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Research Article| Volume 61, ISSUE 6, e267-e278, December 2021

Emerging Indoor Air Laws for Onsite Cannabis Consumption Businesses in the U.S.

  • Thomas L. Rotering
    Affiliations
    Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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  • Lauren K. Lempert
    Affiliations
    Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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  • Stanton A. Glantz
    Correspondence
    Address correspondence to: Stanton A. Glantz, PhD, 1474 24th Avenue, San Francisco CA 94122.
    Affiliations
    Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California; Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, California
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Open AccessPublished:August 13, 2021DOI:https://doi.org/10.1016/j.amepre.2021.05.012
Emerging Indoor Air Laws for Onsite Cannabis Consumption Businesses in the U.S.
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      Introduction

      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.

      Methods

      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.

      Results

      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.

      Conclusions

      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.

      INTRODUCTION

      Smoking and vaporizing cannabis create secondhand cannabis smoke (SHCS) and unhealthy indoor air quality. Although not identical, cannabis and tobacco smoke contain many of the same toxins.
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      Comprehensive state or local 100% smoke-free laws in workplaces, restaurants, and bars covered 61% of the U.S. population as of January 2020.
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      The prevalence of secondhand tobacco smoke (SHS) exposure among U.S. nonsmokers from any source fell from 52.5% in 1999–2000 to 25.2% in 2013–2014,
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      Legalization of adult-use cannabis threatens clean indoor air and public health. As of June 2020, a total of 34 states and the District of Columbia (DC) had legalized medicinal cannabis, and 11 states and DC legalized adult-use cannabis

      Where is cannabis legal? Leafly. https://web.archive.org/web/20200623060641/https://www.leafly.com/news/cannabis-101/where-is-cannabis-legal. Updated January 17, 2020. Accessed July 21, 2021.

      ; 5 additional states legalized medicinal use, adult use, or both through a ballot initiative in November 2020.
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      Although all adult-use states prohibit cannabis consumption in public, some cannabis advocates argue that this prohibition inappropriately limits the opportunity for renters, tourists, and people experiencing homelessness to legally and safely consume cannabis.
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      As of June 2020, a total of 6 states addressed this issue by allowing onsite cannabis consumption at some licensed cannabis businesses by combustion or vaporization, exempting them from existing clean indoor air laws. This study defines these onsite cannabis consumption businesses as businesses licensed by the local or state government to permit onsite cannabis consumption in any manner in a permanent structure, with or without cannabis sales.
      Although there has been some research on state laws that permit cannabis consumption businesses
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      there was no multistate analysis of local onsite consumption laws. This study analyzes state and local laws that allow onsite cannabis consumption businesses to identify how localities approach protecting clean indoor air related to cannabis. Although fully protecting patrons and employees from the health effects of secondhand exposure in smoking areas through engineering controls remains impossible,

      HHS. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: HHS, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. https://www.ncbi.nlm.nih.gov/books/NBK44324/pdf/Bookshelf_NBK44324.pdf. Published 2006. Accessed December 8, 2020.

      ,

      American Society of Heating Refrigerating and Air Conditioning Engineers. ASHRAE position document on environmental tobacco smoke. Atlanta, GA: American Society of Heating Refrigerating and Air Conditioning Engineers. https://no-smoke.org/wp-content/uploads/pdf/ASHRAE_PD_Environmental_Tobacco_Smoke_2019.pdf. Published June 26, 2019. Accessed June 14, 2021.

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      WHO
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      some state and local governments are using ventilation and separation requirements for cannabis smoking lounges, despite the fact that they do not fully protect workers and patrons.

      HHS. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: HHS, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. https://www.ncbi.nlm.nih.gov/books/NBK44324/pdf/Bookshelf_NBK44324.pdf. Published 2006. Accessed December 8, 2020.

      ,

      American Society of Heating Refrigerating and Air Conditioning Engineers. ASHRAE position document on environmental tobacco smoke. Atlanta, GA: American Society of Heating Refrigerating and Air Conditioning Engineers. https://no-smoke.org/wp-content/uploads/pdf/ASHRAE_PD_Environmental_Tobacco_Smoke_2019.pdf. Published June 26, 2019. Accessed June 14, 2021.

      ,
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      https://www.who.int/tobacco/resources/publications/wntd/2007/PR_on_SHS.pdf
      Whether ventilation systems are sufficient to protect nonsmokers from the health effects of SHS has been central to debates over emerging demands to protect nonsmokers since the 1980s.
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      The American Society of Heating, Refrigeration, and Air Conditioning Engineers (ASHRAE) is the professional association that develops technical standards for ventilation and indoor air quality that are often incorporated into municipal building codes in the U.S. In June 2005, ASHRAE modified its Standard 62.1 to acknowledge that some places continued to allow smoking indoors even though it is not possible to produce a ventilation standard that would result in acceptable indoor air quality in smoking areas.

      American Society of Heating Refrigerating and Air Conditioning Engineers. ANSI/ASHRAE Addenda a, b, c, d, and g to ANSI/ASHRAE Standard 62.1-2004. ASHRAE addenda 2006 supplement: ventilation for acceptable indoor air quality. Atlanta, GA: American Society of Heating Refrigerating and Air Conditioning Engineers. https://www.ashrae.org/file%20library/technical%20resources/standards%20and%20guidelines/standards%20addenda/62-1-2004_addendasupplementpackage-a-b-c-d-g.pdf. Published June 30, 2005. Accessed June 18, 2021.

      In the newly added Section 5.19, ASHRAE described how these areas could be constructed to avoid leakage of smoke (which now includes cannabis smoke and emissions from E-cigarettes

      American Society of Heating Refrigerating and Air Conditioning Engineers. ANSI/ASHRAE Standard 62.1-2019: ventilation for acceptable indoor air quality. Atlanta, GA: American Society of Heating Refrigerating and Air Conditioning Engineers. https://www.ashrae.org/technical-resources/bookstore/standards-62-1-62-2. Published November 8, 2019. Accessed June 18, 2021.

      ) into smoke-free areas. In June 2005, ASHRAE also released a position statement elaborating on Standard 62 stating, “At present, the only means of effectively eliminating health risks associated with indoor exposure [to secondhand smoke] is to ban smoking activity.”

      American Society of Heating Refrigerating and Air Conditioning Engineers. Environmental tobacco smoke: position document. Atlanta, GA: American Society of Heating Refrigerating and Air Conditioning Engineers. https://web.archive.org/web/20050805180034/http://www.ashrae.org/content/ASHRAE/ASHRAE/ArticleAltFormat/20058211239_347.pdf. Published June 30, 2005. Accessed June 18, 2021.

      The 2019 version of this document describes the engineering approaches that have been taken to address SHS exposure in buildings.

      American Society of Heating Refrigerating and Air Conditioning Engineers. ASHRAE position document on environmental tobacco smoke. Atlanta, GA: American Society of Heating Refrigerating and Air Conditioning Engineers. https://no-smoke.org/wp-content/uploads/pdf/ASHRAE_PD_Environmental_Tobacco_Smoke_2019.pdf. Published June 26, 2019. Accessed June 14, 2021.

      ASHRAE only recommends 1 engineering approach: a complete ban on indoor smoking. Consistent with ASHRAE, the U.S. Surgeon General in 2006

      HHS. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: HHS, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. https://www.ncbi.nlm.nih.gov/books/NBK44324/pdf/Bookshelf_NBK44324.pdf. Published 2006. Accessed December 8, 2020.

      and WHO in 2007
      WHO
      Protection from exposure to second-hand tobacco smoke: policy recommendations.
      WHO, Geneva, SwitzerlandPublished 2007
      https://www.who.int/tobacco/resources/publications/wntd/2007/PR_on_SHS.pdf
      both acknowledged the inadequacy of ventilation to eliminate exposures of nonsmokers to SHS and recommend 100% smoke-free indoor environments.

