2022 POLICY PRIORITIES AT-A-GLANCE

FEDERAL

  • Safe, Legal, and Equitable Patient Access
    • Scheduling of Cannabis
    • Allow Cannabis Patients to Travel Domestically with Cannabis Medication
    • Protect Patient Rights in Federal Programs
    • No Penalties for Cannabis Patients
    • Veterans Access to Medical Cannabis
      • Allow Physicians Employed in the Veterans Affairs System to Recommend Cannabis 
      • Protect Veteran Medical Cannabis Choices & Promote Safe Disclosure of Medical Information Between Patients and Physicians
      • Allow and Promote Medical Cannabis Research Within the Department of Veterans Affairs 
  • Federal Participation in National Medical Cannabis Program Coordination
    • Create a Federal Agency for the Coordination of Cannabis Policy Nationwide
    • Harmonize Licensing of Medical Cannabis Supply Chain
    • Divert Federal Cannabis Prohibition Enforcement Resources
  • Medical cannabis research
    • Licensing requirements
    • Availability of research material
    • More research opportunities
    • Federally funded research

STATE

  • Affordability
  • Patient-Centered Care
    • No restrictions on doctors
    • No condition list - any eligible
      • Includes availability as first-line treatment
    • Allow home cultivation
  • Health & social equity
    • Identify & address cannabis health disparities
    • Criminal record and restorative justice
      • Including points about job and licensing opportunities for low-level offenders
  • Licensure & safety
    • Ensure dispensary access in localities - zoning 
    • Efficient tracking and reporting of products
    • Ensure Standardized testing and safety requirements 

NO PATIENT LEFT BEHIND

  • Address restrictions in medical cannabis programs
  • Provide parity between programs
  • Special affordability for patients
    • Including taxation 

 

FEDERAL POLICY PRIORITIES

SAFE, LEGAL, AND EQUITABLE ACCESS TO CANNABIS AS MEDICINE

Since the passage of the Controlled Substances Act (“CSA”) on May 1, 1971, the conversation surrounding cannabis has been tethered to cannabis’ Schedule I status, meaning that officially it is recognized as having a high potential for abuse and no accepted medical value. The federal classification of cannabis as a schedule 1 drug hurts patients across the country; from traveling to federal housing and employment rights and everything in between, the federal government’s failure to appropriately recognize the medical value of cannabis harms patient health. In order to move forward with a federal medical cannabis framework, the scheduling of cannabis must change.

Scheduling of Cannabis 

Issue: While the U.S. federal government recognizes the medical value of two components of cannabis, tetrahydrocannabinol (THC) and cannabidiol (CBD), and permits the sale of pharmaceutical drugs made by synthesizing or isolating these compounds, such as Marinol (dronabinol) and Epidiolex, it still classifies cannabis as a Schedule I substance. This designation makes it federally illegal to possess, cultivate, manufacture, dispense, or administer cannabis for medical use. Despite federal prohibition, we estimate there are some 5.1 million registered medical cannabis patients participating in 38 medical cannabis programs across the country. Many physicians and patients who recommend or use medical cannabis find that whole-plant cannabis, cannabis extracts with a broad range of the plant’s chemical components, and other cannabis-containing products more effectively address their symptoms than the aforementioned pharmaceutical products.

Clinical research affirms that cannabis has a low potential for abuse and can be used safely and effectively to alleviate the symptoms of serious and chronic medical conditions. Maintaining cannabis in Schedule I prevents robust research into maximizing the therapeutic benefit that can be derived from cannabis, precludes health insurance coverage for the cost of medical cannabis, and makes federal criminals of people who rely on cannabis to treat debilitating illness as well as the people who produce or provide it even under legally sanctioned state programs.

Recommendation: The federal government, either through Congress or Executive action, must recognize cannabis as medicine and either create a new classification or remove the Schedule I classification on cannabis and cannabinoids. 

 

Allow Cannabis Patients to Travel Domestically with Cannabis Medication

Issue: Traveling is one of the many federal barriers cannabis patients face on a regular basis. Like any other treatment option, a patient’s need for their medication does not stop when they cross their state line. Patients are often faced with an untenable choice when traveling - forego their medication or risk federal prosecution by traveling across state lines with it. Some patients may not even be aware that traveling directly from one medical cannabis state to another puts them in jeopardy of criminal repercussions. 

Recommendation: Allow cannabis patients with a valid state registration to travel among and between territories and states where the medical use of cannabis is legal. The government should re-evaluate Transportation Security Administration policies and other federal enforcement policies that would unduly punish patients for traveling with their cannabis medication. 

