Regulating Cannabis for Public Health

The link between long-term or heavy cannabis use and adverse health effects is well established. Recent international recommendations suggest governments adopt market regulations that promote moderate use. As policymakers debate liberalizing cannabis policy globally, and look to first moving jurisdictions as examples, it is important to examine the extent to which those jursidictions have adopted policies that promote moderate use and public health goals.

We conduct primary and secondary data collection of laws across U.S. states, Canada and Uruguay from January 2020 through January 2022 to summarize evidence on implementation of regulations promoting the public health goal of moderate use. Specific policy areas considered include capping potency of delta-9-tetrahydrocannabinol (THC), instituting sales limits, and taxation based on potency of THC.

Regulations promoting moderate use have been more successfully adopted outside of the U.S. Uruguay and Canada impose caps on THC in at least some of their products sold, while the vast majority of states have no such limits. Only Vermont imposes a cap on potency of THC for all products. Unlike Uruguay, which places sales limits on total purchase amounts and implicitly limits THC servings, states in the U.S. that have implemented sales limits do so based on product weight. Taxation in Canada and the majority of U.S. states remains either price-based or weight based. Illinois currently imposes a tax based on potency of THC above 35%, and two more states (Connecticut and New York) have plans to similarly consider potency levels when taxing cannabis.

Current regulations of legal cannabis markets are weaker in the U.S. compared to Canada and Uruguay in terms of promoting moderate use, with the potential exception of taxation policy. Policymakers should understand the strengths and limitations of existing policies in each of these jurisdictions when determining cannabis regulations in order to protect public health.