What would a public health framework for cannabis legalization look like?

Discussions of drug policy in the United States are highly polarized at best, and cannabis (along with the opioid epidemic) continues to be one of the flashpoints. Talk of cannabis in public health is no different. Public health professionals are rightfully concerned about, well, public health, and raise good points about increasing rates in youth and adult use, harmful health effects, and industry influence. And what about equity? Despite decades of focus on equity in public health, shifting to a policy lens informed by equity continues to be a slow and tedious process on many fronts.


As past chair of the American Public Health Association (APHA) Alcohol, Tobacco, and Other Drugs section, I’ve led efforts to prioritize a public health approach to cannabis legalization since 2014. I’ve also chaired two multinational public health research conferences on cannabis legalization best practices. I’ve also seen how the field of public health has struggled to respond to the rapidly shifting landscape of COVID-19 and its disproportionate impact on minority and vulnerable populations, including those with opioid dependence. It is more important than ever that conversations about cannabis legalization be grounded in a public health framework, which has not really been articulated until now. We all have to get out of our comfort zone, roll up our sleeves, and be willing to think differently.


The APHA passed a cannabis policy statement on the legalization of commercial cannabis in late October of 2020. It calls for evidence-based strategies to protect health and safety while prioritizing equity and social justice and addressing the disproportionate impact of criminalization on people of color and minority and low-income communities. This is yet another wake-up call for public health and cannabis legalization efforts. Decriminalization is not enough. Specific actions and priorities must be at the forefront of our approach going forward, and a public health framework is possible.


APHA’s new policy comes at a time of opportunity and challenge. The accompanying policy brief lays out action priorities in four key areas:

  • Protecting children, youth, and other vulnerable populations;

  • Minimizing harm to the public;

  • Prioritizing equity, social justice, and amelioration of harms caused to populations disproportionately impacted by prior drug policy approaches; and

  • Monitoring patterns of cannabis use and related public health and safety outcomes.

As more states seriously consider legalization, the discussion of change at the federal level is becoming more real. As we re-engage around taxation, potency, banking, and best practices to protect the public, we must truly put equity in the center of our discussions and decision-making. Now, more than ever, we need a public health framework to drive these efforts. Prioritizing equity—not just in access to business opportunities—must be front and center. That will require renewed commitment to engaging all stakeholders, even when the conversation becomes awkward or challenging. If you are wondering how to do that, CPPC can help.

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