      METHODS

      Study Sample

      As detailed in the Appendix (available online), between February and July of 2020, a systematic legal search of Lexis Advance, NewsBank, and government websites for state and local laws that permit and regulate onsite cannabis consumption among the 11 U.S. states that have legalized adult-use cannabis was conducted. The search focused on the 274 local jurisdictions with potentially relevant laws passed between November 6, 2012 (the date of first adult-use legalization) and June 10, 2020 (the study cut off date). Within those identified, there were 56 localities that allowed onsite cannabis consumption businesses in 5 states (Alaska, California, Colorado, Illinois, Michigan).

      Measures

      To assess the strength of clean indoor air laws for these localities, each locality was coded into 1 of the 4 Design and Operation Approaches described in ASHRAE's 2019 Position Document on Environmental Tobacco Smoke.

      American Society of Heating Refrigerating and Air Conditioning Engineers. ASHRAE position document on environmental tobacco smoke. Atlanta, GA: American Society of Heating Refrigerating and Air Conditioning Engineers. https://no-smoke.org/wp-content/uploads/pdf/ASHRAE_PD_Environmental_Tobacco_Smoke_2019.pdf. Published June 26, 2019. Accessed June 14, 2021.

      These approaches are (1) banning smoking indoors, (2) smoking only in isolated rooms, (3) smoking in separate but not isolated spaces, and (4) mixed occupancy of smokers and nonsmokers.

      American Society of Heating Refrigerating and Air Conditioning Engineers. ASHRAE position document on environmental tobacco smoke. Atlanta, GA: American Society of Heating Refrigerating and Air Conditioning Engineers. https://no-smoke.org/wp-content/uploads/pdf/ASHRAE_PD_Environmental_Tobacco_Smoke_2019.pdf. Published June 26, 2019. Accessed June 14, 2021.

      RESULTS

      All of the 11 states and DC where adult-use cannabis has been legalized (Table 1

      The regulation of marijuana, Justia U.S. Law, §17.38.010 et seq. 2019. https://law.justia.com/codes/alaska/2019/title-17/chapter-38/. Accessed September 3, 2020.

      , 

      3 AAC § 306. 370. 2019. http://www.akleg.gov/basis/aac.asp#3.306.370. Accessed September 3, 2020.

      , 

      Cannabis, California Business and professions code – BPC, § 26200 et seq. (2016). https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=BPC&division=10.&title=&part=&chapter=20.&article=. Accessed September 3, 2020.

      , 

      Uniform controlled substances act, California health & safety code – HSC, § 11362.3 et seq. 2017. https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=11362.3.&lawCode=HSC#:~:text=(a)%20Section%2011362.1%20does%20not,where%20smoking%20tobacco%20is%20prohibited. Accessed September 3, 2020.

      , 

      Safety in employment, California Labor code – LAB, § 6404.5 et seq. 2016. https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=LAB&sectionNum=6404.5. Accessed September 3, 2020.

      , 

      Colo. Const. Art. XVIII, Section 16. 2012. https://advance.lexis.com/documentpage/?pdmfid=1000516&crid=3c200054-f11a-4cc3-98de-3d59c8869451&nodeid=AABAATAAS&nodepath=%2FROOT%2FAAB%2FAABAAT%2FAABAATAAS&level=3&haschildren=&populated=false&title=Section+16.+PERSONAL+USE+AND+REGULATION+OF+MARIJUANA&config=0143JAAwODgxYWIyNi1mNGJlLTQwYmItYmE4Ni0yOWY2NzQzMjE3MTAKAFBvZENhdGFsb2ecqetP0coiYGhC4QCG46NJ&pddocfullpath=%2Fshared%2Fdocument%2Fstatutes-legislation%2Furn%3AcontentItem%3A6215-7Y41-JWJ0-G0X3-00008-00&ecomp=_38_kkk&prid=0848edc5-8462-4f38-b544-f8e044ed0058 Published December 10, 2012. Accessed September 3, 2020.

      , 
      Unlawful open and public consumption.
      Colo. Rev Stat. 2019; (§ 44-10-702(1)) (Accessed September 3, 2020)
      https://casetext.com/statute/colorado-revised-statutes/title-44-revenue-regulation-of-activities/marijuana-regulation/article-10-regulated-marijuana/part-7-unlawful-acts/section-44-10-702-unlawful-open-and-public-consumption
      , 

      Colorado General Assembly. House bill 19-1230. Denver, CO: Colorado General Assembly. https://leg.colorado.gov/sites/default/files/documents/2019A/bills/2019a_1230_enr.pdf. Published 2019. Accessed September 3, 2020.

      , 

      Colorado clean indoor air act. Colorado Revised Statutes § 25-14-201 et sq. 2019 https://codes.findlaw.com/co/title-25-health/co-rev-st-sect-25-14-201.html. Accessed September 3, 2020.

      , 

      Colorado marijuana Rules, 1 CCR 212-3. 2019. https://www.sos.state.co.us/CCR/DisplayRule.do?action=ruleinfo&ruleId=3314&deptID=19&agencyID=185&deptName=Department%20of%20Revenue&agencyName=Marijuana%20Enforcement%20Division&seriesNum=1%20CCR%20212-3. Accessed September 3, 2020.

      , 

      DC Code § 48-911.01. 2016. https://law.justia.com/codes/district-of-columbia/2016/title-48/chapter-9a/section-48-911.01/. Accessed September 3, 2020.

      , 

      Cannabis Regulation and Tax Act, Illinois Public Act 101-0027, § 10–35 2019. https://ilga.gov/legislation/publicacts/fulltext.asp?Name=101-0027. Accessed November 7, 2020.

      , 

      Smoke Free Illinois Act. 410 ILCS 82/35 2019. https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2893&ChapterID=35. Accessed September 3, 2020.

      , 

      Adult Use Marijuana Program Rule, C.M.R. 18–691. ch. 1. 2019. https://www.maine.gov/dafs/omp/adult-use/rules-statutes/18-691-C.M.R.-ch.-1. Accessed September 3, 2020.

      , 

      Use of Adult Marijuana and Adult Use Marijuana Products Within Licensed Premises. Maine revised statutes, Title 28-B, § 508. 2017. http://legislature.maine.gov/statutes/28-B/title28-Bch1sec0.html. Accessed September 3, 2020.

      , 

      Chapter 94G: regulation of the use and distribution of marijuana not medically prescribed. The 192nd General Court of the Commonwealth of Massachusetts. https://malegislature.gov/laws/generallaws/parti/titlexv/chapter94g. Accessed September 3, 2020.

      , 

      Gunelius S. Cannabis onsite consumption licenses and social use rules. Cannabiz media.October 3, 2019. https://cannabiz.media/cannabis-onsite-consumption-licenses-and-social-use-rules/. Accessed June 8, 2020.

      , 

      Additional operational requirements for social consumption establishments., 935 Mass. Reg. 500.141. 2019. https://casetext.com/regulation/code-of-massachusetts-regulations/department-935-cmr-cannabis-control-commission/title-935-cmr-500000-adult-use-marijuana/section-500141-additional-operational-requirements-for-social-consumption-establishments. Accessed September 3, 2020.

      , 

      Michigan Regulation and Taxation of Marihuana Act, 333.27951 et seq. 2018. https://www.legislature.mi.gov/documents/mcl/pdf/mcl-Initiated-Law-1-of-2018.pdf. Accessed September 3, 2020.

