THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE

2019, VOL. 45, NO. 6, 689–697

https://doi.org/10.1080/00952990.2019.1611840

REVIEW

Cannabis legalization, regulation, & control: a review of key challenges for local,
state, and provincial officials
Jonathan P. Caulkinsa and Michelle L. Kilbornb
a
Carnegie Mellon University Heinz College, Pittsburgh, PA, USA; bAlberta Health Services, Population, Public and Indigenous Health Unit,
Edmonton, Canada

ABSTRACT ARTICLE HISTORY

Background: A number of countries are legalizing the supply of cannabis or are considering doing Received 31 October 2018
so. Beyond top-level design questions (e.g., who gets to supply and how will it be taxed?) lie many Revised 23 April 2019
equally important and thorny regulatory issues concerning retail sale and use. These issues will Accepted 23 April 2019
often be hammered out at the local and state/provincial level by policy makers who are general- Keywords
ists, not experts in substance misuse, let alone cannabis. cannabis; legalization; drug
Objectives: This review provides a framework for thinking about the role of regulation and delves policy; regulation; public
into three important topics with which these leaders will wrestle: Where and when can cannabis health
be sold? What can retailers sell? And where can their products be used?
Methods: Literature review and drawing parallels with alcohol and tobacco regulation.
Results: The common thread across these questions is that the public health interest is both
nuanced and in conflict with other stakeholder interests, such as companies’ desire to maximize
sales and profits and governments’ desire for tax revenues.
Conclusion: There is a need for data and oversight structures that ensure that public health will not
lose out over time.

Introduction interests. The meta-lesson is that even if there is con-

sensus concerning the overall objectives of regulation,
At various times and for various reasons, governments
cannabis legalization will still present policy makers
have banned production and sale of certain consumer
with significant challenges that cannot be adequately
goods, including fireworks, some types of firearms,
addressed by blindly adopting the approaches taken for
human organs, and horsemeat for human consump-
alcohol and tobacco.
tion. Dependence-inducing intoxicants have often
Legalizing large-scale commercial production (not
been subject to such prohibitions.
just use) of cannabis thrusts us into uncharted territory.
Periodically prohibitions are reversed. In the US, the
st Contrary to popular belief, the Netherlands has never
21 Amendment repealed Prohibition for alcohol, and
legalized production for non-medical use – only its
in 2018 the Supreme Court’s ruling overturned the
retail sale and possession. Nor has the United States,
Professional and Amateur Sports Protection Act’s ban
where federal prohibition remains in place and affects
on state-sponsored sports-betting as unconstitutional.
the industry in multiple ways. Among other things,
The Netherlands legalized prostitution in 1999, and
federal prohibition limits financing as well as banking;
Canada’s courts struck down bans on certain forms of
increases effective tax rates; allows for restrictions on
prostitution as violating its constitutional Charter of
interstate commerce and advertising that would other-
Rights and Freedoms.
wise be unconstitutional; and discourages market entry
A prohibition whose repeal is topical now is the ban
by tobacco, alcohol, and other multinationals.
on producing cannabis for nonmedical use. Legalizing
Uruguay was the first country in the modern era to
supply raises myriad regulatory questions (1,2). This
legalize production, yet its approach is quite restrictive
article discusses the purpose of regulations in the
and to date supplies only a minority of the country’s
abstract and then delves into three particularly thorny
consumption (3). The second country, Canada, only
questions. The immediate goal is to help policy makers
began legal sales of dried cannabis, oils, seeds and
protect the public interest while recognizing that there
plants on October 17th, 2018 (4).
will be other voices at the table with competing

CONTACT Jonathan P. Caulkins caulkins@andrew.cmu.edu Carnegie Mellon Heinz College, 5000 Forbes Ave., Pittsburgh, PA 15213, USA
© 2019 Taylor & Francis Group, LLC
690 J. P. CAULKINS AND M. L. KILBORN
Perhaps the single most important design question is
what kind of organization will be allowed to produce
cannabis legally. There are many options (5). On the
cautious end of the spectrum is only allowing home-
growing for individual consumption or allowing (small)
cannabis clubs to distribute to members at cost but not
to supply non-members (6,7). Intermediate options
include government monopoly, at least of retail sales,
and restricting supply to non-profits (5,8,9). On the
other end is what Canada and various US states are
doing, albeit to different degrees: entrusting supply to
free-enterprise. The specifics differ by province and
state, often in ways that matter, and restrictions on
retailing may persist (e.g., banning bricks and mortar
stores, or at least allowing local jurisdictions to do so).
