Calif Dept of Public Health releases important report presenting policy recommendations that account for the fact that high potency cannabis now dominates the market

On October 4,2024, the California Department of Public Health its REPORT AND
RECOMMENDATIONS OF THE HIGH POTENCY CANNABIS THINK TANK TO THE STATE OF CALIFORNIA prepared by an independent panel of 13 scientist and clinician cannabis experts. It documents the fact that high-potency cannabis has overtaken California and national cannabis markets and summarizes the serious associated health risks, particularly for vulnerable populations.

These findings and recommendations are very important because they highlight the importance that politicians and policymakers understand and act on the fact that the cannabis market in California is very different than it was decades ago when many of these people saw cannabis as largely harmless. The longer policymakers refuse to accept the realities of the modern cannabis market in California (as the Oakland City Council did when it included a cannabis exemption to the pending smokefree multiunit housing ordinance), the more difficult it will be to recover from this over-optimism.

This is not an argument to return to an illegal market. Rather, we should shift to thinking about cannabis the way we think about tobacco: legal but discouraged, with bystanders protected from secondhand exposure.

Key Findings

• California’s cannabis market has migrated almost exclusively to high potency cannabis, with little consumer access to safer lower dose products.
• Health Risks: High-potency cannabis,  from higher potency flower to concentrates (like vapes, was, shatter) with THC levels up to 99%, is associated with heightened risks of cannabis use disorder, problem cannabis use, mental health conditions including psychosis and schizophrenia, and other adverse health outcomes.
• Particularly vulnerable populations include youth below age 26, mothers and infants exposed during pregnancy, and those with familial or personal risk of mental health conditions or substance abuse.

• Policy Actions: To address these risks, the panel recommends 20 targeted policy actions, including capping THC content, fully prohibiting flavored inhaled products, requiring plain packaging, strengthening and enforcing marketing restrictions, taxing based on THC potency, strengthening and funding public education on cannabis risks and requiring retailers to stock lower potency options. 

These findings underscore the need for stronger consumer protections and policy frameworks in legal cannabis markets. As the report recognizes, “We have passively allowed the shift of our cannabis markets to far more potent products likely to cause significantly greater harm It is time to change course and acknowledge that not all substances that can be derived from cannabis can be treated as safe consumer products.”

