State Cannabis Policy and Public Health Research in the United States: Policy Disconnects and Research Gaps.

Tung G.; Leslie L.; Murphy N.; Samet J.; Li T.; Bradley C. · Annual review of public health · 2026

**Background & Methods** This scoping review examined the scientific literature on cannabis legalization in the United States by mapping current state cannabis policies using the National Conference of State Legislatures framework and analyzing peer-reviewed studies from 2015 to 2026 that measured specific cannabis policies and their association with health or use outcomes. The review included 48 studies investigating relationships between regulatory domains and cannabis-related health and behavioral outcomes. **Key Findings** - Research evidence was concentrated in four policy domains: licensing and business practices, nonmedical adult use regulations, medical program regulations, and local control provisions. Studies consistently demonstrated that retail availability, outlet density, proximity to sensitive locations, and local restrictions significantly shape cannabis exposure and patterns of use among populations. - Substantial evidence gaps exist across multiple regulatory areas including product regulations (potency limits, packaging standards), tax structures and revenue allocation mechanisms, hemp and cannabidiol (CBD) policies, criminal justice system provisions, and public health/research policies. These gaps represent critical areas where policy decisions are being made without adequate empirical evidence. - The review identified a disconnect between current policy implementation and scientific evidence, with many states implementing regulations without corresponding research on effectiveness, unintended consequences, or population health impacts. **Dosage & Administration** Not reported. **Safety & Adverse Effects** Not reported. **Evidence Quality** This scoping review has notable limitations. The included studies represent a relatively small body of literature (48 studies over 11 years), suggesting the field is nascent. Evidence quality appears heterogeneous across policy domains, with stronger evidence in retail accessibility domains but weak evidence in emerging regulatory areas. The review identifies critical gaps between policy implementation and research capacity, indicating that many current policies lack empirical support. The authors emphasize the need for improved researcher-policymaker collaboration, detailed policy coding methodologies, implementation fidelity measures, market data integration, and robust surveillance systems to generate higher-quality evidence. These recommendations suggest current evidence represents a preliminary knowledge base requiring substantial strengthening before definitive public health conclusions can be drawn.

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