Cannabis Legalization in State Legislatures: Public Health Opportunity and Risk

One of the problems that we have been facing is the fact that, for the most part, state laws legalizing cannabis have been enacted through the initiative rather than the legislative process and the people writing and passing these initiatives’ main goal is making cannabis as available as possible with little or no attention to the public health implications of these laws.

It is likely that enacting laws through a legislative process (if the health groups actively participate) could yield more balanced public policies.

Dan Orenstein and I have written “Cannabis Legalization in State Legislatures: Public Health Opportunity and Risk” which is a comprehensive review of legislative efforts and how legislation could be crafted to prioritize public health.  The paper, which has been accepted by the Marquette Law Review, is available as a preprint on the Social Science Research Network at https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3463986 and the UCSF eScholarship system at https://escholarship.org/uc/item/01g4z2wd .

Here is the abstract:

Cannabis is widely used in the U.S. and internationally despite its illicit status, but that illicit status is changing. In the U.S., 33 states and the District of Columbia have legalized medical cannabis, and 11 states and D.C. have legalized adult use cannabis. A majority of state medical cannabis laws and all but two state adult use laws are the result of citizen ballot initiatives, but state legislatures are beginning to seriously consider adult use legislation. From a public health perspective, cannabis legalization presents a mix of potential risks and benefits, but a legislative approach offers an opportunity to improve on existing legalization models passed using the initiative process that strongly favor business interests over public health. To assess whether state legislatures are acting on this opportunity, this article examines provisions of proposed adult use cannabis legalization bills active in state legislatures as of February 2019 to evaluate the inclusion of key public health best practices based on successful tobacco and alcohol control public health policy frameworks. Given public support for legalization, further adoption of state adult use cannabis laws is likely, but legalization should not be viewed as a binary choice between total prohibition and laissez faire commercialization. The extent to which adult use cannabis laws incorporate or reject public health best practices will strongly affect their impact, and health advocates should work to influence the construction of such laws to prioritize public health and learn from past successes and failures in regulating other substances.