious when legalizing a range of products that would require extensive regulation, properly considering the concerns of various constituencies, considering the available evidence, and effectively balancing the role of the executive branch. [ABSTRACT FROM AUTHOR]

This Essay considers whether commercial cannabis retailers are adequately constrained in the sale of cannabis to 18- to 21-year-olds. It examines the intersection of the medical cannabis market, recreational cannabis market, and underlying status law regulating late adolescents aged 18 to 21. Because the age of majority licenses full medical decision-making, an 18-year-old can access medical cannabis but not recreational cannabis or alcohol. This Essay proceeds on the assumption that medical cannabis is a construct that has eased the process of achieving a legalized commercial cannabis market. The ambiguity around medical claims is comfortable in the libertarian soil of cannabis discourse, but it invites us to give special attention to 18-year-olds. This Essay argues that the right of an 18-year-old to access commercial cannabis using the medical construct is better understood as a right of the cannabis industry to access the 18-year-old market. People who do not use nicotine, alcohol, or cannabis before the age of 21 are much less likely to use and misuse later. Postponement becomes prevention. Therefore, when those access ages are raised, the industries are losing more than just three additional years of marketing; they are losing access to the creation of lifelong, high-volume users. The underage users are important to the business model because future misusers and abusers buy more reliably. Regulators should monitor the profit motive of the legal cannabis industry as it relates to late adolescents. The age of majority, which is the only explanation for 18-year-old access to medical cannabis, is too weak to justify what is actually self-medication in the colloquial sense. Similarly, the medical status of cannabis is too unclear to justify the risks that selfmedication poses to developing brains. As medical users melt into recreational users, and as medical use receives only the weakest of guidance from physicians due to its unique hybrid character, we should acknowledge that 21 may be the appropriate age of access for both. [ABSTRACT FROM AUTHOR]

Using data from Truven Health MarketScan Commercial Claims and Encounters Database between 2009 and 2015, we studied the effects of medical and recreational marijuana laws on opioid prescribing in employer-sponsored health insurance. We used a differences-in-differences (DD) approach and found that the implementation of medical marijuana laws (MMLs) and recreational marijuana laws (RMLs) reduced morphine milligram equivalents per enrollee by 7% and 13%, respectively. The reduction associated with MMLs was predominately in people aged 55-64, whereas the reduction associated with RMLs was largely in people aged 35-44 and aged 45-54. Our findings suggest that both MMLs and RMLs have the potential to reduce opioid prescribing in the privately insured population, especially for the middle-aged population. [ABSTRACT FROM AUTHOR]

While 33 states and the District of Columbia have adopted laws legalizing medical marijuana, no studies have considered explaining how and why state requirements and restrictions vary, including eligibility requirements, the amount of legal marijuana permitted, sanctions for abuse, and other provisions in state laws that range from more permissive laws to stricter and more limited laws. This study explains the strictness or extent of medical marijuana laws (MMLs) adopted by states from 1996 to 2013, developing hypotheses based on states' economic conditions, political structures, user demands, criminal justice demands, and the impact of neighboring states. We develop an index score that captures state statute strictness by analyzing and coding the statutes of MMLs in each state. Our findings show (1) that factors that influence adoption of MMLs are not the same as the factors that influence the strictness of policies and (2) that the regulation of users and what they are allowed to have for medical marijuana treatment are associated with different variables than the regulation of dispensaries. Overall, the leniency of MMLs is associated with liberal government ideology, poor state fiscal health, unemployment, the size of the state's criminal justice bureaucracy, numbers of AIDS/cancer patients, and number of neighboring states that have adopted MMLs. Laws regarding users tend to become more lenient over time in states. [ABSTRACT FROM AUTHOR]

