AimsTo conduct a systematic review and meta‐analysis of studies in order to estimate the effect of US medical marijuana laws (MMLs) on past‐month marijuana use prevalence among adolescents.MethodsA total of 2999 papers from 17 literature sources were screened systematically. Eleven studies, developed from four ongoing large national surveys, were meta‐analyzed. Estimates of MML effects on any past‐month marijuana use prevalence from included studies were obtained from comparisons of pre–post MML changes in MML states to changes in non‐MML states over comparable time‐periods. These estimates were standardized and entered into a meta‐analysis model with fixed‐effects for each study. Heterogeneity among the study estimates by national data survey was tested with an omnibus F‐test. Estimates of effects on additional marijuana outcomes, of MML provisions (e.g. dispensaries) and among demographic subgroups were abstracted and summarized. Key methodological and modeling characteristics were also described. Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines were followed.ResultsNone of the 11 studies found significant estimates of pre–post MML changes compared with contemporaneous changes in non‐MML states for marijuana use prevalence among adolescents. The meta‐analysis yielded a non‐significant pooled estimate (standardized mean difference) of −0.003 (95% confidence interval = −0.012, +0.007). Four studies compared MML with non‐MML states on pre‐MML differences and all found higher rates of past‐month marijuana use in MML states pre‐MML passage. Additional tests of specific MML provisions, of MML effects on additional marijuana outcomes and among subgroups generally yielded non‐significant results, although limited heterogeneity may warrant further study.ConclusionsSynthesis of the current evidence does not support the hypothesis that US medical marijuana laws (MMLs) until 2014 have led to increases in adolescent marijuana use prevalence. Limited heterogeneity exists among estimates of effects of MMLs on other patterns of marijuana use, of effects within particular population subgroups and of effects of specific MML provisions.

When voters in two US states approved the recreational use of marijuana in 2012, public debates for how best to promote and protect public health and safety started drawing implications from states' medical marijuana laws. However, many of the discussions were simplified to the notion that states either have a medical marijuana law or do not; little reference was made to the fact that legal provisions differ across states. This study seeks to clarify the characteristics of medical marijuana laws in place since 1990 that are most relevant to consumers/patients and categorizes those aspects most likely to affect the prevalence of use, and consequently the intensity of public health and welfare effects. Evidence shows treating medical marijuana laws as homogeneous across states is misleading and does not reflect the reality of medical marijuana lawmaking. This variation likely has implications for use and health outcomes, and thus states' public health. KeywordsMedical marijuana; health care law; medicinal cannabis As of May 30, 2013, the medical use of marijuana is legal in nineteen US states and the District of Columbia. (National Conference of State Legislatures, Sec. 3(k)) Since marijuana is still illegal under federal law, many scholars have focused on issues of federal preemption and the scope of states' rights. However, as policymakers and individuals on the ground in these states know very well, the current debate about federal versus state law is insufficient, as questions still remain about what exactly is legal according to state laws across all the states permitting medical marijuana (MM). The clarification of various provisions in state laws has important implications since policy debates and research have begun to focus on the effects that various medical marijuana laws have on health and safety, rather than on simply whether MM is permissible or not.The protection provided by medical marijuana laws depends on legal details that are frequently overlooked and not well understood, including: who may recommend MM; who may use MM; the medical conditions for which MM may be used; and how individuals may obtain MM. The nature of the problem resides in the presumption that the use of marijuana for medicinal purposes is a binary conclusion, i.e. it is either legal or not. This article reveals this is clearly not the case. Jurisdictions differ widely on how they govern suppliers and consumers of medical marijuana. Some states explicitly allow for, and carefully describe the NIH Public Access While the nominal definitions will tell what the law purported to do, the functional definitions reveal how the law actually changed status quo policies in order to accomplish these goals. Even laws that are similar in one aspect may differ widely in others, resulting in completely different levels of legal protection and access to MM. The specifics of a jurisdiction's policies regarding registration, available supply sources, and oversight authority can greatly affect a patient's ability to obtain and use medical ...

