Paper: The Impact of Adult Cannabis Use Legalization in California: A Qualitative Review of Subject Matter Expert Opinions on Proposition 64

Objective: California legalized adult cannabis use in 2016 with the passing of Proposition 64: The Adult Use Marijuana Act (Prop 64). This qualitative study aimed to explore the impact of legalization on various stakeholders and institutions within California, especially as it relates to public policy, health, and safety.

Method: Twenty-two semi-structured interviews were conducted from January to March 2022 with stakeholders that included Subject Matter Experts (SME) from the following categories: clinicians (primary care, pain management, addiction medicine, cannabis clinicians), researchers, advocates, dispensary owners/personnel, legal professionals, and cannabis consumers. Nine interview guides were constructed to assess participants’ perceptions of Prop 64 and its impact on their given sector/industry as it relates to the use, production, distribution, and access to medicinal and adult cannabis use. Thematic analysis was conducted to identify salient themes from the interviews.

Results: The three primary themes and subthemes included: (1) Successes of Prop 64 (quality control, justice reform, stigma reduction), (2) Shortcomings of Prop 64 (high cost, licensing, bureaucracy, social inequity), and (3) Recommendations for improvement of Prop 64 (need for research, policy change, the transformation of business model).

Conclusions: The implementation of cannabis legalization in California had a broad impact on many key stakeholders. While demonstrating some success, SME described key areas for improvement of Prop 64. A multidisciplinary approach with support from government, state, and local municipalities is necessary to facilitate proper regulation, provide timely support, and reduce social injustice, harm, and unforeseen consequences of use. Updating federal regulations (e.g., Schedule I status) might be an important step to allow for improving regulation and operations (e.g. banking) within the cannabis industry, further research and education, and greater cross-state consistency regarding law enforcement/regulation of cannabis. Public Health Implications: The information gathered will help inform public policy, as well as help health professionals design new health education campaigns for the general public.