Nevertheless, cannabis will be produced, marketed, and
sold by for-profit companies, and their goal is expand-
ing use to increase sales and revenue.
This paper will focus on variations within the com-
mercial/industrial model, not because it is unproble-
matic (10), but rather because “regulate like alcohol”
appears to be the political winner. Other options are
less risky (5). As Rolles and Murkin (11, p.45) note,
“the most obvious risk [of legalization] is that of over-
commercialization and the undermining of public
health goals by profit-motivated commercial activity.”
However, the more cautious options lack an organized
constituency, whereas the profit-generating ones are
awash with financial, cultural, and political power.
After providing a framework for thinking about the
role of regulation in softening the risks of commercial
markets, this paper explores three important topics:
Where and when can cannabis be sold? What can
retailers sell? And where can their products be used?
The objectives of regulation
The public interest is best-served if regulatory systems
are designed to maximize health and social welfare by
facilitating lower-risk consumption (12) that produces
hedonic and other benefits while minimizing, to the
extent possible, both harmful consumption and the
amount and noxiousness of black market activity
(13,14). This powerful conceptual idea gets challenged
by the practical politics of policy making. As legaliza-
tion plays out in the political arena and media, public
health messaging is often over-shadowed by promises
of economic growth and prosperity that the cannabis
industry will bring and by claims of nanny-state pos-
turing. To have health outcomes included in the policy
conversation takes perseverance and tenacity as health
advocates will most certainly be presenting to legisla-
tors and regulatory agencies alongside those with other
agendas. In addition to industry lobbyists pushing for
lenient regulations, lower taxes, and expanded markets,
other voices will be at the table. These include cannabis
consumer groups, those interested in capturing tax
revenue from cannabis sales, and stakeholders with
specialized agendas, such as restaurant owners on the
question of whether indoor smoking will be permitted.
Parents and child-welfare advocates may sound a note
of caution, but times have changed and outside of
conservative areas, old-school drug warriors often
seem conspicuous for their absence. There can even
be delicate dances with groups focused on other aspects
of the public interest, such as tobacco control advocates
concerned about indoor air quality, parent groups wor-
ried about use near children’s playgrounds, and parks
and recreation advocates worried about parks becom-
ing de facto designated consumption sites.
Beyond such practical “politics” there is also
a conceptual tension between the twin goals of mini-
mizing harmful use and minimizing black market activ-
ity. Addressing either in isolation is straightforward;
balancing them is not.
Allowing legal production with few taxes or regula-
tory constraints would minimize harms from the illegal
market. Unfortunately, cannabis impairs performance
and carries health risks, including the risk of depen-
dence (15–17), so a 19th century culture of caveat
emptor is inconsistent with modern notions of consu-
mer protection. Yet regulations that restrict suppliers’
freedom could create space for criminals who ignore
such restrictions to supply products more cheaply and,
hence, keep black markets alive in certain niches.
Kleiman (13) summarized this dilemma thus. We get
to choose the kind of drug problem we have (larger
black markets or greater levels of harmful use), but we
do not get to choose not to have a drug problem.
Regulations can be seen as society’s attempt to finesse
this dilemma, although people vary in their optimism
about regulations’ value. Some, cognizant of human falli-
bility, favor paternalistic regulations that protect the indi-
vidual and society. The Nobel Prize winning economist
Daniel McFadden (18, p.17) observes that “consumers
will often fail to promote their self-interest reliably when
choices involve risk, ambiguity, integration of experience,
and perceptions of remote and/or unlikely events.” For
McFadden, that was a preamble to modifying Medicare
Part D regulations, but the quote serves equally as
a warning about how commercial markets for cannabis
may not serve the consumers’ or public’s interests (19).
