Cannabis
Olivia C. Welter, PharmD
Federal agencies have been working toward potentially changing the drug schedule of cannabis for several years. However, a recent decision by a DEA judge has caused a delay in moving this process forward.
Any rulemaking would affect certain pharmacists and pharmacies participating in cannabis distribution.
The rulemaking hearings were scheduled to begin in January 2025, but a DEA judge placed an administrative pause on the hearings. As of early April 2025, DEA has not announced a new date for the first rulemaking hearing.
Rescheduling cannabis
In October 2022, former President Joe Biden directed HHS and the Department of Justice to determine whether a scientific basis exists to reschedule cannabis.
HHS conducted a thorough investigation and formally recommended that DEA reclassify cannabis from Schedule I to Schedule III in August 2023. HHS indicated that this reclassification is justified because cannabis has lower potential for abuse than Schedule I and II drugs and has documented medical uses.
Following the recommendation by HHS, DEA published a Notice of Proposed Rulemaking in May 2024, allowing public comment until July 2024. DEA received almost 43,000 comments during this 60-day period with a strong majority expressing support for rescheduling cannabis.
Legal consequences
A report written by Joanna Lampe, published in the nonpartisan Congressional Research Service’s official publication, Legal Sidebar, in May 2024, outlined relevant legal consequences of rescheduling cannabis. The document highlighted the contrast between strict federal cannabis regulations and a trend of states legally authorizing cannabis or other cannabis products for medical use.
Despite this regulatory difference, Lampe noted that Congress has passed an appropriations rider during each budget cycle that prohibits federal prosecution of state-level activities related to medical cannabis use. (An appropriations rider is a provision or amendment tacked onto an appropriations bill that addresses a policy issue unrelated to the original funding.)
Riders are used to enact policy changes that might otherwise struggle to pass on their own, essentially “riding” on a must-pass funding bill. If this appropriations rider were to fail in the future, such state-level activities could be challenged at the federal level.
Lampe also indicated that rescheduling cannabis from Schedule I to III would allow FDA to approve prescription drugs containing cannabis and authorize providers to issue prescriptions for such drugs.
Additionally, any manufacturer or distributor of cannabis products approved by FDA would need to register with DEA and adhere to all regulatory requirements of Schedule III substances.
A 2024 publication from the National Academies of Sciences, Engineering, and Medicine explored the effect of cannabis policy on public health and health equity. The authors made several recommendations related to cannabis, including calls for Congress to refine the definition of “hemp” to provide more clarity on which cannabinoid products are subject to regulation under the Controlled Substances Act.
The authors advocated for DEA to specify that any THC or semisynthetic cannabinoid product derived from hemp is not exempt from the Controlled Substances Act. Another recommendation urged state regulators to prioritize patient safety and adopt standards developed by USP, including product quality standards and standards for incorporating cannabis extracts into pills and edible products.
The authors also recommended that state cannabis regulators should require training and certification for all staff at cannabis retail outlets who interact with customers.
Pharmacists’ role
A February 2025 article published in JAPhA highlighted pharmacist care considerations related to cannabis. According to the authors, pharmacists must be aware of cannabis clinical use fundamentals and may use their medication management and counseling skills to lead patient care teams in safe cannabis use.
Pharmacists also have opportunities to contribute to cannabis-related decisions at the state level.
Many states have some version of a cannabis advisory board on which pharmacists may be eligible to serve. For example, the California Cannabis Advisory Committee accepts applications year-round for individuals interested in serving on the committee, the Tennessee Medical Cannabis Commission has two pharmacists appointed by various elected representatives, and the Iowa Medical Cannabidiol Board has a board position designated for a pharmacist.
Pharmacists who would like to participate in such boards and committees may contact their state’s cannabis regulatory authority for information on how to get involved. ■