Principles for a Public Health & Equity Approach to Cannabis Regulation

Getting it Right from the Start

The war on drugs has resulted in large scale unjust incarceration and other harmful social impacts. At the same time, legalizing cannabis without robust regulation and promoting the growth of an unfettered for-profit industry threatens our developing youth and public health, and risks further exacerbating social, economic, and health disparities. Download a simplified one-page Principles for a Public Health & Equity Approach to Cannabis Regulation.

Issue Brief – Complying with SB1186

Getting it Right from the Start, January 2024

Our new policy brief provides detailed recommendations and guidance for your locality to help determine whether to challenge the new law that overrode the foundational local control principle of Proposition 64 or how to modify your current policies around medical marijuana access to include strong guardrails that protect youth, promote public health, and advance social equity.

Intoxicating Hemp Products 

Getting it Right from the Start, June 2023

This policy brief for California local governments, particularly the County of Santa Clara Public Health Department, delves into the the unintentional consequences of Bill 45 (AB45), which legalized the manufacture and sale of products intended for human consumption that contain ingredients derived from industrial hemp. While the intent may have been to legalize hemp-derived cannabidiol (CBD), which is usually non-intoxicating, loopholes have allowed  psychoactive hemp products to be sold.

Health Harms of Cannabis Use: One Pager for General Public

Getting it Right from the Start, November 2023

In 2017, the National Academies of Sciences, Engineering and Medicine (NASEM) reviewed the available scientific evidence on the health effects of cannabis and cannabis products, and while noting substantial evidence of therapeutic effectiveness of medicinal cannabis for a limited number of indications, noted evidence of association of cannabis use with harm in a wide range of areas. We lay out some of the key conclusions from this landmark NASEM study.

Fact Sheet: Ten Tips for Safer Cannabis Use 

Getting it Right from the Start, June 2023

Every form of cannabis use can pose risks to your health. Cannabis products come in many forms and can be used in different ways; some are more hazardous than others. If you decide to use cannabis, follow these recommendations to lower risks to your health.

Fact Sheet: Cannabis vs. Hemp 

Getting it Right from the Start, May, 2023

Learn all about what makes them different, what they have in common, why it matters, what’s legal and what’s not, and what we can do to create a safer legal cannabis market.

Setting the Record Straight: Fact-Checking Claims About California’s Legal Cannabis Industry

Getting it Right from the Start, 2022

Countering online marketing and user endorsements with enhanced cannabis warning labels

Dr. Sijia Yang School of Journalism and Mass Communication, University of Wisconsin, Madison, WI, Getting it Right from the Start, and Others, March 2024

In a national experiment, we found that pro-cannabis online comments increased product appeal in youth-targeting cannabis online ads, increasing the risk for early and/or habitual cannabis use among adolescents. Using enhanced CWLs helped counter online pro-cannabis marketing and social influences, reducing product appeal and intentions for cannabis use among both adolescents and young adults.

Neonatal Outcomes Associated with In Utero Cannabis Exposure: A Population-Based Retrospective Cohort Study

Getting it Right from the Start and Kaiser Permanente Division of Research, November 2023

We recently partnered with Kaiser Permanente Division of Research (norcal) on a report published in American Obsetrics & Gynecology that found cannabis use during pregnancy is associated with low birth weight, small for gestational age, preterm birth, neonatal intensive care, and infant respiratory support. The findings highlight the need to educate women regarding dangers of cannabis use while pregnant, end widespread industry practices of recommending use to pregnant women, and to identify effective, non-stigmatizing communication and preventive strategies for diverse populations.

Adolescent use and co-use of tobacco and cannabis in California: The roles of local policy and density of tobacco, vape, and cannabis retailers around schools

Science Direct, April 7, 2023
By Alisa Padon, Getting it Right from the Start (and numerous others)

Report highlights include: Retail environment policies were negatively associated with student past-month use of tobacco/vape, cannabis, and co-use. Retailer density near schools was positively associated with student past-month tobacco/vape use and co-use. Policies that reduce retailer density near schools may curb youth exposure and access to tobacco and cannabis retailers.

