There is no longer any doubt about it: cannabis should be legalized. This sentiment is practically universal among Americans, with 91% of those interviewed in a 2021 Pew poll believing cannabis should be allowed for medicinal use, and a significant majority (60%) backing both medical and adult-use cannabis.

It is undeniably an exciting moment to be a cannabis consumer. In the global perspective, cannabis is being normalized at a rate not seen since the 1960s, if ever. Cannabis was prohibited in every state at every level before to 1996, when California proclaimed it medicinal. Cannabis drug charges were once counted towards severe three-strike rules, placing far too many tiny cannabis sellers in life prison for selling a flower that is less hazardous and addictive than alcohol and cigarettes.

This was not Always the Case

Cannabis extracts and tinctures were frequently used as treatment for over 100 years, between 1850 and 1942, and had a formal position in what is known as the US Pharmacopeia, a compendium of medicinal information for physicians to reference. It’s also worth noting that, while certain states passed cannabis restrictions beginning in the early 1910s, growing cannabis was not legally banned. Cannabis was not fully controlled until the Marihuana Tax Act of 1937.

We’ve come a long way since a quarter-century ago, with at least 18 states legalizing adult-use cannabis and at least 47 states enacting some form of medical cannabis legislation, even if it’s only for Type III cannabis, sometimes known as low-THC cannabis or hemp. Nonetheless, the federal government continues to classify THC as a Schedule I drug, which means that it has no currently acknowledged medicinal purpose and poses a high risk of misuse.

But things are changing quickly. Washington, DC is now buzzing with talk about cannabis legislative reform, as represented by the MORE Act and the States Reform Act in the US House of Representatives and the Cannabis Administration and Opportunity Act in the US Senate, as well as a discussion draft of The Cannabis Administration and Opportunity Act (CAOA).

Cannabis Reform Bill of the Moment

In brief, the CAOA is a comprehensive federal cannabis reform law that aims to deschedule cannabis, create a tax system for legal cannabis, and provide the groundwork for a more uniform business. The CAOA, perhaps most crucially and appealingly, places a heavy emphasis on social equality, restorative justice, and possibilities for those victimized by the futile war on cannabis.

On the surface, the CAOA appears to be fantastic, and as far as reforms go, it represents a significant step in the right direction. However, upon closer examination, there are a few holes that must be filled in order to ensure that cannabis works for patients rather than companies.

The drafters of the CAOA appear to have forgotten that medical cannabis programs are what led us here, since there is essentially no mention of medical cannabis in the CAOA except from a brief section proposing that Veterans Association doctors be authorized to suggest and discuss medicinal cannabis.

This measure assumes that federal medical cannabis standards are unnecessary since patients are safeguarded by state medicinal cannabis programs, but that rationale is faulty. State law may swing as political pendulums swing, as we continue to witness across the country. If federal regulation safeguarding medical cannabis patients’ rights is not in place, rest confident that patients will fight and suffer unnecessarily to get treatment and adequate medical supervision. Medicinal rights are guaranteed for all other pharmaceuticals, and medical cannabis should be no exception.

Many medical cannabis practitioners share this feeling, which is heartened by the tone of CAOA yet apprehensive about the preservation of medicinal cannabis.

What are the Experts’ Opinions?

Jordan Tishler, MD is a cannabis-based medicine specialist and the founder of the Association of Cannabinoid Specialists. When asked about the CAOA’s benefits and drawbacks, he stated:

“I believe the measure was a huge benefit to industry and social equality. What has to change, in my opinion, is not so much to remove those components as it is to address the reality that little attention has been made to health equity.”

Patients require the same certainties as other medicines, such as access to untaxed cannabis medicine, a framework for insurance coverage, access to clean, tested, and economical cannabis medicine, access to educated healthcare providers who are well knowledgeable in cannabis, and the right to travel with their prescription regardless of how a specific state feels about it. According to Tishler, this framework even includes a prescription written by the physician in the same manner as any other drug, meaning that it may only be amended or deviated from if first addressed with the writing physician.

Dr. Patricia Frye, a board-certified pediatrician, integrative practitioner, and the Society of Cannabis Clinicians’ director of education, is concerned about the tax system and enforcement suggested by CAOA. Her concerns originate from a tax framework that might levy up to a 25% tax on cannabis growers, increasing the prices for patients and pushing them to seek cannabis from other, sometimes unethical marketplaces.

“Whether for medicinal or adult usage, this would drive up prices, making it less available for lower-income neighborhoods, which will promote federally unlawful actions, like as selling homegrown.”

The research component of the CAOA encouraged Frye, as it directly focuses greater research towards the health implications and advantages of cannabis usage, as opposed to the more traditional anti-cannabis study that readily receives government money. There is also a particular mention of study into discovering a means to assess cannabis intoxication to improve traffic safety, which is a greatly needed tool to increase safety during this THC renaissance of the twentieth century.

Another source of worry highlighted by healthcare professionals is the right of patients to cultivate their own food, which prioritizes their livelihood and empowerment over profits.

Rachel Parmelee, MSN, RN, is a nurse educator and executive board member of the American Cannabis Nurses Association who has witnessed firsthand how patients may benefit from producing their own cannabis.

“Growing your own medication has a therapeutic effect,” Parmelee added. The CAOA makes no mention of cultivating your own cannabis, which should be addressed in any future revisions. “Growing your own cannabis is not just beneficial; it is also a means to protect patients from market pressures that might arise in extremely restricted jurisdictions.”

Alan Ao, PharmD, President of Plants and Prescriptions, ISCPH board member, and special advisory board member of the Association for Cannabis Health Equity and Medicine (ACHEM), believes that we must establish a system that treats cannabis more like medicine, including preparing for cannabis and cannabis-related care to be covered by health insurance. Of course, this would need collaboration between the Centers for Medicare and Medicaid Services and third-party payers to develop a medical cannabis framework.

“This would establish specialized license classes that may be awarded to existing healthcare clinics, cannabis processors, and dispensaries/pharmacies to expressly handle medical patients, cGMP-grade cannabis products, and fee-for-service billing.”

The CAOA is a huge step forward in terms of federal cannabis legislation, but it falls short when it comes to medicinal cannabis. The Schedule I designation of cannabis/THC cannot be maintained indefinitely, but how we reframe cannabis’s function in medicine is a vital next step for the sector.

We can expand on the good work of the CAOA by listening to frontline healthcare workers in cannabis medicine and using the opportunity to design public policy that assures fairness, promotes prosperity, and safeguards medical cannabis from the pressures of commoditization.