The trajectories of cannabis and tobacco policies in the United States, Uruguay, Canada and Portugal: is more cross-substance learning possible outside the United States?

Challenges achieving horizontal coherence across health and public security policies in formulating Uruguay's cannabis regulation

In 2013, Uruguay became the first country to regulate the legal production, distribution and sale of recreational cannabis. While key officials have framed Uruguay's landmark legislation as part of the government's strategy to regulate cannabis, tobacco and alcohol, there is limited empirical research exploring the political considerations that influenced its approach. Drawing on the concept of policy coherence-the process by which policymakers seek to minimize conflicts and maximize synergies across policy agendas-this study explores the extent to which Uruguay's cannabis regulation was influenced by the promotion of policy coherence within health and across other policy spheres. Government documents, 43 semi-structured interviews and field observations were thematically analysed. The analysis shows that the pursuit of policy coherence across health issues was relatively limited, and where there is an element of regulatory coherence, there also appears to be minimal coordination. Efforts to promote substantive policy coherence were shaped by a desire to legitimate cannabis use without creating an upstream driver or structural force that would promote excessive consumption. The findings also reveal that the outcome of Uruguay's cannabis regulation was more directly shaped by broader political considerations, including how to resolve tensions between public security and unhealthy commodity regulation goals. This study raises important questions around the extent to which Uruguay's cannabis regulation was shaped by the explicit goal of policy coherence, suggesting rather that comparisons with tobacco and alcohol regulation were strategically used to justify the introduction of a legally regulated cannabis market.

Alignment in local approaches to alcohol and cannabis control policy: A case study of California cities and counties

BACKGROUND

Public health experts have urged governments around the world to regulate newly legalized cannabis as they do alcohol to effectively and efficiently protect health. However, research evaluating the alignment of alcohol and cannabis policies is sparse. We assessed similarities and differences in local alcohol and cannabis control policies across California, and characterized localities adopting distinct policy approaches.

METHODS

Using standard legal epidemiologic techniques, we collected and coded local alcohol and cannabis control policies relevant to public health for 12 California counties and all incorporated cities within them (N=241). We assessed whether localities were equally stringent on alcohol and cannabis policies by comparing overall restrictiveness (summed policy scores) and 9 specific provisions that applied to both substances. We captured distinct local alcohol-cannabis policy approaches using latent class analysis, and examined this classification in relation to local demographic, socioeconomic, political, and retail market characteristics.

RESULTS

All 241 localities permitted alcohol sales, while 71% banned cannabis sales. Among those that did not ban cannabis sales, more stringent alcohol policy scores were associated with more stringent cannabis policy scores (linear regression coefficient: 0.16 [95% CI: 0.07, 0.25]). Local governments rarely adopted the same provisions for alcohol and cannabis (e.g., limits on hours of sale, advertising restrictions), and only two regulated the co-location of cannabis and alcohol outlets. Localities that were restrictive on alcohol yet permissive on cannabis (12%) were more urban, politically progressive, and had more low-income and racial/ethnic minority residents. Localities that were more permissive on alcohol and restrictive on cannabis (51%) were more socioeconomically advantaged.

CONCLUSION

We found few similarities between local alcohol and cannabis control policies. California's experience suggests that, as governments around the world legalize cannabis, lessons learned from regulating alcohol are not routinely applied to cannabis, particularly in communities distinguished by high social and economic advantages.

Mechanisms of Cannabinoids and Potential Applicability to Skin Diseases

The legalisation of cannabis in a growing number of jurisdictions has led to increasing interest in its potential therapeutic effects in a range of disorders, including cutaneous conditions. Cannabinoids have been used as natural medicines for centuries; however, their biological activity in the skin is a new area of study. Recent data suggest that cannabinoids are involved in neuro-immuno-endocrine modulation of skin functioning, yet their effect on the features of dermatologic conditions is unclear. This article sought to review the mechanisms by which cannabinoids regulate skin functioning through the lens of relevance to treatment of dermatologic diseases looking at the effects of cannabinoids on a range of cellular activities and dermatologic conditions both in vitro and in vivo. We identified studies demonstrating an inhibitory effect of cannabinoids on skin inflammation, proliferation, fibrosis, pain, and itch-biological mechanisms involved in the pathogenesis of many dermatologic conditions. Cannabinoids have the potential to expand the therapeutic repertoire of a wide spectrum of skin disorders. Given their widespread unregulated use by the general public, basic and clinical studies are required to elucidate the effectiveness and long-term effects of topical and systemic cannabinoids in cutaneous disorders.

Formulating more consistent public health policies towards cannabis and tobacco

Commentary to: The diverging trajectories of cannabis and tobacco policies in the United States: reasons and possible implications