Getting it Right from the Start

03/12/2026

A new study in Sage Journals examining Quebec’s cannabis retail monopoly (SQDC) highlights how cannabis legalization can prioritize public health over profit. Unlike the commercial model used across the United States, Quebec designed its system with a legislated mission:
..to sell cannabis without encouraging consumption.

Researchers identified several safeguards that help prevent commercialization and reduce harm:
• A not-for-profit mandate
• Independent health oversight
• Separation of regulation from revenue agencies
• Profits dedicated to prevention and research

This stands in sharp contrast to U.S. legalization, which has largely prioritized industry growth, product expansion, marketing, and increasing potency.

Public cannabis monopolies — long used for alcohol in many jurisdictions — offer a promising model for balancing legalization with harm reduction. By removing profit incentives and placing public health at the center of policy design, governments can better protect youth and limit the expansion of high-risk products.

As more jurisdictions consider cannabis legalization or reform, policymakers should seriously consider the public monopoly model as a viable alternative to for-profit commercialization.

Because when it comes to potentially harmful products, the goal should not be maximizing sales — it should be minimizing harm.

Study: https://journals.sagepub.com/doi/full/10.1177/00914509261416113

*****na

03/02/2026

We are at an inflection point in how the United States talks about cannabis and youth mental health.

Our new research - led by Kaiser Permanente - in JAMA Health Forum followed nearly 500,000 adolescents over eight years. The strongest associations were with psychotic and bipolar disorders — where risk was about doubled. Importantly, cannabis use was reported one to two years before diagnosis.

At the same time, clinicians are describing dramatic shifts in what they are seeing on the ground. As pediatrician Dr. Natalie Laub shared this week with KCBS, prior to 2020 her hospital saw a few dozen adolescent cannabis-related cases per year. In 2025, that number approached 600.

Today’s cannabis products are more potent than in previous generations. Youth from lower-income communities are disproportionately affected. Commercialization has moved quickly. Public health protections have not kept pace.

To be clear: this research does not argue for restarting the drug war or criminalizing possession. It does underscore the need for guardrails:
• Meaningful age restrictions
• Potency limits
• Restrictions on youth-targeted marketing
• Clear warning labels
• Science-based parent and community education

Legalization and public health are not opposites. We can oppose incarceration and still prevent hospitalization.

The growing national coverage and clinical conversations reflect something important: the narrative is shifting. Evidence-based, prevention-focused approaches are gaining traction.

Watch key recent interviews with Kelly Young-Wolffe as well as our own Dr. Lynn Silver:

Contemporary Pediatrics: https://bit.ly/4cCr0Sn
Redwood TV: https://bit.ly/4r7BJYp
KCBS: https://bit.ly/4cRKphW

*****na Kaiser Permanente Public Health Institute

A new study published in the Journal of the American Medical Association associates adolescent cannabis use with increased risk for serious mental health conditions.

02/23/2026

Major national coverage for Kaiser Permanente's (that we co-authored with researchers from USC and UCSF) new JAMA Health Forum study. NPR’s Rhitu Chatterjee featured our research on Weekend Edition Saturday, highlighting findings from one of the largest longitudinal studies to date examining adolescent cannabis use and mental health outcomes.

Researchers followed 460,000 adolescents in the Kaiser Permanente system through age 25. After excluding teens with prior psychiatric symptoms, the study found:
• More than double the risk of psychotic disorders
• Roughly double the risk of bipolar disorder
• A one-third increase in depression
• A one-quarter increase in anxiety

As Dr. Lynn Silver explained to NPR, the adolescent brain is still developing — and regular cannabis use may disrupt healthy neural development in ways that increase vulnerability to serious psychiatric disorders. She also underscored that legalization has contributed to a widespread perception of cannabis as a harmless, natural stress remedy — a perception not supported by emerging evidence.

Grateful to NPR for thoughtful, careful coverage of this research.

See article: https://www.npr.org/2026/02/21/nx-s1-5719338/cannabis-ma*****na-weed-teens-psychosis-jama

*****na Public Health Institute NPR

Researchers followed more than 400,000 teens until they were adults. It found that those who used ma*****na were more likely to develop serious mental illness, as well as depression and anxiety.

02/20/2026

A major new study published today in JAMA Health Forum followed nearly 463,000 adolescents and found that past-year cannabis use during adolescence was associated with a significantly increased risk of developing psychotic, bipolar, depressive, and anxiety disorders by young adulthood. The risk of psychotic and bipolar disorders — among the most serious mental health conditions — approximately doubled.