Others favor minimal regulations, allowing free-
markets and individual choices to dictate behaviors.
Yet in a modern economy, it is not just intoxicants
but many professions (e.g., barbers, manicurists),

foods (e.g., lettuce, milk), possessions (e.g., toys, mat-
tresses) and medications (e.g., aspirin, antidepressants)
that are regulated.
Three challenges for regulation
Given the experimental nature of cannabis legalization, it
may be wise to progress incrementally and evaluate out-
comes prior to pursuing more aggressive changes. If the
modern history of alcohol policy is any guide, once loo-
sened, it will be difficult to make regulations more strin-
gent (20). True, policies toward tobacco have become
more restrictive, but tobacco is the exception that proves
the rule (21); the broad trend in Western societies across
a range of “vices” is toward freer markets (22).
Go slow does not mean do little. Many benefits of
cannabis legalization – notably sharp reductions in arrests –
can be achieved just by legalizing possession of small
amounts suitable for personal consumption (5). Indeed,
the question on the General Social Surveys that find the
majority of Americans now support legalization is not “Do
you support the legalizing the production and sale of
marijuana”, let alone “Do you support legalizing
a cannabis industry”, but rather “Do you think the use of
marijuana should be made legal or not?” [emphasis added]
Some aspects of cannabis regulation have received
considerable (deserved) attention, such as the need for
clear labeling, product testing, regulation of pesticides,
restrictions on marketing, and control of impaired
driving. We address three others, both because of
their intrinsic importance and because they illustrate
how even if there were agreement concerning the gen-
eral objectives of regulation, legalization still confronts
policy makers with difficult choices.
Where and When Can Cannabis Be Sold?
Local, state and provincial policy makers will need to
grapple with the question of where cannabis can be
sold. That issue pits the public interest against com-
mercial interests. Both consumers and industry would
generally prefer to have as many retail options as pos-
sible (e.g., brick and mortar stores, online sales, farmers
markets) to maximize convenience and sales, but
experience with alcohol suggests the potential for social
and health benefits of limiting physical access (23).
In Canada, all provinces have elected to set up e-com-
merce systems for online cannabis sales (24). While this
may help squeeze out the black market, home delivery
may also make it easier for people to buy and use cannabis
including, perhaps, for those who are underage. Some
provinces (e.g., Alberta) have rigorous age verification
for purchasers; others (e.g., Ontario) have minimal
THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 691
requirements beyond the user’s simple attestation, and
so rely on age checks by couriers at delivery. None of
which we are aware offer “nudge” options such as allow-
ing customers to set their own purchase quotas or delivery
delays to help them enforce self-determined rules on their
own consumption (cf., 13, 25).
There are also tensions concerning where and when
retail cannabis stores can operate. Again, the industry and
local business community would like stores everywhere,
but regulating the density and location of retail outlets can
be important tools for reducing health and social harms in
communities. Furthermore, merely matching policies for
other substances may not be enough. Research on alcohol
and tobacco use highlights the need for stronger controls
on density and minimum distances between stores and
sensitive locations than are now the norm (26–31).
Density limits and zoning laws can reduce neighbor-
hood impacts and youth access (24,32) and prevent over-
population of cannabis stores in sensitive areas (33).
Similar to liquor stores, higher densities of medical mar-
ijuana dispensaries are associated with greater rates of use
(34), and high-risk consumption behaviors–especially
among youth. Some US researchers have also found that
medical cannabis outlets concentrate spatially in ways
that create disparities. This supports the argument for
regulating store locations to ensure that communities
with fewer resources (e.g., low income, unincorporated
areas) are not burdened by having to host large numbers
of stores and that there is not clustering among liquor,
tobacco and cannabis stores (34).
With regard to protecting sensitive locations, setting
cannabis stores away from schools, daycares, and commu-
nity centers can help protect children from the normal-
ization of cannabis use (35). Local jurisdictions may wish to
extend this logic for minimum distance bylaws to include
other places that children and youth frequent, such as
parks, churches, and recreation facilities (24,35), although
the industry may fight back. During New Zealand’s experi-
ment with regulating new psychoactive substances, a local
government tried to protect bus stops on the grounds that
children gather there, but that was challenged in court as
being too restrictive by an industry lobby group (2).
