Not All Legalization Looks The Same

Several countries have introduced forms of decriminalization, which aim to shift the focus from managing cannabis as a criminal justice issue toa healthcare.

Uruguay became the first country in the world to legalise cannabis nationally in 2013, introducing a tightly controlled system that allows adults to purchase limited products from pharmacies, join cannabis social clubs or grow their own plants.

Germany and Malta have recently adopted similar public-health-oriented approaches, allowing limited home cultivation and non-profit cannabis cooperatives.

But in commercial markets like many of those in North America, private companies compete for customers through retail sales and product development.

“Legalization exists along a regulatory spectrum," Dr Melissa Bone, associate professor of law at the University of Leicester, who was not involved in the study, told me in writing.

“With models that tightly control production, potency, pricing, marketing and retail access producing markedly different outcomes from those that permit commercial markets.”

She explained: “In this context, increases in use, cannabis use disorder and psychiatric hospital admissions following commercial legalization should not be understood as an inevitable consequence of legal access itself, but rather as the predictable result of the corporate capture of cannabis markets, where shareholder value becomes the primary driver of policy and market expansion, often at the expense of public health.”

Criminalization Vs Commercialization

While the authors caution that evidence remains limited outside North America and that more research is needed to understand how different models perform over time, the findings of the Lancet review are not surprising to Steve Rolles, senior policy analyst at Transform Drug Policy Foundation in the U.K.

"Marketing sells stuff," he said during a phone interview.

"If you have a commercial market that allows for traditional branding, marketing, advertising and promotion, and the reason commercial operators exist is to make profits, then people use marketing, branding and promotion to increase their sales and maximise their profits.

"Big corporations don't have million-dollar or billion-dollar marketing promotion budgets if there wasn't a return on that."

But legalization itself is not the problem, he insists, nor are the findings an endorsement for prohibition.

For decades, cannabis use has continued to rise in countries where it remains illegal, while in those which have removed criminal penalties for personal use, or introduced tightly controlled legalisation, there was little evidence for changes in use.

"Prohibition is not stopping people using cannabis or other drugs,” Rolles said.

“Commercialization may accelerate increases in use, but responsibly regulated legal markets can provide opportunities to moderate use and help people make more informed decisions.”

He argues that measures such as restricting branding and advertising, providing information at the point of sale, training vendors in harm reduction and signposting consumers to prevention and recovery services, could help reduce potential harms associated with cannabis use.

Even with these measures in place, controlled markets can still be beneficial for a country’s economy. A report published by Transform last year found that regulating cannabis under a state monopoly model could generate £1.5 billion for the U.K. Treasury, including tax revenue and criminal justice savings.

"The market is there either way,” Rolles explained.

“Legalization allows responsible state authorities to regulate that market rather than leaving it in the hands of unregulated organized crime groups.”

Aiming Higher

Supporters of commercial cannabis markets argue that, as well as displacing illegal operators, licensed businesses create jobs, generate tax revenue and provide consumers with a wider range of tested and regulated products. Some are also attempting to address harms caused by prohibition.

In his new book, The Next Fix, legal scholar Professor Kojo Koram examines how some jurisdictions, such as Massachusetts, Colorado, Washington, Maryland and Delaware, have introduced social equity licensing programs designed to increase participation in the legal cannabis industry among communities disproportionately affected by previous criminalization.

Several states have also ring-fenced a portion of cannabis tax revenues for community reinvestment programs, directing funds toward areas most affected by decades of drug enforcement.

“Some states have been much more explicit in embedding social equity provisions," Koram told me in a phone interview, noting that legalization offers an opportunity to rethink how cannabis markets are structured from the outset.

"There's a real value in the industry thinking about how can we actually do this differently," he said.

"How can we think about environmental sustainability, economic justice and different forms of ownership? Commercialization is better than criminalization, but I think we should aim for something much higher than that."

For Bone, this emphasizes why future cannabis debates should focus less on whether policy change happens and more on what lawmakers hope to achieve through it.

“For future policy discussions, carefully thinking about the underlying goals of any regulatory model—whether that's protecting public health, promoting human rights, achieving social equity or maximising profit—is crucial to predicting outcomes,” she said.

“Those goals should be first and foremost in our minds when designing and implementing cannabis policies."