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Abstract
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The USA experienced a significant reduction in cigarette smoking that relieved the smoking-attributable health and economic burden considerably, thanks to the advancement of comprehensive tobacco control measures.1 However, public health policy currently stands at the crossroads in a rapidly evolving nexus of conventional tobacco, novel tobacco, and cannabis products.
The legalization of cannabis sales is expected to increase the legal supply of cannabis products inducing behavioral and market-level changes in tobacco and cannabis sectors. Recent evidence suggests increased cannabis use among adults, increased hospital encounters due to cannabis intoxication and poisoning among young children, increased cannabis use among women of reproductive age in preconception and postpartum periods, and increased alcohol use, electronic vapor product use and e-cigarette use among adolescents in the US states that adopted recreational cannabis laws (RCLs) and in Canada postlegalization.2 Cannabis use among youth is expected to decrease because RCLs eliminate youth (below age 21) access to legal cannabis. Current evidence on the effects of cannabis legalization on youth cannabis use are, however, mixed.2 The long-term impact of cannabis legalization on population-level cannabis use is still unknown. It will take longer span in the post-implementation period for the full effects to become evident.
While increasing cannabis use may lead to substitution away from tobacco use generating health benefits from reduction in tobacco-induced diseases, co-use of cannabis with tobacco may pose health risks of exposure to toxicants and carcinogens in excess of those associated with exclusive tobacco use.3 More clarity on the implications of cannabis legalization for tobacco-related health consequences and tobacco control is needed to build awareness and inform the public, users, clinicians, advocates, and policy makers.
Cannabis is a Schedule I controlled substance under the federal Controlled Substances Act and is strictly regulated by the federal Drug Enforcement Agency.4 In 2018, hemp (cannabis containing no more than a 0.3% concentration of delta-9-tetrahydrocannabinol [delta-9-THC]--the psychoactive component) was removed from the statutory definition of cannabis. There is, however, wide variation in the legal status of cannabis access and use across states. California was the first state to legalize access to cannabis for "medical" use in 1996. Washington was the first state to legalize access to cannabis for "recreational" use followed by Colorado in the same year in 2012. By 2023, 47 U.S. states, four territories, and Washington DC, legalized access to cannabis for "medical" and/or for "recreational" purposes. ...
Language: en |