This paper examines the effects of state-level medical marijuana laws (MMLs) in the U.S. on birth outcomes, including birth weight, length of gestation, and Apgar scores. Using individual-level natality data from the National Center for Health Statistics from 1990 to 2013, we take advantage of the geographic and temporal variation in the implementation of MMLs in a difference-in-differences estimation framework with state and year fixed effects and state-specific time trends. Overall, we find that MMLs have no impact on gestation period or Apgar scores. While MMLs lead to a statistically significant increase in birth weight by 4.4 g (0.13%), this effect is practically small. Furthermore, we find little variation in the effects of MMLs on birth outcomes across different socioeconomic subgroups and observe no lagged negative effects of MMLs on birth outcomes of children born in the MML states in the years following the legalization of medical marijuana. [ABSTRACT FROM AUTHOR]

As the number of U.S. states that seek to loosen restrictions on marijuana rapidly increases, a heated debate over state and federal regulation has ignited. But an important component of that debate has been largely absent—are these state efforts placing the United States in violation of its international treaty obligations? This article attempts to answer this question by tracing the history of marijuana regulation both in the United States and abroad and outlining the foundations for domestic legislation. It argues that the experiments happening among a number of states and countries to liberalize marijuana laws are bearing fruit and should be tied to a broader reform agenda of the same international narcotics treaties that the United States sought decades ago. [ABSTRACT FROM AUTHOR]

In the context of the opioid epidemic, a limited but growing body of literature has found state medical marijuana laws (MMLs) to be associated with lower levels of opioid prescribing. However, robust evidence linking state MMLs with individual-level opioid-related outcomes is lacking, particularly among women. This finding is especially true for pregnant and parenting women, who have been disproportionately affected by the opioid crisis. Using data drawn from the 2002–2014 National Survey on Drug Use and Heath, the study uses a difference-in-differences estimation strategy to compare opioid-related outcomes (opioid misuse initiation, opioid misuse in the past month and past year, and opioid use disorder) among all women, pregnant women, and parenting women in states with and without MMLs (before and after implementation). The study also investigates the impact of MMLs on marijuana use and marijuana use disorder. The findings indicate that MMLs were not associated with opioid misuse, opioid misuse initiation, or opioid use disorder among all women, pregnant women, and parenting women. These laws were, however, positively correlated with marijuana use and marijuana use disorder among all women and women with children. In addition, MMLs were associated with an increase in the frequency of opioid misuse for pregnant women and a decrease in the frequency of opioid misuse for parenting women. This finding suggests that, although medical marijuana may be viewed by some as a substitute for opioid analgesics, MMLs may not be an effective policy tool to tackle the opioid epidemic among women, especially pregnant and parenting women. [ABSTRACT FROM AUTHOR]

Objective: This article investigates how different types of policies (morality based and highly technical) inform early‐stage policy learning and diffusion processes. Methods: Using process tracing, interviews, archival research, and cross‐case analysis, this article describes and compares the emergence of medical marijuana and offshore wind energy policies in U.S. states. Using iterative data collection and analysis, the study identifies which factors proffered by the literature affect the policy learning and diffusion process. Results: Despite representing different types of policies, there were significant similarities across both cases: State actors drew lessons from Europe; policy lessons from Europe were weaponized by national political interests in an effort to stymy state‐level diffusion; and, as policies diffused to other states, organized opposition curtailed. Conclusion: This study demonstrates how the stage of diffusion can be as determinative of the policy learning context as the type of policy, and highlights how the diffusion and typology literatures can inform each other. [ABSTRACT FROM AUTHOR]

Though the medical use of marijuana is legal in thirty‐three states, it remains illegal under the federal Controlled Substances Act. Any marijuana use can subject individuals to severe criminal and civil penalties under federal law. States that condition patient access and treatment on registration in a state database impose real risks on their citizens. Although many scholars have written about the tension between federal and state treatment of marijuana, this is the first article to examine marijuana patient registry privacy and fundamental rights issues. This article first reviews the relationship between marijuana use and patient treatment, with a focus on health‐care and privacy rights under state and federal law. The article then explains how marijuana registries compare to broader patient registries, such as contagious disease and other medical condition patient registries, and the unique issues presented by marijuana patient registries. It then discusses the elevated risk to constitutional, privacy, and fundamental rights that may result if states do not carefully construct marijuana registries. The article concludes by proposing principles for how both states and dispensaries should approach marijuana registries in order to provide health benefits and avoid harm to patients. [ABSTRACT FROM AUTHOR]

