Background Recreational cannabis legalization has expanded rapidly across US states. The regulatory approaches states adopt vary widely, with varying implications for public health. This study aimed to characterize heterogeneity in recreational cannabis laws (RCLs) across US states and to identify state-level characteristics associated with these regulatory models.

Methods We conducted Latent Class Analysis (LCA) of state-year RCL provisions from 2013 to 2024 (n=612) to identify distinct RCL approaches. Descriptive analyses and exploratory multinomial regression analyses were used to examine correlations between state characteristics and RCL approaches from 2020 to 2024, when sufficient cross-state variation in RCL adoption was available.

Eleven recreational cannabis policy provisions spanning governance, potency limits, consumption restrictions, access controls, taxation, marketing regulations, and driving prohibitions are primarily from the Alcohol Policy Information System. State-level characteristics included cannabis use prevalence, market conditions, medical cannabis history, political factors, demographic, and socioeconomic covariates obtained from multiple secondary data sources.

Results We identified four latent classes of state-year RCL provisions representing different regulatory approaches: No RCL, Pre-commercial, Full Access, and Dispensary Access. The No RCL corresponded to state-years without RCL. The Pre-commercial class represented state-years in early-stage legalization with a minimal regulated approach in terms of commercial infrastructure. The Full Access class was characterized by permitting on-site retail consumption and home delivery and restricting (but not prohibiting) public use. In contrast, the Dispensary Access class limited retail sales to off-site consumption only, prohibited public use, and imposed stricter market controls.

Higher past-month cannabis use prevalence was associated with a greater likelihood of membership in the Full Access class (RRR = 1.78; 95% CI: 1.21–2.62), relative to No RCL. A longer duration since medical cannabis legalization was associated with a higher likelihood of membership in the Dispensary access class (RRR = 1.47; 95% CI: 1.02–2.12). Higher beer excise taxes were associated with a lower likelihood of membership in any RCL class relative to No RCL.

Conclusions From 2013 to 2024, US recreational cannabis regulations clustered into four distinct regulatory approaches, with two distinct commercial models: one permitting on-site retail consumption and home delivery, the other restricting sales to off-premises only and prohibiting public use. Higher cannabis use prevalence and longer medical cannabis history were associated with more access-oriented and more restrictive commercial approaches, respectively.

The authors have declared no competing interest.

Dr. Ellicott C Matthay was supported in part by the National Institute for Alcohol Abuse and Alcoholism (grant number R00AA028256)

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