This briefing provides Members of the 119th Congress and congressional staff with a patient-centered overview of the April 2026 Department of Justice and Drug Enforcement Administration cannabis-related actions, what this new phase of federal policy means for patients, and how the FY2027 appropriations process can shape implementation. It also addresses the implementation of Executive Order 14370, “Increasing Medical Marijuana and Cannabidiol Research,” the patient-access implications of pending federal hemp-law changes, the real-world impact of Schedule III classification, and the need for a comprehensive national medical cannabis program.
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What Changed in April 2026
On April 23, 2026, the Department of Justice announced several federal cannabis actions in response to Executive Order 14370, “Increasing Medical Marijuana and Cannabidiol Research.” These actions included withdrawing the prior August 2024 DEA hearing process, issuing a new Notice of Hearing on Proposed Rulemaking for broader cannabis rescheduling, and scheduling a new administrative law judge hearing to begin on June 29, 2026.
The Acting Attorney General also issued final AG Order No. 6754-2026. That order places FDA-approved marijuana products and marijuana products regulated under qualifying state medical cannabis licenses into Schedule III of the Controlled Substances Act. It also creates a federal registration pathway for qualifying state-licensed medical cannabis manufacturers, distributors, and dispensers.
This is a major shift in federal policy. For decades, federal law treated state-authorized medical cannabis activity as Schedule I activity, even when patients, clinicians, and state programs were operating under carefully regulated medical cannabis laws. AG Order No. 6754-2026 changes that legal posture for qualifying medical cannabis products and qualifying state medical cannabis systems.
However, this order is limited. It does not legalize cannabis nationwide, deschedule cannabis, apply to adult-use markets, expunge criminal records, or automatically update federal policies that have been used to deny patients housing, employment, healthcare, veterans’ care, disability accommodations, or participation in federal programs. Congress must now make sure this federal shift reaches patients in real life.
AG Order No. 6754-2026 and State Medical Cannabis Programs
AG Order No. 6754-2026 recognizes qualifying state medical cannabis programs as part of the federal medical access framework. The order relies on existing state infrastructure, including patient registration, medical certification, licensing, dispensing, labeling, packaging, security, disposal, and recordkeeping.
Importantly, the order treats state-authorized medical cannabis certifications or similar patient documents as functionally equivalent to prescriptions for purposes of this federal framework. For patients participating in qualifying state medical cannabis programs, this matters because qualifying medical cannabis is no longer treated as Schedule I contraband within this specific framework.
The order also creates a federal registration process for qualifying state-licensed medical cannabis manufacturers, distributors, and dispensers. This pathway may also support research by allowing researchers to obtain cannabis from DEA-registered state licensees, subject to applicable FDA and DEA requirements.
This is not the same as a comprehensive national medical cannabis program. But it is federal recognition of the medical cannabis systems that patients, clinicians, advocates, and states have built over more than two decades.
What the DOJ Order Does Not Do
AG Order No. 6754-2026 does not legalize cannabis for adult use or change the status of cannabis obtained outside a DEA-registered, state-regulated medical cannabis system. Unless and until the broader rescheduling process is completed, cannabis outside this framework remains Schedule I.
The order also does not change federal criminal penalties for cannabis possession, cultivation, manufacturing, or distribution outside qualifying medical cannabis systems. It does not expunge federal cannabis-related criminal records, change the Federal Food, Drug, and Cosmetic Act, provide protections in states without medical cannabis laws, resolve the status of hemp-derived cannabinoid products, or allow patients to travel freely across state lines with their medicine.
Most importantly for patients, the order does not automatically update every federal policy that has been used to deny housing, employment, healthcare, veterans’ services, disability accommodations, or access to federal programs. Those policies must now be reviewed and changed.
Why This Matters for Patients
For decades, medical cannabis patients have faced discrimination because federal policy treated state-authorized medical cannabis use the same as unlawful drug use. Patients have lost housing, jobs, healthcare access, medical procedures, child custody, public benefits, veterans’ services, and reasonable accommodations simply because their medicine was cannabis.
AG Order No. 6754-2026 changes the legal premise behind those exclusions. But legal recognition alone is not enough. Federal agencies, state agencies, healthcare institutions, housing providers, employers, and federally funded programs will continue relying on outdated policies unless they are directed to change them.
Patients should not be denied housing, employment, healthcare, reasonable accommodations, veterans’ care, federal workplace protections, or federal program participation solely because they are registered medical cannabis patients. Federal policy must move away from categorical exclusion and toward individualized assessment, reasonable accommodation, patient safety, clinical judgment, actual impairment, and documented risk.
Patient Rights and Federal Agency Guidance
Congress and the White House should press the Department of Justice to issue nationwide civil rights guidance clarifying how federal protections apply to state-authorized medical cannabis patients after AG Order No. 6754-2026.