Aims: Medical marijuana law (MML) enactment in the United States has been associated with increased cannabis use but lower traffic fatality rates. We assessed the possible association of MML and individual‐level driving under the influence of cannabis (DUIC) and also under the influence of alcohol (DUIA). Design and setting: Three cross‐sectional U.S. adult surveys: The National Longitudinal Alcohol Epidemiologic Survey (NLAES; 1991–1992), the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; 2001–2002), and the NESARC‐III (2012–2013). Participants: The total n was 118 497: 41 764, 41 184, and 35 549 from NLAES, NESARC, and NESARC‐III, respectively. Measurements Across the three surveys, similar questions in the Alcohol Use Disorder and Associated Disabilities Interview Schedule assessed DUIC and DUIA. Ever‐MML states enacted MML between 1991–1992 and 2012–2013 (overall period). Early‐MML states enacted MML between 1991–1992 and 2001–2002 (early period). Late‐MML states enacted MML between 2001–2002 and 2012–2013 (late period). MML effects on change in DUIC and DUIA prevalence were estimated using a difference‐in‐differences specification to compare changes in MML and other states. Findings From 1991–1992 to 2012–2013, DUIC prevalence nearly doubled (from 1.02% to 1.92%), increasing more in states that enacted MML than other states (difference‐in‐differences [DiD] = 0.59%; 95% CI = 0.06%–1.12%). Most change in DUIC prevalence occurred between 2001–2002 and 2012–2013. DUIC prevalence increased more in states that enacted MML 2001–2002 to 2012–2013 than in never‐MML states (DiD = 0.77%; 95% CI = −0.05%‐1.59%), and in two early‐MML states, California (DiD = 0.82; 95% CI = 0.06–1.59) and Colorado (DiD = 1.32; 95% CI = 0.11–2.53). In contrast, DUIA prevalence appeared unrelated to MML enactment. Conclusions: Medical marijuana law enactment in US states appears to have been associated with increased prevalence of driving under the influence of cannabis, but not alcohol. [ABSTRACT FROM AUTHOR]

The article advises clinicians about the medicolegal issues surrounding medical cannabis (MC) in the U.S. An overview of the history of MC is provided. Topics mentioned include the areas of variation in MC legislations in U.S. states, the restriction on gun ownership for users of medical marijuana, and the legal risks facing physicians for recommending marijuana for treating a condition including malpractice and criminal charges.

The opioid epidemic has resulted in the deaths of millions of Americans and was declared a public health emergency in 2017. In response, many states have enacted policies and analyzed various interventions for harm reduction and overdose prevention, which have embraced limited success. With more states legalizing medical marijuana, another intervention of interest in pain management, much research has since focused on the potential for medical marijuana laws (MMLs) to curb the opioid epidemic. Nonetheless, marijuana legalization and its use for medical purposes has been a polarizing debate from ethical, social, and clinical perspectives. We examine evidence on the merits of medical marijuana to address its potential as a diversion from prescription painkillers. Additionally, we review the impact of MMLs on opioid-related outcomes. Furthermore, we provide multi-layered recommendations for future directions in the evaluation of medical marijuana and MMLs as potential mitigators of the opioid epidemic. Despite limited and mixed evidence of efficacy, medical marijuana may still play an important role in addressing the opioid epidemic in the United States. Furthermore, we believe coordinated responses among the federal government, states, researchers, and patients are crucial in producing more robust evaluations of medical marijuana and MMLs. [ABSTRACT FROM AUTHOR]