Inside the regulatory process of developing and implementing cannabis warnings: a qualitative study

Abstract Background In 2025, 59.4 million adults used cannabis in the past year. Many states have legalized medical or adult-use (also known as recreational or non-medical) cannabis, and each state oversees related cannabis regulations, including developing warnings on cannabis packages to inform people about the risks of cannabis use. Our study interviewed state regulators to understand the process for developing and implementing cannabis warnings and to assess their perceptions of how existing warnings could be improved. Methods Our study recruited US cannabis regulators familiar with their state’s existing cannabis warning regulations, in partnership with the Cannabis Regulators Association (CANNRA). From October to December 2024, we conducted 17 videoconference interviews, which were recorded and professionally transcribed. Participants were asked about their roles as state regulators, the purpose of cannabis warnings, the development and implementation of warnings, and considerations related to federal standardization. Using ATLAS.ti, we dual-coded transcripts and conducted thematic data analysis. Results Seventeen cannabis regulators were interviewed, representing 16 states: four states with legalized medical cannabis only, and 12 states with both medical and adult-use cannabis. Central themes include: (1) Balancing population needs and product considerations, “…we were thinking about targeting specific audiences—being youth , pregnant women…” and “…I do think that the different types of products need different warnings.” (2) Clarifying a shared purpose for warnings through collaboration, “…it’s certainly a partnership , and it takes both sides.” (3) Designing effective, research-based warnings, “…we need actual research on the cannabis to get the health effects , to get the warnings…” , and (4) Considering federal standardization, “…standardization is important. And the feds cannot take action on this soon enough.” Conclusions Findings highlight the challenge of designing effective cannabis warnings, given the tension between limited packaging space for warnings and regulators’ desire for comprehensive messaging. Importantly, regulators emphasized the need for further research on health impacts and effective warning design and largely favored federal standardization of cannabis warnings across the US.