President Trump: Let’s get moving on rescheduling marijuana for medical use, research

The United States will reclassify marijuana as a potentially beneficial drug that deserves further study for medical use.

President Donald J. Trump signed an executive order directing the U.S. Attorney General to reschedule marijuana as a Schedule III drug under the Controlled Substances Act. Schedule III drugs are classified as having a potential for abuse less than the drugs or other substances in Schedules I and II, a currently accepted medical use in treatment in the United States, and a potential for moderate or low physical dependence or high psychological dependence in the event of drug abuse, according to the executive order.

Greater use, changing perceptions

Marijuana currently is a Schedule I drug, meaning it is defined as having no currently accepted medical use, a high potential for abuse, and a lace of accepted safety for use under medical supervision.

However, in 2023, the U.S. Department of Health and Human Services (HHS) recommended the federal Drug Enforcement Agency reclassify the drug due to an accepted medical use. More than 30,000 licensed health care practitioners across 43 United States jurisdictions are authorized to recommend marijuana for medical use to treat at least 15 conditions for some 6 million patients, according to the White House. The U.S. Food and Drug Administration also had evidence of marijuana used to treat pain, anorexia caused by certain medical conditions, and nausea and vomiting induced by chemotherapy.

“The Federal Government’s long delay in recognizing the medical use of marijuana does not serve the Americans who report health benefits from the medical use of marijuana to ease chronic pain and other various medically recognized ailments,” the executive order said. “Americans who often seek alternative relief from chronic pain symptoms are particularly impacted.”

The Schedule I classification impedes legitimate research on medical marijuana and the two cannabinoids that patients use frequently. Cannabidiol (CBD) and tetrahydracannabinol (THC), the two hemp-derived cannabinoid products, are not controlled substances under the Controlled Substances Act. They are subject to FDA authority and in the future could be controlled as marijuana based on THC levels.

“In short, the current legal landscape leaves American patients and doctors without adequate guidance or product safeguards for CBD,” the executive order said.

“It is the policy of my Administration to increase medical marijuana and CBD research to better inform patients and doctors,” the executive order said. “It is critical to close the gap between current medical marijuana and CBD use and medical knowledge of risks and benefits, including for specific populations and conditions. Research methods and models should include real-world evidence and should facilitate affordable access in order to rapidly assess the health outcomes of medical marijuana and legal CBD products while focusing on long-term health effects in vulnerable populations like adolescents and young adults.”

The president’s advisers and Congress shall work on new rules that allow patients to access CBD products while preserving restrictions on sales potentially harmful products, the executive order said. HHS and its agencies will develop research methods and models on hemp-derived cannabinoid products. The White House also published this fact sheet about the federal actions involving cannabis.

Industry reaction

Cannabinoid industry reaction generally was positive.

“This move will open a door that has been closed for far too long by making it possible to pave a clear, science-driven regulatory pathway that establishes federal standards for manufacturing, testing, labeling, and consumer safety; guardrails that have never existed but are desperately needed,” said Sasha Kalcheff-Korn, executive director of Realm of Caring, a cannabis research, education and community advocacy group. Kalcheff-Korn commented via email to Cannabis Science and Technology, a sister publication of Medical Economics. Realm of Caring also published this summary about effects of the executive order.

Regulate marijuana like alcohol

“The Administration’s order calling to remove the cannabis plant from its Schedule I classification validates the experiences of tens of millions of Americans, as well as those of tens of thousands of physicians, who have long recognized that cannabis possesses legitimate medical utility,” NORML Deputy Director Paul Armentano said in a statement. “It wasn’t long ago that federal officials were threatening to seize doctors’ medical licenses just for discussing medical cannabis with their patients. This directive certainly marks a long overdue change in direction.”

While the direction may be better, the step does not go far enough, according to NORML. States and the federal government have conflicting regulation policies for marijuana. To reconcile those, federal leaders should remove cannabis from the Controlled Substances Act and allow states to set their own regulatory policies like they do for alcohol, Armentano said in the statement.

What comes next, exactly?

The executive order is an order but it does not itself reclassify or reschedule marijuana, said a statement from attorney Josh Bauchner, chair of the Cannabis, Hemp and Psychedelics Practice Group of firm Mandelbaum Barrett PC, operating in New York, New Jersey and other states.

The order had no firm timeline for the government actions, Bauchner said. The recent federal spending bill signed by the president effectively bans the sale of “full-spectrum CBD products,” he said. There also are no details on potential tax implications of deducting ordinary business expenses of a Schedule III drug, Bauchner’s statement said.

“While a Schedule III classification does not solve most of the industry's problems (and could certainly cause a whole host of new ones), what it does do is, for the first time in U.S. history, give the U.S. government public recognition of cannabis as a medicine. And open avenues for future medical research,” he said.

What do the medical journals say?

Advocacy groups tout the potential health benefits of cannabinoid products, and HHS Secretary Robert F. Kennedy, Jr., and his top aides have stated they will follow the evidence when making policy about health and medical treatments.

But benefits of medical marijuana do not appear to be settled science, and other research has indicated potential harms of marijuana use. Earlier this year, Bertha K. Madras, PhD, and Paul J. Larkin, JD, published “Rescheduling Cannabis — Medicine or Politics?” in JAMA Psychiatry to critique the arguments HHS has made for recommending marijuana rescheduling.

In summary: “HHS failed to adequately address the adverse effects of cannabis use, including the high prevalence of cannabis use disorder among users, risks associated with youth consumption, growing evidence linking cannabis to psychosis, and other significant concerns,” they wrote. “HHS asserted that cannabis is widely accepted as a legitimate form of medicine, despite the reality that only a small fraction of patient-care physicians recommend it for symptom relief, in practices that often diverge from the norms of medical practice.”

Time to learn more

Cannabis use is expanding and more physicians need to learn how to handle it with patients, said “Developing Medical Cannabis Competencies,” a consensus statement on medical education published in October in JAMA Network Open. The authors, which included 14 physicians, outlined six core competencies and 26 subcompetencies that physicians should be taught.

“Extensive basic research has characterized the pharmacological properties of cannabis and its active compounds, underscoring their therapeutic potential,” they wrote. “There is good-quality clinical evidence for the therapeutic benefit of cannabis for medical conditions, such as pain, muscle spasticity, and chemotherapy-induced nausea and vomiting.”

But physicians and other clinicians repeatedly have reported low levels of knowledge about medical cannabis, the authors said.

“The goal: to fill a major educational gap,” said a statement from the advocacy group Doctors for Drug Policy Reform, which promoted the consensus statement. “As medical cannabis becomes more used in practice, many physicians feel unprepared to counsel patients, and currently very few medical curricula address it.”