More than half of all U.S. states have legalized cannabis,2 fueled by therapeutic use, social acceptance, a desire for relaxed drug policies, enforcement skepticism, potential tax revenues, and racial justice concerns. The commercial markets created by state legalization require the development of complex policies—surrounding cultivation, processing and manufacturing, distribution, marketing, and sales—to promote public health and health equity. Because cannabis is illegal federally, the federal government has had minimal involvement in cannabis policies within the states. The limited federal guidance on cannabis has focused on its sale—not on public health.Further, federal policies have complicated the efforts of state governments to develop cannabis policies that protect public health. These federal policies include the 2018 Agriculture Improvement Act (2018 Farm Bill), which removed hemp and other cannabinoids from the Controlled Substances Act, creating a lucrative industry for intoxicating cannabis products designated legally as hemp.3 Public health leadership on cannabis policy is needed, not just in those states with legalized cannabis but nationwide.