Marijuana Legalization in the United States: A Comparison of Non-Medical Marijuana Policies and Regulations across Ten U.S. States

Since 2012, eight additional U.S.states have legalized the commercial sale of marijuana – most following fairly closely in line with the frameworks laid out by WA and CO, though each making subtle changes along the way, based on scientific, public health, and policy learnings; political pressures; and a bourgeoning industry. U.S. states will continue to advance and evolve marijuana regulatory policy – perhaps even in the face of a future federal legalization.

In November of 2020, four additional states – Arizona, Montana, New Jersey, and South Dakota will vote on adult use legalization. A number of other states, including New York, Rhode Island, Connecticut, and Pennsylvania have publicly expressed interest in legalizing legislatively. Two additional countries (Canada and Uruguay) have also legalized marijuana – with Canada taking a federal approach that has differences from the preceding U.S. state legalization frameworks, but is essentially still a commercial approach, and Uruguay taking a very different approach with public health and medical principles driving regulations.

These various regulatory approaches should be carefully studied and compared – taking note of the potential benefits and/or harms to public health and safety from different regulatory frameworks. Ultimately, when one regulatory approach is selected – whether for medical legalization or adult use legalization – it becomes challenging to change course, even in the face of new scientific information that may be gleaned.

This may be particularly true when the initial regulatory framework that is selected results in a commercial industry, as has been demonstrated with tobacco. Collecting and triangulating data – both preceding policy change and following policy change can be an effective way to identify unexpected implications from certain policies.10,123Data should include population-based data sources, syndromic surveillance, evaluation data, quality control data, and testing data (among other sources). Focusing on developing a public health approach to any pre-existing medical marijuana policies is also an important consideration in advance of adult use policy change, as policy can be hard to roll back once in place – even if only for medical products.