Time to Treat Cannabis as Medicine

A group of experts in and observers of the growing cannabis industry in the United States recently gathered at Arizona State University West Valley to discuss how government policy is shaping regulatory oversight, public health protections, and environmental outcomes of cannabis products—and how to make policies more effective. As Symone T. Griffith, Marisa L. Kreider, and Maxwell C. K. Leung point out in “A Coordinated Approach to Cannabis Policy and Product Safety” (Issues, Fall 2025), because cannabis laws vary across states and use of cannabis products remains restricted at the federal level, regulatory systems are fragmented. These inconsistencies affect how cannabis is produced, tested, distributed, and enforced, ultimately influencing consumer safety and environmental health.

One major topic was the continued presence of illegal and unregulated cannabis markets. Despite legalization in many states, unregulated markets persist largely to avoid taxation and testing requirements. Without mandatory laboratory testing, these products may contain pesticides, heavy metals, or microbial contaminants. As one participant noted, in illegal markets “God only knows what is actually on the shelves.” This uncertainty poses clear risks to consumers and undermines the goals of legalization.

Quality control was another central concern. Legal cannabis products must undergo laboratory testing, while illegal products bypass these safeguards. As one participant emphasized, in unregulated markets “quality control is going to be much, much lower if nonexistent.” Even within regulated systems, testing integrity remains a challenge. One issue raised was so-called lab shopping, where producers select laboratories known for delivering more favorable results, potentially compromising testing accuracy. Concerns were also shared regarding sample selection processes, including the limited quantity required for testing, which may not fully represent contamination across an entire batch.

Testing standards have become more rigorous in some states. For example, Colorado regulators expanded the number of compounds searched for in tests, which a participant noted “capture over 100 pesticides,” demonstrating progress toward stronger consumer protections. However, because testing requirements vary by state, safety standards remain inconsistent nationwide. Participants emphasized that the lack of standardized federal guidelines creates uneven protection and complicates enforcement.

Enforcement gaps further weaken regulatory systems. Although seed-to-sale tracking systems are designed to monitor cannabis production and prevent diversion, product still enters illegal markets. Participants identified strengthening seed-to-sale tracking as a key to improving accountability and reducing diversion. They also stressed that enforcing existing regulations is just as important as creating new policies.

Environmental health impacts pose another significant concern. Illegal cultivation often involves banned pesticides, water diversion, and habitat disruption, leading to soil and water contamination. Because these operations occur outside of regulatory oversight, environmental damage can persist long-term and affect surrounding ecosystems and communities. Enforcement efforts have attempted to address illegal grow operations, but they continue to pose challenges.

The discussion also addressed the emergence of hemp-derived products and “synthetically created” cannabis products that are genetically or chemically modified by “design” to produce specific effects in users. While hemp legalization expanded legal markets, it introduced new regulatory gray areas. Designed cannabis products are typically not subject to the same comprehensive safety or testing requirements as regulated cannabis, creating additional consumer protection concerns.

Finally, participants discussed potential federal policy changes. Federal rescheduling of cannabis as a lower-risk product or legalizing it entirely could improve regulatory consistency, strengthen enforcement, and establish national testing standards. Currently, the lack of federal oversight contributes to fragmented systems and uneven safety protections across states.

In sum, strengthening regulatory enforcement, standardizing testing requirements, and improving oversight mechanisms will be essential to advancing public health and environmental safety within the evolving cannabis industry.

MJ Cross

Kyle Boyar

Thomas Cahill

Majia Nadesan

Symone T. Griffith, Marisa L. Kreider, and Maxwell C. K. Leung critically point out the need for an evidence-based framework to guide cannabis policy and ensure product safety. As a physician who has spent years doing research and caring for patients of all ages utilizing cannabis therapeutically, I have witnessed firsthand the consequences of the nation’s fragmented and inconsistent approach to regulation.

Patients deserve access to safe, standardized, and properly tested cannabis products—just as they do for any other medication. The absence of federal oversight and unified standards has created unnecessary risk and confusion for patients, providers, and regulators alike. Descheduling cannabis—removing it entirely from the Controlled Substances Act, effectively ending federal prohibition—is the ultimate answer. Rescheduling cannabis could be an important first step, recognizing cannabis as having accepted medical uses, making federal research easier and potentially leading to more medical research and new therapies. In any case, true reform must involve federal-state coordination, clinician education, and a compassionate, patient-centered framework.

I strongly support the authors’ emphasis on product safety and laboratory integrity. Inconsistent testing practices, pesticide contamination, and misleading potency labels pose dangers for all, particularly for immunocompromised patients. We need federally accredited, independent laboratories; standardized good manufacturing practices designed to ensure that products are consistently produced and controlled to quality standards; and transparent, verifiable labeling to restore public trust and protect health.

Education is critical within the health care system itself. Every human being possesses an endocannabinoid system—a complex cell-signaling network that helps regulate how many of the body’s functions respond to cannabinoids—yet most physicians and health care providers complete their medical training without ever learning about it. Integrating cannabinoid science into undergraduate and continuing medical education is essential. Physicians and health care providers must be empowered to discuss cannabis openly and knowledgeably with their patients, free from stigma or fear of professional reprisal.

I also share the authors’ concern about the current barriers to meaningful research. We need studies based on the actual cannabis products patients are using—not solely government-supplied material that doesn’t reflect the diversity and potency of products available in today’s marketplace. Expanding National Institutes of Health funding; fostering collaborations among clinicians, universities, and industry; and supporting real-world evidence studies will help bridge the gap between science and policy.

Ultimately, cannabis policy must be rooted in compassion, education, and patient empowerment. We must ensure that regulatory reforms do not marginalize small, patient-focused producers or restrict affordable access for those who depend on medical cannabis for relief and healing.

In sum, the authors underscore what many of us in the medical cannabis field have been saying for years: Patients have been left behind by outdated policies and persistent stigma. It is time to treat cannabis as medicine—with the same rigor, respect, and responsibility afforded to all therapeutic substances. Moving forward, we must bring cannabis out of the shadows of prohibition and into the light of science, safety, and compassionate care.

Uma Dhanabalan