Dr. Richard Feldman: US poised to clear the haze on marijuana’s benefits, risks

For years the medical and public health communities have awaited the long-overdue federal Controlled Substances Act reclassification of marijuana to characterize it more accurately.

In 2022, President Joe Biden requested the Health and Human Services Administration to conduct an extensive evaluation of marijuana’s medical benefits and risks. As part of the evaluation, the U.S. Food and Drug Administration determined that marijuana has legitimate medical benefits and relatively low toxicity. The resulting 2023 HHS report concluded marijuana’s reclassification from a Schedule I to a less restrictive Schedule III was appropriate. Now, the Biden administration announced a formal rulemaking process by the Department of Justice for the reclassification by the Drug Enforcement Administration.

Schedule I drugs, like heroin and ecstasy, are those with no accepted medical use and which have a high potential for abuse. Schedule I drugs are illegal for medical use, production, distribution, dispensing, and possession except for federally approved research studies. Schedule III drugs, like acetaminophen with codeine, have low-to-moderate potential for dependence and have accepted medical use. Marijuana’s current Schedule I classification designates it as more dangerous than fentanyl.

Rulemaking will proceed with a 60-day public comment period. It may also require a public hearing and formal Congressional review before finalization. The DEA has final authority for any change in status, but given the Biden administration’s strong support for reclassification, the DEA will almost certainly approve.

I’ve written previously about the potential medical benefits as well as the untoward effects of marijuana use. Many studies have demonstrated various medical benefits and also that marijuana is far from a harmless drug. It’s not my intention revisit these subjects now.

Public opinion drives public policy. Marijuana’s reclassification initiative reflects that the clear majority of Americans want legalized marijuana, for better or for worse.

A 2024 Pew Foundation report found that 88% of Americans favor legalization for either medical or adult recreational use, and 57% percent favor both. Recreational marijuana is legal in 24 states and medically in 38. It’s inevitable that more states will follow. A Carnegie Mellon University study found more Americans now use marijuana daily than alcohol.

The federal government has been permissive of states legalizing recreational use. But reclassification won’t affect the federal illegal status of recreational use, although it would appropriately lessen criminal penalties. Federal decriminalization or legalization would require congressional legislation removing marijuana from the Controlled Substances Act.

Also, since 2014, Congress has allowed states to legalize medical marijuana without restriction or prosecution despite being in conflict with federal law. Reclassification would now federally legalize marijuana prescribing in states that have legalized medical marijuana.

Importantly, FDA and DEA regulations make it very difficult to study schedule I drugs adequately. A lower classification would facilitate much-needed thorough research into marijuana’s benefits and risks.

Reclassification is reflective of the evolving public acceptance of marijuana and the tremendous support for legalization. Further, it more justly treats the substance legally in relation to more dangerous and addictive drugs. Reclassification is a first step to reformulating the federal government’s position.

A hugely significant change in federal attitude looms.

Dr. Richard Feldman is an Indianapolis family physician and the former state health commissioner. Send comments to [email protected].