Getting it Right from the Start

09/08/2026

NEW: What’s being sold in California smoke shops?

A new field survey from Public Health Institute’s Getting it Right from the Start and the San Fernando Valley Partnership visited 86 retailers in 23 California communities—and found psychoactive products widely available.

Among smoke shops surveyed:
• 49% sold kratom or 7-OH products
• 24% sold nitrous oxide
• 19% sold psychoactive mushroom products
• 37% were within four blocks of a school or college

“Having a to***co license is not a license to sell drugs to kids,” said Lynn Silver, MD, MPH, senior advisor at the Public Health Institute and director of Getting it Right from the Start. “California has shown with intoxicating h**p that strong public health rules and enforcement can make a real difference. We need to sustain that urgency nationally for intoxicating h**p and extend it to the other addictive and potentially dangerous products now appearing on smoke-shop shelves.”

The findings point to important gaps in regulation and enforcement—and the need for stronger protections, particularly for young people.

Read the new policy brief, “Searchlight on Smokeshops”: https://bit.ly/46bZfLS
Media release: https://bit.ly/4qWGpBP

09/03/2026

California just took an important step to better protect children from cannabis products designed and marketed in ways that can appeal to them.

Gov. Gavin Newsom has signed AB 2249, authored by Assemblymember Jacqui Irwin, strengthening state rules governing cannabis packaging, labeling, advertising and marketing attractive to children.

The need is clear: since 2016, cannabis-related calls to the California Poison Control System involving children 5 and under have increased 406%. Calls involving cannabis edibles among these young children increased 743% from 2017 to 2024.

Getting it Right from the Start and other public health advocates have pushed for stronger protections for years, including AB 1207 in 2023, which Gov. Newsom vetoed.

AB 2249 doesn't go as far as advocates have sought—it doesn't ban flavored inhaled cannabis products and still allows realistic fruit imagery and adult-oriented celebrity branding. But it makes important progress, establishing clearer standards for packaging, labeling, advertising and marketing that appeal to children, including cartoons, candy and sweets imagery and some stylized fruit imagery.

We thank Assemblymember Irwin for her persistence and leadership. Legal cannabis shouldn't mean cannabis packaged or marketed in ways that put children at risk.

ABC 10 covers story: https://bit.ly/4qRyNRe

09/01/2026

Laughing gas belongs in the dentist's office—not the smoke shop.

California lawmakers have unanimously passed SB 936, legislation restricting the sale of large, flavored and direct-inhalation nitrous oxide products while preserving legitimate medical, dental and culinary uses.

Nitrous oxide has legitimate purposes. But products designed and marketed for recreational inhalation are increasingly raising public health concerns, including serious neurological injury and deaths.
The Legislature acted with overwhelming bipartisan support. Now it's Governor Newsom's turn.

Governor Newsom: Sign SB 936!

The public health case for this legislation has brought together a broad coalition, including the California Medical Association, American Academy of Pediatrics–California, and California's local health officers, along with local governments and public safety organizations across the state.

With strong support from California's physicians, pediatricians and public health leaders—and unanimous approval by the Legislature—it's time to protect young people and put public health first - not smokeshop profits.

Learn more from Sen. Blakespear: https://bit.ly/4xxqP2g

Catherine Blakespear California Medical Association American Academy of Pediatrics

08/25/2026

Two major new reports underscore a growing public health problem: cannabis use disorder is rising as today's cannabis products have become dramatically more potent.

A new national study led by researchers at the National Institute on Drug Abuse found cannabis use disorder (CUD) increased among both men and women from 2021–2024, including increases in moderate-to-severe CUD.

Perhaps most striking: among adults who reported using cannabis in 2024, about 30% showed symptoms consistent with cannabis use disorder. Among people who drank alcohol, fewer than 20% showed symptoms consistent with alcohol use disorder.

“The notion that cannabis is not addictive may basically be incorrect,” NIDA Director Dr. Nora Volkow told The New York Times. She pointed directly to today's much stronger products: “The higher the content of the drug, the higher the risk for addiction.”

And those products are dramatically different from cannabis of previous generations. Writing in The New York Times this week, child and adolescent addiction psychiatrist Dr. Sivabalaji Kaliamurthy notes that cannabis contained roughly 2–5% THC a few decades ago. Today's cannabis flower often contains around 20%, while cartridges and concentrates can exceed 70% THC.

