There is a need for greater understanding of the recursive processes involved in drug policy development and its impact on stakeholders. The aim of this study was to examine the challenges of implementing marijuana policy in Massachusetts, where recent policy shifts have occurred. Qualitative data were generated from ethnographic field notes, media reports, public records and in-depth interviews with 25 stakeholders, including six medical marijuana dispensary entrepreneurs, eight health care professionals and 11 medical marijuana patients. Data were triangulated using a grounded theory approach. Stakeholders expressed confusion and misunderstanding, and demonstrated that they held conflicting interpretations of the policy and regulations. Analyses revealed gaps in policy development and implementation that are organised by three specific core implementation processes and the themes of transparency, communication and education. Findings show a need for more transparency in implementation processes, a more effective mode of communicating regulations, and a comprehensive plan for medical marijuna education. Based on our finds, we provide recommendations to help policymakers in the U.S. and other countries considering legalisation of marijuana or other drugs.
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