      , 

      Designated Consumption Establishment Licenses. Mich. Admin. Code. R. 420:22. 2020. https://casetext.com/regulation/michigan-administrative-code/department-licensing-and-regulatory-affairs/marijuana-regulatoty-agency/marihuana-licenses/part-2-special-licenses-under-the-michigan-regulation-and-taxation-of-marihuana-act/section-r-42022-designated-consumption-establishment-license. Accessed September 3, 2020.

      , 

      Nev. Rev Stat § 678D.310. 2019. https://www.leg.state.nv.us/NRS/NRS-678D.html. Accessed September 3, 2020.

      , 

      Nev. Rev Stat § 678B.510. 2019. https://www.leg.state.nv.us/NRS/NRS-678B.html#NRS678BSec510. Accessed September 3, 2020.

      , 

      Prohibition against using marijuana item in public place. ORS. Rev Stat § 475B.381. 2020. https://casetext.com/statute/oregon-revised-statutes/title-37-alcoholic-liquors-controlled-substances-drugs/chapter-475b-cannabis-regulation/recreational-use-of-cannabis/other-provisions/section-475b381-prohibition-against-using-marijuana-item-in-public-place. Accessed September 3, 2020.

      , 

      Marijuana possession by a person 21 years of age or older. 18 V.S.A. § 4230a. 2020. https://legislature.vermont.gov/statutes/section/18/084/04230a. Accessed September 3, 2020.

      , 
      Opening package of or consuming marijuana, useable marijuana, marijuana-infused products, or marijuana concentrates in view of general public or public place—penalty, RCW 69.50.445.
      2012
      https://app.leg.wa.gov/RCW/default.aspx?cite=69.50.445
      , 

      Retail outlets—rules, RCW 69.50.357. 2012. https://app.leg.wa.gov/RCW/default.aspx?cite=69.50&full=true#69.50.357. Accessed September 3, 2020.

      ) prohibit consumption in public places (i.e., places where the public has access or a person could reasonably be expected to be observed by others) but allow cannabis consumption in private residences or private property with the owner's permission if out of public view. A total of 6 states (Alaska, California, Colorado, Illinois, Massachusetts, and Michigan) allow onsite consumption in licensed cannabis consumption businesses subject to local government approval. The remaining 5 states (Maine, Nevada, Oregon, Vermont, and Washington) and DC explicitly prohibit cannabis consumption on the premises of licensed cannabis businesses. No state pre-empts localities from implementing more rigorous regulations for onsite cannabis consumption businesses.
      Table 1Regulations on Public/Onsite Consumption and Requirements for Onsite Consumption Businesses in States That Have Legalized Adult-Use Cannabis
      State code/regs sectionProhibitionsRequirementsNotable features
      Public consumption prohibitedConsumption prohibited in cannabis businessesSeparation between smoking and nonsmoking areasSmoke-free employee viewing areaOdor, visibility outdoor controls
      Alaska
       AK stat.§ 17.38.010 et seq.

      The regulation of marijuana, Justia U.S. Law, §17.38.010 et seq. 2019. https://law.justia.com/codes/alaska/2019/title-17/chapter-38/. Accessed September 3, 2020.

      		✓Establishes Marijuana Control Board in the Department of Commerce as a regulatory and quasijudicial agency.

      Marijuana registration issued by the Marijuana Control Board required to operate retail stores.

      Local government may prohibit the operation of retail marijuana stores by enacting an ordinance or by voter initiative or enact laws governing time, place, manner, and number of establishments.

      Established village may prohibit retail stores by majority vote.

      Consumption is defined as ingesting, inhaling, or otherwise introducing marijuana into the body.
       3 AAC 306.370

      3 AAC § 306. 370. 2019. http://www.akleg.gov/basis/aac.asp#3.306.370. Accessed September 3, 2020.

      		✓✓✓Businesses with an onsite consumption endorsement must be freestanding.

      Unless consumption is outdoors, it requires (1) the consumption area be isolated, separated by walls and a secure door; (2) a smoke-free area for employees to monitor the marijuana consumption area; and (3) a ventilation system that directs air from the marijuana consumption area to the outside of the building through a filtration system sufficient to remove visible smoke and adequate to eliminate odor at the property line.

      If onsite consumption by inhalation is permitted, ventilation plans must be consistent with all applicable building codes and ordinances. However, Alaska has no statewide building codes, so it is left to localities.
      California
       CA Bus & Prof Code § 26200 et seq.

      Cannabis, California Business and professions code – BPC, § 26200 et seq. (2016). https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=BPC&division=10.&title=&part=&chapter=20.&article=. Accessed September 3, 2020.

      		✓Localities may allow for smoking or ingesting cannabis if 3 conditions are met: (1) access restricted to age ≥21, (2) consumption not visible in public, and (3) sale or consumption of alcohol or tobacco prohibited.
       CA health & safety code § 11362.3

      Uniform controlled substances act, California health & safety code – HSC, § 11362.3 et seq. 2017. https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?sectionNum=11362.3.&lawCode=HSC#:~:text=(a)%20Section%2011362.1%20does%20not,where%20smoking%20tobacco%20is%20prohibited. Accessed September 3, 2020.

      		✓Prohibits smoking or ingesting cannabis in public except in accordance with CA Bus & Prof Code § 26200.

      Cannabis, California Business and professions code – BPC, § 26200 et seq. (2016). https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=BPC&division=10.&title=&part=&chapter=20.&article=. Accessed September 3, 2020.



      Prohibits smoking cannabis in locations where the sale or consumption of tobacco is prohibited.

      Retail or wholesale tobacco shops are excluded from the state prohibition against smoking tobacco in most indoor workplaces in California (CA Labor Code § 6404.5.

      Safety in employment, California Labor code – LAB, § 6404.5 et seq. 2016. https://leginfo.legislature.ca.gov/faces/codes_displaySection.xhtml?lawCode=LAB&sectionNum=6404.5. Accessed September 3, 2020.

      ).

      Because cannabis cannot be sold where tobacco is sold, the laws may conflict because smoking is prohibited in all retail stores other than retail tobacco shops, and the exclusion allowing smoking in retail tobacco shops could not logically apply to cannabis retailers.
      Colorado
       Colo. Const., Art. XVIII, §16

      Colo. Const. Art. XVIII, Section 16. 2012. https://advance.lexis.com/documentpage/?pdmfid=1000516&crid=3c200054-f11a-4cc3-98de-3d59c8869451&nodeid=AABAATAAS&nodepath=%2FROOT%2FAAB%2FAABAAT%2FAABAATAAS&level=3&haschildren=&populated=false&title=Section+16.+PERSONAL+USE+AND+REGULATION+OF+MARIJUANA&config=0143JAAwODgxYWIyNi1mNGJlLTQwYmItYmE4Ni0yOWY2NzQzMjE3MTAKAFBvZENhdGFsb2ecqetP0coiYGhC4QCG46NJ&pddocfullpath=%2Fshared%2Fdocument%2Fstatutes-legislation%2Furn%3AcontentItem%3A6215-7Y41-JWJ0-G0X3-00008-00&ecomp=_38_kkk&prid=0848edc5-8462-4f38-b544-f8e044ed0058 Published December 10, 2012. Accessed September 3, 2020.