Presence of Content Appealing to Youth on Cannabis-Infused Edibles Packaging

National Library of Medicine, March 23, 2023
By Alisa Padon, Getting it Right from the Start (and numerous others)

Existing laws have not adequately limited content appealing to youth on U.S. cannabis-infused edibles packaging. Robust and consistent regulations in the U.S. are needed to ensure that the packaging of such products does not contain content that appeal to youth and lead to initiation or inadvertent ingestion.

Public health legislative priorities for cannabis legalization

Hennepin County Minnesota, February 17, 2023
Getting it Right from the Start and the Public Health Law Center

This report prioritizes a framework for regulating the new legal cannabis market to effectively protect public health, including limiting the amount and potency of THC in cannabis products, ensuring the primacy of public health in all aspects of regulation, and preserving local control.

Geographic Accessibility of Retail Cannabis in Northern California and Prenatal Cannabis Use During the COVID-19 Pandemic

National Library of Medicine, November 2022
By Getting it Right from the Start’s Alisa A Padon, Lynn D Silver, and Aurash Soroosh (and numerous others)

Prenatal cannabis use was more common among individuals living in areas with greater retail availability of cannabis. Although relative rates increased similarly during the pandemic regardless of local cannabis retail and policy environment, there was a larger absolute increase associated with living closer to a storefront cannabis retailer. Continued monitoring of local cannabis policy, the retail environment, and prenatal cannabis use is needed.

Yet Again Conversations Matter

National Library of Medicine, October 2022
By Lynn Silver and Alisa Padon of Getting it Right from the Start (and numerous others)

These findings underscore the need to regulate online cannabis marketing and the importance of investing in online education campaigns to increase public understanding of the risks associated with cannabis consumption in young adulthood.

Textual and pictorial enhancement of cannabis warning labels: An Online experiment among at-risk U.S. young adults

National Library of Medicine, August 2022
By Dr. Lynn Silver, Dr. Alisa Padon of Getting it Right from the Start (and numerous others)

Given rapid expansion of the cannabis industry and declining perception of harm, currently required CWLs in the U.S. such as California’s, would benefit from redesign to improve public understanding of health risks and to prevent youth use.

California Cannabis Markets—Why Industry-Friendly Regulation Is Not Good Public Health

JAMA Network, July 8, 2022
By Kelly C. Young-Wolff, Rosalie Liccardo Pacula, Lynn D. Silver

The US legal cannabis market is growing rapidly, and California is leading the way. It has the largest legal cannabis market in the world, and the industry is expected to continue expanding. For better or for worse, many states have adopted practices similar to those in California; across the US, California has become a bellwether.

Local Laws Regulating Cannabis in California Two Years Post Legalization: Assessing Incorporation of Lessons from Tobacco Control

Research Society of Marijuana, July 24, 2022 

Impact of California’s tobacco and cannabis policies on the retail availability of little cigars/cigarillos and blunt wraps.

National Library of Medicine, September 2021
By Getting it Right from the Start’s Alisa A Padon, Lynn D Silver, and Aurash Soroosh (and numerous others), National Library of Medicine, September 2021

A tobacco flavor ban may be an effective strategy to reduce retail availability of LCCs, blunt wraps and possibly other tobacco in California jurisdictions. This finding is of particular relevance as the tobacco industry has successfully petitioned for a referendum vote on California’s statewide flavor ban in the 2022 election.

Association of Cannabis Retailer Proximity and Density With Cannabis Use Among Pregnant Women in Northern California After Legalization of Cannabis for Recreational Use

National Library of Medicine, March 2021
By Getting it Right from the Start’s Alisa A Padon and Lynn D Silver (and numerous others)

This cross-sectional study examines the association of cannabis retailer proximity and density with cannabis use among pregnant women after legalization of cannabis for recreational use in California.

Moving Toward Health and Social Equity for Women Who Use Cannabis During Preconception, Pregnancy, and Lactation

JAMA Open Network, February 2021
By Getting it Right from the Start’s Alisa A Padon and Lynn D Silver (and numerous others)

Improvements in primary prevention and education are vital but also necessary are legal and regulatory policies that protect infants and children, inform women of risks, prohibit health and therapeutic claims for cannabis outside scientific approval processes, and ensure equitable access to supportive and nonpunitive substance use treatment.