Greater Testing and Oversight of Medical Cannabis is Needed Before It is Rescheduled in the US

The US Department of Health and Human Services has recommended that cannabis be rescheduled from Schedule I to Schedule III given its “currently accepted medical use.”* Access to medical cannabis is currently a result of state-level political processes rather than Food and Drug Administration (FDA) approval or clinical guideline development. Due to cannabis’s Schedule I status, insurance plans do not cover its certification or purchasing costs. Locations that certify medical cannabis may charge in the hundreds of dollars per visit with subsequent cash-only purchases due to federal financial restrictions. By linking Arkansas claims, physician licensing, and state medical cannabis application data, this study identified qualifying conditions in medical claims data and determined the association between the medical cannabis certifying physician and patient encounters with traditional medical care.

• Within two years of initiation in the state, medical cannabis was approved for 3.4 percent of adult Arkansans by 12.5 percent of medical-licensed physicians.
• Posttraumatic stress disorder and four pain diagnoses were the most frequent qualifying conditions.
• Seven high-volume certifying physicians—each with >1000 certifications and who certified more than a third of all certified Arkansans—demonstrated limited patient contact. Conversely, low-volume certifying physicians had seen and diagnosed a greater proportion of patients with qualifying conditions.

* As defined by the US Drug Enforcement Administration, Schedule I substances have “no currently accepted medical use.” Schedule III substances have “a moderate to low potential for physical and psychological dependence.”

Comments: These findings suggest that “cash-only payment” certification sites are highly financially beneficial for these physicians, reminiscent of opioid “pill mills.” Before cannabis is rescheduled and widely adopted as a medical therapeutic by the FDA, it should undergo appropriate testing, monitoring, and guideline development—like any other medical intervention—to optimize its impact and avoid undesirable outcomes.

Susan L. Calcaterra, MD, MPH, MS

Reference: Thompson JW, Martin B, Goudie A, et al. Arkansas medical marijuana certifications: higher-volume physicians associated with less evidence of care coordination. Health Aff (Millwood). 2025;44(3):351–360.