      C.R.S.§ 44-10-702(1)
      Unlawful open and public consumption.
      Colo. Rev Stat. 2019; (§ 44-10-702(1)) (Accessed September 3, 2020)
      https://casetext.com/statute/colorado-revised-statutes/title-44-revenue-regulation-of-activities/marijuana-regulation/article-10-regulated-marijuana/part-7-unlawful-acts/section-44-10-702-unlawful-open-and-public-consumption
      		✓Prohibits public consumption, including smoking, eating, and vaping.
       HB 19–1230

      Colorado General Assembly. House bill 19-1230. Denver, CO: Colorado General Assembly. https://leg.colorado.gov/sites/default/files/documents/2019A/bills/2019a_1230_enr.pdf. Published 2019. Accessed September 3, 2020.

      		Created exception to public marijuana prohibition in Constitution and C.R.S. § 44-10-702 and to Colorado Clean Indoor Air Act

      Colorado clean indoor air act. Colorado Revised Statutes § 25-14-201 et sq. 2019 https://codes.findlaw.com/co/title-25-health/co-rev-st-sect-25-14-201.html. Accessed September 3, 2020.

      by allowing marijuana consumption at licensed marijuana hospitality and retail marijuana hospitality and sales establishments if approved by local government.
       1 CCR 212–3, 6–700 Series

      Colorado marijuana Rules, 1 CCR 212-3. 2019. https://www.sos.state.co.us/CCR/DisplayRule.do?action=ruleinfo&ruleId=3314&deptID=19&agencyID=185&deptName=Department%20of%20Revenue&agencyName=Marijuana%20Enforcement%20Division&seriesNum=1%20CCR%20212-3. Accessed September 3, 2020.

      		✓Display and consumption of marijuana may not be visible from outside the licensed premises.

      Marijuana hospitality establishments are prohibited from admitting people aged <21 years, distributing free samples, permitting consumption by a patron who appears intoxicated, allowing on-duty employees to consume, allowing alcohol or tobacco to be consumed on premises.

      Must provide informational materials about the safe consumption of marijuana, must not make health claims, and must include warning statements about the harmfulness of using marijuana while pregnant, breastfeeding, or driving.
      District of Columbia
       DC code § 48–911.01

      DC Code § 48-911.01. 2016. https://law.justia.com/codes/district-of-columbia/2016/title-48/chapter-9a/section-48-911.01/. Accessed September 3, 2020.

      		✓✓Criminalizes public smoking or consumption of marijuana and impairment owing to marijuana smoking or consumption.

      Smoking means to inhale, ingest, or otherwise introduce marijuana into the body or to hold or carry lighted smoking equipment filled with marijuana.
      Illinois
       Illinois Public Act 101-0027,§ 10–35

      Cannabis Regulation and Tax Act, Illinois Public Act 101-0027, § 10–35 2019. https://ilga.gov/legislation/publicacts/fulltext.asp?Name=101-0027. Accessed November 7, 2020.

      		✓Using cannabis in a public place is not permitted.

      Creates an exemption to Smoke Free Illinois Act to allow on-premises consumption in specially designated areas with authorization or permission from local government.
       410 ILCS 82/35

      Smoke Free Illinois Act. 410 ILCS 82/35 2019. https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2893&ChapterID=35. Accessed September 3, 2020.

      		✓Requirements for dispensing organizations with onsite consumption: (1) specially designated area for purpose of heating, burning, smoking, or lighting cannabis; (2) age ≥21 years; and (3) locked door or barrier to designated area.
      Maine
       18–691 CMR ch.1

      Adult Use Marijuana Program Rule, C.M.R. 18–691. ch. 1. 2019. https://www.maine.gov/dafs/omp/adult-use/rules-statutes/18-691-C.M.R.-ch.-1. Accessed September 3, 2020.

      		✓Marijuana may only be consumed in the person's private residence (including curtilage) or on private property with the property owner's explicit permission. A violation carries a civil fine of up to $100.
       MRS Title 28-B§ 508

      Use of Adult Marijuana and Adult Use Marijuana Products Within Licensed Premises. Maine revised statutes, Title 28-B, § 508. 2017. http://legislature.maine.gov/statutes/28-B/title28-Bch1sec0.html. Accessed September 3, 2020.

      		✓Permits municipal regulation and licensing of marijuana establishments but prohibits the consumption of adult-use marijuana within licensed premises of a marijuana establishment.
      Massachusetts
       MGL Ch. 94G

      Chapter 94G: regulation of the use and distribution of marijuana not medically prescribed. The 192nd General Court of the Commonwealth of Massachusetts. https://malegislature.gov/laws/generallaws/parti/titlexv/chapter94g. Accessed September 3, 2020.

      		✓Allows local control and regulation, including prohibiting consumption on the premises.

      For the first 2 years, onsite consumption licenses will be awarded only to social equity and economic empowerment businesses.

      Gunelius S. Cannabis onsite consumption licenses and social use rules. Cannabiz media.October 3, 2019. https://cannabiz.media/cannabis-onsite-consumption-licenses-and-social-use-rules/. Accessed June 8, 2020.

       935 CMR 500.141

      Additional operational requirements for social consumption establishments., 935 Mass. Reg. 500.141. 2019. https://casetext.com/regulation/code-of-massachusetts-regulations/department-935-cmr-cannabis-control-commission/title-935-cmr-500000-adult-use-marijuana/section-500141-additional-operational-requirements-for-social-consumption-establishments. Accessed September 3, 2020.

      		✓✓✓Prohibits indoor consumption of combustible products but allows vaping and heated tobacco products (e.g., IQOS).

      Where vaping and other nonsmoking consumption permitted indoors, requires plans ensuring (1) that areas are isolated, separated by walls and a secure door; (2) that employees may monitor from smoke-free, vapor-free area; and (3) that ventilation system directs air from consumption area to outdoors through filtration system sufficient to remove visible vapor, consistent with building codes and ordinances and adequate to eliminate odor.

      Vaping may be permitted in a designated outdoor area if it cannot be viewed by the public.
      Michigan
       MCL 333.27951 et seq.

      Michigan Regulation and Taxation of Marihuana Act, 333.27951 et seq. 2018. https://www.legislature.mi.gov/documents/mcl/pdf/mcl-Initiated-Law-1-of-2018.pdf. Accessed September 3, 2020.

      		✓Consuming marihuana in a public place or smoking marihuana in a private place where prohibited by the owner is prohibited except a public place does not include an area designated for consumption that is not accessible to persons aged <21 years and authorized by a municipality.
       Mich. Admin. Code R 420.22

      Designated Consumption Establishment Licenses. Mich. Admin. Code. R. 420:22. 2020. https://casetext.com/regulation/michigan-administrative-code/department-licensing-and-regulatory-affairs/marijuana-regulatoty-agency/marihuana-licenses/part-2-special-licenses-under-the-michigan-regulation-and-taxation-of-marihuana-act/section-r-42022-designated-consumption-establishment-license. Accessed September 3, 2020.

      		✓✓✓A licensed, designated consumption establishment requires (1) smoke-free area for employees to monitor consumption area; (2) ventilation system that directs air outdoors through a filtration system sufficient to remove visible smoke, consistent with all applicable building codes and ordinances, and adequate to eliminate odor if consumption by inhalation is permitted; and (3) physical separation from areas where smoking is prohibited.
      Nevada
       Nev. Rev Stat § 678D.310

      Nev. Rev Stat § 678D.310. 2019. https://www.leg.state.nv.us/NRS/NRS-678D.html. Accessed September 3, 2020.

      		✓Consuming cannabis in public is a misdemeanor.
       Nev. Rev Stat§ 678B.510

      Nev. Rev Stat § 678B.510. 2019. https://www.leg.state.nv.us/NRS/NRS-678B.html#NRS678BSec510. Accessed September 3, 2020.

