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Earlier this week, the Brookings Institution issued a report that takes the federal government to task for undermining research on medical cannabis. In “Ending the U.S. government's war on medical marijuana research,” Brookings fellow John Hudak and senior research assistant Grace Wallack explain the various barriers that make authoritative research on cannabis extremely difficult to conduct in the United States. While many legitimate studies of medical cannabis do exist,  federal government policy makes it extremely difficult for researchers to follow up on existing knowledge and scale up research. The barriers to research that have been put in place are no small matter, as the reports asserts that these federal barriers have “paralyzed science” surrounding medical cannabis. This outcome is especially troubling as more and more state medical cannabis programs are being created and millions of patients are participating in these programs.

One interesting fact pointed in the paper is the truly unique conditions that exist for cannabis, which are in fact much different than other drugs regulated under the Controlled Substances Act (CSA):  

 “The irony of the issue is that it has very little to do with marijuana. This policy problem involves medical research and scientific freedom. This same conversation would be had if such barriers hindered the study of morphine or diazepam or Propofol or any other drug. Yet, of all the controlled substances that the federal government regulates, cannabis is treated in a unique manner in ways that specifically impede research.”

This is troubling on a number of levels and indefensible given that cannabis is a far safer drug than the other drugs listed in Schedule I of the CSA (or many of the drugs listed below Schedule I) and has an extensive history of medicinal use. As Hudak and Wallack document the placement of cannabis on Schedule I is a big part of the problem and creates a self-reinforcing justification for not rescheduling cannabis:

“The current Schedule I designation of cannabis, in conjunction with the numerous additional, and unique institutional rules regulating the substance, creates a circular policy trap that hinders scientific research. Research on the medical value of cannabis is limited by the Schedule I designation of cannabis, which asserts that the substance has no medicinal value. However, the scientific community is unsure whether marijuana has medicinal value because of a lack of research."

However, rescheduling alone would be insufficient to fully fix the problem without a more comprehensive set of reforms to kick start research:

“Rescheduling cannabis from Schedule I to Schedule II (or to some other schedule) would be one step in a multi-part reform that would induce expanded research into medical marijuana.

[...] The scheduling of marijuana under the CSA is one part of this layered system that impedes legitimate medical research on the benefits—and harms—that marijuana can have for a variety of ailments. But rescheduling is by no means the only barrier. Removing the DEA-mandated NIDA (National Institute of Drug Abuse) monopoly on production of marijuana for research, issuing agency guidance, expanding the compassionate use program, and reforming license and registration requirements would all go a long way towards improving the scientific community’s capacity and ability to study marijuana for medical use."

The CARERS Act was written to reflect this reality by including not only provisions to reschedule cannabis, but also end the DEA-mandated monopoly on the cannabis production for research purposes held by the National Institute of Drug Abuse and end other barriers that have held back research.

Another important issue covered in the paper is that while the executive branch can reschedule cannabis without Congress, the process would likely take many years. Given that reality, it would clearly be wise for Congress to take up the issue of rescheduling directly rather than hope the executive branch solves the problem for them.  Hudak and Wallack also note that rescheduling is not a drastic change that would be equivalent to de facto legalization. Rescheduling would leave cannabis under the restrictions of the CSA as well as state laws that restrict its use.  While an important part of reforming cannabis laws, rescheduling  is certainly not a straight path towards Colorado-style legalization.

On a political level the paper notes that the public is more than ready for reform on this issue and there is little holding back politicians from crafting policies to address the situation:

“Candidates are hesitant to take a bold position on (medical) marijuana policy. And frankly, this reluctance is very difficult to understand. Public support for medical marijuana reform is quite high across the country and at the state-level. Multiple polls put the national support for physician-prescribed marijuana between 70 and 80 percent approval.”

Reforming medical cannabis laws and enabling medical research to move forward will certainly require a comprehensive reform plan that takes into account the multiple dimensions of the policy problem. The CARERS Act is by far the best comprehensive legislative option available at the federal level and has been steadily gaining important supporters. Between the 23 states, including Guam and the District of Columbia, with medical cannabis programs and the 17 additional states with more restrictive, primarily cannabidiol (CBD) focused, laws the vast majority of the country lives in states with that are not in line with federal law regarding medical cannabis. Moving forward with the CARERS Act would end the conflict between state and federal that has caused so much damage to patients.  

It’s essential that in addition to improving state laws and and reform federal law to ensure access for sick patients, we also allow researchers to conduct comprehensive and in-depth studies on cannabis and its therapeutic uses to guide those patients and their doctors towards the most effective course of treatment. The CARERS act provisions addresses both the issue of creating permanent safe and legal access in states with medical cannabis programs, but also would help breakdown the barriers that prevent research.