Cannabis Social Equity Programs and Their Unintended Consequences

Cannabis social equity programs have been implemented in many U.S. jurisdictions to address disparities associated with cannabis prohibition and expand participation in the legal cannabis market. While these initiatives reflect important policy goals, their implementation intersects with emerging public health concerns. Legal cannabis markets have expanded availability and access to high-potency cannabis products, and studies in several jurisdictions have reported increases in frequent cannabis use and cannabis use disorder (CUD) following legalization. Social equity frameworks often designate economically underdeveloped neighborhoods for increased licensing opportunities. These neighborhoods are also often disproportionately affected by cannabis-related law enforcement, which may result in higher concentrations of cannabis retailers in communities already experiencing structural disadvantage and limited behavioral health infrastructure. Increased exposure to high-potency cannabis products in settings with limited access to addiction and psychiatric services may contribute to elevated risks of undertreated CUD and psychiatric symptoms. Clinicians serving patient populations in these jurisdictions are well positioned to screen and counsel patients at-risk for CUD, as well as to advocate for policy changes that protect the public health of the communities affected by social equity frameworks.