While most states in the US now have comprehensive smokefree laws which cover workplaces and restaurants, there are few similar policies on tobacco smoking in multiunit housing, despite the fact that exposure differentially impacts children, the elderly, and disabled, particularly in publically funded multiunit housing. A recent study in California of tobacco smoke exposure among Hispanic residents also identified respondents who were concerned about marijuana smoke incursions. An important lesson from tobacco control is that if commercial interests are heavily involved in the early marijuana regulatory process then it is likely that as negative public health impacts of increased use develop, it will become ever more difficult to implement public health policies that have, over many years and with great difficulty, been applied to tobacco because there will be a rich and politically powerful industry working against implementation of effective policies to reduce consumption. Commercial sales of medical marijuana in the United States through for-profit dispensaries began in the 2000s. In 2012 and 2014, drug reform groups in Colorado, Washington, Alaska, and Oregon, and the District of Colombia used the initiative process to legalize sales, possession, and use of non-medical marijuana for adults age 21 and over. The four US states that legalized retail sales have implemented tax and regulatory structures for the marijuana market, based on the 2014 US Department of Justice Cole Memorandum, rolling flood tables which stated that the federal government would only intervene in states that failed to prevent diversion to other states, criminal involvement, and access to minors. 

The four states that have legalized retail marijuana are using US alcohol policies as a model for regulating retail marijuana, which prioritizes business interests over public health. Large and immediate increases in cannabis use and cannabis-related harms should not be expected in jurisdictions that have legalized use and sales for adults because it will take time for population shifts in perceived risks and social acceptability of its use that will likely lead to increased use. Alcohol use and alcohol-caused harm did not increase substantially in the immediate post-Prohibition era of alcohol in the United States. Alcohol producers were slow to develop and expand the market, possibly due in part to alcohol use not being socially acceptable. An additional factor was implementation among several states of the “Rockefeller Model” alcohol policy framework, which recommended tight control over the legal market through either a government monopoly or a comprehensive licensing system which divided the industry into three tiers , limited hours of operation for retail outlets, prohibited price reductions or other strategies to increase consumption, including rigid restrictions on alcohol promotions. It is also recommended by the World Health Organization that governments dedicate funding for comprehensive enforcement programs provides legal protection and an ongoing revenue stream for government efforts to monitor and enforce regulatory compliance with marketing bans.An important lesson from tobacco control is that if commercial interests are heavily involved in the early marijuana regulatory process then it is likely that as negative public health impacts of increased use develop, it will become ever more difficult to implement public health policies that have, over many years and with great difficulty, been applied to tobacco because there will be a rich and politically powerful industry working against implementation of effective policies to reduce consumption. 

Commercial sales of medical marijuana in the United States through for-profit dispensaries began in the 2000s. In 2012 and 2014, drug reform groups in Colorado, Washington, Alaska, and Oregon, and the District of Colombia used the initiative process to legalize sales, possession, and use of non-medical marijuana for adults age 21 and over. The four US states that legalized retail sales have implemented tax and regulatory structures for the marijuana market, based on the 2014 US Department of Justice Cole Memorandum, which stated that the federal government would only intervene in states that failed to prevent diversion to other states, criminal involvement, and access to minors. The four states that have legalized retail marijuana are using US alcohol policies as a model for regulating retail marijuana, which prioritizes business interests over public health. Large and immediate increases in cannabis use and cannabis-related harms should not be expected in jurisdictions that have legalized use and sales for adults because it will take time for population shifts in perceived risks and social acceptability of its use that will likely lead to increased use. Alcohol use and alcohol-caused harm did not increase substantially in the immediate post-Prohibition era of alcohol in the United States. Alcohol producers were slow to develop and expand the market, possibly due in part to alcohol use not being socially acceptable. An additional factor was implementation among several states of the “Rockefeller Model” alcohol policy framework, which recommended tight control over the legal market through either a government monopoly or a comprehensive licensing system which divided the industry into three tiers , limited hours of operation for retail outlets, prohibited price reductions or other strategies to increase consumption, including rigid restrictions on alcohol promotions. For several years, alcohol control employed in the US states through state-owned and operated stores was more effective than pre-prohibition policies, and at least as effective as prohibition, in maintaining low levels of alcohol per capita consumption. 

