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While rescheduling cannabis to Schedule III may seem like a significant deviation from the recommendations provided by the Department of Health and Human Services (HHS) in their 2015 "Basis for the Recommendation for Maintaining Marijuana in Schedule I of the Controlled Substances Act," which led to the Drug Enforcement Administration's (DEA) 2016 "Denial of Petition to Initiate Proceedings to Reschedule Marijuana," it's essential to recognize the substantial changes that have occurred since then.

It has been thirteen years since Governors Lincoln D. Chafee (RI) and Christine O. Gregoire (WA) filed the last rescheduling petition that HHS and the DEA were responding to. In the intervening years, a wealth of research, developments in state programs, and patient experiences have driven a global movement toward recognizing cannabis's therapeutic applications. Here are some examples of changes that have taken place between the last rescheduling denial and the current rescheduling process:

 In 2011, at the time of the filing of the last rescheduling petition, while sixteen states had passed medical cannabis laws, only thirteen of these programs were operating, and only five had operating distribution programs, accounting for 286,243[1] registered medical cannabis patients (excluding WA, CA, HI no data available DC, DE, NJ not online yet) and estimated 600,000[2] non-registered patients. Today, over 6 million medical marijuana patients are being treated in practice in state programs by more than 30,000 state-authorized physicians in a majority of state jurisdictions in the U.S. [3].

2015-2022 As HHS noted in their findings in "Basis for the Recommendation to Reschedule Marijuana into Schedule III of the Controlled Substances Act" and as highlighted by the Justice Department’s Office of Legal Counsel (OLC) in defending HHS’s approach:

"Several states have also established processes through which experts can recommend additions to, or removals from, the list of conditions that marijuana may be used to treat... Indeed, HHS has informed us that 17 jurisdictions have added conditions that may be treated with marijuana using such processes; see HHS Part 1 Analysis Memo at 4. In short, it is simply not the case that state practice concerning medical marijuana is completely divorced from scientific and medical assessment."[4]

These boards rely on a combination of research, expert testimony, and public input. To date, 21 states have established such boards, which have approved 58 distinct qualifying conditions since 2014, three years after the last federal rescheduling petition.

April 2016- The Federation of State Medical Boards (FSMB) adopted “Model Guidelines for the Recommendation of Marijuana in Patient Care”[5] and several state medical boards have issued guidelines for physicians to incorporate cannabis into their patients’ treatment regime for example: “Medical Board of California’s Guidelines for the Recommendation of Cannabis for Medical Purposes”[6].

January 2017- The National Academies of Sciences, Engineering, and Medicine published The Health Effects of Cannabis and Cannabinoids[7], which concluded: " There is conclusive or substantial evidence that cannabis or cannabinoids are effective for the treatment of chronic pain in adults, as anti-emetics in the treatment of chemotherapy-induced nausea and vomiting, and for improving patient-reported multiple sclerosis spasticity symptoms."

October 2017- The United States declares the opioid crisis a “public health emergency” after reaching an average of “91 deaths a day.”[8]

2017-2018- Connecticut, Washington DC, Florida, Illinois, New Jersey, and New York add pain as a qualifying condition to their medical cannabis program following the ASA report “Medical Cannabis as a Tool to Combat Pain and Opioid Crisis: A Blueprint for State Policy.”[9]

January 2019-The World Health Organization recommends that the United Nations Committee on Narcotic Drugs reschedule cannabis based on “a multi-year review process conducted by the Expert Committee on Drug Dependence (ECDD), an independent scientific advisory body to the WHO. Based on scientific assessment, potential health risk, and therapeutic benefit.[10]

December 2020- “…the UN Commission on Narcotic Drugs (CND), the drug policy-making body of the UN re-classified cannabis and cannabis resin under an international listing that recognizes its medical value. The CND voted on recommendations made by the WHO’s 41st Expert Committee on Drug Dependence (ECDD), which suggested that cannabis and cannabis resin should be reclassified from its current listing alongside heroin, fentanyl analogues and other opioids considered to be exceptionally harmful to public health.”[11]

January 2023- The International Narcotics Control Board (INCB) Report for 2022: “In 2018, WHO carried out a critical review of cannabis and cannabis-related substances and came to the conclusion that these substances can have a therapeutic value. Following the recommendation of WHO, the Commission on Narcotic Drugs decided in December 2020 to remove cannabis and cannabis resin from Schedule IV of the 1961 Convention as amended but kept(?) it in Schedule I. The 1961 Convention (Article 28) allows State parties to cultivate and use cannabis for medical purposes under certain conditions. The Convention requires that States license and control cannabis production for medical use, establish a national cannabis agency, provide estimates of the national requirements for cannabis for medical purposes, and ensure that medicinal cannabinoids are used in accordance with the evidence of their safety and effectiveness under medical supervision. As far as the specific control measures for cannabis are observed, these medical cannabis programs comply with the conventions. However, in some States “medical cannabis programs(?)” are operated without the necessary I. control required by the conventions or by the standards recommended by WHO in relation to good manufacturing and good prescribing guidelines.”[12]

May 2023- Minnesota Department of Health issues “Dosing and Chemical Composition Report: A Review of Medical Cannabis Studies Relating to Chemical Compositions and Dosages for Qualifying Medical Conditions.[13]

These developments highlight the evolving landscape of medical cannabis over the past decade. The growing body of research, changes in state and international policies, and increased recognition of cannabis's therapeutic potential have all contributed to the current considerations for rescheduling. As the conversation continues, it's essential to acknowledge these significant milestones that have shaped the understanding and acceptance of medical cannabis.

Footnotes

1. Bowles, Daniel W. (2012). "Persons Registered for Medical Marijuana in the United States." Journal of Palliative Medicine, Volume 15, No. 1.
2. Americans for Safe Access (2013, June 13). "What's the Cost."
3. Page 24, Basis for the Recommendation to Reschedule Marijuana into Schedule III of the Controlled Substances Act.
4. Page 20, OLC memo: Questions Related to the Potential Rescheduling of Marijuana
5. Federation of State Medical Boards. "Model Guidelines for the Recommendation of Marijuana in Patient Care."
6. Medical Board of California. "Guidelines for the Recommendation of Cannabis for Medical Purposes."
7. National Academies of Sciences, Engineering, and Medicine (2017). The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research.
8. S. Government Accountability Office (2018). "Opioid Crisis: Status of Public Health Emergency Authorities."
9. Americans for Safe Access (2017). "Medical Cannabis as a Tool to Combat Pain and Opioid Crisis: A Blueprint for State Policy."
10. World Health Organization. "Extract from the Report of the 41st ECDD: Cannabis and Cannabis-Related Substances."
11. World Health Organization (2020, December 4). "UN Commission on Narcotic Drugs Reclassifies Cannabis to Recognize Its Therapeutic Uses."
12. International Narcotics Control Board (2022). Report of the International Narcotics Control Board for 2022, Chapter I.
13. Minnesota Department of Health (2023). "Dosing and Chemical Composition Report: A Review of Medical Cannabis Studies Relating to Chemical Compositions and Dosages for Qualifying Medical Conditions."