      		✓A local government is prohibited from licensing a business that allows the consumption of cannabis on its premises or allowing such a business to operate.
      Oregon
       Or. Rev Stat § 475B.381

      Prohibition against using marijuana item in public place. ORS. Rev Stat § 475B.381. 2020. https://casetext.com/statute/oregon-revised-statutes/title-37-alcoholic-liquors-controlled-substances-drugs/chapter-475b-cannabis-regulation/recreational-use-of-cannabis/other-provisions/section-475b381-prohibition-against-using-marijuana-item-in-public-place. Accessed September 3, 2020.

      		✓✓Unlawful to use marijuana in a public place.
      Vermont
       18 V.S.A.§ 4230a

      Marijuana possession by a person 21 years of age or older. 18 V.S.A. § 4230a. 2020. https://legislature.vermont.gov/statutes/section/18/084/04230a. Accessed September 3, 2020.

      		✓✓Unlawful to consume marijuana in a public place, including places of public accommodation (e.g., schools, restaurants, stores) or where tobacco products or tobacco substitutes (e.g., E-cigarettes) are prohibited.
      Washington
       RCW 69.50.445
      Opening package of or consuming marijuana, useable marijuana, marijuana-infused products, or marijuana concentrates in view of general public or public place—penalty, RCW 69.50.445.
      2012
      https://app.leg.wa.gov/RCW/default.aspx?cite=69.50.445
      		✓Consumption is prohibited in public places.
       RCW 69.50.357

      Retail outlets—rules, RCW 69.50.357. 2012. https://app.leg.wa.gov/RCW/default.aspx?cite=69.50&full=true#69.50.357. Accessed September 3, 2020.

      		✓Consumption is prohibited at licensed retail marijuana outlets.
      Alaska permits onsite cannabis consumption licensing and regulation on a statewide level through its Alcohol and Marijuana Control Board, as long as incorporated local governments do not protest (veto) these establishments. Local governments in Alaska also have the authority to add their own regulations related to onsite consumption on top of state requirements. California, Colorado, Illinois, Massachusetts, and Michigan prohibit onsite consumption unless authorized by local government and allow localities to impose regulations beyond state requirements. In California, onsite consumption businesses must first obtain a California state license to dispense cannabis and must meet 3 basic requirements: access must be restricted to adults aged ≥21 years (consistent with that in all the 6 states that allow onsite consumption), consumption must not be visible in public; and the sale or consumption of alcohol or tobacco is prohibited. Colorado and Vermont prohibit cannabis consumption where tobacco or alcohol is prohibited.
      The 6 states that allow onsite cannabis consumption impose various other regulations. A total of 3 states (Alaska, Massachusetts, and Michigan) require physical separation between cannabis smoking and nonsmoking areas, separate ventilation systems, and a smoke-free area for employees to monitor the consumption area. These states also require local regulations to control cannabis odors outside the premises and ensure that consumption areas are not visible from outside the premises. Illinois requires cannabis businesses to install air treatment systems to reduce odors. All the 6 states restrict access to adults aged ≥21 years. None of these requirements have been proven effective in creating healthy indoor air quality or in eliminating SHCS exposure.
      Illinois’ 2008 Smoke Free Illinois Act was amended to allow onsite cannabis consumption in a designated area of cannabis dispensaries or retail tobacco stores even though it acknowledges ASHRAE's conclusion that “the only means of eliminating health risks associated with indoor exposure is to eliminate all smoking activity indoors” and the Environmental Protection Agency's determination that SHS “cannot be reduced to safe levels in businesses with high rates of ventilation.”

      Smoke Free Illinois Act. ILCS 410:82/5. 2008. https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2893&ChapterID=35#. Accessed September 3, 2020.

      By contrast, Alaska allows ventilation without specific requirements, specifying that if localities permit indoor consumption by inhalation, their ventilation plans must be consistent with applicable building codes,

      Section 3 AAC 306.370(d)(1)(B). 2019. http://www.akleg.gov/basis/aac.asp#3.306.370. Accessed September 3, 2020.

      which are determined by localities.
      California's law (Business and Professions Code Section 26,200) permitting onsite smoking, vaping, and ingestion of cannabis (except where tobacco or alcohol is sold) seems to conflict with its law (Labor Code Section 6,404.5) prohibiting smoking in most indoor workplaces. Smoking tobacco is permitted in retail tobacco shops, but cannabis cannot be sold where tobacco is sold,

      Cannabis, California Business and professions code – BPC, § 26200 et seq. (2016). https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=BPC&division=10.&title=&part=&chapter=20.&article=. Accessed September 3, 2020.

      suggesting that smoking cannabis would be prohibited in all retail shops, including cannabis stores.
      Illinois explicitly permits retail tobacco stores to allow onsite consumption of cannabis in specially designated areas if authorized by the local government.

      Smoke Free Illinois Act. 410 ILCS 82/35 2019. https://www.ilga.gov/legislation/ilcs/ilcs3.asp?ActID=2893&ChapterID=35. Accessed September 3, 2020.

      A total of 4 states (Alaska,

      3 AAC § 306. 370. 2019. http://www.akleg.gov/basis/aac.asp#3.306.370. Accessed September 3, 2020.

      California,

      Cannabis, California Business and professions code – BPC, § 26200 et seq. (2016). https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=BPC&division=10.&title=&part=&chapter=20.&article=. Accessed September 3, 2020.

      Colorado,

      Colo. Rev Stat § 24-14-205 (l). 2019. 2710 https://casetext.com/statute/colorado-revised-statutes/title-25-public-health-and-environment/environmental-control/article-14-control-of-smoking/part-2-colorado-clean-indoor-air-act/section-25-14-205-exceptions-to-smoking-restrictions. Accessed September 3, 2020.

      and Massachusetts

      Additional operational requirements for social consumption establishments., 935 Mass. Reg. 500.141. 2019. https://casetext.com/regulation/code-of-massachusetts-regulations/department-935-cmr-cannabis-control-commission/title-935-cmr-500000-adult-use-marijuana/section-500141-additional-operational-requirements-for-social-consumption-establishments. Accessed September 3, 2020.

      ) explicitly prohibit tobacco consumption on the premises of cannabis consumption businesses, and Michigan prohibits smoking tobacco in places of employment, which includes onsite cannabis consumption businesses.

      Public Health Code (Excerpt), 333.12601 et seq. 2009. http://legislature.mi.gov/doc.aspx?mcl-333-12601. Accessed September 3, 2020;

      Although Massachusetts prohibits indoor consumption of combustible cannabis products, it allows cannabis to be consumed indoors through vaporization or other nonsmoking forms of consumption involving heat.
      Of the 274 local jurisdictions included in the sample from 11 states and DC where adult-use cannabis is legal, 56 in 5 states (Alaska, California, Colorado, Illinois, and Michigan) allowed onsite consumption of cannabis in a licensed business under local laws. Although Massachusetts allows localities to permit onsite cannabis consumption businesses, no local laws allowing them were identified. The remaining 218 localities either explicitly prohibit or are silent on onsite cannabis consumption in licensed businesses.
      The analysis below covers the 56 localities that permit onsite cannabis consumption businesses. These local laws should be interpreted in the context of corresponding state laws that establish minimum requirements. For example, even though the Grand Rapids, Michigan law is silent on ventilation or filtration systems, all licensed consumption establishments there must comply with state law that includes a ventilation system requirement.
      Table 2

      City and town population totals; 2010-2019. U.S. Census Bureau. https://www.census.gov/data/datasets/time-series/demo/popest/2010s-total-cities-and-towns.html. Updated April 6, 2021. Accessed April 1, 2021.

      summarizes the local requirements for onsite cannabis consumption businesses. Each locality was categorized into 1 of ASHRAE's 4 Design and Operation Approaches.