 

Protect Patient Rights in Federal Programs

Issue: There are over 5 million cannabis patients nationwide with conditions ranging from acute to terminal. Many of these patients receive benefits from the federal government including Medicare, Social Security, Temporary Assistance for Needy Families, housing through the U.S. Department of Housing and Urban Development, or other benefits and services offered to citizens. Despite living in a state that has legalized the use of medical cannabis, patients receiving federal benefits are still at risk of losing those benefits by virtue of being a cannabis patient. The federal government should not discriminate against patients in these programs. 

Recommendation: The Administration should prioritize the immediate reversal of agency policies that would discriminate against cannabis patients, and Congress should fast-track any legislative fixes necessary to ensure that patients can maintain their federal benefits and services while continuing their legally permitted treatments. 

 

No Penalties for Cannabis Patients

Issue: States have worked hard to protect citizens who lawfully use medical cannabis under their laws. Unfortunately, however, the state is unable to extend those protections to patients whose lives intersect the federal government. From HUD housing to federal employment issues and beyond, cannabis patients live in a continual jeopardy of prohibition enforcement actions. Without any guidance or laws protecting these patients, millions are left without a legal safety net simply based on their medical treatment decisions. 

Recommendation: Congress and the Administration must prioritize identifying and correcting holes in the legal protections afforded to cannabis patients. It is past time for the federal government to acknowledge that millions of Americans have access to, and use, cannabis for therapeutic reasons, and federal law should reflect the rights afforded to these patients in their home states. Gaps in legal protections include housing protections, employment protections, privacy protections, and arrest protections - to name only a few.

 

Veterans Access To Medical Cannabis

As of May 2013, there were more than 23 million total living veterans of military service in the US. Among them, almost 17 million served in wars, including more than 1.7 million veterans of WWII, 2.2 million veterans of the Korean War, 7.4 million veterans of the Vietnam War, 2.3 million veterans from the Gulf War (1990-1991), and more than 1.3 million who served in Afghanistan, Iraq or both.

Veterans of military service have a disproportionately high rate of certain debilitating medical conditions as compared to the general population. Some of those conditions may result from injury or exposures to toxins, but not all. The correlation between military service and higher rates of certain medical conditions are clear and well-documented, but the cause is not known for many.

The Veterans Health Administration (VHA) has resisted making all recommended treatments available to veterans. Cannabis has been found to help many patients suffering from conditions that can afflict veterans as a result of their service, including chronic pain, cancer, ALS, traumatic brain injury, post-traumatic stress disorders, and phantom limb pain. State medical cannabis programs making therapeutic use legal with a doctor’s recommendation were in place for almost 15 years before the VA changed its policy to allow veterans who use medical cannabis to receive all VA health services. In January, 2011, Robert A. Petzel M.D., the Under Secretary for Health, issued VHA Directive 2011-004, which states that “patients participating in State marijuana programs must not be denied VHA services.”

For more resources on this topic, please visit www.safeaccessnow.org/veterans-cannabis 

 

Allow Physicians Employed in the Veterans Affairs System to Recommend Cannabis

Issue: Despite the fact that 37 states and DC have reformed their laws to provide for safe and legal access to cannabis for qualifying patients, veterans living across these states still face a confusing system of federal and state laws regarding physician engagement and affordable access. For example, veterans who rely on the U.S. Department of Veterans Affairs as their primary healthcare provider are unable to receive medical cannabis recommendations from their doctors even if they live states with medical cannabis programs. And, veterans who use medical cannabis to treat their condition must also pay for this medication out-of-pocket with no financial support or subsidy from the VA. 

Recommendation: While the Schedule I status of cannabis, which ASA recommends changed, does hinder VHA from unilaterally granting access to medical cannabis recommendations from VHA physicians, internal policy currently prohibits VHA-employed physicians from recommending cannabis as well. VHA should modernize its internal cannabis policies and rescind guidance that prohibits physicians from discussing cannabis, and, once cannabis is removed from Schedule I, permit physicians to recommend cannabis as a treatment option.

 

Protect Veteran Medical Cannabis Choices & Promote Safe Disclosure of Medical Information Between Patients and Physicians 

Issue: It should be a top priority in all healthcare settings to facilitate a safe and comfortable environment for medical disclosure. This helps patients and physicians work together to achieve the best possible health outcomes for each individual. However, a safe and comfortable environment cannot be achieved when veterans are forced to seek needed healthcare in the form of medical cannabis from other providers. The VHA’s total prohibition on medical cannabis puts veteran patients in an impossible position, and guidelines are not clearly communicated to the patients; many wonder if they are at risk of losing their VHA care if they disclose cannabis use.