Nementh and Ross (36) provide summary tables of
some US state and city buffer zones. In Canada, pro-
vincial and local governments deliberated about cap-
ping the number of business licenses issued and
determining buffer zones, including:
● Between cannabis retail outlets,
● Between cannabis stores and school daycares and
community centers, and
● Between cannabis stores and tobacco and liquor
retailers.
692 J. P. CAULKINS AND M. L. KILBORN
The alcohol literature suggests that buffer zones help
limit negative impacts on neighborhoods and youth;
however, local decision-makers are tasked with estab-
lishing optimum distances. A 100-meter set back may
have different effects in a center city than in a suburb
or rural area. Without adequate research on the impact
of various separation distances and how they interact
with other aspects of physical geography, local govern-
ments can only speculate on what is most effective.
Similar considerations pertain to hours of operation,
where again there is a tension between public health and
convenience for customers. International evidence on
alcohol availability indicates that longer hours of sale
increase the amount of alcohol consumed and the rates
of alcohol-related harms (37). The Canadian Centre for
Addiction and Mental Health suggests restricting alcohol
sales to nine business hours per day, with limited avail-
ability late at night and in the early hours of the morning
(38). Regulations in Canada and US states that have
legalized cannabis often fail to meet that standard, with
hours of operation only limited to 10 pm, midnight or 2
am closing times (39–44).
What Products Can be Sold?
Not long ago, most cannabis consumed in North
America was smoked, either in joints, pipes or bongs.
With liberalizing policies, consumption has expanded
to a broad range of intoxicating products including
solid and liquid edibles, oils for vaping, waxes for dab-
bing, tinctures, lotions, and even suppositories (45,46).
(There are also non-intoxicating products including
seeds, fibers, and medical products that contains CBD
but not THC.) Two years after state-licensed stores
opened in Washington, nontraditional products had
captured one-third of the market (47).
One question is whether to legalize all or only
a subset of these product forms. Opinions differ. Rolles
and Murkin (11, p.104) favor restricting legalization to
conventional smoked forms, arguing that “There is also
no obvious or urgent need to make cannabis edibles
available for retail at the outset of any regulatory sys-
tem”. By contrast, some states (e.g., New York), do not
allow forms of medical cannabis that are smoked, but do
allow chewable tablets and lozenges.
These are tricky questions, in part because the rela-
tive risks associated with different routes of adminis-
tration have not been well researched (48). Smoking
cannabis carries obvious risks – including exposure to
known carcinogens – and its use in public may reverse
decades of slow progress to alter societal norms about
the propriety of smoking generally. Yet edibles carry
unique risks of inadvertently taking more than expected
and, especially in the form of candies, may increase the
risk of accidental poisoning of children (49). Pediatric
exposure cases reported by regional poison control
centers increased five-fold in the six years after canna-
bis dispensaries became common in Colorado (50),
including at least one death from myocarditis-
associated cardiac arrest in an 11-month old that was
plausibly related to cannabis overdose (51). Legalizing
states generally saw greater increases in these uninten-
tional pediatric exposures than did other states (52).
Some restrictions seem prudent. Restrictions on THC
content in edibles (e.g., Alaska and Oregon only allow 5
milligrams per serving and 50 milligrams per product)
may reduce the risk of accidental cannabis poisoning.
Requiring that extracts be produced by supercritical CO2
extraction, not with butane or other hydrocarbon sol-
vents, would all but eliminate the risks of explosions in
production facilities and of residual solvents contaminat-
ing consumer products. Restrictions on cannabis mar-
keting are important for protecting youth. After national
legalization, there will be limits to what can be done in
the US due to 1st Amendment protections of commercial
free speech, but in Canada, there are strict regulations
limiting cannabis marketing. This includes plain packa-
ging requirements on products (restricting logos, colors,
and branding), and prohibiting the promotion of canna-
bis in a way that is appealing or glamorous to youth.