IMPORTANCE Federal and state governments implemented temporary strategies for providing access to opioid use disorder (OUD) treatment during the COVID-19 pandemic. Advocates hope many of these policies become permanent because of their potential to expand access to care. OBJECTIVE To consider the multitude of ways access to and utilization of treatment for individuals with OUD might have been expanded by state and federal policy so researchers can do a better job evaluating the effectiveness of specific policy approaches, which will depend on the interaction with other state policies. EVIDENCE REVIEWWe summarize state-level policy data reported by government and nonprofit agencies that track health care regulations, specifically the Kaiser Family Foundation, Federation of State Medical Boards, American Association of Nurse Practitioners, American Academy of Physician Assistants, and the National Safety Council. Data were collected by these sources from September 2020 through January 2021. We examine heterogeneity in policy elements adopted across states during the COVID-19 pandemic in 4 key areas: telehealth, privacy, licensing, and medication for opioid use disorder. The analysis was conducted from March 2020 through January 2021.FINDINGS This cross-sectional study found that federal and state governments have taken important steps to ensure OUD treatment availability during the COVID-19 pandemic, but few states are comprehensive in their approach. Although all states and Washington, DC have adopted at least 1 telehealth policy, only 17 states have adopted telehealth policies that improve access to OUD treatment for new patients. Furthermore, only 9 states relaxed privacy laws, which influence the ability to use particular technology for telehealth visits. Similarly, all states have adopted at least 1 policy related to health care professional licensing permissions, but only 35 expanded the scope of practice laws for both physician assistants and nurse practitioners. Forty-four states expanded access to initiation and delivery of medication for OUD treatment. Together, no state has implemented all of these policies to comprehensively expand access to OUD treatment during the COVID-19 pandemic. CONCLUSIONS AND RELEVANCEWith considerable policy changes potentially affecting access to treatment and treatment retention for patients with OUD during the pandemic, evaluations must account for the variation in state approaches in related policy areas because the interactions between policies may limit the potential effectiveness of any single policy approach.

ABSTRACTAlthough information made public after a data breach can provide insight into difficult research questions, use of these data raises ethical questions not directly addressed by current ethical guidelines. This article develops a framework for identifying and managing risks to human subjects when conducting research involving leaked data. We contend that researchers who seek to use leaked data should identify and address ethical challenges by considering the process through which the data were originally released into the public domain.

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Prescription drug monitoring programs (PDMPs) are databases designed to help healthcare professionals identify problematic drug-seeking behavior from patients. PDMPs can also be used by police officers to obtain evidence, raising concerns about exposure of sensitive health information. In this paper, I describe the approaches that states have taken to regulate law enforcement access to PDMPs, and present evidence that some but not all protection mechanisms are associated with fewer law enforcement requests for PDMP information. This research provides novel and important information about law enforcement behavior in response to privacy protections.

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With the Russian government hack of the Democratic National Convention email servers and related leaks, the drama of the 2016 U.S. presidential race highlights an important point: nefarious hackers do not just pose a risk to vulnerable companies; cyber attacks can potentially impact the trajectory of democracies. Yet a consensus has been slow to emerge as to the desirability and feasibility of reclassifying elections—in particular, voting machines—as critical infrastructure, due in part to the long history of local and state control of voting procedures. This Article takes on the debate—focusing on policy options beyond former Department of Homeland Security Secretary Jeh Johnson’s decision to classify elections as critical infrastructure in January 2017—in the U.S., using the 2016 elections as a case study, but putting the issue in a global context, with in-depth case studies from South Africa, Estonia, Brazil, Germany, and India. Governance best practices are analyzed by reviewing these differing approaches to securing elections, including the extent to which trend lines are converging or diverging. This investigation will, in turn, help inform ongoing minilateral efforts at cybersecurity norm building in the critical infrastructure context, which are considered here for the first time in the literature through the lens of polycentric governance.