Cannabis use preceded psychiatric diagnoses by an average of 1.7 to 2.3 years, strengthening evidence that adolescent exposure may contribute to the development of mental illness rather than simply reflect underlying symptoms.

The research was conducted by scientists at Kaiser Permanente Division of Research (lead authors), the Public Health Institute’s Getting it Right from the Start, UCSF, and USC, and funded by the National Institute on Drug Abuse.

As lead author, Kelly Young-Wolff, Kaiser Permanente, noted: “Even after accounting for prior mental health conditions and other substance use, adolescents who reported cannabis use had a substantially higher risk of developing psychiatric disorders — particularly psychotic and bipolar disorders. This study adds to the growing body of evidence that cannabis use during adolescence could have potentially detrimental, long-term health effects. It’s imperative that parents and their children have accurate, trusted, and evidence-based information about the risks of adolescent cannabis use.”

Dr. Lynn Silver, program director of Getting it Right from the Start and study co-author continued: “As cannabis becomes more potent and aggressively marketed, this study indicates that adolescent cannabis use is associated with double the risk of incident psychotic and bipolar disorders…The evidence increasingly underscores the importance of a strong public health response.”

Cannabis is the most commonly used illicit drug among U.S. adolescents. At the same time, THC potency in legal markets has risen dramatically compared to prior decades. As legalization expands, this study adds to a growing body of evidence that youth exposure is not benign — and that prevention, accurate risk communication, and thoughtful policy guardrails matter.

Study link in comments.

*****na

02/10/2026

A long-overdue shift in the cannabis conversation. This week, the Editorial Board of the The New York Times published an important editorial acknowledging what public-health researchers and community advocates have been warning for years: legalization without strong regulation has real and growing costs.

The piece documents dramatic increases in frequent use, addiction, ER visits, psychosis, and impaired driving—alongside the clear failure of many states to adequately regulate potency, marketing, and industry behavior after legalization.

While the editorial isn’t perfect—it understates today’s rates of dependency and repeats outdated comparisons to alcohol—it marks a meaningful break from the long-standing assumption that cannabis legalization would bring few downsides.

Notably, it calls for:
• Limits on THC potency
• Taxation based on THC content
• A shift away from treating cannabis as an economic growth strategy
• Regulation grounded in public health, not industry profits

The editorial lifts up the concept of “grudging toleration,” advanced by late drug-policy scholar Mark Kleiman—keeping cannabis legal while actively working to curb excessive use, addiction, and harm. That approach stands in sharp contrast to the high-potency, profit-driven markets many states have allowed to flourish.

Big questions remain—especially around federal action, industry influence, and how to set a true regulatory floor without repeating the mistakes of commercialization. But acknowledging reality is a necessary first step.

This is where local policy matters. Our cannabis scorecards show, jurisdiction by jurisdiction, where states and local governments have failed to regulate—and where stronger, evidence-based protections are possible right now.

Alarm bells are finally ringing where they matter. The next step is using evidence to guide smarter policy.

Our Scorecards (special thanks to The Center at Sierra Health Foundation for their support): https://bit.ly/3MfmYV8
Editorial: https://bit.ly/4chAWQK

*****na The Center at Sierra Health Foundation

Given the growing harms from ma*****na use, American lawmakers should do more to regulate it.

02/06/2026

Another strong example of how our California Cannabis Policy Scorecards are meant to function — and why independent journalism plays such a critical role in advancing public health.

In a deeply reported column for the Orange County Register, Teri Sforza examines how multiple Orange County cities stack up on protecting youth and communities as legal cannabis continues to expand. The piece does exactly what the scorecards are designed to enable: it names scores city by city, explains what each locality has done, and just as importantly, what it has not — making local policy choices visible and comparable.

Just as importantly, the article situates those scores within the broader public-health context driving this work. It walks readers through the growing body of evidence around today’s hyper-commercialized cannabis market — including rising potency, youth-appealing flavors and packaging, declining risk perception among adolescents, increased emergency-room visits, mental-health harms, and the particular risks to youth and young adults. The message is clear: legalization has moved faster than the guardrails needed to protect public health.

