Regulatory Framework for Cannabis: A Position Paper From the American College of Physicians.

Cannabis, also known as marijuana, is the dried flowers, stems, seeds, and leaves of the Cannabis sativa plant. It contains more than 100 compounds, including tetrahydrocannabinol, which has psychoactive effects. Federal law prohibits the possession, distribution, and use of cannabis outside limited research activities, but most states have legalized cannabis for medical or recreational use. However, research into the potential therapeutic and adverse health effects of cannabis has been limited, in part because of the drug's federal legal status. In this position paper, the American College of Physicians (ACP) calls for the decriminalization of possession of small amounts of cannabis for personal use and outlines a public health approach to controlling cannabis in jurisdictions where it is legal. ACP recommends the rigorous evaluation of the health effects and potential therapeutic uses of cannabis and cannabinoids as well as research into the effects of legalization on cannabis use. It also calls for evidence-based medical education related to cannabis and increased resources for treatment of cannabis use disorder.

Key Informants' Perceptions of Health Equity and Racial Justice Impacts of the 2019 Massachusetts An Act Modernizing Tobacco Control.

INTRODUCTION: The Massachusetts legislature passed An Act Modernizing Tobacco Control in November 2019 to restrict retail sales of flavored commercially manufactured tobacco products including menthol products, increase penalties for violating the law's provisions, and provide health insurance coverage for tobacco treatment. AIMS AND METHODS: This study explores key informants' perceptions of intended and unintended impacts of implementation of the 2019 Massachusetts statewide law through a health equity and racial justice lens. We conducted in-depth interviews with 25 key informants from three key informant groups (public health officials and advocates, clinicians, and school staff) between March 2021 and April 2022. Using deductive codes on unintended impacts of the implementation of the law's policies, we conducted a focused analysis to identify impacts that were perceived and observed by informants from different key informant groups. RESULTS: Perceived or observed impacts of the law were identified across multiple levels by key informants and included concerns related to three broad themes: 1) intended impacts on health equity and racial justice, 2) ongoing availability of restricted products undermining the intended impact of the law, and 3) inequitable targeting by the policies and enforcement among communities of color. CONCLUSIONS: Future evaluation is needed to assess the intended and unintended impacts of implementation of the Massachusetts law to maximize the potential of the policies to reduce tobacco-related health disparities. We discuss implications and recommendations for achieving a national policy and equitable enforcement of flavored tobacco sales restrictions. IMPLICATIONS: This qualitative study among 25 key informants including public health and tobacco control advocates, clinicians, and school staff obtained perspectives of intended and unintended health equity and racial justice impacts of the 2019 Massachusetts An Act Modernizing Tobacco Control. Findings and recommendations from this study can inform monitoring efforts to assess the law's impacts in Massachusetts and the adoption of similar flavored tobacco sales restrictions and other tobacco control policies in other states to maximize the health equity benefits and minimize unintended impacts.

Quantitative Measurement of the Direct Public Health Impact of Medicines Withdrawals in Europe: Development of a Modelling Method and Proof-of-Concept Study to Estimate the Morbidity and Mortality Prevented by Regulatory Action.

PURPOSE: Removing medicines from market may benefit public health by preventing adverse drug reactions (ADRs), which should be quantified. This study's aim was to identify a model to quantify the impact of medicines' marketing authorisation (MA) withdrawal and revocation in terms of preventing morbidity and mortality. METHODS: MA withdrawals and revocations for safety reasons in France, Germany and/or the United Kingdom between July 2012 and December 2016 were identified for prescription medicines. Annual exposure was estimated for each medicine, using IQVIA Medical Research Data (IMRD)-France, IMRD-Germany and IMRD-UK primary care electronic health record databases. European Medicines Agency records provided reasons for regulatory action for each medicine. Absolute risks of ADRs which led to MA withdrawal were estimated for patients exposed to each medicine by systematic review of quantitative research. Public health impact, expressed as annual number of ADRs avoided, was estimated by modelling exposure and ADR risk. RESULTS: Four MA withdrawals and two revocations met study inclusion criteria. Each product's usage decreased following MA withdrawal or revocation. Absolute risk for ADRs was 0.1%-41.25%. To estimate impact of each withdrawal or revocation, its average annual exposure within each IMRD population was multiplied by the absolute risk to give the crude number of ADRs prevented annually due to regulatory action. CONCLUSIONS: This model quantifies the public health impact of MA withdrawal and revocation in terms of serious morbidity, resulting from eliminated or reduced usage of medicines. This method can be applied to products in other settings to quantify the impact of other pharmacovigilance actions.

