JAMA Health Forum – Health Policy, Health Care Reform, Health Affairs | JAMA Health Forum | JAMA Network
[Skip to Navigation]
Sign In
Insights
Social Determinants of Health
March 2, 2020

Challenges in Navigating a New Marijuana Retail Environment

Author Affiliations
  • 1Nicotine and Cannabis Policy Center, University of California, Merced
  • 2Department of Public Health, School of Social Sciences, Humanities, and Art, University of California, Merced
  • 3Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
  • 4Department of Psychological Sciences, School of Social Sciences, Humanities, and Art, University of California, Merced
JAMA Health Forum. 2020;1(3):e200189. doi:10.1001/jamahealthforum.2020.0189

Legalization of marijuana in US states has produced a rapidly evolving policy and retail landscape. To date, 11 states and Washington DC have legalized marijuana for recreational use for adults 21 years and older; 33 states have legalized medical marijuana.1

In 2016, Proposition 64 legalized recreational marijuana use in California, the state with the largest population, creating a regulatory and licensing system for all marijuana products and dispensaries (ie, stores). While it became legal in California for individuals to buy and consume marijuana, retailers now have to obtain licenses from both the state and their local governments. A recent audit of marijuana retailers in California revealed that there were 3 times as many unlicensed (illegal) as licensed (legal) retailers.2 As the state struggles to regulate marijuana sales, unlicensed retailers offer consumers similar products at much lower prices than their licensed counterparts.2

The recent outbreak of lung injuries associated with electronic vaping products has turned a spotlight on unlicensed marijuana retailers, unregulated marijuana products, the existence of a counterfeit market, and questions about how to best protect consumers in the absence of federal safety regulations. As of January 14, 2020, 2668 people have been hospitalized and 60 have died because of such lung injuries.3 Most of these individuals (82%) reported using marijuana-associated products.3

Regulatory entities stress that licensing serves an important role in ensuring product safety; however, this role diminishes if consumers do not purchase licensed products or are not aware of the differences between regulated and unregulated products. Changes in marijuana policies and the evolution of marijuana products have been accompanied by confusion among the general public around topics such as potential health risks and benefits of cannabis, maximum product dosage,4 and legal issues, including licensing. Rural and other marginalized communities (eg, racial/ethnic minorities, youth) with decentralized media markets and small retail environments may be even more at risk for confusion. Our experience in the field in rural California was that the general public could not determine whether they had bought marijuana products from unlicensed vendors. Indeed, we found that consumers commonly assume that if a retailer sells marijuana products, the retailer must be licensed and regulated.

There may be several reasons for our field observations in California. First, much of the California population is unaware that vendors must be licensed by both the state and the local government to sell marijuana products. Second, even if an individual is aware of the licensing requirements to sell marijuana, they are unaware of how to determine the difference between retailers who are licensed vs unlicensed. Finally, there may be social barriers that prevent individuals from asking retailers to see their licenses, particularly if they live in areas where few retailers exist.

There are at least 4 types of communication strategies states have used to warn their population about and protect them from unregulated products and vendors, but all have limitations. A first strategy involves banning the products. Some states, like Massachusetts and Washington, drew clear distinctions between regulated vs unregulated products by temporarily banning the legal sales of various vaping products for several months. However, some states, like California, were unwilling to implement product bans. A second strategy has been to warn consumers at the point of sale. Washington has required dispensaries to hang signs warning customers about vaping-associated lung injuries at the point of sale, while California is encouraging licensed retailers to put QR matrix barcodes linked to an online list of licensed retailers in their window. Third is the enaction of public health campaigns. Colorado has announced a vaping campaign aimed at youth, and California is funding a campaign encouraging consumers to purchase legal products. Finally, product labeling has been used. Some states are requiring universal symbols to be placed on cannabis products; however, some symbols (eg, stickers) may be easily counterfeited.