Recommendation: The Administration and the VA can and should repeal §3(b) of the Veterans Health Administration Directive 1315, so that cannabis is no longer defined as a drug of abuse. Doing so will enable VA physicians to consult with veterans on medical cannabis and initiate an important process of integrating medical cannabis education and training into the curriculum of VA doctors.

 

Allow and Promote Medical Cannabis Research Within the Department of Veterans Affairs

Issue: For more than 95 years, the VA Research and Development program has been improving the lives of veterans across the country through medical research and clinical trials. Today, the program has five overarching goals: increasing Veterans’ access to high-quality clinical trials; increasing real-world impact of VA research; putting VA data to work for Veterans; actively promoting diversity, equity, and inclusion; and building community through VA research. Research into the therapeutic effects of cannabis falls within many of these goals, yet VA Research and Development does not allow this kind of research. The VA Research and Development program is missing an opportunity to provide veterans with real-world data on all therapeutic options available to them.

Recommendation: Congress should allow, and the VHA should promote, medical cannabis research. VHA can begin by offering funding opportunities and commending departmental research in order to better understand the therapeutic effects of cannabis.

 

FEDERAL PARTICIPATION IN NATIONAL MEDICAL CANNABIS PROGRAM COORDINATION

For the last 27 years, patient advocates have worked state by state to pass medical cannabis legislation, bringing legal access to over 5 million patients in 37 states and US territories. Through this “laboratory of democracy” experiment, states have developed robust programs that safely license businesses to cultivate, manufacture and distribute medical cannabis to patients. The programs include product and worker safety protocols as well as guidance for all agencies to evolve policies to recognize the legality of medical cannabis.

The good news is that the states have already done most of the work, the bad news is that the inconsistencies between state and federal laws has left millions of patients without access. 

Currently, there are over 5 million medical cannabis patients across the country; ninety-one percent of Americans now live in states with some form of access to medical cannabis, while sixty-six percent of American adults are in favor of full legalization. Despite this, cannabis retains its Schedule I status under the Controlled Substances Act, meaning the federal government considers it to be a dangerous, highly addictive substance with no medical value. This continues to cause numerous conflicts between the federal government and the states that have rolled programs for their citizens. The only protection for these programs in federal law is the Rohrabacher–Farr amendment found in the Commerce Justice Science and Related Agencies appropriations bill which, as a budget bill, is subject to change each year. Plans for legalization at the federal level by different means have been introduced for years with little impact. It is time for a new approach to end the federal conflict on cannabis policy.

 

Create a Federal Agency for the Coordination of Cannabis Policy Nationwide

Issue: Nearly a dozen federal agencies now play a role in decision-making processes relating to the scheduling of cannabis. These agencies differ from one another in their aims, methods, and missions. For example, the Department of Health and Human Services exists to enhance the health and well-being of all Americans, while the Drug Enforcement Administration exists to enforce the controlled substances laws and regulations of the United States. This promotes competition for funding among the various agencies involved and impedes progress on important research and federal recognition of cannabis as medicine - a feat dozens of other countries have managed to accomplish at the national level.

Recommendation: Follow the lead of many other nations, by transferring oversight of medical cannabis to a new federal agency responsible for leading and coordinating regulatory responsibilities associated with federal cannabis policy. This agency would be responsible for promoting and facilitating research and regulating the production and distribution of cannabis as medicine. This new federal agency would result in a consistent and predictable regulatory environment nationwide.

To help end the conflict between states and the federal government on cannabis policy, Americans for Safe Access has created draft legislation which creates an Office of Medical Cannabis Control (OMCC). This draft legislation is explained in ASA’s Ending the Federal Conflict: Changing the Paradigm on Medical Cannabis report. This legislative language takes an entirely new approach to ending the conflict between the majority of states and the federal government on cannabis policy. The report calls for the descheduling of cannabis (or, failing that, the rescheduling of cannabis to a new Schedule V(A) that would allow for cannabis to be used as a frontline medication) and for the creation of a federal oversight agency with centralized regulatory authority over medical cannabis research, production, and distribution. 

 

Harmonize Licensing of Medical Cannabis Supply Chain

Recommendation: A new federal licensing program should allow these programs to continue uninterrupted, while building and expanding these programs:

  1. State granted cultivation and manufacturing licenses are also granted DEA licenses and that moving forward states take the lead in granting these licenses. 
  2. State granted dispensary or access centers would be granted specialty pharmacy licenses, and the state would continue to decide on the number and locations of these facilities.
  3. All laboratories would be able to test cannabis with a special license from the state.