      American Society of Heating Refrigerating and Air Conditioning Engineers. ASHRAE position document on environmental tobacco smoke. Atlanta, GA: American Society of Heating Refrigerating and Air Conditioning Engineers. https://no-smoke.org/wp-content/uploads/pdf/ASHRAE_PD_Environmental_Tobacco_Smoke_2019.pdf. Published June 26, 2019. Accessed June 14, 2021.

      Only 9% (5/56) of the localities that permit onsite cannabis consumption ban indoor cannabis smoking and vaping in cannabis businesses, restricting consumption to outdoor areas or only permitting edible consumption indoors. In total, 23% (13/56) of the localities require indoor smoking and vaping to be in isolated rooms only, meaning that the smoking and nonsmoking areas are physically separated so that smoke cannot drift to the nonsmoking areas.
      Table 2Local Legal Requirements for Cannabis Consumption Businesses in States That Allow Any Public Consumption
      Locality2019 Population estimates
      2019 population estimates from census.gov.57
      		Design and operation approaches

      American Society of Heating Refrigerating and Air Conditioning Engineers. ASHRAE position document on environmental tobacco smoke. Atlanta, GA: American Society of Heating Refrigerating and Air Conditioning Engineers. https://no-smoke.org/wp-content/uploads/pdf/ASHRAE_PD_Environmental_Tobacco_Smoke_2019.pdf. Published June 26, 2019. Accessed June 14, 2021.

      		Additional local code features
      Location requirements: S (combustion), V (includes heating of liquid or solid cannabis), and E.
      Indoor smoking banSmoking only in isolated rooms
      Only San Francisco, California, and Niles, Michigan include requirements for isolating smoking rooms that match some of the technical requirements in ASHRAE Standard 62.1 Section 5.19.
      		Smoking in separate but not isolated spacesNo separation requirements
      This is what ASHRAE calls mixed occupancy between smokers and nonsmokers.
      		Odor control at property lineVentilation or filtration system requiredConsumption of tobacco is prohibitedForms of indoor consumption prohibitedFreestanding buildingIndoor consumption onlyOutdoor consumption only
      Alaska
       Anchorage (unified)288,000XXXXS, VX
       Fairbanks30,917X
       Fairbanks North Star borough96,849X
       Juneau (unified)31,974XS, VS, V
      California
       Adelanto34,049XX
       Alameda77,624XXXS, VX
       Berkeley121,363XXXX
       Calexico39,825XXXX
       Cathedral City55,007XXXXX
       Coachella45,743XX
       Colton54,824XXXX
       Eureka26,710XXX
       Hayward159,203XXX
       Humboldt County135,558XX
       Lemoore26,725XXXX
       Lompoc42,853XXXE
       Mendocino County86,749XS, V, ES, V, E
       Oakland433,031XXS
       Palm Springs48,518XXXX
       Point arena449XS
       San Francisco881,549XXXX
       San Jacinto49,215XXX
       San Leandro88,815XXX
       Santa Rosa176,753XXXS, VS, V if ≥25ft from the building
       Sebastopol7,674XXXS
      Adult-use cannabis is prohibited, but medicinal is allowed here.
      , V
      Adult-use cannabis is prohibited, but medicinal is allowed here.
       Union City74,107XXX
       Weed2,725X
       West Hollywood36,475XXXX
      Colorado
        Black-hawk128XXX
       Colorado Springs478,221XX
       Denver727,211XX
       Glendale5,141XX
      Illinois
       Carpentersville37,254XX
       Collinsville21,652XXX
       E. Dundee3,216X
       Fox Lake9,963X
       Gilman1,652XX
       Indian Head park3,719XX
       Island lake8,020XX
       Jacksonville18,603XX
       Macomb17,413XS
      Medicinal Cannabis is prohibited, but Adult-Use is allowed here. ASHRAE, American Society of Heating, Refrigeration, and Air Conditioning Engineers; E, edibles; S, smoking; V, vaporization.
      , V
      Medicinal Cannabis is prohibited, but Adult-Use is allowed here. ASHRAE, American Society of Heating, Refrigeration, and Air Conditioning Engineers; E, edibles; S, smoking; V, vaporization.
      , E
      Medicinal Cannabis is prohibited, but Adult-Use is allowed here. ASHRAE, American Society of Heating, Refrigeration, and Air Conditioning Engineers; E, edibles; S, smoking; V, vaporization.
       Pingree grove9,874XX
       Rochelle9,052XX
       Springfield114,230XX
       Wheeling38,646X
      Michigan
       Ann Arbor119,980XXX
       Buchanan4,263XXS, V
       Clark township1,976XXXX
       Grand Rapids201,013X
       Kalamazoo76,200XXX
       Lansing118,210XXX
       Marquette20,995XXXX
       Muskegon36,565XXX
       Niles11,149XXX
       Wise township1,385X
       Ypsilanti20,171XX
      Note: A copy of this table, including citations, is available in the Appendix (available online) to the online version of this article at http://www.ajpm.org.
      a 2019 population estimates from census.gov.

      City and town population totals; 2010-2019. U.S. Census Bureau. https://www.census.gov/data/datasets/time-series/demo/popest/2010s-total-cities-and-towns.html. Updated April 6, 2021. Accessed April 1, 2021.

      b Location requirements: S (combustion), V (includes heating of liquid or solid cannabis), and E.
      c Only San Francisco, California, and Niles, Michigan include requirements for isolating smoking rooms that match some of the technical requirements in ASHRAE Standard 62.1 Section 5.19.
      d This is what ASHRAE calls mixed occupancy between smokers and nonsmokers.
      e Adult-use cannabis is prohibited, but medicinal is allowed here.
      f Medicinal Cannabis is prohibited, but Adult-Use is allowed here.ASHRAE, American Society of Heating, Refrigeration, and Air Conditioning Engineers; E, edibles; S, smoking; V, vaporization.
      In total, 16% (9/56) of the localities require smoking to be in separate or designated areas but do not require physical isolation. These places may allow smoking and nonsmoking areas to be in a single larger space or to be serviced by the same air handling system. In this situation, engineering may reduce irritation or odor but cannot effectively limit exposure in nonsmoking areas. In total, 52% (29/56) across all the 5 states do not require separation between smoking and nonsmoking areas. Under this approach, which ASHRAE calls mixed occupancy of smokers and nonsmokers,

      American Society of Heating Refrigerating and Air Conditioning Engineers. ASHRAE position document on environmental tobacco smoke. Atlanta, GA: American Society of Heating Refrigerating and Air Conditioning Engineers. https://no-smoke.org/wp-content/uploads/pdf/ASHRAE_PD_Environmental_Tobacco_Smoke_2019.pdf. Published June 26, 2019. Accessed June 14, 2021.

      smoking may be allowed throughout the space, and there is no effort to isolate smokers.
      Odor control at the property line of cannabis businesses (Table 3) was the most popular local law requirement, with 59% (33/56) of localities requiring either a specific odor control technical requirement (e.g., carbon air filters or controlled air pressure) or a general requirement that odor should not be detectable outside the business. In total, 21 localities (38%) require some form of ventilation or filtration system where onsite consumption is permitted. This requirement varies considerably, from Berkeley, California that mandates that a smoking room should have a “ventilation system capable of removing all detectable odors, smoke and by-products of combustion”

      Berkeley Municipal Code § 12.21.020(U) & (V) 2020. https://www.codepublishing.com/CA/Berkeley/. Accessed September 3, 2020.

      to Adelanto, California that simply asks that smoking lounges be well ventilated.