There is fear that banning certain products may
leave the black market for those products intact, but
that may depend on whether close substitutes are avail-
able. The US and many European countries prohibited
absinthe for most of the 20th century without creating
major black market problems, presumably because
other types of alcohol were sold freely. Likewise, ban-
ning just BHO may not create much black market
demand if extracts made with supercritical C02 are sold.
Another question is whether highly potent waxes, dabs,
and shatter should be allowed. Banning them might leave
room for black market sales as they account for about one-
third of all sales of extract products in Washington State
(53). On the other hand, their health consequences have
not been well studied and alarming (54).
There is also the question of whether the potency of
cannabis flower should be limited. For example, the
Netherlands has debated classifying cannabis with potency
over 15% as a hard drug. Potency has clearly been rising,
and Freeman et al. (55) document a time-dependent asso-
ciation between changes in potency and first-time admis-
sions to cannabis treatment programs in the Netherlands.
Higher potency probably stimulates greater con-
sumption of THC. While users may consume smaller
quantities when potency increases, such titration seems
to be partial (56,57).

Indeed, much cannabis is now used by people whose
average daily THC consumption dwarfs that of some
older images of typical consumption patterns. Data
from the US household survey indicate that before
1993 only about one-in-nine current marijuana users
reported consuming daily or near daily, and before
2000 the average potency of seized cannabis was
below 5% (58). If the prototypical consumption pattern
then was smoking one joint each weekend night, and
those joints contained 0.4 grams of cannabis that was
4% THC, that works out to an average of (2/7) * 0.4 *
4% = 0.0046 grams, or 4.6 milligrams, of THC per day.
Now the plurality of users report consuming every day,
and 80% of cannabis is consumed by daily or near-daily
users (1). In Washington State, daily users consume an
average of 1.5 grams of flower per day (59), and the
average potency is around 20% (47). That implies aver-
age daily THC consumption of 1.5 * 20% = 0.3 grams,
or 300 milligrams, or 65 times that of a typical week-
end-only user 25 years earlier.
Regular users develop tolerance to cannabis, particu-
larly to its cognitive effects (60), so the behavioral effects
of consuming 300 not 5 milligrams of THC per day may
be modest. However, rather eerily, 4–5 milligrams is also
the amount of cocaine ingested by drinking a cup of
coca tea (61), and chronic cocaine users in the US appear
to consume no more than 290 milligrams per day since
dividing total US cocaine consumption (327 MT in
2005) by the number of “chronic” users (3.1 million)
works out to 290 milligrams per user per day (59).
Consuming 290 milligrams per day of cocaine creates
greater health concerns than does drinking coca tea,
which Indigenous populations in the Andes have used
without harm for centuries. Whether Paracelsus’ axiom
that “the dose makes the poison” will likewise apply to
THC remains to be seen, since most clinical studies of
THC’s effects work with doses of only 20–50 milligrams.
Where Can Cannabis Products Be Used?
Regulating public consumption presents unique chal-
lenges. The natural tendency may be to simply apply
existing tobacco or alcohol rules to cannabis (21,62,63),
but that can be problematic for two reasons. First,
cannabis is both commonly smoked (as are tobacco
cigarettes) and it is an intoxicant (as is alcohol). One
could follow the rules for both, but as it is common – at
least in the US – to ban both indoor smoking in public
establishments and drinking in outdoor public spaces,
that may leave few options for cannabis users who do
not own their own homes.
Second, neither the tobacco nor the liquor models
are perfect; after all, both substances remain leading
THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 693
causes of premature death. So the question may not
be “How can we regulate cannabis like alcohol or
tobacco?” but rather “How can we regulate cannabis
better than we have regulated alcohol and tobacco?” In
particular, governments may wish to consider stronger
regulations than are common for alcohol, and are per-
haps more like those governing tobacco in Australia,
Canada, or the UK than in the US
If we think about cannabis on its own merits, three
main considerations arise with public consumption:
intoxication, risk of normalization, and second-hand
smoke.