That guidance should make clear that patients may not be denied services, housing, healthcare, employment, benefits, reasonable accommodations, or federal program participation solely because they participate in a state-approved medical cannabis program or use medical cannabis in accordance with state law.
Every federal agency should also be directed to immediately identify, review, and update policies, guidance documents, forms, enforcement practices, funding conditions, and data systems that still treat medical cannabis patients as categorically engaged in disqualifying illegal drug use.
HUD should withdraw and replace outdated housing guidance that permits denial of admission, eviction, termination of assistance, lease nonrenewal, or refusal of reasonable accommodation for state-authorized medical cannabis patients in federally assisted housing.
VA should update its policies so clinicians may discuss medical cannabis with veterans, recommend medical cannabis where permitted by state law, complete state medical cannabis forms, document therapeutic cannabis use, and treat medical cannabis as part of clinical care rather than substance use or misconduct by default.
HHS and CMS should instruct hospitals, hospices, nursing homes, assisted living facilities, federally qualified health centers, Medicare- and Medicaid-participating providers, transplant programs, pain clinics, and other federally supported healthcare settings not to deny care, refuse documentation, or force discontinuation of medical cannabis solely because of outdated federal policy.
Federal workplace and drug-testing policies should also be updated. A cannabis-positive test alone should not be treated as proof of impairment, misconduct, deficient performance, or lack of fitness for duty for qualified medical cannabis patients without evidence of on-duty impairment, unsafe conduct, or demonstrable job-related safety risk.
DOD should create a responsible medical cannabis review pathway for active-duty service members and end zero-exception policies that treat therapeutic medical use as automatic misconduct.
Medical Cannabis and Cannabinoid Access in the United States
Medical cannabis has moved from the margins of state policy into the center of national healthcare access debates. Forty-one states now have medical cannabis laws, and millions of patients rely on state-regulated medical cannabis programs, hemp-derived cannabinoid products, or both to manage serious and chronic health conditions.
Medical cannabis patients include people living with cancer, chronic pain, neurological conditions, PTSD, autism spectrum disorder, seizure disorders, appetite loss, sleep disturbances, arthritis, anxiety, and other serious or persistent illnesses. Many are older adults, veterans, children with complex conditions, people with disabilities, and patients who have exhausted, cannot tolerate, or do not respond well to conventional therapies.
What many patients have in common is not a single diagnosis. It is the external barriers that shape access. Geography, income, housing status, employment, military service, healthcare access, product availability, and state law can determine whether a patient can obtain, afford, discuss, or continue using medical cannabis.
The implementation of AG Order No. 6754-2026 may reduce some access barriers by recognizing qualifying state medical cannabis products within Schedule III. But it will not eliminate the larger access problems created by a patchwork of state laws, inconsistent federal policies, limited product availability, cost barriers, and uneven patient protections.
Until cannabis is fully integrated into the U.S. healthcare system through a national medical cannabis program, large portions of the U.S. population will continue to face unequal access and inconsistent protections.
Access Deserts Still Exist
Even in a country where most states have medical cannabis laws, many patients still live in medical cannabis access deserts.
An access desert is not limited to states without medical cannabis laws. It can exist anywhere patients technically have legal access but cannot realistically obtain, afford, or safely use the products they need. A state may have a medical cannabis law on paper while patients still face long travel distances, high registration costs, limited product types, few participating clinicians, inadequate pediatric access, employment risks, or fear of losing housing, benefits, custody, or healthcare access.
Access deserts are especially common for patients in rural areas, low-income communities, federally assisted housing, long-term care settings, hospice, nursing homes, hospitals, military communities, and states with restrictive or underdeveloped medical cannabis programs. They also affect patients who need formulations that adult-use markets often deprioritize, including high-CBD products, balanced-ratio products, non-inhaled formulations, low-dose products, pediatric preparations, and products with consistent cannabinoid profiles.
Hemp-Derived Cannabinoid Products Filled Medical Access Gaps
For many patients, hemp-derived cannabinoid products became a bridge across these access deserts. Patients turned to full-spectrum CBD and other cannabinoid products because they were available online, did not require navigating a state medical cannabis bureaucracy, and were often more affordable than dispensary products.
This was not an ideal access system. It was a workaround born of federal inaction, inconsistent state medical cannabis programs, and market failures in both medical and adult-use systems.
Pending federal hemp restrictions could deepen these access deserts. Federal changes scheduled to take effect in November 2026 will close loopholes that allowed intoxicating hemp-derived products to proliferate, but they may also remove many full-spectrum cannabinoid products from lawful commerce. That would cut off access for many patients who rely on those products as medicine.