Alcohol consumption in the US did not reach pre-prohibition levels until 35 years after its repeal in 1970. In part, this rise in alcohol consumption can be attributed to privatization of alcohol monopolies or partial privatization of alcohol sales,  where private companies take control over a portion of the market . There is a positive relationship between privatization and alcohol sales, a well-established proxy for excessive alcohol consumption, due to several intermediate outcomes including increased alcohol density, increased availability , increased advertising, and reduced prices. These intermediate outcomes increase access and artificially stimulate demand for privatized alcohol, which leads excessive consumption and the associated health, social, and economic adverse outcomes. Confirming previous research in Iowa and West Virginia, privatization of wine sales was associated with significant increases in sales in five US states. An interrupted time-series analysis found that after privatization, wine sales increased by 42% in Alabama, 150% in Idaho, 137% in Maine, 75% in Montana and 15% in New Hampshire, while beer and spirit sales, under public monopolies, remained stable. Eliminating government control over alcohol sales is associated with increases in retail density of alcohol outlets. Ten years following privatization of liquor sales in Alberta, Canada the number of retail outlets increased three fold from 310 in 1993 to 938 in 2003, with an associated increase in absolute alcohol consumption. In contrast, re-monopolization of alcohol sales in Sweden resulted in significant declines in the number of outlets from 11,550 to 300 after implementation in 1977. Government control over the market in Sweden also led to declines in hospital admissions for alcohol intoxication, suicides and falls, as well as declines in alcohol related traffic accidents. The experience with alcohol suggests that governments should consider alternative frameworks for marijuana regulation over the commercially-focussed model implemented in the four US states. Avoiding a privatized marijuana market, as well as an industry that will aggressively oppose any public health effort to increase consumption in order to maximize profits, would likely lead to lower consumer demand, consumption and prevalence, even among youth, and may reduce the associated public health harm. As discussed below, one model for doing so would be to create an agency, similar to Uruguay’s Regulation and Cannabis Control Institute , to control the production and distribution of marijuana and cannabis products. Alterative or a variation of existing frameworks that might avoid corporatization or other forms of excessive commercialization could also be considered, including the European models of the Dutch coffeeshops or the Spanish cannabis clubs. De facto legalization in the Netherlands allows coffee shop owners to distribute cannabis to Dutch residents as long as certain guidelines are followed: sales limited to 5 grams per person/day at the same store, prohibition of advertising, flood and drain tray and sales and shop access restricted to adults 18 and above. Failure to comply with these guidelines will result in shop closure. Between 1997 and 2007, the number of shops decreased by 40% from 1,179 to 702 due to non-compliance with Dutch cannabis policy. Cannabis social clubs or cannabis collectives, are quasi-legal, largely unregulated distribution systems for cannabis. In jurisdictions where cannabis consumption is legal but production remains illegal, cannabis users form informal networks to maximize production and avoid purchase through the illegal market.

Governments tolerate this form of cannabis distribution on the basis that private members cultivate cannabis for personal use and do not profit from production. Proponents of CSCs argue that cannabis collectives can control product quality and reduce risky consumption. In both regulated and unregulated markets, cannabis collectives can help to reduce the harms of consumption in the illegal market by providing potency education to consumers as well as on the effects of cannabis varieties on individual users. Whether or not such claims are valid remains to be seen, particularly if cannabis clubs have to compete with other access points . For example, in a 2016 survey conducted in Uruguay, CSCs were the least favored cannabis source compared to pharmacies and home cultivation . These findings suggest that consumers would need incentives to access cannabis clubs over other access points or these other access points would need to be prohibited entirely. Moreover, in contrast to the cannabis collectives in Spain where product quality is not monitored by the government, policymakers or societies could implement strict product testing requirements for cooperatives to follow under existing product safety protocols.The architecture of the marijuana regulatory regime will depend upon the regulatory agencies charged with developing and implementing new regulations and the charge to that agency. In particular, making the health department the lead agency with a clear mandate to minimize consumption will lead to a different regulatory environment than an agency that views its primary mission as promoting business or tax revenue, albeit in a regulated market. As of October 2016 the four US states have opted for government agencies that prioritize a regulated business environment over implementation of public health programs that seek to minimize use through demand reduction programs based on social norms change. California, which legalized recreational marijuana in November 2016, also followed the business framework. As of November 2016, none of the US retail marijuana legalization states had designated the public health department the lead regulatory agency. Designating the revenue department or agriculture department as the lead regulatory agency has not benefited public health because the interest of revenue generation is considered equal to or at times more important than that of public health. From the tobacco control experience, granting substantial authority to business oriented agencies, such as the Department of Food and Agriculture, that would support the interests of marijuana growers and retailers, will likely result in these agencies issuing regulations that would help to increase market size, rather than institute strong controls to protect public health. In US tobacco growing states, commissioners of agriculture have been important allies to the tobacco industry and have blocked tobacco control policies to support the financial interests of tobacco growers. Analogous problems with regulatory agencies for alcohol and food regulation provide additional examples of the problems of regulatory capture. Public health departments in Colorado and Oregon were involved in developing policy recommendations for new regulatory frameworks, but were not the lead agencies. In Washington the health department was in control of developing the public education and research programs which led to the implementation of some public health policies but a comprehensive approach to reduce population level harm was not undertaken in any of the states6 .For example, the marijuana industry in Colorado has already worked to minimize public health protections on packaging and THC limits per serving size by working through a member of the advisory committee that set up the initial rules and in Alaska industry participation on the regulatory board led to adoption of cannabis smoking clubs. Recognizing that there may be some areas where regulators and public health experts need third party expertise on regulatory issues, one option could be to hold public hearings where members of the public, including the marijuana industry, provide testimony to government authorities on complex regulatory issues.