Structural foundations, triggering events, and facilitative contingency : the social origins of California’s Compassionate Use Act of 1996

2018 ◽  
Author(s):  
◽  
David W. Criger

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT AUTHOR'S REQUEST.] Currently in the United States there is a nationwide legislative movement to legalize marijuana for persons with certain diagnosable diseases. Despite representing a dramatic departure from the war on drugs approach which characterized 20th century American marijuana policy, the development of state-level medical cannabis laws has largely been ignored by criminologists and critical legal scholars. This dissertation aims to address this gap in the literature by examining the social origins of California’s Compassionate Use Act of 1996. California was the first state in the nation to legalize the medical use of marijuana when voters in that state approved Proposition 215 with 56% support. Using Galliher’s (2012) framework for understanding the structural foundations and triggering events associated with law formation, I constructed a dataset containing newspaper articles, voter pamphlets, legislative records, press releases and various secondary resources such as interview recordings and activist biographies. I ultimately argue that the categorial criteria used by the federal government to classify marijuana as a Schedule I narcotic under the Controlled Substances Act provided medical reform activists with the latitude necessary to challenge marijuana’s criminal status. The data suggests that the AIDS crisis during the late 1980s brought widespread attention to the potential therapeutic benefits of medical marijuana. Poorly timed police drug raids, an increasingly unpopular war on drugs, and San Francisco’s political legacy as a wide-open town helped to create a context where medical marijuana reform could find electoral success.

2019 ◽  
Vol 46 (2) ◽  
pp. 165-179 ◽  
Author(s):  
Joanne Spetz ◽  
Susan A. Chapman ◽  
Timothy Bates ◽  
Matthew Jura ◽  
Laura A. Schmidt

Thirty-three U.S. states and the District of Columbia (DC) have legalized the use of marijuana for medicinal purposes and 10 states and DC have legalized marijuana for adult recreational use. This mirrors an international trend toward relaxing restrictions on marijuana. This article analyzes patterns in marijuana laws across U.S. states to shed light on the social and political forces behind the liberalization of marijuana policy following a long era of conservatism. Data on U.S. state-level demographics, economic conditions, and cultural and political characteristics are analyzed, as well as establishment of and levels of support for other drug and social policies, to determine whether there are patterns between states that have liberalized marijuana policy versus those that have not. Laws decriminalizing marijuana possession, as well as those authorizing its sale for medical and recreational use, follow the same pattern of diffusion. The analysis points to underlying patterns of demographic, cultural, economic, and political variation linked to marijuana policy liberalization in the U.S. context, which deserve further examination internationally.


Author(s):  
Samuel Raine ◽  
Amy Liu ◽  
Joel Mintz ◽  
Waseem Wahood ◽  
Kyle Huntley ◽  
...  

As of 18 October 2020, over 39.5 million cases of coronavirus disease 2019 (COVID-19) and 1.1 million associated deaths have been reported worldwide. It is crucial to understand the effect of social determination of health on novel COVID-19 outcomes in order to establish health justice. There is an imperative need, for policy makers at all levels, to consider socioeconomic and racial and ethnic disparities in pandemic planning. Cross-sectional analysis from COVID Boston University’s Center for Antiracist Research COVID Racial Data Tracker was performed to evaluate the racial and ethnic distribution of COVID-19 outcomes relative to representation in the United States. Representation quotients (RQs) were calculated to assess for disparity using state-level data from the American Community Survey (ACS). We found that on a national level, Hispanic/Latinx, American Indian/Alaskan Native, Native Hawaiian/Pacific Islanders, and Black people had RQs > 1, indicating that these groups are over-represented in COVID-19 incidence. Dramatic racial and ethnic variances in state-level incidence and mortality RQs were also observed. This study investigates pandemic disparities and examines some factors which inform the social determination of health. These findings are key for developing effective public policy and allocating resources to effectively decrease health disparities. Protective standards, stay-at-home orders, and essential worker guidelines must be tailored to address the social determination of health in order to mitigate health injustices, as identified by COVID-19 incidence and mortality RQs.


2020 ◽  
Vol 9 (4) ◽  
pp. 1166 ◽  
Author(s):  
Joshua D. Brown ◽  
Brianna Costales ◽  
Sascha van Boemmel-Wegmann ◽  
Amie J. Goodin ◽  
Richard Segal ◽  
...  

