Marijuana Regulatory Frameworks in Four US States: An Analysis Against a Public Health Standard

Rachel A. Barry; MA; Stanton A. Glantz, PhD


Am J Public Health. 2018;108(7):914-923. 

In This Article

Abstract and Introduction


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.


State policies to legalize and regulate recreational marijuana are being developed and implemented despite the fact that marijuana remains illegal under federal law, with marijuana listed as a Schedule I drug under the Controlled Substances Act. Nevertheless, since 1996, states have been legalizing marijuana for medicinal use.[1,2] The first 4 US states legalized recreational marijuana use through the initiative process (Colorado, 2012; Washington, 2012; Alaska, 2014; and Oregon, 2014). Policymakers have had to develop regulatory systems for the new retail marijuana industry[2–6] with only limited models and empirical evidence on the health impact of possible regulations.[7]

Considering health is important because legalization will likely increase consumption and associated health impacts[8,9]—including cancer,[10] respiratory problems,[9] and cardiovascular diseases[11]—as well as mental health impacts—including the development of schizophrenia or other psychoses, symptoms of mania and hypomania in individuals with bipolar disorders, and suicide.[9] In the short term, marijuana use has an adverse impact on short-term memory, motor control, judgment, and, for some, triggers paranoia and psychoses at high doses.[12]

State laws to legalize recreational marijuana are diffusing rapidly, with 4 more states (California, Nevada, Maine, and Massachusetts) doing so in 2016. By 2017, 29 states and the District of Columbia, representing 63% of the US population, had legalized medical marijuana use and 8 states and the District of Columbia, representing 21% of the US population, had legalized recreational marijuana use.[2] This article takes a normative approach to examining implementation of recreational marijuana in the first 4 US states by comparing their implementation to public health best practices from tobacco and alcohol with the policy objective of regulating commercially legalized marijuana "as a public health priority and develop, adopt, monitor, and evaluate regulatory controls for commercially legalized marijuana that reduce and prevent the drug's use, misuse, and abuse."[13]