Temple's Center for Public Health Law Research examines how states are stepping up to the task of drug regulation.
At first blush, medical marijuana as a public health issue may appear relatively benign, and states continue to pass legislation allowing it: In the November general elections Arkansas, Florida, Montana, Nevada, and North Dakota passed initiatives, further normalizing the practice. But the profound and singular challenges of this issue can be found in an area of public health where we sometimes forget to look: the lawbooks.
“You can’t really understand how policy impacts public health until you really know what the laws are,” says Sarah B. Klieger, a public health policy analyst at the Center for Public Health Law Research, which is based at Temple University. She leads a team of public health and legal researchers that has been mapping data on medical marijuana laws that address dispensaries, product safety, caregiver rules, and patient laws in each state.
Their findings, presented at the 2016 meeting of the American Public Health Association in October, reveal a patchwork of regulations attempting an unprecedented task: regulating at the state level a prohibited schedule 1 drug that has always been under the purview of the federal government. This has a number of implications for public health. First, of the 24 states plus the District of Columbia that have authorized medical marijuana, 21 specify qualifying diseases, and those diseases differ from state to state. Nearly all states protect patient privacy, but only 12 include legislation that protects against discrimination. These inconsistencies can affect access in multiple ways.
Mandatory product safety testing is notably lacking as well. It’s built into the medical marijuana laws of only 14 states, although the majority do have package or label regulations. In addition, there are no clinical trials for medical marijuana and no consistent supply chain. Marijuana is unique as a medicine in these ways, and more akin to an herbal supplement than a regulated pharmaceutical. Importantly, without such controls, the potential side effects of, or even contaminants in, medical marijuana remain unknown.
Though the broad picture the project paints is obviously imperfect, it’s a big opportunity to discover which policies are showing positive impacts. “The variation allows us to look at different regulatory schemes, which is great from a researcher’s perspective in that we can see the most effective policies,” Klieger says. “And we’re hoping that might provide a little more pressure to reschedule medical marijuana. It runs counter to public opinion as well as to what clinicians would like to see as well.”
Federal law looms large over the question of state regulation of medical marijuana, not least because there is such disagreement at the federal level about how to treat the drug. The Drug Enforcement Administration has placed a ban on it. A Supreme Court decision in 2005 said marijuana is subject to regulations of other controlled substances. The executive branch has taken a non-interference stance. Meanwhile, Klieger says, the legislative branch says they won’t fund legal enforcement of medical marijuana violations. “There’s no harmonious stance from the federal perspective,” she says.
This makes the center’s role as a neutral observer of the laws and their impact all the more crucial. Taking cues from traditional epidemiological surveillance, the center’s Policy Surveillance Program, funded by the Robert Wood Johnson Foundation and based in the Beasley School of Law, quantifies the impact of myriad health-related laws. “Researchers can demonstrate which states with medical marijuana don’t have negative outcomes—for example, not having increased traffic fatalities,” Klieger says.
And overall, the impact of public health law research can be felt throughout the field, from theory to clinical practice. “It provides the methodological foundation for evaluating policies that can affect health, thereby generating evidence upon which practice can be based,” says Jennifer Ibrahim, associate dean of academic affairs at the College of Public Health, who collaborates frequently with the center. “Policy surveillance allows public health officials to track changes in public health laws at the level of individual provisions and evaluate the impact on health-related behaviors and morbidity and mortality.”
“Law is a huge factor in public health. It’s a very impactful intervention,” says Bethany Saxon, the center’s director of communications. “When we think about public health, we often think about programs and other interventions. But we don’t always think about public health law as being something that can effect change.”
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