      Cannabis Dispensaries, CA Code of ordinances § 17.80.120(d) (1)(Q). 2019. https://codelibrary.amlegal.com/codes/adelanto/latest/adelanto_ca/0-0-0-36259. Accessed September 3, 2020.

      Table 3Features of the 56 Local Laws Allowing Onsite Cannabis Consumption Businesses
      FeaturesStateTotal,
      AKCACOILMIn (%)
      Design and operations approaches
       Indoor smoking ban130015 (9)
       Smoking only in isolated rooms1407113 (23)
       Smoking in separate but not isolated spaces041139 (16)
       No separation requirements21335629 (52)
      Odor control at property line11932833 (59)
      Ventilation or filtration system required11310621 (38)
      Consumption of tobacco prohibited onsite11310116 (29)
      Restrictions placed on adult-use and/or medicinal smoking, vaping, or ingestion2701111 (20)
      Freestanding building100708 (14)
      Indoor consumption only030137 (13)
      Outdoor consumption only120003 (5)
      AK, Alaska; CA, California; CO, Colorado; IL, Illinois; MI, Michigan.
      Localities also limit what kinds of products may be used onsite. In total, 29% (16/56) prohibit any consumption of tobacco onsite. In total, 80% (45/56) allow all forms of indoor cannabis consumption, whereas the remaining 20% (11/56) prohibit ≥1 form of cannabis consumption.
      In total, 14% (8/56) of localities require that the building where cannabis consumption occurs be freestanding, meaning that it does not share a wall or connection with another building, to stop smoke from migrating into adjacent buildings. Doing so would stop smoke from migrating into adjacent buildings via passages, ventilation systems, plumbing, or walls.
      In total, 13% (7/56) of the localities require all forms of consumption to be indoors, eliminating the possibility that a business in these areas would move consumption outdoors. By contrast, 5% (3/56) of the localities restrict smoking and vaping of cannabis in licensed businesses to outdoor areas only, presumably resolving indoor air quality concerns.

      DISCUSSION

      There is wide variation in how state and local governments address SHCS exposure in cannabis consumption businesses. Although the only effective means of preventing the health problems associated with SHCS is to require a smoke-free environment,

      HHS. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: HHS, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. https://www.ncbi.nlm.nih.gov/books/NBK44324/pdf/Bookshelf_NBK44324.pdf. Published 2006. Accessed December 8, 2020.

      ,

      American Society of Heating Refrigerating and Air Conditioning Engineers. ASHRAE position document on environmental tobacco smoke. Atlanta, GA: American Society of Heating Refrigerating and Air Conditioning Engineers. https://no-smoke.org/wp-content/uploads/pdf/ASHRAE_PD_Environmental_Tobacco_Smoke_2019.pdf. Published June 26, 2019. Accessed June 14, 2021.

      ,
      WHO
      Protection from exposure to second-hand tobacco smoke: policy recommendations.
      WHO, Geneva, SwitzerlandPublished 2007
      https://www.who.int/tobacco/resources/publications/wntd/2007/PR_on_SHS.pdf
      most local laws that permit onsite cannabis consumption businesses either do not address SHCS or use ineffective ventilation or engineering requirements.
      The 56 identified localities fell across the spectrum of Design and Operation Approaches described by ASHRAE,

      American Society of Heating Refrigerating and Air Conditioning Engineers. ASHRAE position document on environmental tobacco smoke. Atlanta, GA: American Society of Heating Refrigerating and Air Conditioning Engineers. https://no-smoke.org/wp-content/uploads/pdf/ASHRAE_PD_Environmental_Tobacco_Smoke_2019.pdf. Published June 26, 2019. Accessed June 14, 2021.

      with only 9% (5/56) requiring that indoors be smoke-free (including vaping and other inhaled forms of cannabis). The 23% (13/56) of local governments that provide for smoking in isolated rooms only do so through functional requirements, requiring that smoke not drift to nonsmoking areas or that there be a smoke-free employee viewing area. This approach can control cannabis smoke exposure in nonsmoking spaces in the same building if executed properly but does not protect employees and patrons from SHCS exposure in smoking areas. The remaining local approaches do not protect nonsmokers from SHCS because they do not require physical separation of smoking and nonsmoking areas.

      American Society of Heating Refrigerating and Air Conditioning Engineers. ASHRAE position document on environmental tobacco smoke. Atlanta, GA: American Society of Heating Refrigerating and Air Conditioning Engineers. https://no-smoke.org/wp-content/uploads/pdf/ASHRAE_PD_Environmental_Tobacco_Smoke_2019.pdf. Published June 26, 2019. Accessed June 14, 2021.

      They resemble the tobacco industry's accommodation framework by inviting smoke inside and positioning ventilation or engineering controls as solving SHS.
      • Bialous SA
      • Glantz SA
      ASHRAE Standard 62: tobacco industry's influence over national ventilation standards.
      Tob Control. 2002; 11: 315-328https://doi.org/10.1136/tc.11.4.315
      ,
      • Dearlove JV
      • Bialous SA
      • Glantz SA.
      Tobacco industry manipulation of the hospitality industry to maintain smoking in public places.
      Tob Control. 2002; 11: 94-104https://doi.org/10.1136/tc.11.2.94
      Ventilation system requirements are often vague, requiring systems to remove visible smoke, remove smoke, or provide reasonable mechanical smoke elimination. These requirements ignore the fact that ventilation cannot eliminate the health risks from SHS exposure when smoking is present.

      HHS. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: HHS, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. https://www.ncbi.nlm.nih.gov/books/NBK44324/pdf/Bookshelf_NBK44324.pdf. Published 2006. Accessed December 8, 2020.

      ,

      American Society of Heating Refrigerating and Air Conditioning Engineers. ASHRAE position document on environmental tobacco smoke. Atlanta, GA: American Society of Heating Refrigerating and Air Conditioning Engineers. https://no-smoke.org/wp-content/uploads/pdf/ASHRAE_PD_Environmental_Tobacco_Smoke_2019.pdf. Published June 26, 2019. Accessed June 14, 2021.

