Federal legalization of cannabis must address medical use


L.Federal cannabis legalization legislation recently proposed by Senator Chuck Schumer (DN.Y.) and a group of Senate Democrats is long overdue. While it aims to address injustices among color communities most harmed by the war on drugs, it excludes a very important demographic: patients.

The bill is presented as a “comprehensive” cannabis reform. It makes cannabis legal for recreational use in the United States and contains many provisions for expanding the cannabis industry. It also adds taxes that generate revenue for the federal government and provides that some of the money raised will be used to improve the lives of the communities hardest hit by the failed war on drugs.

The lack of patient care overlooks the largest group of people who will or could be affected by this new law.


An estimated 115 million Americans over 50 will develop one or more diseases, such as osteoarthritis, anxiety, insomnia, or cancer, that can be treated with cannabinoid drugs. Not including them in the draft discussion underlines that the legislature does not take into account the needs of patients, the differences between patients and recreational users, and the way in which a recreational paradigm does not support the necessary clinical care.

My colleagues and I at the Association of Cannabinoid Specialists, a professional body dedicated to educating clinicians and lawmakers on the use of cannabinoid drugs, believe that a medical cannabis paradigm should contain four key components, which we Schumers and colleagues have communicated.


First, legislation should decouple medicinal and recreational cannabis. While legalizing recreational cannabis can meet the needs of healthy people, it cannot meet people’s medical needs. People need competent care based on sound scientific knowledge, aligned with the same core values ‚Äč‚Äčthat apply in all areas of medicine, including respect for patient decisions through informed consent, charity through sound medical advice that ensures patient benefit and while minimizing the harm of providing accurate prescriptions to patients ensuring patients receive the correct medicine and justice by ensuring that everyone is treated fairly and all have equal treatment options.

Second, national standards must regulate the manufacture and safety of cannabis drugs. The packaging must be uniform throughout the country and have precise and easily legible labeling of the ingredients and potency. Many states have already set their own standards that address some of these concerns, but these rules vary from state to state. We believe that part of the role of federal law should be to incorporate the best of these guidelines into a national standard. These are commonly referred to as harmonizing standards, and my colleagues and I believe that it will be welcomed by many state lawmakers and regulators.

To ensure that national standards enable innovation in cannabinoid medicines, the Association of Cannabinoid Specialists promotes ongoing research and collaboration between industry, scientists, clinicians and regulators.

Third, all states – including those without medical cannabis programs – must allow individuals to move freely across state borders with cannabis drugs, which they are currently prohibited from doing. Individuals with nationally recognized prescriptions under a new federal law should be able to use their medication freely and travel across jurisdictions and state lines, including by air, in all US states and territories.

Fourth, there must be clear rules for properly promoting cannabis products, whether they are sold in recreational or medical markets. These regulations must include a restriction on dealers providing medical advice at the point of sale – only qualified, licensed healthcare professionals should direct patient care. Sellers must also be required to complete medical cannabis prescriptions as written, without attempting to sell additional or different products.

Federal regulations should also prohibit advertising that is misleading, false, fraudulent, or creates a misleading impression – whether direct or through omission or ambiguity – or that encourages over-consumption or the consumption of products with higher potency.

With so much focus on cannabis as an economic opportunity and a method of correcting social injustice, it’s easy to forget that cannabis is also a medicine and that helping patients is a social justice issue.

In creating and implementing cannabis legalization, the health and safety of patients who use cannabis for the treatment of numerous physical and mental illnesses must not be forgotten. The guidelines we have proposed for federal regulation will ensure that cannabis patients are not forgotten and that, like all other patients, they have easy access to safe and efficient treatments.

Jordan Tishler is an internal medicine doctor, founder of inhaleMD in Cambridge, Massachusetts, lecturer in medicine at Harvard Medical School, and president of the Association of Cannabinoid Specialists.