Millions of New Yorkers consume cannabis; far fewer understand details, such as content and dosage

BUFFALO, N.Y. — In 2023, about 2 million adults in New York state reported consuming some form of cannabis.

However, only a small portion has a full understanding of cannabis products labeling, which includes ingredients, dosages and if they were legally produced in New York, according to a recent study led by Daniel J. Kruger, PhD, research associate professor of community health and health behavior in the University at Buffalo School of Public Health and Health Professions.

Kruger and a small team of researchers administered an online survey last fall to almost 200 adult cannabis users in New York. They were recruited from dispensaries and social media to gauge consumer understanding of required cannabis product labeling.

Participants stated a mix of recreational use and therapeutic use, with almost 40% using cannabis to treat medical conditions or reduce their reliance on pharmaceuticals or other substances.

The researchers’ findings from those surveys were published in the June edition of Psychoactives.

Kruger, who also serves as a research scientist with UB’s Clinical and Research Institute on Addictions, has conducted previous studies of cannabis and its effect on public health. He says this particular study stemmed from a discussion with Mark Schlueter, sales director and general manager of the Buffalo-based cannabis dispensary Premier Earth, who expressed concerns regarding consumer understanding of cannabis product labels.

All products sold in New York must display the universal cannabis symbol — a bright yellow equilateral triangle with a black stylized cannabis leaf and the letters “THC!” boldly displayed in black on the main panel of the packaging, letting consumers know the presence of tetrahydrocannabinol, a psychoactive compound that makes people feel high. These symbols are often displayed on the front of dispensary stores, including the entrance doors

In addition, labels must clearly state the total THC and cannabidiol (CBD) content per serving and per package, along with the number of servings, net weight or volume. A scannable quick response (QR) code is also required to provide access to the product’s Certificate of Analysis (COA).

“COA is a laboratory-issued document that shows exactly what is in cannabis products. The required testing for the COA helps guarantee that you are not buying a product that contains anything harmful,” Kruger says. “There was one study, commissioned by a cannabis industry organization, showing that gray market products sold at unregulated stores contained mold, heavy metals and industrial solvents. Products sold in dispensaries are required to have testing and COAs.”

Some of the survey respondents showed little knowledge of the risks, including THC levels in the products they purchase.

“Different forms of cannabis contain varying amounts of THC and produce different effects, which people may not realize until it’s too late,” Kruger says. “You hear stories about people who take way too much and have a panic attack. Usually, they are consuming edibles and don’t realize that it could take an hour or more to feel the effect.”

Also, on cannabis products sold in New York, there are two additional required symbols: a clear “21+” in a red circle to indicate that the product is intended exclusively for adults, and an outline image of the state, with the words “New York State,” highlighting that it’s a legal product produced and sold within New York.

However, three-quarters of the survey participants incorrectly selected the symbol required in California when asked to identify the labels required on New York-regulated cannabis products.

“This suggests that people are still purchasing a considerable amount of cannabis from the black market,” Kruger says. “These products may be legal products shipped from California or illicit cannabis mimicking California products. With illicit products, you do not really know what you are getting. That is why it is safer to buy from licensed dispensaries.”

The findings were a bit surprising, Kruger says, considering that New York legalized recreational cannabis use for adults in March 2021. And, since the first dispensary opened at the end of 2022, “weed stores” are ubiquitous, selling everything from cigarettes to tinctures to edibles.

Overall, the legalization of cannabis products for medical use in 40 U.S. states and adult recreational use in 24 states may give people a false sense of security, especially when the products come in professional-looking packages, Kruger says.

“We have the additional challenge that people may not trust the government as a source of information about cannabis,” he says. “They may have been warned that it’s addictive or a gateway drug. But they try it and have a good time. This makes it difficult to convince people that there are genuine risks and potential harms.”

While labels are intended to protect consumers, this study indicates they are not sufficient.

“States, such as New York, with legal adult-use and medical-use cannabis should consider public education and outreach opportunities to ensure consumers are aware of proper labeling practices and understand the meaning and implications of COA results,” Kruger points out. “Similarly, continued research is necessary to determine optimal strategies for community cannabis production information to both experienced and naïve consumers.”

Co-authors on the study were Jessica S. Kruger, PhD, clinical associate professor of community health and health behavior, and Nicholas Felicione, PhD, assistant professor of community health and health behavior, both within the School of Public Health and Health Professions, along with Schlueter.