His prescription: regulate cannabis based on risk—including THC potency caps, standardized labeling and dosing, stronger health warnings, research, and better public education.

That's an important distinction. The question isn't whether we return to cannabis prohibition. It's whether legalization means allowing an increasingly commercialized industry to sell ever-more-potent products with inadequate public health safeguards.

As alcohol use declines, replacing one preventable public health problem with another isn't progress. Cannabis policy needs to catch up with the products being sold today.

New York Times investigative piece by Rony Robin: https://www.nytimes.com/2026/08/19/well/cannabis-use-disorder-alcohol.html

NY Times opinion piece by Dr. Nora Volkow: https://lnkd.in/gKS5Y4CC

A growing number of Americans report they are unable to quit or cut down.

08/19/2026

Nine intoxicating h**p brands. 837 Instagram posts. Almost no safeguards for young people.

In a new study out today in Addiction (journal of the Society for the Study of Addiction): Alisa Padon, a researcher with the Public Health Institute’s Getting it Right from the Start program, teamed up with researchers at Rutgers University and others to analyze those posts. Here’s what they found:

- 49.6% used youth-oriented content: memes, cartoons, pop culture references
- 52% promoted relaxation and happiness, showing products in everyday social settings
- Beverages were marketed most aggressively: 84.3% used recreational themes, 56.9% youth-oriented themes
- Just 2.5% carried any health or age warning

This is the familiar tension between economic interests and public health: allow marketing tactics that drive sales at the expense of people’s health or protect the health of Americans.

Public Law 119-37 — which takes effect November 12 and prohibits these products by narrowing the federal definition of h**p and capping THC per package — is now being challenged. Maintaining that federal prohibition will be important to protect our youth.

Read more about the study: https://www.phi.org/press/youth-oriented-marketing-intoxicating-h**p-products/

Brands selling intoxicating h**p products are rarely warning about health risks or age limits, according to a new study.

08/07/2026

A powerful Sacramento Bee opinion from Tom Philp raises urgent questions about California’s cannabis regulations—particularly access for young people ages 18–20.

Philp examines the tragic case of Carlos Reales Dominguez, who obtained a medical cannabis authorization online at age 19, later developed schizophrenia, and in 2023 killed two people and seriously wounded another during a stabbing spree in Davis.

We cannot know whether cannabis caused Dominguez’s schizophrenia or what role it may have played in this tragedy. But his case highlights a broader problem: California allows 18–20-year-olds—whose developing brains are particularly vulnerable to cannabis-related harms—to gain legal access to the full range of dispensary products through medical recommendations.

Research we conducted with Kaiser Permanente Northern California (lead author) underscores the concern: adolescents who reported cannabis use were more than twice as likely to later be diagnosed with a psychotic disorder or bipolar disorder, with increased risks of depression and anxiety as well.

The circumstances surrounding Dominguez’s authorization are also troubling. According to Philp, an online physician cited diabetes as a justification even though Dominguez’s application did not indicate he had diabetes. Online medical-card businesses can make cannabis remarkably easy to access, raising serious questions about whether California’s standards for medical recommendations are being adequately followed and enforced.

We know substantially more about cannabis, the developing brain, addiction, and mental health risks today than we did when California legalized adult-use cannabis in 2016. Our policies should reflect that evidence. As Philp concludes: “Sacramento needs to wake up.”

Read the Sacramento Bee opinion: https://bit.ly/4gizz5Z

Carlos Dominguez started legally using cannabis at age 19. Four years later and with schizophrenia, he went on a stabbing spree in Davis.

08/03/2026

For years, Getting it Right from the Start has warned that a loophole in the 2018 Farm Bill allowed intoxicating h**p products—including gummies, beverages, and vapes—to be sold with far too few public health safeguards.

Last year, Congress voted to close that loophole by changing the federal definition of h**p and establishing new limits that would effectively remove most intoxicating h**p products from the market. Now, according to Forbes, Senate leaders have proposed delaying implementation of those restrictions until December while industry groups lobby for a different legislative approach.

This is an important moment for public health advocates. After years of work to strengthen protections against intoxicating h**p products, we encourage policymakers to preserve the progress already made and keep the focus where it belongs: protecting young people, consumers, and public health—not reopening the loophole that allowed this largely unregulated market to flourish.

