Federal marijuana policy finally moves—but are you ready for what comes next? Docs weigh in
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Expanded research into cannabis may help us better understand its role—if any—as a lower-risk alternative, adjunct, or tool for symptom management for certain patients. This is not about promoting use or minimizing risk; it is about replacing ideology with data, and punishment with public health.
—Nzinga Harrison, MD, double-board certified physician in psychiatry and addiction medicine
Federal marijuana policy is changing after decades of static regulation.[] In December 2025, the United States government moved marijuana toward becoming a federally recognized medical drug by initiating the process of rescheduling it from a Schedule I to Schedule III substance.
Under the new policy, marijuana’s status would change from a drug with “no currently accepted medical use” to one that acknowledges medical use under federal scheduling criteria, and that may reduce barriers to research and development of FDA-approved cannabinoid medicines.[]
Details on Medicare coverage aren’t finalized; the order primarily directs health agencies, including the Centers for Medicare and Medicaid Services, to develop a research and evidence framework that could support future access policies.[]
Clinical implications
This shift could reduce some regulatory barriers and support more clinical research; downstream effects on coverage and reimbursement, if any, would likely be incremental and policy-dependent.
Physicians have worked for years under a paradox: Many states allow medical marijuana, but federal Schedule I status constrained research and contributed to uncertainty around clinician participation and reimbursement. In most states, clinicians recommend or certify marijuana use rather than prescribe medical marijuana.
Integrative physician Dustin Sulak, DO, explains that the most common patient populations raising cannabis- or CBD-related questions include older adults with pain and/or sleep disturbances.
Rachit Marwaha, MD, an internal medicine and interventional pain management physician and lead family medicine physician at Naperville Internist in Naperville, IL, adds, “Patients with chronic pain who failed multiple existing pain medications often are interested in CBD. Patients who have read about the potential negative harmful side effects of current pain medications are also interested. [This also] goes to patients who deal with chronic mood disorders ranging from anxiety to PTSD. They have often tried current standard of care therapies and do not like the side effects and seek a more organic alternative.”
Research implications
Federal research expansions have already been underway since the 2022 Medical Marijuana and Cannabidiol Research Expansion Act, which authorized broader NIH-funded studies on cannabis and CBD.[]
Standardizing cannabis products and understanding pharmacokinetics in controlled trials is a priority. According to a summary of prospective clinical developments, cannabinoids like dronabinol derivatives and spray formulations, such as Sativex, are in phase 3 or late-stage evaluation for indications including spasticity and chronic pain, with US trials planned.[]
Nzinga Harrison, MD, co-founder of Eleanor Health and double-board certified in general adult psychiatry and addiction medicine, says, “For people with substance use disorders, particularly those at risk of overdose from alcohol or opioids, expanded research into cannabis may help us better understand its role—if any—as a lower-risk alternative, adjunct, or tool for symptom management for certain patients. This is not about promoting use or minimizing risk; it is about replacing ideology with data, and punishment with public health.”
According to Dr. Marwaha, “rescheduling botanical marijuana opens opportunities to [allow] physicians and patients to have more open dialogue regarding cannabis. This will further reduce the negative bias around cannabis, which will allow for more usage in clinical practice. We are also hopeful this will lead to further research in clinical trials and increased trust in cannabis. With regards to CBD, it is important for patients to understand [that] CBD can serve as a meaningful and beneficial treatment option in the appropriate clinical context.”
Providers should anticipate:
Updating intake forms to screen for cannabis and CBD use.
Tracking outcomes, adverse events, and interactions with CNS drugs and cardiovascular agents.
Collaborating with pharmacists to document product quality and sources.
Dr. Sulak adds, “Patients who are federal employees and who have federal licenses or certifications will have more freedom to use cannabinoid-based medicines. People in residential facilities—for example, people with dementia in memory care facilities or adults with autism in group homes—will be able to use cannabinoid medications without the facility fearing the loss of federal funding. Most of all, many patients who need but cannot afford these products will be able to benefit from them with Medicare reimbursement. Since cannabinoid medicines usually treat multiple symptoms (eg, pain, sleep, blood pressure, and anxiety control from a single medication) and frequently replace pharmaceutical medications, patients will likely have [fewer] side effects and risks by discontinuing or reducing the dose of other drugs.”
Dr. Harrison adds, “Policies that prioritize research, transparency, and patient-centered care ultimately save lives, and that is the standard we should be holding ourselves to.”
What's next?
Rescheduling does not substitute for high-quality evidence. Systematic reviews and emerging data caution that cannabis products vary widely in potency and adverse effects.[] Some literature highlights limited support for pain, PTSD, and sleep disorders outside narrow indications and flags possible cardiovascular and cognitive side effects.
Brian Kendall, MD, FACEP, an emergency medicine physician practicing in South Carolina, states, “When Colorado legalized marijuana, marijuana-related incidents increased. For example, CHS cases doubled per their data. I also see many people who use marijuana recreationally who drive while under the influence of marijuana and then are involved in car accidents. Both could lead to an increase in [the] number of ER patients.”
Sangeeta Hatila, MD, a board-certified consultant psychiatrist at Aiman Health, warns, “From a psychiatric standpoint, the biggest risk is normalization without guardrails. When a substance gets framed as ‘medical’ through reimbursement pathways, patients can assume it’s universally safe, even when their history (psychosis, bipolar disorder, panic disorder, substance-use disorder) makes the risk profile very different.”
She adds, “There’s also a drug–drug interaction problem. CBD can affect [the] metabolism of other medications. In psychiatry, that’s relevant for antidepressants, antipsychotics, mood stabilizers, benzodiazepines, and sleep agents—so we may see more sedation, dizziness, or unexpected changes in blood levels.”