Having a dispensary in your neighborhood could be harmful to your health

Embargoed for release until 5:00 p.m. ET on Monday 24 November 2025   

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Below please find summaries of new articles that will be published in the next issue of Annals of Internal Medicine. The summaries are not intended to substitute for the full articles as a source of information. This information is under strict embargo and by taking it into possession, media representatives are committing to the terms of the embargo not only on their own behalf, but also on behalf of the organization they represent.   
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1. Having a dispensary in your neighborhood could be harmful to your health

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-01960

URL goes live when the embargo lifts             

A population-based natural experiment study examined the association between exposure to cannabis retail stores and cannabis-related harms. The study found that exposure to retail stores was associated with increased rates of harm, particularly in neighborhoods with greater densities of stores. The findings suggest that restrictions on the overall number of cannabis retail stores, on store concentrations, or on being located in certain areas could offer public health benefits. The study is published in Annals of Internal Medicine.

Researchers from North York General Hospital and colleagues studied data from 6,140,595 residents of Ontario, Canada aged 15 to 105 years old residing in 10,574 neighborhoods between April 2017 and December 2022 to determine if exposure to a cannabis store after legalization in October 2018 affected neighborhood-level rates of cannabis-related emergency department (ED) visits. They leveraged provincial data on cannabis store locations to define neighborhoods as exposed (within 1000m of a cannabis retail store) or unexposed (more than 1000m from a cannabis retail store). The primary health outcome was the neighborhood level rate of cannabis-attributable ED visits per 100,000 persons aged 15 years or older. The researchers found that exposed neighborhoods were more likely to be in large urban centers and the lowest income quintile compared to unexposed neighborhoods. Overall, exposed neighborhoods did not experience an increase in monthly rates of cannabis-attributable ED visits after they were exposed to a cannabis store, whereas unexposed neighborhoods experienced a reduction in monthly rates of cannabis-attributable ED visits. Relative to unexposed neighborhoods, the absolute rate of cannabis attributable ED visits increased by 12% (CI, 6% to 19%) in exposed neighborhoods. There was also evidence that having more cannabis stores within 1000 m correlated to larger increased in rates of cannabis-attributable ED visits. The findings suggest that legalization of cannabis accompanied by retail commercialization may have different public health risks as opposed to legalization alone.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Daniel T. Myran, MD, MPH, please email Misty Pratt at misty.pratt@ices.on.ca. 

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2. ACP Says Managed Care Strategies Should Focus on Improving Health Outcomes

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-03178

URL goes live when the embargo lifts             

Managed care strategies employed by insurance plans should have the goal of improving health outcomes for patients rather than focusing solely on conserving costs, says the American College of Physicians (ACP). In a new paper, “Principles of Managed Care: A Position Paper from the American College of Physicians” published in Annals of Internal Medicine, ACP addresses the complex issue of managed care and offers recommendations to protect patients and allow physicians to provide better care.

Managed care refers to health care payment or delivery models wherein the plan coordinates how members use it to control cost. Most health care plans in the United States use managed care strategies to control enrollees’ coverage. With health care costs rising at record rates, the use and misuse of these strategies is likely to increase. Strategies such as prior authorization and narrow clinician networks have far-reaching implications for patients and physicians, such as administrative burden, delayed or foregone care, and negative health outcomes. 

The paper offers recommendations to protect the patient-physician relationship, prevent inappropriate restrictions on access to care, and ensure that the primary goal of managed care is to improve health outcomes, not solely reduce costs. The recommendations include streamlining payments and administrative processes and providing physicians with means to more effectively advocate on behalf of patients. Evidence-based standards and current guidelines should inform utilization management decisions. Plans should maintain transparency and ensure patients can access equitable, high value, medically necessary care in a timely manner.

The paper concludes that plans must collaborate with patient advocacy organizations, physician associations, policymakers, and other key entities to ensure that the top priority is the mutual goal of connecting patients to high-value, evidence-based care.

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To speak with someone at ACP, please email Jacquelyn Blaser at jblaser@acponline.org.

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3. EHR-linked patient intervention with clinical training and patient outreach increases advanced care planning 

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-02111

Editorial: https://www.acpjournals.org/doi/10.7326/ANNALS-25-04538

URL goes live when the embargo lifts             

A comparative, cluster randomized trial compared different advance care planning (ACP) approaches for adults with serious illness. The trial found that implementing a patient-facing automated ACP intervention coupled with clinician training and mailed materials within health systems increases ACP documentation in the EHR and is enhanced with patient navigator outreach. The findings of this study can serve as a foundation for developing more intensive ACP interventions in health systems. The study is published in Annals of Internal Medicine. 

ACP clarifies patients’ values and goals, oftentimes yielding documents and medical orders within the patient’s electronic health record (EHR) to guide care. However, there is a gap in knowledge of how health systems can implement ACP amongst their patient populations. Researchers from University of California, Los Angeles (UCLA), University of California, San Francisco (UCSF), and University of California, Irvine (UCI), compared three evidence-based ACP interventions among 8,707 seriously ill adult primary care patients across 50 primary clinics at UCLA, UCSF, and UCI among whom 5,810did not have a prior advance directive (AD) or Physician Orders for Life-Sustaining Treatment (POLST) form in the EHR. Clinics were randomly assigned to one of three intervention groups. Interventions were sent to patients via the EHR and mail before a primary care clinician visit. Group 1 intervention included a message through the EHR patient portal with a link to an AD and a mailed message and AD. Group 2 intervention included group 1 materials and a link to the PrepareForYourCare.org website and mailed PREPARE pamphlet with website information. Group 3 intervention included the group 2 materials plus health navigator outreach. Primary care clinicians were invited to attend an educational session about ACP. The researchers found that at both 12 and 24 months, group 3 patients were more likely to have an AD or POLST form in the EHR compared to group 1 and group 2, who did not differ. An ACP discussion was documented for 33.4% (CI, 31.3% to 35.6%) of patients in group 1, 34.6% (CI, 32.5% to 36.8%) in group 2, and 39.0% (CI, 36.9% to 41.1%) in group 3. Documentation of clinician ACP discussion was highest in group 3, reflecting more patient conversations. The researchers note that the ACP interventions examined work within existing clinical workflows, can be adjusted for desired intervention frequency, and can serve as a foundation for more intensive interventions. 

Media contacts: For an embargoed PDF, please contact Gabby Macrina at gmacrina@acponline.org. To contact corresponding author Neil Wenger, MD, MPH and first author Anne Walling, MD, PhD, please email Enrique Rivero at erivero@mednet.ucla.edu or call 310-267-7120.

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Also new this issue:

Massive Amounts of Data: More Publications, Better Science?

Howard Bauchner, MD; and Frederick P. Rivara, MD, MPH

Ideas and Opinions

Abstract: https://www.acpjournals.org/doi/10.7326/ANNALS-25-03424