Read more in Forbes: https://www.forbes.com/sites/maryroeloffs/2026/08/03/senate-seeks-delay-on-crackdown-of-h**p-thc-products/

**p **p

Congress is trying to delay a law that would effectively kill the $28 billion intoxicating h**p industry.

07/20/2026

Recent national media coverage is highlighting an important public health message.

MSN recently featured our own Getting it Right from the Start (a program of the Public Health Institute) Director Dr. Lynn Silver discussing the growing evidence linking cannabis use to serious cardiovascular disease.

The discussion is based on a major analysis of 24 studies involving nearly 200 million people, along with an accompanying editorial co-authored by Dr. Silver and Dr. Stanton Glantz in the journal Heart. The evidence found that, compared with non-users, cannabis use was associated with:
🫀 More than double the risk of cardiovascular death
❤️ 29% higher risk of heart attack
🧠 20% higher risk of stroke

As Dr. Silver explains in the interview, cardiovascular disease remains the leading cause of death in the United States and worldwide. She argues that clinicians should routinely screen patients for cannabis use and educate them about cardiovascular risks—just as they do for to***co and alcohol—and that cannabis regulations should do far more to protect public health.

As cannabis policies continue to evolve, ensuring that consumers, clinicians, and policymakers have access to the best available scientific evidence has never been more important.

Watch the MSN feature: https://bit.ly/4hi4Gzy (Important correction to MSN article: Dr. Silver was NOT the co-author of the study itself, but rather, the commentary ABOUT the study with Professor Glantz.)
Read original CNN coverage: https://bit.ly/3TarW8I

07/07/2026

Our research (PublicHealth Institute's Getting it Right from the Start) continues to reach new audiences.

A new Medical Daily article by Josesh James features our JAMA Health Forum study, led by Kaiser Permanente Northern California in collaboration with the Public Health Institute, UCSF, and USC.

The study followed nearly 463,000 adolescents and found that past-year cannabis use was associated with more than double the risk of developing psychotic disorders and bipolar disorder by young adulthood. Researchers also found elevated risks for depression and anxiety, with cannabis use typically preceding diagnosis by nearly two years.

Importantly, this was an observational study—it does not prove cannabis caused these illnesses. But its size, longitudinal design, and rigorous analysis make it one of the strongest pieces of evidence to date that adolescent cannabis use deserves serious public health attention.

We're also proud that the study has now been covered by 169 news outlets and ranks in the top 1% of all research tracked by Altmetric.

As cannabis policy evolves, protecting young people from preventable harm should remain at the center of the conversation.

Read more: https://www.medicaldaily.com/teen-cannabis-mental-illness-psychosis-bipolar-jama-study-2026-475908

Medical Daily Public Health Institute

A JAMA Health Forum study of 463,396 teens found cannabis use doubles the risk of psychosis and bipolar disorder. Cannabis typically preceded psychiatric diagnosis by 1.7–2.3 years.

06/23/2026

Another major international review validates what public health experts have been warning for years. A new review published in Psychiatry and highlighted this week by the Guardian found a consistent pattern across cannabis policy changes around the world:
• Commercial cannabis markets were associated with increases in cannabis use, higher-potency products, and more cannabis-related psychosis and other psychiatric harms.
• Decriminalization alone did not show the same increases.
• Countries using strictly regulated public models, such as Uruguay, likewise did not experience the same public health trends seen in highly commercialized markets.

These findings go directly to the heart of the debate. The greatest public health risks come not simply from legalization, but from building a for-profit cannabis industry whose financial success depends on increasing consumption. Like the to***co and alcohol industries before it, commercial markets create powerful incentives to:
• Increase product potency
• Expand marketing and promotion
• Normalize frequent use
• Develop products that appeal to new consumers
• Oppose stronger public health safeguards

One promising example is Quebec's public monopoly model, where cannabis sales occur through a government-operated retailer rather than private companies competing to maximize sales. A public monopoly can prioritize health objectives over shareholder returns, helping limit commercialization while reducing criminal penalties.

As more jurisdictions reconsider cannabis policy, the evidence continues to point in the same direction: The choice isn't simply legalization vs prohibition. It's commercialization vs public health.

Read: https://bit.ly/3SIvvmd

The Guardian