Against that backdrop, the reporting highlights why local policy matters so much. The article explains why Pomona leads the state (60 points), and then details how Orange County cities such as Santa Ana (40), Laguna Woods (25), Costa Mesa (21), La Habra (21), and Stanton (18) earned their scores — connecting specific policies (or gaps) around retailer limits, buffers from schools, health warnings, delivery rules, event bans, marketing, and use of cannabis tax revenue to real health implications.

That transparency is the point. The scorecards are not just a grading exercise. They are a tool to show that state law is a floor, not a ceiling — and that as cannabis becomes more potent, more aggressively marketed, and more widely available, local governments have both the authority and responsibility to do more.

Read the full article here: https://www.ocregister.com/2026/02/06/cannabis-report-card-do-o-c-cities-make-the-grade/

Public Health Institute *****na Prevention Institute

Columnist Teri Sforza writes: In the few O.C. cities that allow cannabis businesses, the industry generates tax revenue — up to $10 million for youth and safety programs. But public health ty…

02/05/2026

We’re incredibly grateful for the in-depth, public-service reporting by Michele Chandler and the Redding Record Searchlight (USA Today Network) on our newly released 2025 California Cannabis Policy Scorecards.

This story takes a close look at how Redding, Anderson, and Shasta Lake are doing when it comes to protecting youth and public health as legal cannabis expands — and, importantly, why those local policy choices matter. It doesn’t just report the scores; it explains where communities are making progress and where key protections are still missing.

That’s exactly how we hope these scorecards will function.

They are meant to do two things at once:

- Recognize leadership, by highlighting communities that go beyond state minimums to protect health and advance equity.
-Create accountability, by clearly showing where local governments are leaving proven public-health protections on the table.

As the article underscores, simply following state law isn’t enough. Local governments have real authority to shape safer cannabis markets — and the scorecards provide both transparency and a roadmap for how to do better.

We’re especially thankful for the care and depth of this reporting, and for the opportunity to contribute data and analysis that can help inform local conversations and drive smarter, science-based policy.

Read the full story here: https://www.redding.com/story/news/2026/02/05/california-cities-cannabis-policies-fail-to-protect-youth/88476560007/?gnt-cfr=1&gca-cat=p&gca-uir=true&gca-epti=z11xx81p002750c002750v11xx81d--66--b--66--&gca-ft=140&gca-ds=sophi

*****na

Current California rules on legal cannabis aren't tough enough, according to an Oakland-based research group.

02/03/2026

Yesterday, in partnership with Kaiser Permanente Research NorCal and the Sierra Health Foundaiton, we released the 2025 California Cannabis Policy Scorecards, a statewide assessment of how well cities and counties are protecting youth, public health, and communities as legal cannabis access continues to expand.

While most jurisdictions still fall short of basic public-health and equity protections, this year’s scorecards also highlight what strong local leadership looks like.
🏆 City of Pomona earned the highest overall score (60 points), setting a strong example for protecting health and advancing equity. Pomona capped the number of retail licenses, banned temporary cannabis events and on-site consumption, required a 1,000-foot buffer from schools and other youth-sensitive sites, mandated in-store health warnings, prioritized equity in hiring with fee deferrals, and dedicated local cannabis tax revenue to youth programs and prevention.
🚚 San Benito County scored highest among delivery-only jurisdictions (39 points), demonstrating how strong protections are possible even without storefront sales. Its policies include a temporary event ban, billboard ban, a local cannabis tax on deliveries, permit requirements for outside delivery businesses, and delivery-location restrictions.

These communities show that local governments have both the authority and the tools to reduce harms, protect youth, and shape a safer legal cannabis marketplace — even as state policy has lagged.

“As more Californians live in communities that allow cannabis sales, local policy decisions increasingly shape who is exposed to risk and who is protected. These scorecards show how uneven protections remain across the state, and the science shows how much those choices matter.”
— Alisa Padon, PhD, Getting it Right from the Start

📊 Explore the scorecards and see how communities across California compare: bit.ly/3NSzMkG
🗺️ Read our press release: https://bit.ly/3Zfy2o4

02/02/2026

Today, in partnership with Kaiser Permanente Research NorCal and the Sierra Health Foundaiton, we released the 2025 State of Cannabis Policy in California Scorecards — a statewide assessment of how well cities and counties are protecting youth, public health, and communities in the era of legal cannabis.

The findings are clear: while a handful of jurisdictions are leading, most communities are still leaving critical public-health protections on the table, even as cannabis use, potency, and related harms continue to rise.