It is necessary for US states to create a clear, recognizable, and difficult-to-counterfeit way to signal the difference between licensed and unlicensed retailers and products across all US jurisdictions. In Canada, standardized plain packaging and rotating health warnings are required for all products sold in legal dispensaries.5 Enacting standardized plain packaging requirements with high-tech encrypted tax stamps, similar to those recommended for tobacco products by Healthy People 2020,6 wherever cannabis is legal in the US, would clearly signal that the product has undergone testing and complied with all regulations. Furthermore, plain packaging would limit the youth appeal of the products, since youth-targeted packaging would be eliminated.

As more states allow the use of medical and recreational marijuana, it will be crucial to ensure product safety, discourage the sale and use of unregulated products, prevent youth uptake, and ensure that dispensaries are regulated.7 More research is also needed to develop effective public outreach campaigns that are accessible by at-risk communities (eg, low-income, racial/ethnic minority, and rural populations). The continued existence of illegal dispensaries and unlicensed products implies that tamper-proof plain packaging and clear and effective health communication campaigns, combined with continuous regulation of vendors by local and state governments, is warranted.

Back to top
Article Information

Open Access: This is an open access article distributed under the terms of the CC-BY License.

Corresponding Author: Mariaelena Gonzalez, PhD, Nicotine and Cannabis Policy Center, University of California, Merced, 5200 North Lake Rd, Merced, CA, 95343 (mgonzalez82@ucmerced.edu).

Conflict of Interest Disclosures: This research was supported by the California Tobacco Related Disease Research Program (grant 28PC-0044), which was not involved in the preparation, review, or approval of the manuscript and decision to submit the manuscript for publication. Dr Gonzalez is currently appointed as an unpaid member of the California Tobacco Education Research Oversight Committee. No other disclosures were reported.

References
1.
Gould  S, Berke  J. Legal marijuana just went on sale in Illinois. Here are all the states where marijuana is legal. Business Insider. June 25, 2019. https://www.businessinsider.com/legal-marijuana-states-2018-1. Accessed October 24, 2019.
2.
Queally  J, McGreevy  P. Nearly 3,000 illegal marijuana businesses found in California audit, dwarfing legal trade. September 11, 2019. Accessed November 11, 2019. https://www.latimes.com/california/story/2019-09-11/california-marijuana-black-market-dwarfs-legal-pot-industry
3.
Ellington  S, Salvatore  PP, Ko  J,  et al; Lung Injury Response Epidemiology/Surveillance Task Force.  Update: product, substance-use, and demographic characteristics of hospitalized patients in a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury—United States, August 2019-January 2020.   MMWR Morb Mortal Wkly Rep. 2020;69(2):44-49. doi:10.15585/mmwr.mm6902e2PubMedGoogle ScholarCrossref
4.
Lee  JP, Lipperman-Kreda  S, Saephan  S, Kirkpatrick  S.  Tobacco environment for Southeast Asian American youth: results from a participatory research project.   J Ethn Subst Abuse. 2013;12(1):30-50. doi:10.1080/15332640.2013.759499PubMedGoogle ScholarCrossref
5.
Goodman  S, Leos-Toro  C, Hammond  D.  The impact of plain packaging and health warnings on consumer appeal of cannabis products.   Drug Alcohol Depend. 2019;205:107633. doi:10.1016/j.drugalcdep.2019.107633PubMedGoogle Scholar
6.
US Centers for Disease Control and Prevention. STATE System Tax Stamp Fact Sheet. Last reviewed December 17, 2019. Accessed January 21, 2019. https://cdc.gov/statesystem/factsheets/taxstamp/TaxStamp.html
7.
Morgan  S. Legal dispensaries struggle to compete against illegal pot shops as closure deadline looms. Published March 4, 2019. Accessed November 11, 2019. https://www.bakersfield.com/news/legal-dispensaries-struggle-to-compete-against-illegal-pot-shops-as/article_c587125e-3edc-11e9-b370-d7a504495dcb.html.
Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×