Early Impacts of Marijuana Legalization: An Evaluation of Prices in Colorado and Washington.

Following the legalization and regulation of marijuana for recreational purposes in states with medical markets, policymakers and researchers seek empirical evidence on how, and how fast, supply and demand changed over time. Prices are an indication of how suppliers and consumers respond to policy changes, so this study uses a difference-in-difference approach to exploit the timing of policy implementation and identify the impacts on marijuana prices 4-5 months after markets opened. This study uses unique longitudinal survey data of prices paid by consumers and a web-scraped dataset of dispensary prices advertised online for three U.S. medical marijuana states that all eventually legalized recreational marijuana. Results indicate there were no impacts on the prices paid for medical or recreational marijuana by state-representative residents within the short 4- to 5-months window following legalization. However, there were differences in how much people paid if they obtained marijuana for recreational purposes from a recreational store. Further analysis of advertised prices confirms this result, but further demonstrates heterogeneous responses in prices across types of commonly advertised strains; prices either did not change or 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 consumption.

Exploring the Use of a General Equilibrium Method to Assess the Value of a Malaria Vaccine: An Application to Ghana.

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.

Continuous quality improvement in substance abuse treatment facilities: How much does it cost?

Continuous quality improvement (CQI) has grown in the U.S. since the 1970s, yet little is known about the costs to implement CQI in substance abuse treatment facilities. This paper is part of a larger group randomized control trial in a large urban county evaluating the impact of Plan-Study-Do-Act (PDSA)-CQI designed for community service organizations (Hunter, Ober, Paddock, Hunt, & Levan, 2014). Operated by one umbrella organization, each of the eight facilities of the study, four residential and four outpatient substance abuse treatment facilities, selected their own CQI Actions, including administrative- and clinical care-related Actions. Using an activity-based costing approach, we collected labor and supplies and equipment costs directly attributable to CQI Actions over a 12-month trial period. Our study finds implementation of CQI and meeting costs of this trial per facility were approximately $2000 to $10,500 per year ($4500 on average), or $10 to $60 per admitted client. We provide a description of the sources of variation in these costs, including differing intensity of the CQI Actions selected, which should help decision makers plan use of PDSA-CQI.

The Impact of Legalizing and Regulating Weed: Issues with Study Design and Emerging Findings in the USA.

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.

Words Can Be Deceiving: A Review of Variation Among Legally Effective Medical Marijuana Laws in the United States.

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.

Continuous quality improvement (CQI) in addiction treatment settings: design and intervention protocol of a group randomized pilot study.

BACKGROUND: Few studies have designed and tested the use of continuous quality improvement approaches in community based substance use treatment settings. Little is known about the feasibility, costs, efficacy, and sustainment of such approaches in these settings. METHODS/DESIGN: A group-randomized trial using a modified stepped wedge design is being used. In the first phase of the study, eight programs, stratified by modality (residential, outpatient) are being randomly assigned to the intervention or control condition. In the second phase, the initially assigned control programs are receiving the intervention to gain additional information about feasibility while sustainment is being studied among the programs initially assigned to the intervention. DISCUSSION: By using this design in a pilot study, we help inform the field about the feasibility, costs, efficacy and sustainment of the intervention. Determining information at the pilot stage about costs and sustainment provides value for designing future studies and implementation strategies with the goal to reduce the time between intervention development and translation to real world practice settings.

Tackling Problem Drug Use.

The National Audit Office (NAO) is conducting a value-for-money study on the UK Government's 2008 drug strategy, Drugs: Protecting Families and Communities ("the Strategy"). The NAO study, Tackling Problem Drug Use, focuses in particular on local delivery authorities' capacity and capability to effectively tackle problem drug use (PDU) through delivery of local services. To inform the NAO's value-for-money study, RAND Europe performed a literature review on problem drug use and reviewed the evidence base, both literature and data, underpinning the Strategy. One of the key findings is that the narrower focus in the UK on most significant harms may be useful, but also carries risks and drawbacks. In addition, we find that the Strategy draws on robust evidence in the area of drug treatment and drug-related crime; however, other topics would benefit from further context or detail, and in places it is difficult to relate the evidence base to implications for intervention and delivery of services.

Further Study on the Affordability of Alcoholic Beverages in the EU: A Focus on Excise Duty Pass-Through, On- and Off-Trade Sales, Price Promotions and Statutory Regulations.

Policies related to alcohol pricing, promotion and discounts provide opportunities to address harms associated with alcohol misuse. However, there are important gaps in information and knowledge about the regulations in place across parts of Europe and their impacts on consumer prices and locations of purchase. Using market data, we explored the overall scale and trend of price promotions and discounts in the off-premise (e.g. supermarket) and on-premise (e.g. restaurants, pubs) across five EU Member States. To better understand the factors that may influence sales in the on- vs. off-premises, we performed regression analysis for four EU Member States with relevant data. This found that increases in broadband penetration and population density were associated with relatively higher levels of off-premise alcohol purchases and that increases in income were associated with relatively higher levels of on-premise purchases of alcohol. There was no statistically significant relationship for female higher education. We further used time-series methods, drawing on data for Ireland, Latvia, Slovenia and Finland, to estimate the impact of changes in excise duty on price ("pass-through"). This showed that a €1 increase in excise duty increased beer prices by €0.50-€2.50 in the off-premise, and increased spirits prices by €0.70-€1.40 in the off-premise. These findings suggest that, depending on the price sensitivity of consumers and other strategies employed by suppliers (e.g. advertising), changes in excise duty may be an effective instrument to reduce harmful alcohol consumption.

Assessing the Impacts of Revising the Tobacco Products Directive: Study to Support a DG SANCO Impact Assessment.

Tobacco use is one of the largest avoidable causes of morbidity and premature death in the EU. Whilst smoking prevalence in the EU has been declining over the past 30 years, smoking has remained more prevalent among men than women in the EU-27, with some of the new Member States reporting the widest gaps between male and female smokers. For young smokers (13 to 15 years old) this situation is somewhat reversed, with slightly more girls than boys smoking. Against this background, the European Commission Directorate-General for Health and Consumer Protection (DG SANCO) considered a revision of the Tobacco Products Directive 2001/37/EC across five general areas: scope of the directive, labelling requirements, registration and market control fees, ingredients, and sales arrangements. More specifically, the types of policy options under consideration included (but were not limited to): an increase of warning label sizes on the back of packaging to 100%, a restriction for the display of products at retail outlets and an introduction of additional measurement method for TNCO (the modified ISO method) with maximum limits set accordingly. DG SANCO commissioned RAND Europe to provide support in assessing the potential health, macroeconomic, and compliance cost and administrative burden impacts of revising the Tobacco Products Directive. In addition to assessing impacts, the study provides an up-to-date overview of the evidence and basis for current tobacco product regulation that may be of interest to a wider audience interested in tobacco control policies.