Cannabis legalization has created a conundrum about where to allow its use without undermining smokefree norms

Jane Steinberg and colleagues recently published “A Tobacco Control Framework for Regulating Public Consumption of Cannabis: Multistate Analysis and Policy Implications” in American Journal of Public Health.  They did a comprehensive review of how the first eleven states that legalized adult use cannabis are dealing with public usage.  Seven of the states allow some form of public use, which has the potential to undermine nonsmoking norms and protections from secondhand smoke.

They provide a good summary of the state of affairs, but don’t have any good solutions to the knotty problem of how to allow use of legal cannabis outside the home.  This is a particular problem for people who live in multi-unit housing, where smoking is increasingly restricted.  In public housing, using cannabis (which is still federally illegal) raises concerns about eviction.

One thing that they don’t address directly is that, unlike tobacco smoking, many state governments are still looking for ways to promote cannabis use as a cash cow.  I don’t think that this will materialize because as time passes we will get a better understanding of the adverse effects of cannabis.

My view is that cannabis should be legal but discouraged.  (We don’t arrest people for using nicotine.)  The California Department of Public Health took a step in this direction with its new and excellent Smoke is Smoke campaign.  Cigs, e-cigs, and cannabis all pollute nonusers’ air.  We need to work on strengthening that norm.

In the meantime Steinberg’s paper gives the first comprehensive overview of what is going on in public cannabis use, which is the first step toward developing a solution.

Here is the abstract:

Eleven US states and Washington, DC, legalized recreational (adult use) cannabis. Seven states-Alaska, California, Colorado, Massachusetts, Nevada, Oregon, and Washington-allow cannabis sales. A public health concern is that exemptions in state or local smoke-free laws for public cannabis smoking or vaping will weaken smoke-free laws, expose the public to secondhand cannabis, and renormalize smoking. We describe the experience of the seven states and challenges faced in maintaining smoke-free laws. Using elements of a tobacco control framework, we identify best practices in cannabis regulation by comparing each state's smoke-free laws and allowances for public cannabis use. All states prohibit public cannabis use; two lack 100% smoke-free protections; one lacks vaping devices in its smoke-free law; three allow cannabis use in retailers; two allow cannabis use in social consumption lounges; and two allow cannabis use in tourism venues. States should close gaps in smoke-free laws and not expand where cannabis use is permitted to ensure public health.

The citation is:   Steinberg J, Unger JB, Hallett C, Williams E, Baezconde-Garbanati L, Cousineau MR.  A Tobacco Control Framework for Regulating Public Consumption of Cannabis: Multistate Analysis and Policy Implications. Am J Public Health. 2019 Dec 19:e1-e6. doi:10.2105/AJPH.2019.305423. [Epub ahead of print].  It is available here.