Blog

Leading up to the 2024 election, publicly traded cannabis companies and some advocates promoted overly optimistic narratives on cannabis futures—Schedule III was inevitable, or that a new presidential administration would legalize cannabis, despite the fact that POTUS doesn’t have the authority to do so. But none of that materialized. The new administration’s appointments to key posts, such as the DEA and DOJ, have not signaled support for reform. With the GOP now controlling the Senate, key committees on cannabis policy are led by some of the most oppositional lawmakers.

This isn’t just unfortunate policy—it’s a looming economic disaster. Without federal reform, many cannabis businesses, especially those focused on serving medical patients, may not survive. State-level programs with geo-fenced markets are nearly impossible to sustain, much less find funds to invest in R&D.

But the collapse of the U.S.-based cannabis market doesn’t mean the end of cannabis innovation—it just means it will happen elsewhere. Ironically, this undercuts a core tenet of Trump’s platform: supporting domestic manufacturing and innovation through “Made in the USA” policies.

A key but underreported issue in federal cannabis policy is the competitive disadvantage U.S. companies face— not only in the future U.S. medical cannabis market but also on the global stage. While the U.S. continues to stall on federal regulation, more than 60 countries have already established national medical cannabis programs, offering consistent regulatory frameworks for cultivation, manufacturing, and patient access*.

This disparity is underscored by the Global Cannabis Regulatory Summit taking place this week in Washington, D.C. Organized by two UK-based investment firms, the summit features companies that supply cannabis to national medical programs around the world—programs that are often state-run and structured to serve pharmacies and patients, rather than private recreational markets. Many of these firms comply with strict pharmaceutical-grade standards for cannabis products, including a ±5% deviation requirement for active compounds like THC or CBD in flower.

Cannabis has been available in Dutch pharmacies since 2003, making it available (sometimes with copious amounts of paperwork) to all EU citizens. Over the years, many more countries have created national medical cannabis programs to ease patients' access. For companies to operate in these markets, they must produce standardized products that meet public health agency specifications, similar to those for other medications.

Meanwhile, the U.S. medical cannabis market—serving over six million patients—remains federally illegal [1]. This leaves state programs vulnerable to federal enforcement, limits investment, research, and innovation, and has driven many companies to focus on supplying adult-use markets with products unsuitable for patient populations.

Medical cannabis isn’t going away. Chronic diseases account for 90% of the $4.9 trillion the U.S. spends annually on healthcare. Roughly 129 million Americans have at least one chronic illness, and older adults often take 5–20 prescription medications daily—many of them palliative. Yet, treatments for complex diseases like neurodegenerative disorders, cancer, and chronic pain remain inadequate.

Cannabis-based therapies offer a safer, often more effective option—particularly for patients unresponsive to standard drugs or who suffer intolerable side effects. Unlike opioids, cannabinoids do not affect respiratory or cardiac function, making lethal overdose virtually impossible. This is one reason over two-thirds of U.S. clinicians recognize cannabis’s medical value—and why many recommend it [2].

The pharmaceutical industry has long focused on single-compound drugs that target one receptor or enzyme. However, chronic, complex illnesses often involve multiple overlapping physiological pathways. In contrast, full-spectrum cannabis products act on several targets simultaneously, offering multi-modal relief with fewer side effects.

This kind of multi-modal therapeutic approach is gaining momentum in medicine. Drugs like aspirin were developed without a complete understanding of their mechanisms—are now staples because of their proven efficacy and safety. Regulations should foster a similar pathway for cannabis products.

Cannabis Companies Will Lead These Efforts Over Traditional Pharma Companies

Federal investment in cannabis research remains paltry. Between 2000 and 2018, the NIH spent $1.4 billion on cannabis studies—but over $1 billion of that went to the National Institute on Drug Abuse (NIDA) to examine potential harms, not therapeutic uses [3]. By comparison, NIH invested $187 billion in research related to the 354 FDA-approved drugs from 2010 to 2019. That’s an average of $1.4 billion per drug, rising to $1.7 billion when adjusted for inflation [4]. In other words, without the US picking up the tab on preclinical and early-stage research, Pharma companies are not coming to the rescue.  

President Trump has an opportunity to take leadership on this issue. He could work with RFK Jr. to establish an Office of Medical Cannabis and Cannabinoid Control (OMC) under HHS—as we propose in ASA’s model legislation—and join bipartisan voices to urge Congress to pass the medical cannabis legislation. With a dedicated federal agency and the passage of a national medical cannabis law, U.S. companies could finally compete globally on a level playing field.

If not, we risk abandoning a sector that supports over 600,000 jobs-- we’ll lose a chance to lead in one of the most promising areas of 21st-century medicine. The global cannabis marketplace is advancing with or without us. Congress and the President must act to give US companies a chance to compete.

* 9 AFRICA: Ghana, Lesotho, Malawi, Morocco, Rwanda South Africa, Uganda, Zambia, and Zimbabwe, 12 AMERICAS: Argentina, Brazil, Canada, Chile, Colombia, Costa Rica, Ecuador, Mexico,  Panama, Paraguay, Peru, and Uruguay, 3 ASIA: South Korea, Sri Lanka, Thailand, 4 CARIBBEAN: Barbados, Bermuda, Jamaica, St. Vincent and the Grenadines, 21-27 EU: All patients in the EU have access to medical cannabis under their rights as EU citizens and Austria, Belgium, Croatia, the Republic of Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Malta, the Netherlands, Poland, Portugal, Romania, Slovenia, and Spain have national programs, 9 EUROPE non-EU United Kingdom, Moldova, North Macedonia, Georgia, Norway, San Marino, Switzerland, Sweden, Ukraine, 2 MIDDLE EAST: Israel, Lebanon, and 3 OCIANA: Australia, New Zealand, Vanuatu

 Citations:

1. DEA, DOJ. Notice of Proposed Rulemaking: Schedules of Controlled Substances: Rescheduling of Marijuana. May 21, 2024.
2. Schauer GL, Njai R, Grant AM. Clinician Beliefs and Practices Related to Cannabis. Cannabis Cannabinoid Res. 2022;7(4):508-515. doi:10.1089/can.2020.0165
3. ScienceInsider. Cannabis research database shows how U.S. funding focuses on harms of the drug. August 2020.
4. Galkina Cleary E, Jackson MJ, Zhou EW, Ledley FD. Comparison of Research Spending on New Drug Approvals by the National Institutes of Health vs the Pharmaceutical Industry, 2010–2019. JAMA Health Forum. 2023;4(4):e230511. doi:10.1001/jamahealthforum.2023.0511