Regulation of Cannabis Retailers: Facilitating Responsible Adult Use and Promoting Health Equity While Preventing Access to Minors

Matthay et al. (p. 1640) compared cannabis control policies in 241 California jurisdictions and found that jurisdictions which lacked comprehensive bans on cannabis retail outlets had higher proportions of residents who had low education, lived in poverty, and were Black or Latinx individuals. Consequently, cannabis retailers tend to cluster in these socially and economically disadvantaged areas.¹ Alcohol and tobacco retailers also tend to be concentrated in areas with low socioeconomic status.² The concentration of licensed cannabis retailers in economically disadvantaged areas could create or exacerbate health disparities if these communities disproportionately bear the burden of the negative consequences of cannabis use, such as increased cannabis availability to youths, driving under the influence of cannabis, car crashes,³ cannabis-associated emergency room visits,⁴ and accidental ingestion of edibles by children.⁵ In addition, disadvantaged neighborhoods might lack the resources to enforce policies on cannabis licensing, sales to minors, and public use. Poor enforcement could facilitate sales to minors, sales of incorrectly labeled products or products without childproof packaging, and crime. As Matthay et al. stated, this could result in a “not in my backyard” situation, in which Californians statewide can benefit from the positive aspects of cannabis in nearby cities, but the burden of the negative aspects of cannabis falls completely on economically underresourced communities. This analysis highlights some additional issues that should be considered in decisions about the regulation of cannabis retailers.

PATCHWORK OF DIFFERENT POLICIES

Matthay et al. noted a wide variation in cannabis retail policies across the state of California. Most Californians, especially those in urban and suburban areas, live within a short drive of a cannabis retailer.⁶ Policies limiting cannabis retailers might be less effective if they are not uniform across the state. Residents of cities where cannabis retailers are not allowed can simply drive to an adjacent city to purchase cannabis. Perhaps it is time for statewide implementation of local policies that have been shown to be effective. The evolution of cannabis regulation could emulate that of tobacco regulation. In California, antitobacco policies have historically begun at the local, grassroots level and finally become adopted statewide.⁷ Perhaps cannabis policy would benefit from statewide adoption of consistent cannabis policies; this could prevent lax policies in one locality from undermining stricter policies in neighboring localities. Research is needed to determine the relative efficiency and effectiveness of bottom-up versus top-down approaches to achieve uniform policies.

ACCESS BY MINORS

Prevention of cannabis use by adolescents remains an important public health priority, because cannabis adversely affects the developing adolescent brain.⁸ Restriction of cannabis retailers could potentially be an effective strategy to reduce cannabis use among youths. We¹⁰ found that adolescents who live in California jurisdictions that allow cannabis retail are more likely to report easy access to cannabis and report more frequent cannabis use. However, only a small minority of adolescent cannabis users obtain their cannabis from retailers; most obtain their cannabis from social sources.⁹ Research is needed to determine what proportion of the social sources is adults who purchase cannabis products from licensed retailers and what proportion comprises friends, acquaintances, or dealers who share or sell products of dubious origin with unknown ingredients. Strict enforcement of restrictions on cannabis sales to minors could potentially prevent youth use in areas where retailers are allowed.¹⁰ However, cities with high levels of neighborhood economic disadvantage might lack resources to enforce regulations against cannabis sales to minors. In addition, even if sales to minors can be prevented, the mere presence of cannabis retailers in the neighborhood could be a risk factor for adolescent cannabis use. Exposure to advertisements for cannabis retailers (e.g., billboards, outdoor signs) in neighborhoods with cannabis retailers could signal to adolescents that cannabis use is normative, resulting in increased adolescent use.¹¹ In the current environment of increased legalization, effective prevention programs will be needed to help adolescents make informed decisions about potentially impairing their neurodevelopment with cannabis.

UNLICENSED RETAILERS

Despite California’s extensive cannabis retailer licensing program and local policies, unlicensed retailers continue to proliferate throughout the state.¹ Similar to licensed retailers, unlicensed retailers are more prevalent in neighborhoods experiencing social and economic disadvantage,¹ and proximity to unlicensed retailers is associated with heavy cannabis use among young adults.¹² Cannabis regulators have described the regulation of unlicensed cannabis retailers as a game of “Whack-A-Mole”; as soon as they close down one unlicensed retailer, several more appear in other locations.¹³ Unlicensed retailers are more likely than licensed retailers to sell to minors, sell products that exceed the legal tetrahydrocannabinol limit, sell counterfeit products that contain pesticides, allow consumption in retail stores, ignore daily limits on purchases, stay open late at night, and sell products that are attractive to youths and lack child-resistant packaging.¹⁴ Consumers are likely to turn to unlicensed cannabis sources when they perceive that licensed cannabis retailers are too inconvenient or that their products are too expensive.¹⁵ Therefore, stricter retail licensing laws and higher taxes could push consumers back to unlicensed retailers unless the unlicensed retailers are eliminated. States with retail cannabis need to dedicate sufficient money to enforcement of the licensing laws to prevent proliferation of unlicensed retailers. However, this must be done carefully and thoughtfully to ensure that populations which have historically been victimized by overly harsh prosecution of possession and sales are able to afford and access the new retail licenses that are intended to reverse previous inequities.

HOME DELIVERY

Although cannabis storefront retailer policies vary across California jurisdictions, home delivery of cannabis is available throughout the state. Home delivery is available to anyone aged 21 years or older with a form of identification and a residential address. The easy availability of home delivery, even in localities where brick-and-mortar retailers are banned, could undermine local policies. The effect of home delivery on cannabis use and its consequences is unknown. Home delivery could potentially decrease car crashes and public consumption by encouraging users to use their cannabis at home, but it also could facilitate youth access if adults leave cannabis in accessible locations at home or if youths use an adult’s identification to receive purchases at home.¹⁶ Research on the positive and negative consequences of cannabis home delivery is needed.

Many cannabis users experience physical and mental health benefits from this substance. Policies should enable easy and affordable access by medical patients while preventing access by youths. Public opinion appears to be shifting toward increased legalization. It will be important for states and local jurisdictions to develop and enforce policies that allow safe cannabis purchases and responsible use by adults while preventing use by youths and preventing the adverse medical, legal, and economic consequences of being concentrated in economically disadvantaged areas.