Congress must address public safety concerns around intoxicating hemp-derived products without abandoning patients who rely on appropriate full-spectrum cannabinoid products for therapeutic use.
CMS Has Opened a Narrow Access Pathway
CMS’s Substance Access Beneficiary Engagement Incentive is a meaningful federal milestone. It allows certain CMS Innovation Center model participants to consult with eligible beneficiaries about the possible use of eligible hemp products for symptom control and, where model requirements are met, furnish eligible hemp products up to $500 per year per eligible beneficiary.
This is the first major federal healthcare access opening for cannabis-derived products in decades. It creates a narrow but important bridge between cannabinoid products, clinician-guided care, and federal healthcare systems.
However, this is not Medicare coverage for medical cannabis. The incentive is optional, model-specific, limited to eligible participants and beneficiaries, and restricted to eligible hemp-derived products. CMS does not pay ordinary Medicare claims for these products.
The CMS action is best understood as a proof of concept. It shows that cannabinoid access can be connected to federally supported healthcare settings, but it does not resolve the barriers facing state-authorized medical cannabis patients. Patients still need healthcare documentation, VA clinical support, product safety standards, continuity-of-care protections, civil rights protections, and access through federally funded care settings.
Congress Must Act to Make This Federal Shift Meaningful
AG Order No. 6754-2026 has changed the federal landscape, but patients remain vulnerable. Congress should use FY2027 appropriations and oversight authority to ensure federal agencies update outdated policies, protect patients from discrimination, preserve state medical cannabis programs, and align implementation with patient safety, civil rights, healthcare integration, research, and product safety.
Appropriations directives cannot replace comprehensive legislation, but they can prevent harm now. Congress can require DOJ, HUD, HHS, CMS, VA, OPM, SAMHSA, DOD, FDA, Treasury, IRS, FinCEN, DEA, and other federal entities to issue guidance, review existing policies, report back to Congress, and align federal implementation with the new legal framework.
Treasury and IRS have already recognized the need for implementation guidance for businesses, including guidance on Section 280E and related tax issues. Patients need the same urgency. Federal recognition of cannabis medicines must translate into practical protections for patients, caregivers, families, veterans, workers, tenants, and people who depend on federally funded healthcare, housing, and services.
FY2027 Appropriations Priorities
Congress should use the FY2027 appropriations process to protect state medical cannabis programs, prevent anti-rescheduling riders, and require federal agencies to update policies that still rely on obsolete Schedule I assumptions.
The Medical Cannabis CJS Amendment must be retained. Since 2014, this amendment has protected state medical cannabis programs, patients, and healthcare providers from federal prosecution, arrest, asset forfeiture, and harassment. These protections remain essential until Congress creates a permanent federal framework.
Congress should also remove appropriations language that would block the DEA from completing the cannabis rescheduling process. Rescheduling has been underway since 2022 and has included scientific review, public engagement, and the administrative process. Interrupting that process midstream would undermine evidence-based policymaking and public trust.
Congress should direct DOJ to issue civil rights guidance explaining how the Americans with Disabilities Act, the Fair Housing Act, and Section 504 of the Rehabilitation Act apply to state-authorized medical cannabis patients following AG Order No. 6754-2026.
Congress should require HUD to withdraw and replace outdated housing guidance that allows categorical exclusions of medical cannabis patients from federally assisted housing.
Congress should require HHS and CMS to issue guidance on healthcare for federally funded healthcare entities and Medicare- and Medicaid-participating providers. Patients entering hospitals, hospices, nursing homes, assisted living facilities, federally qualified health centers, transplant programs, pain clinics, and other care settings should not be denied care, documentation, care coordination, or accommodation solely because they use state-authorized medical cannabis.
Congress should require VA to update medical cannabis policy so veterans can discuss medical cannabis with clinicians, receive documentation where permitted by state law, and have therapeutic cannabis use treated as part of clinical care.
Congress should require the FDA to address hemp-derived cannabinoid labeling, safety disclosures, real-world evidence reporting, and product safety standards for medical cannabis and cannabinoid products.
Congress should require OPM to update workplace policies so medical cannabis patients are not automatically excluded from employment or workplace protections based solely on patient status or a positive cannabis test without evidence of impairment or job-related risk.
Congress should require DOD to review cannabis, hemp-derived cannabinoid, CBD, and medical disclosure policies for service members and create responsible clinical review pathways.
DEA Registration Must Be Fair
AG Order No. 6754-2026 creates a federal registration process for qualifying state-licensed medical cannabis manufacturers, distributors, and dispensers. That process must be fair.
One area requiring immediate attention is how the DEA will apply the public-interest standard. Because federal law allows the DEA to consider prior controlled-substance convictions, there is a risk that prior cannabis-related convictions could be used to exclude people and communities harmed by prohibition from participating in the lawful medical cannabis framework now being created.
