Behavioral Health Risks and State Strategies Related to Increasingly Potent and Accessible Psychoactive Products

On August 26, 2026, the NGA Health team convened state and territory health policy advisors to discuss how they are addressing the rapidly evolving market for psychoactive substances. The call featured Dr. Lynn Silver, Program Director at the Public Health Institute, to share her expertise on trends in cannabis potency, behavioral health considerations in relation to the frequent usage of high-potency substances, and potential policy levers for states to look at when addressing these health concerns. The discussion covered high-potency cannabis, intoxicating hemp products and emerging psychoactive substances such as kratom.

As the market for psychoactive products has expanded, consumers now have access to a wider range of cannabis, hemp-derived and other intoxicating products. This includes high-potency cannabis flower; concentrated THC products such as vapes and shatter; edibles; intoxicating hemp-derived cannabinoid items such as THC-containing vapes, pre-rolls, infused gummies, and beverages; as well as other intoxicating products like kratom and synthetic kratom alkaloids. These products have raised several concerns, including youth exposure, dependency, acute and long-term adverse physical and mental health effects, delayed onset of effects from edibles, consumer misunderstandings about serving sizes and dosages, and the availability of high-potency products outside traditional regulatory frameworks.

Key Takeaways

• High-potency cannabis is emerging as a public health concern due to higher-potency products, increased availability and frequent use. The public health issue stems from the interaction of product design, dose, frequency of use and individual vulnerability.
• Psychoactive substances have become increasingly appealing to children and young adults through packaging featuring cartoons, food imagery, action/adventure appeals, discounts, and colors or shapes that attract children.
• Frequent use of high-potency products heightens the risk of cannabis use disorder and adverse mental health outcomes, ranging from acute anxiety, panic, and memory impairment to serious harms such as psychosis, schizophrenia, and mood disorders.
• States are working to find effective ways to regulate potency, highlighting that emerging research is being used to shape current legislative conversations.
• Hemp-derived psychoactive products remain a growing concern, particularly as federal proposals could preserve or expand access to hemp-derived THC beverages by regulating them through alcohol-style distribution and retail frameworks.
• Kratom and 7-OH regulation is becoming an active state policy issue. Kratom, along with highly concentrated kratom-derived products, is a growing area of concern due to their opioid-like effects and potential for addiction. Many kratom products now contain elevated levels of a more potent synthesized chemical called 7-hydroxymitragynine (7-OH). These products have been available at gas stations and smoke shops, and states are beginning to adopt legislative approaches that include regulation, restrictions and bans.

Recent Legislation

Cannabis Policy

In 2024, the California Department of Health convened a group of scientists and experts as part of California Gov. Gavin Newsom's directive to address the problem of increasing potency of cannabis products. The group released a report recommending 20 state policy actions.

Intoxicating Hemp Product Policy

In May of 2026, Gov. J.B. Pritzker of Illinois signed SB 3222. The bill bans the sale of intoxicating hemp products to people under the age of 21. The action comes in response to reports of minors using these substances and the prevalence of packaging that may be misleading or appealing to children. The bill will require childproof packaging, ban misleading marketing and packaging that appeals to children, and ensure that existing cannabis regulatory frameworks will apply to intoxicating hemp products.

In May of 2026, Gov. Mikie Sherrill of New Jersey signed bill A4791, tightening controls on intoxicating hemp products such as Delta 8 THC, THC-P, HHC and other intoxicating hemp-derived cannabinoids. The bill will prohibit the sale of hemp-derived products with cannabinoids not naturally found in cannabis and establishes a restrictive THC limit for hemp cannabinoid products.

Kratom Policy

In August 2026, Massachusetts Gov. Maura Healey announced an emergency order restricting the sale of kratom across the state and enhancing public education and outreach to inform residents about health risks and connect individuals with treatment and recovery services. Associated health effects of kratom may include seizures, hallucinations, psychosis, physical dependence and withdrawal symptoms. Highly concentrated products such as 7-OH increase the risk of overdose.

In August 2026, Gov. Kelly Armstrong of North Dakota issued an executive order declaring a state of emergency in response to the public health crisis resulting from the sale, possession, and use of kratom, mitragynine, and 7-OH and related derivatives and called a special session for September to consider a statutory framework. The action responded to a growing number of overdoses and deaths linked to readily available, unregulated products in gas stations and smoke shops.

In May 2026, Gov. Bill Lee of Tennessee signed HB 1649 / SB 1656, also named "Matthew Davenport's Law," which takes significant state action on high-potency kratom-derived substances that contain 7-hydroxymitragynine. The bill creates new criminal offenses and enforcement mechanisms for kratom products to ensure that they do not contain unsafe concentrations of the substance, revises offenses regarding the sale, distribution and possession of kratom products to make it an offense for a person to knowingly possess, manufacture, deliver or sell the product.

In March 2026, Utah adopted an approach to concentrated kratom products by restricting sales to products consisting solely of pure kratom leaf. The law prohibits kratom extracts and extract-derived products, including increasingly concentrated forms of the substance which have been more widely available in the marketplace, prohibits the sale of kratom products to individuals under the age of 21, and requires products to include adequate labeling to improve consumer awareness and reduce misleading claims.