Review highlights opportunities to enhance effectiveness of warnings to improve public health.
ATLANTA— A growing number of states have legalized recreational marijuana use, but a lack of consistency in warning consumers of potential harms threatens public health.
That’s one of many takeaways from a review article authored by a Georgia State University School of Public Health researcher and her colleagues that examines the impact of warning labels on tobacco, cannabis and prescription opioids. The article appears in the early online edition of the journal Annual Review of Public Health.
Lucy Popova, associate professor in the Department of Health Policy and Behavioral Sciences, emphasized that lessons learned from decades of domestic and international research on tobacco warning labels can inform better policies for all three substances.
“The purpose of the paper is to bring these diverse and siloed areas together to give researchers and policymakers information that can help them create messages that are clear and understandable,” Popova said. “By improving warning labels, we can improve public health.”
Popova and her colleagues note that the legalization of recreational cannabis use in more than 20 states has led many consumers to believe that it is not very harmful. Although cannabis has demonstrated health benefits in certain medical situations, such as reducing nausea for cancer patients, it can impair motor function and increase the risk of car crashes when consumed with alcohol. Its impact on lung cancer is unclear, Popova said, because until recently most cannabis smokers also smoked tobacco.
Consumers are either unaware of or underestimate the health risks of cannabis, Popova and her colleagues note, which highlights the importance of informing the public about them. Warning labels on cannabis products vary by state, but Popova said they are typically text-based and are likely to be overlooked by consumers.
For cigarettes, research shows that large pictorial warning labels, with graphic images of people with gangrene, lung cancer and other illnesses associated with smoking, and the use of plain packaging without logos are effective at increasing perceptions of the harms of tobacco and influencing behavior. Efforts by the Food and Drug Administration to strengthen cigarette warning labels have been mired in legal challenges from the tobacco industry, however, and the warning labels American smokers see today haven’t changed since 1985.
Electronic cigarettes, also known as vapes, are still relatively new. Their long-term health harms are unknown, so warnings in the U.S. simply inform users about the presence of nicotine with text such as, “This product contains nicotine. Nicotine is an addictive chemical.”
In contrast, electronic cigarettes in Canada warn that “Vaping products release chemicals that may harm your health.” Israel, the Netherlands and the Canadian providence of British Columbia require plain packaging for e-cigarettes.
The FDA requires that prescription opioids carry what is known as a “black box warning,” which note that opioids hold serious risks of misuse and abuse, which can lead to addiction, overdose and even death. The FDA recently mandated that opioid medication packaging include a recommendation that patients and caregivers discuss naloxone — a potentially life-saving opioid-involved overdose reversal medication — with their clinician. The challenge, Popova and her colleagues note, is that these messages are typically found in the lengthy package inserts that come with prescription medications filled at pharmacies and are likely to be overlooked.
“Warning labels, when combined with public education campaigns and effective policies, can play an important role in protecting consumers from harm,” Popova said. “In light of the growing number of cannabis users and a persistently high level of opioid overdoses, we need more research that examines how warnings impact perceptions and behavior. We also need regulatory agencies to put that research into practice.”
