Open Minds

What rescheduling will mean for medicinal cannabis research

Humans have been using cannabis for thousands of years, but there’s still plenty about the plant and its effects that we don’t understand. Since its inclusion on Schedule I of the Controlled Substances Act in 1970, research on drugs derived from cannabis has been difficult. While cannabis use remains federally illegal, it’s approved for medical use in 38 states and for recreational use in 24. That’s has provided a growing body of evidence for cannabis’ medicinal properties, but research remains heavily restricted. With the DEA moving to reclassify it to Schedule III, that could change.

“The public health use of cannabis has gone far ahead of what we know from the research. We’re really at this point trying to play catch-up,” David Shurtleff, deputy director of the National Center for Complementary and Integrative Health, told STAT. “The real issue here is getting access to diverse products that are being used by the public.”

Schedules

The move stands to be the most significant change in cannabis’ federal legal status since 1970, when it was placed on Schedule I, a label that indicates high potential for abuse with no accepted medical use. It sits on Schedule I alongside heroin, LSD, peyote, and ecstasy. But since 1996, when California’s Compassionate Use Act made it the first U.S. state to pass medical marijuana legislation, dozens of states have acknowledged the medical efficacy of cannabis.

Despite warnings that cannabis is a “gateway drug,” research and data have shown that its potential for abuse is much lower and its medicinal properties much higher than a Schedule I classification warrants. On Schedule III, cannabis will be alongside ketamine, Tylenol with codeine, testosterone, and anabolic steroids. The argument that reclassifying cannabis to Schedule III doesn’t go far enough and that it should be legalized federally is growing in popularity, even in the halls of Congress.

“While this rescheduling announcement is a historic step forward, I remain strongly committed to continuing to work on legislation like the SAFER Banking Act as well as the Cannabis Administration and Opportunity Act, which federally deschedules cannabis by removing it from the Controlled Substances Act,” Senate Majority Leader Sen. Chuck Schumer of New York said in a statement. “Congress must do everything we can to end the federal prohibition on cannabis and address longstanding harms caused by the War on Drugs.”

But for now, rescheduling remains a big, if incremental, step forward.

Easier Path

To conduct cannabis research, scientists have needed a Schedule I license, which can be very hard to obtain. They’ve also had to spend a great deal of money acquiring cannabis from a limited number of DEA-licensed sources and ensuring compliance with stringent regulations. University of California, San Francisco, associate professor Suzaynn Schick told STAT it took her over a year to obtain a license and that she spent $28,000 for 750 grams of research cannabis, about seven times what that amount would cost at a dispensary near her office. It’s also expensive to dispose of waste, one of the precautions taken to prevent a Schedule I substance from entering public supply.

“I should be able to throw cannabis butts into something slightly more regulated than I throw tobacco butts, but I should not have to pay thousands of dollars to dispose of them as hazardous waste,” Schick told STAT.

The move to Schedule III would in many ways be less restrictive, though dispensaries would have to register with the DEA and cannabis would remain a controlled substance with sellers subject to federal prosecution. Still, there would be more money available and less restriction on research drugs that could prove incredibly useful in treatment of chronic pain, some cancers, epilepsy, and PTSD.

Rescheduling cannabis is “a very, very big paradigm shift,” neuroscientist Staci Gruber at McLean Hospital and Harvard Medical School told NPR. “”I think that has a big trickle-down effect in terms of the perspectives and the attitudes with regard to the actual sort of differences between studying Schedule III versus Schedule I substances. For researchers who are looking to get into the game, it will be easier. You don’t have to have a Schedule I license. That’s a big deal.”

That could lead to better understanding and acceptance of cannabis as medicine, as physicians are often hesitant to recommend cannabis, fearing legal and professional backlash.

How Much Change?

With the switch to Schedule III, licensed medical practitioners will be able to prescribe cannabis-based drugs. Even in states with medical programs, most only allow medical professionals to recommend cannabis. This would also open the possibility of FDA approval for cannabis-derived drugs, potentially meaning that Medicare/Medicaid, the VA, and state workers’ compensation programs would cover the costs.

Because of cannabis’ federal status, researchers at universities have been hesitant to bring it on campus for fear of losing federal funding because of other War on Drug-era legislation. With that restriction gone, they could better study the effects of different dosages, formulations, and modes of administration for cannabis-derived drugs. If you live in a state where recreational use is legal, you might head to your local dispensary and find edibles, THC drinks, and other assorted products. But researchers have been unable to get their hands on most of them. Even with rescheduling, they still might not.

“As long as there’s this conflict between federal and state law, we are not going to be able to really study things people are actually using,” said Igor Grant, a professor of psychiatry at the University of California, San Diego, told STAT.

Still, the change could make things like outpatient clinical trials possible.

Any advancement that makes studying cannabis and its effects easier is vital to understanding the endocannabinoid system, the largest neurotransmitter system in the body, which might help us regulate many physiological and cognitive processes.

“We’re hopeful that it would help facilitate research, do things maybe quicker, faster than we were able to do now. That’s our hope,” Shurtleff told STAT.

The process could take years to play out, but there’s hope it will make the medical benefits of cannabis less hazy.