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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 ...

Crime is an important outcome in many social policy evaluations. Benefits to society from preventing crime are based on avoiding victimization and freeing criminal justice system resources. For the latter, analysts need information about the marginal cost of policing for different types of crime across jurisdictions; however, this information is not readily available. This paper details key economic concepts relevant to law enforcement services, and then combines publicly available police expenditure data with insights from observational and time-diary studies to generate state-level, crime-specific, average variable cost estimates for crimeresponse services conducted by police by crime type. Since there is considerable uncertainty concerning various parameters underpinning these calculations, we use Monte Carlo simulation methods to incorporate the uncertainty into our estimates. This study finds that the U.S. population-weighted average variable cost of law enforcement response per police-reported Part 1 violent crime is $10,900, ranging from $6900 to $15,400 at the 10th and 90th percentiles, respectively. For a Part 1 property crime, the equivalent figure is $1300, with a range from $700 to $1700.

Following the legalization and regulation of marijuana for recreational purposes in states with medical markets, policymakers and researchers are in need of empirical evidence related to how, and how fast, supply and demand have changed over time. Because prices constitute an indication of how suppliers and consumers respond to policy changes, we used a difference-indifference approach to capitalize on the timing of policy implementation and to identify the effects of legalization on marijuana prices four to five months after markets opened. We used a unique longitudinal survey of self-reported prices and a web-scraped dataset of dispensary prices advertised online in three U.S. states that had legalized medical marijuana, and which later legalized recreational marijuana as well. Results indicate there were no effects on the prices paid for medical or recreational marijuana among state-representative samples of residents within the short four- to five-month window following legalization. However, there were differences in how much people paid if they obtained marijuana for recreational purposes from a recreational store. Further analyses of advertised prices confirmed this result, but also demonstrated heterogeneous responses in prices across types of commonly advertised strains; prices either did not change or they increased depending on the strain type. A key implication of our findings is that there are both supply and demand responses at work in the opening of legalized markets, suggesting that evaluations of immediate effects may not accurately reflect the long run impact of legalization on marijuana consumption.

Evaluations of the impact of medical and recreational marijuana laws rely on quasi- or natural experiments in which researchers exploit changes in the law and attempt to determine the impact of these changes on outcomes. This chapter reviews three key issues of causal inference in observational studies with respect to estimating of impact of medical or recreational laws on marijuana use-intervention definition, outcome measurement, and random assignment of study participants. We show that studies tend to use the same statistical approach (differences-in-differences) and yet find differential impacts of medical marijuana laws on adult use in particular. We demonstrate that these seemingly conflicting findings may be due to different years of analysis, ages of the study sample in each year, and assignment of jurisdictions to the control group versus treatment group.

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Background. Malaria is an important health and economic burden in sub-Saharan Africa. Conventional economic evaluations typically consider only direct costs to the health care system and government budgets. This paper quantifies the potential impact of malaria vaccination on the wider economy, using Ghana as an example. Methods. We used a computable general equilibrium model of the Ghanaian economy to estimate the macroeconomic impact of malaria vaccination in children under the age of 5, with a vaccine efficacy of 50% against clinical malaria and 20% against malaria mortality. The model considered changes in demography and labor productivity, and projected gross domestic product (GDP) over a time frame of 30 years. Vaccine coverage ranging from 20% to 100% was compared with a baseline with no vaccination. Results. Malaria vaccination with 100% coverage was projected to increase the GDP of Ghana over 30 years by US$6.93 billion (in 2015 prices) above the baseline without vaccination, equivalent to an increase in annual GDP growth of 0.5%. Projected GDP per capita would increase in the first year due to immediate reductions in time lost from work by adults caring for children with malaria, then decrease for several years as reductions in child mortality increase the number of dependent children, then show a sustained increase after Year 11 due to long-term productivity improvements in adults resulting from fewer malaria episodes in childhood. Conclusion. Investing in improving childhood health by vaccinating against malaria could result in substantial long-term macroeconomic benefits when these children enter the workforce as adults. These macroeconomic benefits are not captured by conventional economic evaluations and constitute an important potential benefit of vaccination.

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