Participatory governance in public health emergencies: A case study of Quanzhou from a legal perspective.

During public health emergencies, the work of prevention and control must be normalised, and coordination between economic development and epidemic prevention is crucial. However, in China, there is a lack of research on participatory governance in public health emergencies, particularly from a legal perspective. Existing studies are insufficient in terms of using legal texts and exploring legal governance in a normative sense, and there is an inadequate in-depth exploration of issues such as the legitimacy, path, motivation, and other aspects of participation. This article addresses these gaps by analysing the issues of participatory governance in public health emergencies from a legal perspective, using practical cases as examples. The research has shown that there are significant differences among the three types of organisations regarding their internal motivation, external incentives, and legal basis, and therefore it is necessary to distinguish different participation paths. Finally, we propose several measures to promote the active and sustained participation of organisation in governance, including cultivating the ability of organisations, emphasising organizational demands, seeking consensus, strengthening the guiding role of legislation, and broadening the channels of engagement.

State Laws Governing the Hiring of Public Health Government Employees, 2023.

OBJECTIVE: Governmental public health agencies have experienced longstanding challenges in recruiting individuals at the state and local level. Understanding civil service laws as they relate to the hiring processes is an important component of recruitment and increasing public health workforce capacity. This study presents state hiring laws and regulations governing the public health government workforce. METHODS: Legal mapping techniques were employed to collect and code data on current hiring laws governing governmental public health employees across all 50 states. The review of laws included constitutions, statutes and regulations, and searches of administrative code. RESULTS: In 12 states, the laws do not specify civil service exam criteria or they have no mention of civil service exams in the law. Almost a third of states have laws that establish civil service exam requirements without specifying conditions for when exams must be required, or which positions allow which types of exam/criteria. Similarly, almost all of the states that have civil service exams denoted in their laws have unspecified language about whether there are exam fees. Requirements for the maintenance/use of state hiring lists are in place in 36 states and 26 states have a non-public health agency managing this process. Nearly all states (n = 48, 96%) require hiring preferences for certain types of individuals, most commonly veterans (n = 48, 96%) and family members of veterans (n = 30, 60%). No state laws provide hiring preferences for individuals from public health fellowships or special training programs. CONCLUSION: Key findings suggest that the laws governing the merit system and civil service vary and often lack clarity, which may be difficult for public health agencies and for potential employees to understand, navigate, and successfully recruit key employees. The recruitment and hiring of new governmental public health staff are complicated by the management of hiring by other state agencies and the vague civil service exam requirements and process. Developing preferences for hiring individuals who have additional practical training in public health (eg, public health fellowships and AmeriCorps) should be considered.

Banning Engineered Stone: A Landmark Australian Public Health Law Reform.

Union activism, medical lobbying and occupational health and safety prosecutions led to a major public health initiative in Australia - the banning from 1 July 2024 of work with engineered/artificial stone, including manufacturing, supplying, processing and installing it. This editorial contextualises within the history of regulation of workers' exposure to risks of contracting silicosis the growing international awareness of the dangers posed by working with engineered stone, particularly in relation to making and installing kitchen and bathroom benchtops made from engineered stone. It argues that the Australian initiative is an important public health decision that has a sound justification, is likely to save many lives and should be emulated internationally.

Can EU Law Be Used to Challenge Better Regulation Practices That Do Not Lead to Better Health?

