Dispensary warning signs about cannabis use during pregnancy found ineffective

Warning signs at dispensaries about the potential health effects of cannabis use in pregnancy may not be effective, according to a new report in the Journal of Studies on Alcohol and Drugs, based at Rutgers University. In fact, those who are pregnant and using cannabis may actually distrust the content of warning signs altogether.

"Mandatory warning signs aren't working," says lead researcher Sarah C. M. Roberts, DrPH, of the University of California, San Francisco. In fact, some of the respondents "saw the signs as having stigmatizing or negative effects on pregnant people who use cannabis, leading them to avoid health care."

Although the exact effects of cannabis use in pregnancy are not as well known as with alcohol and other drugs, research indicates it is linked to increased risk of low birth weight as well as increased risk of cognitive, behavioral and emotional issues in offspring.

With nearly half of U.S. states now having legalized recreational cannabis, there is an increased need to provide the public with evidence-based information about the effects of cannabis use in pregnancy. However, how best to communicate this information to those who are pregnant is up for debate.

To address this, five states that legalized recreational cannabis have instituted "point-of-sale" signs at cannabis dispensaries-similar to the alcohol warning signs that are posted in bars, restaurants and liquor stores.

But are these warnings effective? To find out, Roberts and colleagues interviewed 34 pregnant or recently pregnant individuals who had used cannabis before or during pregnancy. The researchers asked for reactions to specific cannabis warnings as well as about people's overall experiences with and views about warning signs. They analyzed the answers, synthesizing the responses into overall themes.

Participants reacted differently to different messages. Some warnings they tended to view as negative ("There is no safe level of cannabis use during pregnancy"), some they had mixed views about ("Morning sickness? There are healthier options than cannabis") and some they viewed more positively ("Do your own research on cannabis and pregnancy. Here's one place to start. . .").

Overall, more than half of the respondents had only negative reactions to the warning signs and questioned whether the scientific evidence about cannabis and pregnancy was strong enough to justify the warnings. "People who use cannabis do not trust the information in warning signs," says Roberts.

Three specific themes emerged. First, more than half said such signs were not useful or relevant and that the warnings could lead those who are pregnant to avoid health care because of a "shaming effect."

Second, 18 of the 34 participants said there was not enough scientific evidence about the effects of cannabis use during pregnancy to justify the warnings.

Third, just under half (16 participants) said that the warning signs would not be effective and simply would not deter anyone from using cannabis while pregnant.

Health officials need to "listen to the needs and preferences of pregnant people who use cannabis as they develop and test public health messages," Roberts says, and not assume that any one type of warning will be effective or useful universally.