Trump rolls on medical marijuana

Several years ago, I asked my rheumatologist, who was prescribing my pain medication for severe idiopathic arthritis, if medical marijuana was something I should consider.

He shook his head. “The problem with medical marijuana,” he said, “is that there’s not a lot of research on long-term use.”

It made sense to me that there wouldn’t be, given the federal prohibitions on marijuana.

That could change soon. On Thursday, President Donald Trump signed an executive order seeking a change to how the drug is classified by the Drug Enforcement Agency.

Like every other medical treatment out there, there will be benefits and side effects.

Drugs placed in ‘schedules’ based on medical use, abuse potential

Trump’s executive order is designed to fast-track the reclassification of marijuana under the Controlled Substances Act, which classifies drugs into five different "schedules,” or categories based on their accepted medical use and potential for abuse or dependency.

Currently, marijuana is classified as a Schedule I drug – the most severe category – meaning it has no accepted medical use and a high potential for abuse. Other Schedule I drugs include heroin, LSD and ecstasy.

At first glance, this might seem bizarre: Cocaine, fentanyl and methamphetamine are classified as Schedule II controlled substances, meaning they are not treated as severely as marijuana. Despite their enormous potential for dependency and abuse, all three are recognized as also having legitimate medical uses such as topical anesthesia and management of acute pain and attention deficit disorders.

Trump’s Thursday order directs members of his administration to get rolling (pun intended) on the federal rulemaking process to reclassify marijuana as a Schedule III controlled substance, which would put it in the same category as testosterone, anabolic steroids and Tylenol with codeine and characterize it as having an accepted medical use with a low to moderate potential for dependence or abuse.

It’s quite a change to how we regulate a substance many advocates say was wrongly classified upon passage and signing of the Controlled Substances Act (CSA) in 1970.

What the order won’t do – and what it might

Recreational users shouldn’t celebrate yet. The executive order does not legalize marijuana at the federal level, even for medical purposes. It still cannot be prescribed by physicians. Although 40 states have regulated programs for medical use, medicinal products containing marijuana can only be recommended.

The order also does not supplant the new hemp limits included in the appropriations bill passed last month to reopen the federal government. Those limits were added to close a loophole in prior legislation, which legally defined cannabis so narrowly that it ended up allowing for products with certain forms of THC to be sold with little or no oversight. THC, short for tetrahydrocannabinol, is the intoxicating compound in marijuana.

Hemp industry advocates say the limits imposed in last month’s appropriations bill – which are set to take effect late next year and can only be repealed by an act of Congress – will decimate their industry. The limits, they say will ban over 90% of even non-intoxicating products, including those that contain only CBD (short for cannabidiol), which does not produce a high and has become very popular for therapeutic use.

It wouldn’t be the first time the U.S. government attempted to address regulation that was too lax with regulation that was too tight.

Thursday’s executive order directs the administration to work with Congress to "update the statutory definition of final hemp-derived cannabinoid products" to prevent blocking access to full-spectrum CBD products while restrictions on riskier products are kept in place.

Trump says the change is necessary for research.

“A lot of people want to see it, the reclassification, because it leads to tremendous amounts of research that can’t be done unless you reclassify it,” the president told reporters in the Oval Office Monday.

Indeed, research on Schedule I controlled substances is notoriously cumbersome. Schedule I researchers must obtain a separate registration with the DEA. Their research applications are much more closely scrutinized; their facilities face strict additional security requirements that often add time and expense to an already time-consuming and costly process.

And that’s to say nothing about the process of obtaining the substances themselves. Prior to 2021, only one facility in the whole country held a license to provide marijuana for research purposes. It had been that way since 1968. It took a new federal rule, finalized in the final days of the first Trump administration, to bump that number up to seven by 2023.

Such strict standards might make sense for heroin or LSD. For a substance that about one in five Americans used in 2024, not so much. Especially not when there’s a growing list of potential medical benefits.

Medical marijuana has already shown promise in treating epileptic seizures, anxiety, nausea and vomiting in chemotherapy patients, muscle spasms nerve tremors in multiple sclerosis patients, chronic pain and reduction in the use of highly addictive opioids.

From pain pills to ‘pot gummies’

Even your friendly neighborhood opinion columnist has tried therapeutic cannabis.

The opioid-based painkillers I had been prescribed for chronic pain – a combination of hydrocodone and acetaminophen, a Schedule II controlled substance – had worked well for 19 years. But after I began experiencing debilitating headaches, I learned that opioids are known to exacerbate frequent headaches and found myself quitting cold turkey. As of Wednesday, I’ve been opioid-free for 18 months.

That's not all good news for a person with now-untreated chronic pain, of course. To help myself cope, I ordered some “pot gummies,” as I bluntly called them: little fruit-flavored chews containing 10 milligrams of CBD and a beginner’s dose of five milligrams of THC.

I’ll be honest – after 19 years on painkillers, the pot gummies were a letdown. I didn’t feel better so much as I felt ... confused. Natural blondes like me don’t need any help with that.

But I’m glad they were there for me to try. And I’m certainly glad for those who have gotten some relief with medical cannabis while battling with cancer and Parkinson’s and other awful conditions.

We need more research to tell us how cannabis can help people cope with debilitating medical issues. Reclassifying it as a Schedule III drug could open the floodgates for that kind of valuable research. It could also tell us more about the dangers associated with marijuana use we haven’t yet discovered.

Republican officials: Don’t do it

Some Republicans are pushing back. Twenty-two Republican senators signed a joint letter asking Trump to “uphold marijuana’s status as a Schedule I drug,” saying its potential for abuse will undermine his economic agenda as marijuana use threatens occupational safety and the strength of the American workforce.

Closer to home, Iowa Attorney General Brenna Bird joined seven other Republican attorneys general cautioning against the change.

Their concerns aren’t misguided. But acknowledging that there are acceptable medical uses for marijuana and cutting the red tape for research won’t be the driving forces behind increased marijuana use.

Even if moving marijuana down the schedule is a precursor to its full federal legalization, it won’t be the cause. The force driving the U.S. toward legalizing marijuana is society’s increasing acceptance of it. Just shy of half of U.S. states have already legalized cannabis for recreational use.

That means that the increased research Trump’s reclassification is intended to promote will be more vital than ever. We need detailed information on the negative effects of marijuana so industries can implement best practices and states can stay on top of their duties to govern and regulate in what will, yes, be whole new scene if and when marijuana is federally legalized.

Cannabis industry about to boom

With that, I offer a warning to the cannabis industry, which has a lot to celebrate here. But there’s also a lot they can learn from the mistakes of the opioid industry from 20 years ago, when the promise of obscene profits motivated deceptive marketing campaigns, physician overprescribing and ignorance of concerning side effects bought us an epidemic of addiction that will haunt us for some time.

The cannabis industry will be more lucrative than ever if the objectives in Trump’s executive order are achieved smoothly. When new products start racing to the market under a relaxed regulatory framework, the industry must remember that there is such a thing as too much, too fast.

I was lucky 20 years ago – my physician was diligent and responsible when prescribing and supervising my use of opioids. I never faced addiction like so many others did.

Patients seeking relief with medical marijuana shouldn’t need to rely on luck. If Trump’s executive order means more research and better guidelines, they might not have to.

Lucky them.

Comments: 319-343-8222; althea.cole.writer@gmail.com