Use of medical marijuana is increasing in the United States and older adults are the fastest growing user group. There is little information about the characteristics and outcomes related to medical marijuana use. This study is a descriptive analysis of older adults (aged ≥50 years old) who were early adopters of a medical marijuana program in the U.S. state of Florida. Per state legislation, initial and follow-up treatment plans were submitted to the University of Florida College of Pharmacy. Data collection included demographics, clinical history, medical conditions, substance use history, prescription history, and health status. Follow-up treatment plans noted changes in the chief complaint and actions taken since the initial visit. Of the state’s 7548 registered users between August 2016 and July 2017, N = 4447 (58.9%) were older adults. Patients utilized cannabidiol (CBD)-only preparations (45%), preparations that had both tetrahydrocannabinol (THC) and CBD (33.3%) or were recorded to use both CBD-only and THC + CBD products (21.7%). The chief complaints indicating medical cannabis treatment were musculoskeletal disorders and spasms (48.4%) and chronic pain (45.4%). Among other prescription medications, patients utilized antidepressants (23.8%), anxiolytics and benzodiazepines (23.5%), opioids (28.6%), and cardiovascular agents (27.9%). Among all drug classes with potential sedating effects, 44.8% of the cohort were exposed to at least one. Patients with follow-up visits (27.5%) exhibited marked improvement as assessed by the authorizing physicians. However, the patient registry lacked detailed records and linkable information to other data resources to achieve complete follow up in order to assess safety or efficacy. Future improvements to registries are needed to more adequately capture patient information to fill knowledge gaps related to the safety and effectiveness of medical marijuana, particularly in the older adult population.


2018 ◽  
Vol 65 (1) ◽  
pp. 14-21
Author(s):  
Ettie Rosenberg

California was the first state in the union to pass medical marijuana legislation with Proposition 215, the voter enacted California Compassionate Use Act (CCUA, 1996), though regulatory oversight for the medical marijuana industry was negligible over the next 20 years. In 2015, California legislators passed the Medical Marijuana Regulation and Safety Act (MMRSA), providing a new and comprehensive regulatory framework for medical marijuana, subsequently renaming it the Medical Cannabis Regulation and Safety Act (MCRSA), with a planned implementation of January 1, 2018. In 2016, California's marijuana landscape dramatically changed with the Adult Use of Marijuana Act (AUMA), also known as Proposition 64 (“Prop 64”), a voter initiative successful in legalizing recreational marijuana, where many prior similar initiatives had failed. In 2017, California lawmakers merged the two Acts (MCRSA and AUMA) into the Medical and Adult Use of Cannabis Regulation and Safety Act, (MAUCRSA), known as Senate Bill 94 (SB 94), which passed overwhelmingly and created a single comprehensive marijuana regulatory scheme for California by integrating the 2015 recreational marijuana law with the state's longstanding medical marijuana program, also effective in January 2018. Given the current national marijuana landscape and political climate, California's novel unified model for regulating and taxing marijuana will likely influence how other states proceed to regulate and tax the emerging legal marijuana industry, which has an estimated value of $7 billion. Part One of this article provides an overview of the soon to be effective “harmonized” regulatory scheme for California's medicinal and recreational marijuana industries, touching on its potential to influence other states. Part Two surveys the changed national marijuana landscape within which three states have already implemented a role for pharmacists in medical marijuana dispensing, despite that under the federal Controlled Substances Act, as a Schedule I substance, marijuana remains illegal for any purpose. The recent developments have not surprisingly triggered questions about a pharmacist's liability vis a vis marijuana dispensing and federal enforcement risks. Part Two also attempts to answer those questions through an informative discussion of the national marijuana landscape, the current political climate, and their respective influences on federal marijuana policy and enforcement.


2019 ◽  
Vol 2 (3) ◽  
pp. 6
Author(s):  
Matthew Yeung ◽  
Kevin Janz ◽  
Colin Weaver ◽  
Rebecca Saah-Haines ◽  
Eddy Lang

Background: On October 17th, 2018, non-medical cannabis became legal to adults for the first time in Canada. This has created a previously unseen opportunity to investigate the effects of recreational cannabis legalization in a developed country, particularly on strained Emergency Departments (EDs). Secondly, reports within the United States have suggested state-level legalization of cannabis, both recreationally and medically, has resulted in a decrease of opiate-related presentations. Given the pressure of the opiate crisis on healthcare resources, we sought to examine if this trend was present in Alberta. Objectives: The current study aims to identify if presentation patterns in adult and pediatric populations have changed when comparing pre- and post-legalization periods, and if rural-urban disparities exist. We also aim to identify if the legalization of cannabis is correlated with a reduction in opiate-related ED presentations. Lastly, we aimed to address the aforementioned objectives in the context of telehealth by examining calls to poison control and HealthLink within Alberta. Methods: Retrospective data was collected from the National Ambulatory Care Reporting System, HealthLink, and Poison and Drug Information Service. Extraction is currently in progress, and we expect to include 20 000 records and 12 000 calls. An interrupted time-series analysis will be completed, allowing for a comparison of trends pre- and post-legalization. Participants have been identified based on International Disease Classifications for cannabis and opiate-related injury. Commonly reported injuries will be clustered to identify changes in injury patterns. Data was collected from October 1st 2013 up to May 31st, 2019 for all EDs within Alberta. Results: Preliminary results suggest the legalization of cannabis initially led to a dramatic increase in ED presentations, followed by a return to pre-legalization volume. HealthLink data suggests a different trend, with steadily increasing calls in the months prior to legalization, followed by stabilization. Cannabis legalization is also correlated with a decrease in post-legalization opiate-related calls (r=-0.51, p=0.01). Conclusion: Overall, national legalization of cannabis appears to be responsible for a short period of increased ED usage, but does not appear to have long-lasting effects on healthcare resource utilization. Differences are apparent between telehealth service and ED use.