That must not happen. Prior cannabis-related convictions should not be treated as a categorical basis to deny DEA registration. DEA should conduct an individualized review and deny registration only where there is a current, documented risk to public health, safety, diversion control, or treaty compliance.
The MCCA Pathway: A National Medical Cannabis Program
AG Order No. 6754-2026 is important, but it is not enough. Medical cannabis policy should not be administered primarily through an enforcement agency. It should be led by experts in cannabis medicines, healthcare, science, and public health.
Congress should pass the Medical Cannabis and Cannabinoid Act to create a national medical cannabis framework housed within the Department of Health and Human Services. The MCCA would create an Office of Medical Cannabis and Cannabinoid Control to coordinate federal implementation, healthcare integration, product safety, research, data collection, patient protections, and national standards.
A national medical cannabis program should protect patient access, support healthcare integration, establish product safety standards, collect clinical and real-world evidence, standardize medical cannabis data, support CMS studies on coverage and cost savings, guide federally funded healthcare settings, coordinate federal agencies, and protect patients from discrimination.
State programs proved that regulated medical cannabis access is possible. The current landscape shows that possibility is not the same as equity, consistency, or healthcare integration. Congress must finish the job.
What Members of Congress Should Do
Members of Congress should protect the Medical Cannabis CJS Amendment, remove appropriations language that blocks rescheduling or undermines state medical cannabis programs, direct DOJ to issue civil rights guidance, and require federal agencies to update outdated policies.
Congress should also ensure that DEA registration is fair, protect patients from discrimination in housing, employment, healthcare, veterans’ services, federal programs, and reasonable-accommodation requests, and create a responsible pathway for patients who rely on appropriate full-spectrum cannabinoid products.
Most importantly, Congress should advance the Medical Cannabis and Cannabinoid Act and create an Office of Medical Cannabis and Cannabinoid Control within HHS. Federal medical cannabis policy must move from patchwork enforcement to healthcare integration.
Medical Cannabis Is a Healthcare Issue
Millions of Americans rely on medical cannabis and cannabinoid products to manage serious and chronic health conditions. State medical cannabis programs exist because federal access failed. AG Order No. 6754-2026 is a major federal recognition of medical cannabis, but it does not automatically protect patients.
Patients should not lose housing, employment, healthcare, veterans’ services, federal program participation, or reasonable accommodations because their medicine is cannabis. Federal agencies must update outdated policies that still rely on Schedule I assumptions.
Congress must protect state medical cannabis programs while building a national framework. Hemp policy must address public safety without cutting off patients from appropriate full-spectrum cannabinoid products. CMS has opened a narrow pathway, but patients need comprehensive healthcare integration.
The next step is clear: Congress must pass the Medical Cannabis and Cannabinoid Act and create a national medical cannabis program that protects patients, supports clinicians, advances research, ensures product safety, and integrates cannabis into the U.S. healthcare system.
Take Action
Medical cannabis patients cannot wait for outdated policies to catch up on their own. Congress must act now to protect patients, preserve state medical cannabis programs, prevent anti-rescheduling riders, and build a national medical cannabis framework.
Send this briefing to your members of Congress. Ask them to support FY2027 appropriations language that protects medical cannabis patients. Urge them to advance the Medical Cannabis and Cannabinoid Act. And help Americans for Safe Access document medical cannabis patient discrimination so federal agencies and lawmakers understand the real-world harm patients continue to face.
About Americans for Safe Access
Americans for Safe Access is the nation’s leading medical cannabis patient advocacy organization, with the mission of ensuring safe and legal access to cannabis for therapeutic use and research.
Since 2002, ASA has been at the forefront of medical cannabis policy, advancing patient rights, product safety, healthcare integration, research, and federal and state policy reform.
Is Cannabis (marijuana) Legal Now?
What the New Federal Cannabis Scheduling Means for Patients, Advocates, Researchers, & Providers
Read more: www.safeaccessnow.org/is_cannabis_legal_now
Memo: Federal Guidance: AG Order No. 6754-2026: Rationale for Immediate Action
Prepared by Americans for Safe Access Date: May 11, 2026
This memorandum provides rationale for the request delivered to President Trump and Acting Attorney General Blanche: Immediate Federal Guidance Needed to Protect Medical Cannabis Patients Regarding AG Order No. 6754-2026: Schedules of Controlled Substances: Rescheduling of Food and Drug Administration-Approved Products Containing Marijuana from Schedule I to Schedule on behalf of patients, disability, veterans, housing, healthcare, labor, and medical organizations and professionals.
Read more: www.safeaccessnow.org/guidance_rationale_ag_order
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