For concerns regarding intoxication, regulations for
alcohol are more pertinent, since tobacco does not
affect behavior in the same way. Yet alcohol regulations
vary across jurisdictions. The majority of Canadian
provinces and US states ban consumption in public
altogether, but some places ban only public alcohol
intoxication (“drunk and disorderly” laws). Because
cannabis is not known to produce violence, one could
argue for the more lenient approach. However, not
aligning public consumption of cannabis with existing
alcohol laws risks public confusion and the possibility
that more lenient rules concerning cannabis will be
used as justification for relaxing the laws governing
public use of alcohol. For instance, a city councilor in
Calgary raised the possibility of allowing open contain-
ers of alcohol in city parks in response to hearings on
public cannabis consumption (64).
Lessons learned from tobacco and alcohol suggest
that normalization leads to increases in rates of use
(65,66). Indeed, one drug prevention strategy that has
shown success is providing youth with more accurate
information about how common drinking is (67). The
premise is that when youth realize drinking is less
common than they thought, they will be less likely to
use themselves. This suggests a concern that visible or
public cannabis use (and sale) might increase adoles-
cents’ perceptions of how common cannabis use is in
a way that increases the likelihood that they too will
use. Allowing cannabis to be smoked in public also
carries the risk of renormalizing all forms of smoking,
including tobacco (68).
Second-hand smoke considerations argue for sub-
jecting smoked and vaped cannabis to the same indoor
air quality rules that apply to smoked tobacco and
vaped nicotine, respectively. Sidestream cannabis
smoke contains known carcinogens, some (e.g., poly-
cyclic aromatic hydrocarbons) in greater concentra-
tions than in sidestream tobacco smoke (69). Second-
hand cannabis smoke can also produce adverse physio-
logical effects (70), raising concerns about occupational
health harms for servers in restaurants or “cannabars.”
694 J. P. CAULKINS AND M. L. KILBORN
Many jurisdictions will ban indoor public use, but
take varying positions on outdoor use. Yet, many other
issues arise between the poles of banning or not ban-
ning. These include exceptions for medical users, desig-
nated spaces for festivals and events (should cannabis
users be able to consume in “cannabis gardens”?),
multi-unit housing (where will these residents smoke/
vape?), parks (how do you enforce rules in these large
spaces?), designated consumption sites (outdoor spaces,
cafes, bars), and co-use.
For example, the city council in Edmonton, Alberta
banned smoking and vaping cannabis within 10 meters
of any entrance, exit, window, air intake, or bus shelter
(and in the process expanded the restriction for tobacco
from 5 to 10 meters). However, that position stabilized
only after a preliminary action, a temporary reversal,
and intense debate. Restaurants owners along dense
commercial streets feared that no part of the sidewalk
would be more than 10 meters from some doorway,
preventing patrons from stepping outside to smoke and
thereby driving those customers to restaurants in places
with lower building density. That case also illustrates
the value of local data. The council’s final action came
after a survey showed that 68% of Edmontonians sup-
ported the new requirement (71).
Conclusions
This paper discussed three important regulatory ques-
tions concerning cannabis legalization: Where and
when can cannabis be sold? What products can be
sold? And where can those products be used?
All three present challenges. Whatever else can be
said of legalization, it is not a simple binary choice.
Deciding to legalize is deciding to confront conundrums.
One challenge is conflicting objectives. We wrote
from a public health or welfare perspective, presuming
that the goal is to facilitate lower-risk consumption
while minimizing both black markets and harmful
use. Other stakeholders vying for policy makers’ atten-
tion will have other agendas, including growing sales by
selling to daily and near-daily users, many of whom
meet diagnostic criteria for substance use disorder with
respect to cannabis or some other drug.
Tensions can arise even within a single objective.
Should public health advocates prefer to push use
inside, risking indoor air quality, or outside, even if
that normalizes use? If one wishes to minimize harmful
use, does that mean eschewing smoking because can-
nabis smoke contains carcinogens, avoiding edibles
which increase the risk of emergency room visits, or
banning dabs with their very high THC concentrations?
Lack of adequate evidence is also a challenge.
