Six policy lessons relevant to cannabis legalization

Abstract

Background: Cannabis (marijuana) has been legalized for recreational and/or medicinal use in many U.S. states, despite remaining a Schedule-I drug at the federal level. As legalization regimes are established in multiple countries, public health professionals should leverage decades of knowledge from other policy areas (e.g., alcohol and tobacco regulation) to inform cannabis policy. Objectives: Identify policy lessons from other more established policy areas that can inform cannabis policy in the U.S., Canada, and any other nations that legalize recreational cannabis. Methods: Narrative review of policy and public health literature. Results: We identified six key lessons to guide cannabis policy. To avoid the harms of "a medical system only in name", medical cannabis programs should either be regulated like medicine or combined with the recreational market. Capping potency of cannabis products can reduce the harms of the drug, including addiction. Pricing policies that promote public health may include minimum unit pricing or taxation by weight. Protecting science and public health from corporate interest can prevent the scenarios we have seen with soda and tobacco lobbies funding studies to report favorable results about their products. Legalizing states can go beyond reducing possession arrests (which can be accomplished without legalization) by expunging prior criminal records of cannabis-related convictions. Finally, facilitating rigorous research can differentiate truth from positive and negative hype about cannabis' effects. Conclusion: Scientists and policymakers can learn from the successes and failures of alcohol and tobacco policy to regulate cannabis products, thereby mitigating old harms of cannabis prohibition while reducing new harms from legalization.

Assessing the public health impacts of legalizing recreational cannabis use: the US experience

“…These evaluations should inform the design of policies to reduce cannabis‐related harm after legalization. These may include: tighter regulation of youth access to cannabis; using taxes to discourage heavy cannabis use (e.g., by setting minimum prices for cannabis products, imposing potency caps, and basing cannabis taxes on THC content 115 ); consumer‐tested health warnings about the risks of cannabis use, especially daily cannabis use, such as cognitive impairment and can­nabis dependence; and research to develop more effective ways of discouraging adolescents from starting cannabis use 116 .…”

The legalization of cannabinoid products and standardizing cannabis-drug development in the United States: a brief report

“…As such, the future of cannabis legalization in the United States appears to be one both of great promise and associated with significant risk. [3][4][5] Although legislative actions (ie, new laws allowing states to issue licenses for cannabis operations, laws allowing cultivation and distribution, etc) have allowed a majority of cannabis and cannabidiol (CBD)-containing products to be available direct to consumers, a lack of cohesive regulation and oversight has left many alarming gaps concerning product quality and patient safety. For example, reports show that non-US Food and Drug Administration (FDA)-approved CBD products available to consumers are often inaccurately labeled, containing varying amounts of active ingredient, and lack evidence for their safety and effectiveness.…”

Recreational cannabis legalization presents an opportunity to reduce the harms of the US medical cannabis industry

“…This pre­vents recreational customers from using the medical cannabis system to evade taxes (medical cannabis is often taxed at a lower rate). Combining systems preserves access to medical cannabis for genuinely sick individuals without subjecting them to a potentially dangerous false promise of medical‐level regulation and consumer protection 8 . It also protects public trust in genuine medicine by not labelling an under‐regulated and frequently unsafe industry as medical.…”