 

Divert Federal Cannabis Prohibition Enforcement Resources

Issue: The Cato Institute estimates that the federal government spends around $18 billion annually on drug prohibition enforcement, including on efforts against cannabis. Not included in this estimate is the time and manpower the federal government spends on other policies that further reinforce cannabis prohibition, such as DEA resources to review and approve cannabis research licenses or the resources OPM dedicated toward personnel matters. All told, the federal government spends an inordinate amount of money attempting to maintain an archaic stance on medical cannabis. These resources would be more productive and beneficial if diverted away from prohibition efforts and towards ensuring that patients receive safe and legal access to medical cannabis. 

Recommendation: Congress should immediately request the Congressional Research Service conduct both a financial and workforce audit examining medical cannabis prohibition policies. The financial audit should address all direct funding the government allocates toward cannabis prohibition while the workforce audit should examine internal agency resources. The works force audit should outline which policies each agency and department is responsible for overseeing. 



MEDICAL CANNABIS RESEARCH

Cannabis has been used medicinally for millennia, but modern cannabis research in the United States has been stymied by decades of prohibition. The federal government has repeatedly acknowledged that cannabis’ Schedule I status prevents research that would provide more information about both the potential benefits and potential harms of cannabis. Researchers must complete a lengthy and onerous application process to obtain permission to conduct research, and if approved, the only cannabis they can study is that produced at the University of Mississippi for the National Institute on Drug Abuse, which pales in quality and chemotypic diversity when compared to the cannabis available to patients and consumers in dispensaries nationwide.

Issue: While research has been conducted and is ongoing in other countries, dozens of which have legalized medical cannabis at the national level, the United States, despite having tremendous resources that could be brought to bear to more quickly unlock cannabis’ full medical potential, has fallen in this scientific regard. Researchers are hindered by outdated policies and licensure requirements that require considerable time and funding to surmount. Without 

Recommendation: The federal government should eliminate barriers to research, immediately let researchers use commercially available cannabis to get a comprehensive picture of cannabis’ medical advantages and drawbacks, authorize additional producers of medical cannabis for scientific research, fund high-quality scientific studies, and take any other action necessary to enable and facilitate comprehensive medical cannabis research. Further, the federal government should promote and support medical cannabis research through already-established medical research opportunities.

 

STATE POLICY PRIORITIES

AFFORDABILITY

Patients responding to ASA’s 2021 patient survey expressed concerns with affordability. This includes the high costs for enrollment into the medical cannabis program, the cost for the doctor appointment(s) to receive a recommendation, as well as the cost of the products themselves. Given the rise in recreational adult-use cannabis laws across the country, it is more important than ever to ensure that both the administrative process and the medical cannabis products themselves are affordable for patients. Taxes allocated for the adult use program should not be imposed on the medical program and it should not be more expensive or onerous for patients to buy medical cannabis products.

Allow Medical Cannabis Patients to Grow Their Own Cannabis for Medicine

PATIENT-CENTERED CARE

No Restrictions on Physicians Recommending Cannabis

“Authorized practitioner” means a physician, advanced practice registered nurse, physician assistant, dentist, or naturopathic physician who is licensed and in good standing to practice under [STATE] law.

 

Let Healthcare Practitioners Decide

Issue: Too many states limit which patients can qualify for medical cannabis by arbitrarily listing conditions while excluding others. Recommending cannabis for medical purposes should be left to the discretion of physicians and other healthcare providers. Healthcare providers are in the best position to review a patient’s medical history, symptoms, and physiological responses to medicine in order to make a treatment decision. A patient should not be required to try other options first that fail to help them before being recommended cannabis as a treatment option. A healthcare practitioner should be free to recommend medical cannabis as a first level of treatment simply if they believe their patient will benefit, as is medical practice for other treatment options.

Recommendation: Policymakers should refrain from limiting the use of medical cannabis to only those with debilitating medical conditions, and ensure that physicians are free to make treatment determinations based on medical judgment, not a legislative qualifying list. ASA urges all policymakers to work to make medical cannabis accessible in their state by adoption legislation with the following language:

“Qualifying medical condition” means any condition for which treatment with medical cannabis would be beneficial, as determined by the patient’s authorized practitioner.

 

HEALTH & SOCIAL EQUITY

  • Identify & address cannabis health disparities
  • Criminal record and restorative justice
    • Including points about job and licensing opportunities for low-level offenders

 

LICENSURE & SAFETY

  • Ensure dispensary access in localities - zoning 
  • Efficient tracking and reporting of products
  • Standardize testing and safety requirements