Published research on the health effects of cannabis
focuses on one modality (smoking), whereas legaliza-
tion can bring a proliferation of product forms.
Likewise, most research examines the effects of modest
doses of THC (20–50 milligrams), but most cannabis is
now consumed by daily users who may ingest 300
milligrams per day. And most empirical evaluations of
regulations pertain to alcohol and tobacco; the parallels
with cannabis are strong but not perfect.
One possible response is building in flexibility. Do
something sensible at the outset, observe, and adjust as
needed. That sounds wonderful in theory but may run
into two practical problems. The first is the likelihood
that industry and its allies will be more persistent and
powerful than will be those approaching the issue from
a public health perspective, translating flexible regula-
tions into weakening regulations over time. This sug-
gests that it may be prudent to err on the side of more
restrictive regulations at the outset, as it is easier to
remove regulations as more evidence becomes avail-
able, than it is to add regulations later.
The second is that neither the research community nor
the government may be well positioned to provide the
evidence necessary to adjust these initial policy decisions
wisely. Many cannabis regulations are made at the local
level (e.g., business licensing, buffer zones, public con-
sumption), but indicator data are often collected at the
national and/or state/provincial level without adequate
sample size to produce spatially disaggregated estimates;
that limits local governments’ ability to monitor impacts
of their policy decisions. Indeed, even just obtaining
access to data sets that do exist can be a challenge given
the nature of multi-level and multi-sectoral involvement
in regulating cannabis. In many cases, data sharing agree-
ments are difficult to negotiate and problematic to main-
tain. With data collection being cost-prohibitive and
access to data sets limited, many local jurisdictions may
be at the whim of industry pressure, corporate lobbying,
and public opinion when faced with the task of amending
their initial “best guess” regulations.
All of these point to the need for a careful balancing
of powers across the levels of government, so ultimate
authority for oversight and the largest decisions remain
at the levels least vulnerable to industry pressure, while
still giving each local government the ability to adapt to
its unique situation.
The US is no model to follow in this regard, with the
federal and state governments in direct conflict even over
the basic question of whether cannabis should be legal.
In Canada, federal legislation provided the overarch-
ing direction for legalization and outlined provincial
jurisdiction for specific legislative decision points.

Operational regulations were drafted for all federal and
provincial legislative items, and each level of govern-
ment is responsible for monitoring its own regulations.
Provincial cannabis acts further outlined municipal
responsibilities and/or provided legal maneuverability
for municipalities to enact stricter regulations than out-
lined by the provincial governments. Subsequent
changes to provincial regulations will rest with each
province’s oversight body and will not normally have
to go back to the legislature for vote.
The intent of federal and provincial legislation was
to eliminate the black market while protecting public
health and keeping cannabis out of the hands of youth.
These are admirable goals, but they are at odds with
a privatized retail model. In Alberta, for example, the
privatized retail system for alcohol, and now cannabis,
has presented challenges for public health because deci-
sions are grounded in a business model with a focus on
maximizing revenue. There are few opportunities to
insert a lens that includes minimizing harms, protect-
ing health and safety of citizens, and health equity.
Inasmuch as Canada is the first nation to legalize can-
nabis in the modern era with supply delegated to
a (regulated) for-profit industry, only time will tell whether
this structure succeeds in protecting public health. It was
designed with good intentions, but even well-intentioned
policies sometimes produce unintended consequences. So
just as epidemiologists will keenly track cannabis preva-
lence in Canada and investors will track cannabis compa-
nies’ stock prices, policy researchers should track the
performance of Canada’s regulatory structures. If we have
described three specific policy conundrums, perhaps the
meta-conundrum is how society should structure its over-
all approach to cannabis regulation in order to respond to
such challenges in the most constructive way possible. Even
when the goals of the regulation are clear, divining the best
path forward may not be.
Acknowledgments
We are indebted to Bryon Adinoff for giving the original
impetus to this article and for many key insights it contains,
and to Martin Bouchard, Keith Humphreys, Eric Sevigny,
and Chris Wilkins for many useful comments and sugges-
tions on earlier drafts.
Financial Disclosures: The first author has consulted for
McKesson.
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