Policy Solutions

• Marketing and Advertising

• Prohibit cannabis and cannabis product advertising on billboards, and any other general public-facing advertising (Because billboard advertising reaches children, and because a high percentage of the market is high potency).
• Restrict advertising of cannabis flower with over 20% THC or cannabis products with over 35% THC to simple plain text only.
• Product Requirements
• Limit manufacture and sale of high THC products. Specifically:
  • Prohibit the sale of liquid or solid concentrates for inhalation (e.g. dabs, wax, shatter) with THC content above 60% and implement careful oversight of allowable vehicles and diluents to ensure safety.
  • Prohibit the sale of cannabis flower with THC content above 25% and prohibit the infusion of additional THC (or other psychoactive cannabinoids) into flower or pre-rolls.
  • Limit edible products to a maximum of one 10 mg THC dose per physical piece or liquid beverage container (excluding tinctures).
• Prohibit the use of added flavors (including fruits, mint, menthol, vanilla, chocolate, spices, and other common food flavors) in all inhaled products, whether natural or synthetic. Additionally, prohibit language and images that could lead consumers to believe the product has flavors other than those of cannabis.
  • At a minimum, this should apply to flower or pre-rolls with THC content above 20% and other inhaled products with THC content above 35%.
• Retail Environment
• Require retailers to offer lower dose options for flower (<10% THC) and edibles (5 mg or less), including products which are more suitable for medical use.
• Consider testing, promoting, or facilitating a Quebec-style public monopoly approach to cannabis sales, particularly in jurisdictions that have not yet legalized cannabis sales.
• Require more robust age-gating for websites, online sales, and other online content, including independent third-party verification of identification before entry and sale.
• Taxation and Pricing
• Restructure state excise taxation on adult-use cannabis to be proportional to the milligrams of THC in the taxed product, applicable to all cannabis products.
  • Ensure that the restructuring maintains or increases cannabis tax revenue in line with the goals established by Assembly Bill 195 (Chapter 56, Statutes of 2022, a legislative commitment to replace revenue lost from the cultivation tax cut by 2026). Prohibit discounting or promotion of flower >20% THC or other inhaled products over>35% THC.
• Attractiveness to Children, Packaging, Labeling, and Consumer Information
• Enforce existing laws and regulations that prohibit products that are attractive to children and restrict flavored additives in inhaled cannabis products.
• Require plain packaging for all cannabis products with flower THC content above 20%, inhaled products exceeding 35% THC, and edibles containing more than 10 mg of THC per individual piece or liquid container, if permitted. Ideally, this should extend to all cannabis products.
• Require clear standard information on the number of standard doses in a package on all cannabis and cannabis product packaging, based on a standard dose of 5 mg THC.
• Strengthen regulations with clearer, evidence-based criteria for identifying and prohibiting products, packaging, marketing, and advertising characteristics that appeal to children and youth.
• Require prominent, rotating, graphic front-of-pack health warning labels on cannabis products and on advertising, including specific warnings about high potency THC, such as risks of dependency and mental health harms. Health warnings should cover at least one-third of the front-of-pack and 15% of any print advertisement surface, with clear contrast between the warnings and the background.
  • Examples: “WARNING: Cannabis use may contribute to mental health problems, including serious mental health conditions. Risk is greatest for people who use frequently and when using products with high THC levels; “WARNING: The higher the THC content, the more likely you are to experience adverse effects and impairment. THC may cause severe anxiety and disrupt memory and concentration; “WARNING: Prolonged use of cannabis products high in THC may cause recurrent, severe nausea and vomiting.”
• Adopt this Committee’s recommendations for implementing SB540 requirements
• Public Education
• Fund and implement public education campaigns on the risks of high potency cannabis, including mental health risks. Allocate additional funds from Tier 3 of cannabis tax revenue (without reducing the Elevate Youth program) to the CDPH, totaling $10 million or more per year beyond their current allocation. These funds should be used to enhance high-quality cannabis prevention education campaigns, including those focused on high potency messaging, as well as supportive formative research and testing of messaging. Prioritize campaigns addressing use during pregnancy, drugged driving, and education for youth and seniors.
• Compliance Screening, Data Collection, Research, and Evaluation
• The Department of Cannabis Control and the state budget should allocate funds from the regulatory tier of taxation to establish a pre-market product and packaging review team. This team would screen new products for compliance with these recommendations (if accepted), existing regulations, and attractiveness to children. The team should also review all existing products within two years. Priority should be given to inhaled products with over 50% THC, followed by cannabis flower with over 20% THC, and edibles with more than one dose in a single container or physical piece.
• Fund and ensure the tracking and regular reporting of negative health outcomes associated with high potency products in California hospitals, hospital emergency departments, and ambulatory care settings. Surveillance systems should include the type and potency of marketed products as required data elements. Additionally, incentivize increased screening to more clearly document the product type used in clinical services and poison control cases.
• The Administration and the DCC should support making the current Prop 64 requirement of at least $10 million in annual cannabis tax revenue for research an ongoing budgetary commitment. This funding should maintain a focus on research on health outcomes and policies related to cannabis potency. The requirement, currently set from 2018 to 2028, should be extended beyond 2028 and adjusted for inflation.
• Provide additional funding in the 2024 budget to the University of California Office of the President to support scientific advice and testing related to the implementation of SB540. This funding should include support for developing additional warning messages, such as those regarding high potency, and for creating and evaluating SB540 retailer flyer language. Additionally, allocate funding for similar support every five years for re-evaluating messaging and message design, adjusted for inflation.

The full report is available for free here.