Abstract
Secondhand cannabis smoke, like secondhand tobacco smoke, creates unhealthy indoor air quality. Ventilation and engineering techniques cannot reduce this pollution to healthy levels, and complete smoke-free policies are the only way to provide healthy indoor environments. Even so, multiple state and local governments have begun to allow indoor smoking of cannabis in businesses. A systematic search of Lexis Advance, NewsBank, and government websites for U.S. state and local laws passed between November 6, 2012 and June 10, 2020 that permit and regulate onsite cannabis consumption businesses was conducted in February-July 2020. In total, 6 of 11 states and the District of Columbia that legalized adult-use cannabis as of June 10, 2020 allowed onsite consumption and ≥56 localities within these 6 states allowed onsite cannabis consumption. Only 9% (5/56) of localities ban indoor smoking in these businesses; 23% (13/56) require indoor smoking to occur in physically isolated rooms. Other common local legal requirements address onsite odor control, ventilation/filtration, and building location. The majority of the localities that allow onsite cannabis consumption do not explicitly prohibit smoking or vaping inside. Policymakers should be made aware that ventilation and other engineering interventions cannot fully protect workers and patrons. Health authorities and local leaders should educate policymakers on the science of secondhand smoke remediation and advocate for the same standards for secondhand cannabis smoking and vaping that apply to tobacco, particularly because other modes of cannabis administration do not pollute the air.
Highlights
Secondhand cannabis smoke, like secondhand tobacco smoke, creates unhealthy indoor air quality
All of the 11 states and District of Columbia (DC) where adult-use cannabis has been legalized (Table 127−52) prohibit consumption in public places but allow cannabis consumption in private residences or private property with the owner’s permission if out of public view
The only effective means of preventing the health problems associated with secondhand cannabis smoke (SHCS) is to require a smoke-free environment,[11,20,21] most local laws that permit onsite cannabis consumption businesses either do not address SHCS or use ineffective ventilation or engineering requirements
Summary
Secondhand cannabis smoke, like secondhand tobacco smoke, creates unhealthy indoor air quality. Ventilation and engineering techniques cannot reduce this pollution to healthy levels, and complete smoke-free policies are the only way to provide healthy indoor environments. Smoking and vaporizing cannabis create secondhand cannabis smoke (SHCS) and unhealthy indoor air quality. Cannabis and tobacco smoke contain many of the same toxins.[1] Cannabis joints generate 3.5 times the secondhand smoke (SHS) (measured as particulate matter less than 2.5 mm in diameter, PM2.5) as a Marlboro cigarette.[2] Even vaping, which does not produce sidestream smoke, pollutes the air as much as a Marlboro.[2] Smoking cannabis is associated with some similar health effects as smoking tobacco, including myocardial infarction,[3] ischemic stroke,[3,4] and chronic bronchitis.[5] SHCS impairs vascular endothelial function (a precursor to cardiovascular disease) in rats,[6] an established model for human vascular response.[7] SHCS results in detectable cannabinoid levels in blood and urine among nonsmoking adults[8] and children.[9]
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