What Does the Reclassification of Marijuana Mean for Physicians?

Governmental figures have spent decades debating the laws and regulations regarding cannabis. The current political climate has reinvigorated a proposal to downgrade the drug class of marijuana from a Schedule I to Schedule III controlled substance.1 It remains unclear, however, whether this proposal is solely political grandstanding, or if the change would have serious implications for medical practices and patients.

We spoke to Dr Mikhail Kogan, associate professor of medicine and medical director at the George Washington University (GWU) Center for Integrative Medicine,2 as well as Griffen J Thorne, a partner at Lewis Brisbois and chair of the Lewis Brisbois Cannabis, Hemp, and Regulated Substances Practice,3 to help discern the possible effects of the reclassification of marijuana.

Thorne believes reclassification will not affect the average person. Politicians claim no individual should be in jail for the use of marijuana; however, if political figures really wanted to ensure that was the reality, they would need to consider de-scheduling the substance and allowing the states or at least 1 federal agency to regulate it, as is the case with tobacco and alcohol, he explained.

Reclassifying marijuana from a Schedule I to Schedule III substance means that any individual found in possession of the substance could still face penalties or jail time from federal law enforcement or law enforcement in states that have not yet regulated marijuana. “The idea that no one will be arrested is inaccurate,” Thorne further clarified.

Although the reclassification of marijuana may not impact the average person in certain respects, Thorne believes it will likely reduce tax burdens for state-licensed cannabis businesses and enable more research opportunities, which may have downstream effects on clinical practices and social stigmas.

According to Dr Kogan, the reclassification of marijuana will open new doors for research.

“Reclassifying marijuana from Schedule I to a lower schedule would significantly ease the regulatory burden on researchers. A lower classification would streamline the process for obtaining necessary federal licenses and funding,” Dr Kogan explained. This change would lead to more studies and a greater variety of research since researchers won’t need to obtain Schedule I licenses and follow required Schedule I procedures. 

Dr Kogan continued, “With fewer regulatory hurdles, studies could expand to explore the impacts of marijuana on conditions beyond pain management, such as neurologic disorders, mental health conditions, autoimmune diseases, and more.”

Current research demonstrates the promising effects of cannabis when it is used to treat seizure disorders, symptoms of multiple sclerosis (MS), and chronic pain. However, cannabis-based medications are already available for these conditions.4 Broadening research on marijuana could help better understand the risks vs benefits of its use in healthy populations and for specific mental or physical conditions.

As a Schedule 1 drug, cannabis is said to have “no accepted medical purpose” and a high risk for abuse.5 Although this may be debatable, clear criteria have been established for cannabis use disorder (CUD), which is defined as the continued use of cannabis and an inability to quit regardless of harmful consequences.4

Per the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), cannabis use and dependence can be defined as “a problematic pattern” that includes at least 2 of the following criteria over the span of 1 year:5

Cannabis is usually consumed in more significant amounts or over a longer period than originally intended;      
Efforts to cut down or control cannabis use are unsuccessful;      
A lot of time is spent engaging in activities that are necessary to obtain or use cannabis, or recover from its effects;      
A craving or a strong desire or urge to use cannabis persists;      
Recurrent cannabis use results in failure to fulfill work or school obligations, or obligations at home;      
Uninterrupted cannabis use, despite having continued social or interpersonal problems due to or exacerbated by the effects of cannabis;      
Important social, occupational, or recreational activities are forfeited or reduced in number due to cannabis use;
Recurrent use of cannabis even if in an environment in which cannabis is physically hazardous;      
Cannabis use continues despite knowledge of having a persistent or recurrent physical or psychologic problem that is likely to have been attributable to or exacerbated by cannabis;
Increased tolerance, defined by either a need for markedly increased cannabis to achieve intoxication or desired effect, or a markedly diminished effect with continued use of the same amount of the substance; or,      
Experiencing a withdrawal, as manifested by either the characteristic withdrawal syndrome for cannabis, or cannabis is taken to relieve or avoid withdrawal symptoms.

“Reclassification should consider the potential for increased marijuana use and risk for CUD,” stated Dr Kogan. “Education and preventive measures must be in place to mitigate these risks. However, it is unlikely that recreational marijuana use and CUD risk will increase considering its widespread use, despite its current legal status,” continued Dr Kogan.

Health care providers should receive updated training on the risks and benefits of marijuana use, including the identification and management of CUD, Dr Kogan stated. “For example, there are currently no required standards in any health care training curriculum. Our GWU medical cannabis research team recently finished developing a national standard for medical schools and we are waiting to get it published before advocating for broad acceptance,” he shared.

The ways in which reclassification might affect different populations, particularly vulnerable groups who might be at higher risk for substance use disorders (SUDs), must also be considered. Research suggests that men in high-income countries have the greatest risk for CUD.4

Finally, evidence-based policies must be prioritized. “Policymaking should be guided by current scientific evidence and continuous research should inform adjustments to regulations and guidelines,” advised Dr Kogan.

Cannabis policy reform may further promote the common misbelief that marijuana and cannabis products are completely natural and risk-free. As a result, clinicians remain responsible for messaging on the potential risks, both short- and long-term, particularly for young adults and pregnant women. In addition, adults must stay vigilant about the dangers of accidental intoxication in children and safely store cannabis out of the reach of children.5

Physicians should approach marijuana use with an open and nonjudgmental attitude to encourage honest communication, warned Dr Kogan. When engaging with patients, Dr Kogan suggested utilizing the following process:

Assess use: Ask patients about their marijuana use (ie, frequency, methods of use, reasons for use) in a routine and standard way. Discuss use in the context of symptom management, not “drug use.”
Provide education: Provide evidence-based information about the potential benefits and risks of marijuana use. 
Offer personalized advice: Tailor advice based on the patient’s medical history, current health status, and specific conditions being treated. For example, discuss potential interactions with other medications and the impact of marijuana on chronic conditions.
Share safety precautions: Advocate for safe practices (ie, avoiding smoking) and the consideration of alternative methods (ie, topical, oral, sublingual, rectal). 

Rescheduling marijuana from a Schedule 1 to Schedule III drug is not likely to remedy any societal or legal ramifications of marijuana use. Nonetheless, this change could help advance research on the substance.

While certain populations may benefit from the use of marijuana and cannabis products, the potential dangers shouldn’t be overlooked, especially in young and healthy populations. Not only is marijuana associated with a risk for CUD, its use can also induce changes in brain development, reduced intelligence, driving impairments, the “unmasking of chronic psychotic disorders,” and negative effects on fertility and pregnancy outcomes.4

Physicians should better counsel patients on the potential health risks of using cannabis to treat self-treat chronic, neurologic, and psychiatric conditions.

The U.S. Drug Enforcement Administration (DEA) hearing on the proposed rescheduling of marijuana on January 21, 2025 has been postponed, which has delayed the process for approximately 3 months.6