Nine Insights From 10 Years of Legal Cannabis for Nonmedical Purposes.

Whereas the 20th century could be largely characterized as the age of cannabis prohibition, the 21st century may ultimately be known as the era of cannabis legalization. Although several countries and subnational jurisdictions have relaxed laws to allow cannabis to be used for medical purposes, the policy landscape shifted dramatically in 2012 when voters in Colorado and Washington passed ballot initiatives to allow cannabis to be sold to adults for nonmedical purposes. Since then, Canada, Uruguay, and Malta have legalized nonmedical cannabis, and >47% of the US population live in states that have passed laws allowing commercial production and for-profit retail sales. Some countries are now implementing pilot programs for legal supply (eg, the Netherlands, Switzerland), and others are seriously contemplating changing their laws (eg, Germany, Mexico). This commentary offers 9 insights from the first 10 years of legal cannabis for nonmedical purposes, with the goal of informing policy discussions in places considering, implementing, or revising their approach to cannabis legalization: (1) cannabis prices are declining in places with commercial regimes and this matters for several outcomes; (2) noncommercial models are being implemented and seriously considered in some places; (3) policy discussions about cannabis taxes are evolving; (4) the number of cannabis products available in commercial regimes is proliferating; (5) emerging research on higher potency cannabis products raises some public health concerns, but there is still a lot to learn; (6) social equity is playing a larger role in many legalization debates; (7) it takes time to move consumers to the legal market; (8) data collection about cannabis consumption is getting better, but there is much work to do; and (9) ongoing methodological advances should improve our understanding of cannabis policy changes.

Access challenges for patients with limited English proficiency: a secret-shopper study of in-person and telehealth behavioral health services in California safety-net clinics.

The recent growth of telehealth may be impacting access to care for patients, including those with limited English proficiency (LEP). Using a secret-shopper design, simulated patients contacted 386 safety-net clinics in California in both Spanish and English from February-March 2023. Callers stated that they were new patients seeking medication for depression, and they documented time to an appointment and available visit modalities (telehealth and in-person). Multinomial logistic regression models examined associations between clinic characteristics and available modalities. English-speaking callers were more likely to speak with a live scheduler and to obtain appointment information from a scheduler who could engage with them in their preferred language. Among Spanish-speaking callers who reached a live scheduler, 22% reached someone who did not engage (eg, were hung up on) and, as a result, could not obtain appointment information. The mean estimated time to a prescribing visit was 36 days and did not differ by language. Sixty-four percent of clinics offered both telehealth and in-person visits, 14% only offered in-person visits, and 22% only offered telehealth visits. More attention and resources are needed to support patients with LEP at the point of scheduling and to ensure choice of visit modality for all patient populations.