Recently, the Biden administration came under fire for its apparent treatment of junior staffers who admitted using cannabis. Now, Senate Majority Leader Schumer has lashed out to say that he’ll push for cannabis legalization with or without Biden. This just points out how our leaders are grandstanding instead of making laws that protect citizens—and patients in particular.
Legalization may sound like the solution, but it’s unfortunately an oversimplification of what needs a nuanced approach. There are three options: making cannabis a medication by prescription, decriminalizing cannabis possession, or commercial legalization.
Keeping cannabis as a medication, preferably under the sole regulation of the FDA, will stimulate medical research and provide care and medication to those in need. Decriminalization will end the War on Drugs and prevent continued targeting of people of color. Legalization, on the other hand, while also ending the War on Drugs, will also sabotage medical research, end the knowledgeable use of cannabis as a medicine, and lead to an industry hellbent on sales revenue at the cost of patients’ wellbeing.
Herein lies the rub: current discussion in Congress about legalization does not address patient care at all. There is a lot of talk about the harms of prohibition and social justice. There is no acknowledgement that medical care is a social justice issue and that patients must be protected.
For example, it is commonly believed that legalization will set the stage for “getting better research on cannabis done.” In fact, it will be the death knell for science into cannabis. Drug development research is slow, painstaking, and expensive. Why would any cannabis company spend the time and money to prove that its product works and is safe if the law allows them to simply go to market and say whatever they want? Put another way, why do pharma companies do all that work? Only because they wouldn’t be able to go to market without FDA approval.
Every president, Biden included, has the ability should he so choose, to instruct the DEA to reschedule a substance consistent with the schedule criteria. So far, no president has chosen to do so. Biden needs to do this. He needs to instruct the DEA to relinquish control of cannabis to the scientists at the FDA by descheduling it (removing it from the Controlled Substances Act). Then we can get the funding and research done that will truly benefit society.
Congress needs to take a moment to understand how barreling headlong into commercial legalization will undermine the enormous pool of patients needing this medication. For example, in California, only 4% of cannabis sold was through its medical system. While we cannot know how much of the recreational sales were guided by medical professionals, these numbers suggest that the vast majority of purchasers were getting their medical information from the non-medical salespeople at the dispensaries or from their buddies. We have ample evidence that this is not the ideal way to get medical advice.
In my practice, I have seen patients who start with very reasonable and effective regimens suddenly go overboard following the advice of these salespeople. I have seen harm done to patients from the rampant misdirection and conflict-of-interest-laden advice from dispensaries. We avoid these pitfalls in the conventional medical system by requiring clinicians to prescribe the medication complete with instructions on use and an amount to be sold. Only Florida requires an actual prescription (they call it an order) for a specific cannabis medication with an amount to be dispensed—and requires dispensaries to uphold that order.
Many advocates see cannabis, among other things, as a solution to the Opioid Crisis. The evidence to support this is robust and mounting. However, what they do not acknowledge is the high likelihood that without proper medical guidance, we will see an explosion of cannabis-related problems down the line.
The legal sales of large amounts of cannabis suit the industry well, but they are not good for patients nor citizens. There is a substantial practical and moral difference between ending the War on Drugs and granting an industry carte-blanche permission to sell vast amounts of cannabis using whatever sales tactics they can devise.
Patients deserve safe effective medicine and caring, knowledgeable guidance from clinicians to achieve the best outcomes. Congress is willfully overlooking the importance to all Americans of proper medical cannabis treatment and not doing anything to safeguard care for patients. There are two main tenets of any reform to cannabis laws so that patient care is preserved and improved: requiring prescriptions for all medical cannabis and prohibiting marketing of cannabis with claims about its medical uses, whether to patients or to recreational users.
So, Biden put his foot in it. In doing so, he demonstrated how thoughtless Congress is being about patients’ needs and how their concept of social justice only fits the soundbite of the moment. We should expect better from our leaders, regardless of branch.
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