      ,
      WHO
      Protection from exposure to second-hand tobacco smoke: policy recommendations.
      WHO, Geneva, SwitzerlandPublished 2007
      https://www.who.int/tobacco/resources/publications/wntd/2007/PR_on_SHS.pdf
      In total, 77% (43/56) of the localities that allow onsite consumption are in states that prohibit tobacco consumption at onsite cannabis consumption businesses (Alaska, California, Colorado, Massachusetts, and Michigan). From an air quality perspective, there is no distinction between cannabis smoke and tobacco smoke, but this provision may discourage the co-use of tobacco and cannabis. Cannabis use predicts tobacco use onset,
      • Weinberger AH
      • Delnevo CD
      • Wyka K
      • et al.
      Cannabis use is associated with increased risk of cigarette smoking initiation, persistence, and relapse among adults in the United States.
      Nicotine Tob Res. 2020; 22: 1404-1408https://doi.org/10.1093/ntr/ntz085
      and co-use is associated with higher toxicant exposure
      • Meier E
      • Vandrey R
      • Rubin N
      • et al.
      Cigarette smokers versus cousers of cannabis and cigarettes: exposure to toxicants.
      Nicotine Tob Res. 2020; 22: 1383-1389https://doi.org/10.1093/ntr/ntz199
      and decreased smoking cessation.
      • McClure EA
      • Baker NL
      • Hood CO
      • et al.
      Cannabis and alcohol co-use in a smoking cessation pharmacotherapy trial for adolescents and emerging adults.
      Nicotine Tob Res. 2020; 22: 1374-1382https://doi.org/10.1093/ntr/ntz170
      Illinois allows tobacco and cannabis to be consumed at the same business location, and no local laws in Illinois prohibiting this activity were found.
      A requirement that onsite cannabis consumption businesses operate in freestanding buildings would limit smoke contamination of adjacent buildings but does nothing for the business's occupants. Requiring cannabis consumption to be indoors only may keep consumption out of the public eye but does not prevent all the harms from SHCS. Alternatively, local code requirements to keep cannabis consumption exclusively outdoors may serve to normalize smoking if in public view.
      This study contributes to a growing body of literature concerning onsite cannabis consumption businesses. These findings expand on those of previous studies that identified onsite cannabis consumption laws in 3 states
      • Steinberg J
      • Unger JB
      • Hallett C
      • Williams E
      • Baezconde-Garbanati L
      • Cousineau MR.
      A tobacco control framework for regulating public consumption of cannabis: multistate analysis and policy implications.
      Am J Public Health. 2020; 110: 203-208https://doi.org/10.2105/AJPH.2019.305423
      (Alaska, California, and Colorado) and 27 California local governments
      • Silver LD
      • Naprawa AZ
      • Padon AA.
      Assessment of incorporation of lessons from tobacco control in city and county laws regulating legal marijuana in California.
      JAMA Netw Open. 2020; 3e208393https://doi.org/10.1001/jamanetworkopen.2020.8393
      (using a different methodology), and this study is the first to examine state and local laws in Illinois and Michigan and to characterize the strength and characteristics of each local law.
      The growing number of localities permitting onsite cannabis consumption businesses to bypass clean indoor air laws is concerning from a disease prevention perspective. Some advocates argue that designating indoor locations for renters, tourists, and people experiencing homelessness to smoke or vape cannabis is the only reasonable alternative to illegally consuming in public or exposing nonsmokers to SHCS. However, similar to tobacco,
      • Hafez AY
      • Gonzalez M
      • Kulik MC
      • Vijayaraghavan M
      • Glantz SA.
      Uneven access to smoke-free laws and policies and its effect on health equity in the United States: 2000-2019.
      Am J Public Health. 2019; 109: 1568-1575https://doi.org/10.2105/AJPH.2019.305289
      by normalizing indoor smoking and exposing employees and customers to SHCS, these businesses may promote more smoking and fail to reduce overall exposure to SHCS. State and local governments have an opportunity to model strong preventative health standards by banning indoor smoking and vaping in onsite cannabis consumption businesses. Despite the challenge inherent in maintaining strong clean indoor air laws in the face of the increasingly powerful cannabis industry,
      • Barry RA
      • Glantz SA.
      Lessons from tobacco for developing marijuana legalization policy.
      UCSF Center for Tobacco Control Research and Education, San Francisco, CAPublished January 11, 2017
      https://escholarship.org/uc/item/87j477b7
      health advocates must ensure that public health is protected.
      • Orenstein DG
      • Glantz SA.
      The grassroots of grass: cannabis legalization ballot initiative campaign contributions and outcomes, 2004-2016.
      J Health Polit Policy Law. 2020; 45: 73-109https://doi.org/10.1215/03616878-7893579
      State and local laws should reflect the reality that ventilation, odor control, and other engineering features cannot adequately protect the public and employees from SHCS.

      HHS. The health consequences of involuntary exposure to tobacco smoke: a report of the Surgeon General. Atlanta, GA: HHS, Centers for Disease Control and Prevention, Coordinating Center for Health Promotion, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. https://www.ncbi.nlm.nih.gov/books/NBK44324/pdf/Bookshelf_NBK44324.pdf. Published 2006. Accessed December 8, 2020.

      ,

      American Society of Heating Refrigerating and Air Conditioning Engineers. ASHRAE position document on environmental tobacco smoke. Atlanta, GA: American Society of Heating Refrigerating and Air Conditioning Engineers. https://no-smoke.org/wp-content/uploads/pdf/ASHRAE_PD_Environmental_Tobacco_Smoke_2019.pdf. Published June 26, 2019. Accessed June 14, 2021.

      ,
      WHO
      Protection from exposure to second-hand tobacco smoke: policy recommendations.
      WHO, Geneva, SwitzerlandPublished 2007
      https://www.who.int/tobacco/resources/publications/wntd/2007/PR_on_SHS.pdf
      Reasonable alternatives to permitting indoor cannabis smoking and vaping may include permitting outside, out-of-view cannabis use at retailers or allowing only the use of non-inhalable modes of administration that do not pollute the air. If all onsite use is prohibited, local governments may encourage multiunit housing or other places serving these groups with fewer options (i.e., renters, the unhoused, and tourists) to create outdoor, designated smoking areas out of view of the public. To avoid conflicts with tobacco prevention program efforts around smoke-free multiunit housing, it is important that all indoor areas remain smoke free. If smoking or vaping is permitted indoors, smoking rooms must be completely isolated from nonsmoking areas as specified in ASHRAE Standard 62.1 Section 5.19 so that people are exposed to the least amount of SHCS possible.

      Limitations

      The study only examines the fully enacted laws passed by June 10, 2020 and does not include ballot initiatives from 4 states (Arizona, Montana, New Jersey, and South Dakota) that legalized adult-use cannabis in November 2020 or subsequent legalization in other states. These laws have not yet been implemented, making it impossible to determine whether onsite consumption businesses will be permitted. How onsite consumption laws are being implemented and enforced was outside the study scope. Laws governing cannabis consumption lounges on tribal lands such as those allowed on the Las Vegas Tribe of Paiute Indian land
      • Jones J.
      At this Vegas cannabis lounge, you can try before you buy despite state law.
      Los Angeles Times. November 12, 2019; (Accessed November 12, 2019)
      https://www.latimes.com/travel/story/2019-11-12/vegas-cannabis-lounge-legal-consumption
      were not included because they fall outside state governance.

      CONCLUSIONS

      Onsite cannabis consumption businesses are subject to a broad range of unique state and local requirements. Unfortunately, most state and local laws that allow onsite consumption do not protect clean indoor air. Strong smoke-free cannabis laws, such as smoke-free tobacco laws, can reduce the health burdens of SHCS. Policymakers may be unaware that ventilation and other engineering interventions cannot fully protect workers and patrons. Health authorities and local leaders should educate policymakers on the science of SHS remediation and advocate for the same standards for secondhand cannabis smoking and vaping that apply to tobacco, particularly because other cannabis administration modes do not pollute the air. Where onsite smoking or vaping is permitted, even measures such as truly separate indoor and outdoor smoking areas may reduce but not eliminate SHCS exposure to patrons, staff, and residents.

      ACKNOWLEDGMENTS

      The authors thank Dorie Apollonio for her review of the manuscript and suggestions.
      The funding agency played no role in the conduct of the research or in the preparation of the manuscript.
      This work was supported by National Institute on Drug Abuse Grant DA-043950.
      TLR developed the study design; collected, analyzed, and interpreted local and state laws; and drafted the initial manuscript. LKL collected and interpreted state laws and assisted in drafting and revising the manuscript. SAG obtained funding, oversaw the study procedure, and reviewed and revised the manuscript. TLR contributed to the study conceptualization, methodology, formal analysis, investigation, data curation, and visualization and to the writing (original draft preparation) of the paper. LKL contributed to the study methodology, formal analysis, investigation, and visualization and to the writing (review and editing) of the paper. SAG contributed to the study conceptualization, methodology, formal analysis, investigation, resources, visualization, supervision, and project administration and to the writing (review and editing) of the paper.
      The contents of this article were presented in a poster session at the 2020 American Public Health Association annual meeting.
      No financial disclosures were reported by the authors of this paper.

      Appendix. SUPPLEMENTAL MATERIAL

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      Published online: August 13, 2021

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