Author(s):  
Zachary Parolin ◽  
Rosa Daiger von Gleichen

AbstractThis chapter investigates the diversity and divergence of three sets of family policy indicators across the 50 United States: money, services, and time. Our findings show that the 50 United States vary considerably in their family policy packages. States have become more dissimilar over time with respect to social assistance transfers and statutory minimum wages, but have become more similar in their subsidization of low-pay employment. Moreover, states vary greatly in their levels of support for early childhood education and healthcare. State-level variation in out-of-pocket medical spending has more than doubled from 1980 to 2015, in large part due to some states deciding to expand Medicaid access from 2009 onward. Despite large diversity and some divergence in states’ family policy packages, post-tax/transfer poverty rates have remained relatively stable over time. This is partially due to an increase in federally funded transfer programs mitigating the social consequences of state-level diversity.


2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 342-342
Author(s):  
Yang Li ◽  
Jan Mutchler ◽  
Edward Miller ◽  
Jing Jian Xiao ◽  
Reginald Tucker-Seeley

Abstract Despite a large body of literature documenting the association between individual characteristics and financial literacy, our understanding of the impact of macro-environmental conditions on individual financial literacy remains limited, particularly in later life. Drawing from a micro-macro perspective on the social environment and individual processes, we examined the extent to which three state-level contextual characteristics were associated with individual later-life financial literacy in the United States: tertiary educational attainment, poverty prevalence, and Internet penetration. We utilized data from the 2019 Understanding America Study (UAS) for adults aged 50 years or older to assess financial literacy (n=2,930), and data from the American Community Survey to evaluate contextual conditions. The UAS is a nationally representative survey panel supported by the Social Security Administration and the National Institute on Aging. Cross-sectional multilevel regression models were used to examine the hypothesized effects. We found that state-level poverty prevalence was negatively associated with individual financial literacy while state-level Internet penetration was positively associated with individual financial literacy, over and above individual characteristics known to impact financial literacy. No association was found between state-level educational attainment and individual financial literacy after controlling for respondents’ own education. Findings suggest that the social environment may condition financial literacy in later life through exposure to opportunities that promote knowledge acquisition. Interventions to enhance later-life financial literacy may benefit from targeted approaches that take into account the environmental characteristics of their locations of residence.


Author(s):  
Deena Damsky Dell, MSN, APRN, AOCN, LNC ◽  
Daniel P. Stein, MD

Medical marijuana, also known as cannabis, is being sought by patients and survivors to alleviate common symptoms of cancer and its treatments that affect their quality of life. The National Academy of Sciences (2017) reports conclusive or substantial evidence that cannabis is successful in treating chronic cancer pain and chemotherapy-induced nausea and vomiting, moderate evidence that cannabinoids are beneficial for sleep disorders that accompany chronic illnesses, and limited evidence supporting use for appetite stimulation and anxiety. However, due to the fact that cannabis is classified as a Schedule I controlled substance, there is an absence of rigorous, scientific evidence to guide health-care professionals. In addition, the Schedule I designation makes it illegal for health-care professionals in the United States to prescribe, administer, or directly distribute these drugs. Legislation has outpaced research in this area. Therefore, the National Council of State Boards of Nursing (NCSBN) appointed a medical marijuana guideline committee to create guidelines for the nursing care of patients using medical marijuana, marijuana education in nursing programs, and guidelines for advanced practice registered nurses (APRNs) certifying a patient for the use of medical marijuana (The NCSBN Medical Marijuana Guidelines Committee, 2018). Six states/districts authorize APRNs to recommend the use of medical marijuana to patients with qualifying conditions (Kaplan, 2015). As of March 2021, 35 states plus the District of Columbia have authorized the use of medical marijuana (DISA Global Solutions, 2021). Therefore, APRNs will be caring for these patients and need to know the medical, pharmacological, and legal issues surrounding medical cannabis use.


2019 ◽  
Vol 4 (1) ◽  
pp. 1-15
Author(s):  
Max Gakh, JD, MPH

The Health in All Policies (HiAP) approach presents different and often complementary avenues to address the social determinants of health. But at its core, HiAP relies on collaborations to make health a governmental priority across sectors. In the United States, HiAP efforts can involve multiple levels of government and strategies that may vary in formality. In some states, state-level HiAP efforts may be advanced by gubernatorial executive orders (GEOs). GEOs are often used to promote health. GEOs may be powerful in the HiAP context because of their potential to manage the different sectors that comprise state government and thereby address the social determinants of health. By synthesizing the relevant literature and providing illustrative examples of HiAPpromoting GEOs, this review explores how, why, and whether to use GEOs for HiAP. It demonstrates that GEOs may advance HiAP with or without using a HiAP label, along different steps in the policymaking cycle, and by addressing common HiAP challenges. Champions of HiAP should therefore examine the possible utility of GEOs to promote state-level HiAP efforts.


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