Warning Labels as a Public Health Intervention: Effects and Challenges for Tobacco, Cannabis, and Opioid Medications

Abstract

Warning labels help consumers understand product risks, enabling informed decisions. Since the 1966 introduction of cigarette warning labels in the United States, research has determined the most effective message content (health effects information) and format (brand-free packaging with pictures). However, new challenges have emerged. This article reviews the current state of tobacco warning labels in the United States, where legal battles have stalled pictorial cigarette warnings and new products such as electronic cigarettes and synthetic nicotine products pose unknown health risks. This article describes the emerging research on cannabis warnings; as more places legalize recreational cannabis, they are adopting lessons from tobacco warnings. However, its uncertain legal status and widespread underestimation of harms impede strict warning standards. The article also reviews opioid medication warning labels, suggesting that lessons from tobacco could help in the development of effective and culturally appropriate FDA-compliant opioid warning labels that promote safe medication use and increased co-dispensing of naloxone.

Keywords: cannabis; opioid medications; tobacco; warning labels.

Figure 1

Proposed warning labels on cigarette packs and cigarette sticks, Canada. Figure adapted with permission from Health Canada.

Figure 2

Cannabis warning labels from (a) Colorado, (b) Missouri, and (c) Canada. Canada (like Uruguay) requires cannabis products to be sold in plain packaging. Panel c reproduced with permission from Health Canada.

Figure 3

FDA boxed warning for immediate-release and extended-release/long-acting opioid analgesics’ packaging and inserts (from https://www.fda.gov/media/167056/download).