Legislation produced under the EU Commission's Better Regulation Agenda sometimes fails to achieve the Treaty obligation to ensure a high level of health protection in all EU policies and activities. Public health advocates have raised the question of whether EU law can be employed to challenge this apparent breach of Treaty obligations at the proposal preparation stage, compelling the Commission to amend prospective EU legislation so that it better protects health. This article will demonstrate that unfortunately this is not possible due to the justiciability of both Article 168 TFEU and the Better Regulation Agenda. However, this awareness can help public health advocates to re-focus their efforts on strategies that will likely have a greater impact in swaying the direction of EU health policy.

[i-Leviathan: towards precision public health?] / i-Léviathan : vers une santé publique de précision ?

Hobbes' Leviathan symbolizes state sovereignty. In public health, this concept now extends to the prevention and promotion of health and the fight against non-communicable diseases (NCDs). This article explores the evolution towards an i-Leviathan, utilizing health data for more effective health surveillance. Precision public health, grounded in a personalized law approach, relies on the collection, availability, and use of these health data. This article analyzes the legal challenges of this precision, such as stigmatization, discrimination, and repression. It addresses the balance between public interests and individual freedoms, outlining state measures to monitor, control, and discipline healthy individuals.

Le Léviathan de Hobbes symbolise la souveraineté étatique. En santé publique, ce concept s'étend aujourd'hui à la prévention et la promotion de la santé et à la lutte contre les maladies non transmissibles. Cet article explore l'évolution vers un i-Léviathan, recourant à nos données de santé en vue d'une surveillance sanitaire plus efficace. Une santé publique de précision, ancrée dans une approche de droit personnalisé, dépend de la collecte, de la disponibilité et de l'utilisation de ces données de santé. Cet article analyse les enjeux juridiques de cette précision, tels que la stigmatisation, la discrimination et la répression. Il fait état de la balance entre intérêts publics et libertés individuelles, traçant les démarches étatiques de surveiller, contrôler et discipliner l'individu en bonne santé.

Global Substance Registration System: consistent scientific descriptions for substances related to health.

The US Food and Drug Administration (FDA) and the National Center for Advancing Translational Sciences (NCATS) have collaborated to publish rigorous scientific descriptions of substances relevant to regulated products. The FDA has adopted the global ISO 11238 data standard for the identification of substances in medicinal products and has populated a database to organize the agency's regulatory submissions and marketed products data. NCATS has worked with FDA to develop the Global Substance Registration System (GSRS) and produce a non-proprietary version of the database for public benefit. In 2019, more than half of all new drugs in clinical development were proteins, nucleic acid therapeutics, polymer products, structurally diverse natural products or cellular therapies. While multiple databases of small molecule chemical structures are available, this resource is unique in its application of regulatory standards for the identification of medicinal substances and its robust support for other substances in addition to small molecules. This public, manually curated dataset provides unique ingredient identifiers (UNIIs) and detailed descriptions for over 100 000 substances that are particularly relevant to medicine and translational research. The dataset can be accessed and queried at https://gsrs.ncats.nih.gov/app/substances.

Population susceptibility: A vital consideration in chemical risk evaluation under the Lautenberg Toxic Substances Control Act.

The 2016 Frank Lautenberg Chemical Safety for the 21st Century Act (Lautenberg TSCA) amended the 1976 Toxic Substances Control Act (TSCA) to mandate protection of susceptible and highly exposed populations. Program implementation entails a myriad of choices that can lead to different degrees of public health protections. Well-documented exposures to multiple industrial chemicals occur from air, soil, water, food, and products in our workplaces, schools, and homes. Many hazardous chemicals are associated with or known to cause health risks; for other industrial chemicals, no data exist to confirm their safety because of flaws in 1976 TSCA. Under the 2016 Lautenberg amendments, the United States Environmental Protection Agency (EPA) must evaluate chemicals against risk-based safety standards under enforceable deadlines, with an explicit mandate to identify and assess risks to susceptible and highly exposed populations. Effective public health protection requires EPA to implement the Lautenberg TSCA requirements by incorporating intrinsic and extrinsic factors that affect susceptibility, adequately assessing exposure among vulnerable groups, and accurately identifying highly exposed groups. We recommend key scientific and risk assessment principles to inform health-protective chemical policy such as consideration of aggregate exposures from all pathways and, when data are lacking, the use of health-protective defaults.