June 19, 2020

Stanton A. Glantz, PhD

California is not applying best practices from tobacco control to marijuana

Lynn Silver, Amanda Naprawa, and Alisa Pardon just published “Assessment of Incorporation of Lessons From Tobacco Control in City and County Laws Regulating Legal Marijuana in California” in JAMA Open.  This paper comprehensively reviews all state and local laws on marijuana in California and finds that few are incorporating any best practices from tobacco control.  The State is clearly prioritizing increasing sales and even working to undermine the local control provisions in Proposition 64, the ballot initiative that legalized adult use sales.

Of the 539 local jurisdictions, only 8 have rules exceeding state regulations, 1 which prohibits sale of favored products, 3 prohibit marijuana-infused beverages, and 5 imposed some restrictions on edible products.  27 allow onsite consumption of marijuana, which exposes people to secondhand smoke, something the state ended for tobacco a quarter century ago.

With the movement of major corporate interests into the marijuana business, we are seeing all the kinds of activities Big Tobacco uses to maximize new customers, sales and profits.  We need to start applying lessons from tobacco control to head of an epidemic of marijuana-caused disease.  It is shocking that California State Government is not doing more to protect the public.  We have been able to do that with tobacco even though it is legal; we need to do it with marijuana, too.

Here are the Key Points and Abstract:

Key Points

Question  What legal limits have cities and counties adopted since California legalized marijuana use for adults, and to what extent do these legal limits incorporate public health recommendations and lessons from tobacco control?

Findings  This cross-sectional study of all 539 California cities and counties found that jurisdictions differed widely in how they regulated marijuana and that key public health recommendations and lessons from tobacco control have generally not been adopted, although local innovation is emerging.

Meaning  Jurisdictions undergoing marijuana legalization may need to consider incorporating policy lessons from control of other legal but harmful products to reduce potential future burden of harm.

Importance  As marijuana continues to be legalized in many states, little is known about best regulatory practice, exposing the population to significant potential harm.



Objective  To assess the extent to which potential best practices, including those from tobacco control, were incorporated into state and local marijuana policies in California.

Design and Setting  California legalized medical marijuana in 1996 and adult recreational use in 2016, effective in January 2018. A cross-sectional study with data collection and analysis from February 1 to November 30, 2019, measured the adoption of potential demand reduction and youth protection best practices, including restrictions on sales, products, marketing, warnings, and taxation. Laws in effect by January 31, 2019, were verified and all 539 California local jurisdictions were studied.

Main Outcomes and Measures  Adoption of potential best practices in marijuana laws for demand reduction and youth protection.

Results  The laws of 534 of California’s 539 jurisdictions (99%) were successfully identified; 263 of these 534 jurisdictions (49%) allowed any retail sale of marijuana, covering 57% of the state’s population. More than one-third of jurisdictions allow sales of marijuana for adult recreational use (203 of 534 [38%]); of those, 122 allow storefront dispensaries and 81 allow sales by delivery only. A total of 257 of 534 jurisdictions (48%) allow medical sales. Of 147 jurisdictions allowing medical or adult use dispensaries, 93 (63%) limited the number of licenses, with a mean of 1 store for every 19 058 residents (range, 154-355 143). The state imposed no limits on number of dispensaries or deliverers. Forty-two jurisdictions increased the state-specified distances required between dispensaries and schools. Only 8 jurisdictions allowing retail sales imposed restrictions on products exceeding state regulations; 1 prohibited sale of flavored products, 3 prohibited sale of marijuana-infused beverages, and 5 imposed additional restrictions on edible marijuana products. No jurisdictions limited potency of products sold, although 1 established a potency-linked tax. The state did not limit or tax potency, except for establishing a standard 10-mg dose of tetrahydrocannabinol for edible marijuana products, nor did they limit manufacturing or sale of flavored products. The state required only a health warning in 6-point font on packages. Twenty-seven jurisdictions required additional health warnings in stores or on packages, 27 allowed onsite consumption of marijuana products, and 13 allowed marijuana-related events. More than half of jurisdictions legalizing any cannabis commerce (154 of 289 [53%]) did not tax marijuana locally and little revenue was captured for prevention. Much of the state excise and cultivation taxes is slated for youth substance use prevention and treatment.

Conclusions and Relevance  In implementing legalization of marijuana in California, local policies varied widely. Where marijuana was legalized, many lessons from tobacco control to reduce demand, limit harm, and prevent youth use were not adopted, potentially creating greater risk of harm.

The full citation is:  Lynn D. Silver, Amanda Z. Naprawa, Alisa A. Padon.  Assessment of Incorporation of Lessons From Tobacco Control in City and County Laws Regulating Legal Marijuana in California.  JAMA Netw Open. 2020;3(6):e208393. doi:10.1001/jamanetworkopen.2020.8393.  It is available for free here.


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