Amid these growing concerns, the scorecards provide a clear roadmap for local action to better protect health and advance equity. Local governments remain the primary line of defense where state policy has not kept pace.

Our scorecards evaluate local policies across six areas — retailer requirements, taxation, product and marketing rules, smoke-free air, and equity — and highlight both promising models and persistent gaps. With more Californians than ever living in areas where cannabis is legally available, local decisions matter.

📄 Read the press release: https://lnkd.in/ev-DXPX4
🗺️ Explore the scorecards and best-practices map: https://lnkd.in/eJe8c6-T
📊 See full scorecard: https://lnkd.in/eki2VV42

01/20/2026

Congress is quietly moving to delay a federal ban on intoxicating h**p products—and the public health stakes are high.

This fall, Congress finally made progress by embedding a ban on intoxicating h**p and synthetic cannabinoids in budget legislation (with a one-year delay) made possible by a farm bill loophole (we warned about in 2018). That window gave the h**p industry time to push back.

According to Roll Call, Rep. James Baird (R-IN) and Sen. Amy Klobuchar (D-MN) are now backing legislation to delay the ban by three years, potentially inserting it into must-pass spending bills. The Trump administration has also signaled support for reversing h**p restrictions, urging agencies and Congress to act.

These products—often sold as “legal CBD”—frequently contain dangerous levels of intoxicating and synthetic cannabinoids, harming kids, families, and communities.

States like New Jersey are stepping up. The question is whether Congress will too? We urge our friends, allies, and public-health experts to educate their members of Congress about the public-health risks posed by highly intoxicating h**p products—often containing large amounts of untested, synthetic cannabinoids—that are widely marketed and readily accessible to children across the country.

Read article in comments!

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01/16/2026

Worth reading: In a thoughtful new op-ed for the Los Angeles Times, Susan Shapiro shares her personal journey of quitting cannabis—and why legality doesn’t equal harmlessness.

She clearly lays out what the research is telling us: as cannabis has become easier to access and more heavily marketed, rates of dependence have risen, along with links to psychosis, cardiovascular risks, and su***de. Nearly 1 in 3 users, she notes, may be genetically predisposed to developing cannabis use disorder.

Importantly, Shapiro doesn’t just warn—she offers practical, compassionate guidance: how to assess whether use is becoming a problem, what withdrawal can signal, and concrete strategies for cutting back or quitting, from tapering and therapy to peer support.

This is exactly why California—and the rest of the country—needs smarter public-health guardrails: policies that reduce harm, curb aggressive commercialization, and put health ahead of profit. Right now, the market is largely designed to do the opposite.

Read this candid, humane piece that adds much-needed nuance to the conversation about cannabis, health, and prevention: https://www.latimes.com/opinion/story/2026-01-13/cannabis-addiction-signs-recovery-strategy

*****na

Pot is quickly becoming America's drug of choice, on track to replace alcohol, but its harms are becoming clear as well.

01/12/2026

Even “light” cannabis use can harm teens — new national study

A major new study our of Columbia and published in Pediatrics analyzed data from more than 160,000 U.S. middle and high school students and found that even teens who use cannabis just once or twice a month already show worse mental health and school outcomes.

The study was led by child and adolescent psychiatrist , who explains:

“While previous studies have focused on the effects of frequent cannabis use among teens, our study found that any amount of cannabis use at all may put kids at risk of falling behind in school, and the kids using most often may have the greatest risk. A few ‘harmless’ joints can snowball into real academic consequences. Teens using it regularly often struggle to focus, miss school, and may lose interest in their future plans.”

Why is this happening now? Today’s cannabis products are two to three times more potent than in the past — and adolescent brains are still developing the systems that control learning, mood, and self-regulation. Even casual use can interfere with that development.

This is why public-health-based cannabis policy matters:

- Limits on THC potency
- Youth protections
- Honest education about risks
- Prevention and early-intervention resources

At Getting it Right from the Start, this is exactly what we’ve been warning about: We can respect adult choice while still protecting adolescent brain health. The science is clear — and policy needs to catch up.

Read more: https://www.cuimc.columbia.edu/news/teens-any-cannabis-use-may-have-impact-emotional-health-academic-performance

*****na

Even occasional cannabis use is linked to worse school performance and emotional distress for teens, finds a new study led by Columbia University.