Marijuana regulatory frameworks in four US states: An analysis against a public health standard

The movement to legalize and regulate retail marijuana is growing. We examined legislation and regulations in the first 4 states to legalize recreational marijuana (Colorado, Washington, Oregon, and Alaska) to analyze whether public health best practices from tobacco and alcohol control to reduce population-level demand were being followed. Only between 34% and 51% of policies followed best practices. Marijuana regulations generally followed US alcohol policy regarding conflict of interest, taxation, education (youth-based and problematic users), warning labels, and research that does not seek to minimize consumption and the associated health effects. Application of US alcohol policies to marijuana has been challenged by some policy actors, notably those advocating public health policies modeled on tobacco control. Reversing past decisions to regulate marijuana modeled on alcohol policies will likely become increasingly difficult once these processes are set in motion and a dominant policy framework and trajectory becomes established. Designing future marijuana legislation to prioritize public health over business would make it easier to implement legalization of recreational marijuana in a way that protects health.