In response to Attorney General Jeff Sessions’ intent to prioritize prosecution of federal marijuana crimes in states in which such activities have been legalized, Senator Elizabeth Warren introduced a bipartisan bill in June 2018 (S.3032) that would exempt most marijuana-related activities from the Controlled Substances Act when they are allowed under state or tribal law. President Donald Trump says he supports the bill.

In a perspective piece published in the New England Journal of Medicine, Rebecca L. Haffajee, JD, PhD, MPH, from the Department of Health Management and Policy at the University of Michigan School of Public Health in Ann Arbor, and colleagues discussed the issues surrounding the current legal environment for marijuana and its effect on medical marijuana use and research.

The Obama administration deprioritized marijuana prosecutions in states where use was legal, allowing states to regulate and tax marijuana. The Rohrabacher-Farr Amendment, which is currently renewed through September 2018, prohibited the use of federal funds to prosecute medical marijuana-related activities. As a result of these developments, more than half the states went on to legalize medical marijuana, and others are considering doing so. Furthermore, 9 states and the District of Columbia have legalized recreational marijuana, and 6 more states are about to do so. Sales of marijuana exceeded $8 billion in 2017 in states where it is legal.

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However, Sessions’ intentions to prosecute those activities in states where they are legal have cast a shadow of uncertainty over the status of medical marijuana, which could endanger the continuity of the medical marijuana supply. Medical marijuana is effective in treating the chronic pain, nausea, and vomiting related to cancer, as well as the muscle spasms associated with multiple sclerosis. If Sessions has his way, these patients may be forced to use riskier alternatives such as opioids to find relief. If Congress fails to renew the Rohrabacher-Farr Amendment, prescribers, dispensers, and patients may be exposed to federal prosecution.

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The failure to adopt a sensible stable federal marijuana policy affects the safety of marijuana products and physicians’ willingness to recommend or prescribe them. Without oversight by the US Food and Drug Administration, there may be a lack of consistency in marijuana products, including tetrahydrocannabinol content, and little reliable information on efficacy, dosing, and adverse effects that may deter physicians from prescribing them. Furthermore, the current designation of marijuana as a schedule 1 Controlled Substances Act substance hinders research into the potential benefits of the substance in treating patients with a variety of disorders.

Dr Haffajee and colleagues believe that although Senator Warren’s legislation addresses some pressing conflict-of-law concerns including unpredictable criminal enforcement, a more comprehensive federal policy that resembles Canada’s recent legalization could promote health and safety through research and regulation.


Haffajee RL, MacCoun RJ, Mello MM. Behind schedule—reconciling federal and state marijuana policy. N Engl J Med. doi: 10.1056/NEJMp1804408