Q&A: What would reclassifying marijuana mean for medical research?

UNIVERSITY PARK, Pa. — There may be a major change in national drug policy coming soon.

The Trump administration is considering reclassifying marijuana from a Schedule I to a Schedule III substance. The change in classification was proposed in 2024 under the Biden administration, following a recommendation from the U.S. Department of Health and Human Services, and was still under review by the Drug Enforcement Administration (DEA) when the new administration took office in January. 

While the change in classification doesn’t legalize marijuana for recreational use, it would remove restrictions that have hindered medical research on marijuana, explained Kent Vrana, director of the Penn State Center for Cannabis and Natural Product Pharmaceuticals (CCNPP), which studies the benefits and harms of cannabis and its potential for treating human disease.

In the following Q&A, Vrana, who is also the Elliott S. Vesell Professor of Pharmacology at the Penn State College of Medicine, spoke about how reclassifying marijuana would affect medical research and patient access to medical marijuana as well as promising benefits of medical marijuana.

Q: What’s the difference between a Schedule I and a Schedule III drug?

Vrana: Under the Controlled Substances Act of 1970, Schedule I drugs are defined as any drug that has the potential for abuse and has no medical benefits. This includes substances like heroin and LSD. Schedule III drugs, on the other hand, also have abuse potential, but they have documented medical benefits. This includes substances like ketamine, anabolic steroids and testosterone.

Q: Why is marijuana being considered for reclassification?

Vrana: Marijuana is a type of cannabis where the compound tetrahydrocannabinol or THC is dominant, which is the main psychoactive component. It’s currently classified as a Schedule I drug. But, while there is abuse potential with marijuana, we know that it has medicinal benefits, too.

The Food and Drug Administration (FDA) has approved four drugs that are derived from cannabinoids — the compounds found in cannabis — for nausea, vomiting and appetite stimulation, particularly for patients with cancer and patients with HIV/AIDS. There’s also a prescription drug, purified from cannabis, for seizure disorders in young people. These kinds have seizures maybe 100 times a day and this drug can reduce the number of seizures and, in a small percentage, abolish the seizures.

Q: One argument for marijuana reclassification is that current federal policies impeded research, including medical research. How so?

Vrana: To use a Schedule I drug in research, I have to get approvals from multiple federal agencies like the FDA and DEA. I can only get cannabis and cannabinoids from a handful of federally approved sources. Otherwise, it puts our federal funding at risk. It makes it harder for us to conduct clinical trials that would help us better understand the potential benefits — and harms — of cannabis.

The other issue is that the cannabis we study isn’t the same as what people use or that might be sold in the medical marijuana dispensaries. Over the last 30 years, the amount of THC in cannabis has been bred to over 30% by weight. That’s 10 times stronger than what it used to be. There are also some vaping products that are almost pure THC. But the cannabis I routinely get from approved sources is 8% or 10% by weight. It’s a big difference.

Q: What are some of the implications of not being able to study these higher potency strains?

Vrana: My center is very much focused on potential benefits, but harms as well. One of the things that we spend a lot of time thinking about and writing about is the fact that these new high potency and synthetic compounds are in the marketplace and they have potential harms from drug-drug interactions.

For instance, the blood thinner Coumadin, or warfarin, is used when you have an arrhythmia or you've had a stroke. It has a very narrow therapeutic index, meaning that the amount that helps you is one level but, given a little more, it becomes toxic, and people start having bleeding disorders and bruising. We’ve done a deep dive into the literature, and there are several examples of patients who were on Coumadin and their levels were well regulated. Then, they started using cannabis or increased their use, and all of a sudden, they had a bleeding problem because the cannabis interfered with the metabolism of the Coumadin.

We'd like to study that kind of stuff, but it's going to take higher concentrations than what I can get through the approved sources.

Q: What are some other promising benefits of medical marijuana?

Vrana: There are a number of very promising areas. Anxiety is one. Pain is another area. The cannabis plant makes roughly 180 different cannabinoids. Some of the ones that don't get you high seem to be quite effective for pain in animal models. But both areas haven’t been rigorously tested in humans.

In Europe, their version of the FDA has approved a complex cannabis extract that contains equal amounts of THC and CBD to help with muscle spasticity where the muscles become stiff and can cause involuntary muscle spasms. But that hasn’t been approved in the United States.

Q: What areas of research is your center focused on?

Vrana: We’re interested in neuropathic pain, or pain arising from the nervous system, like the tingling-like pain that can be a side effect from cancer treatment. We’re also interested in seeing how the minor cannabinoids — the compounds that don’t get you high — help with bone healing and cartilage repair and the pain that comes with that. In both cases, we are conducting more research trials.

We also know that CBD is an anti-inflammatory. We’ve seen that, in a mouse model, cannabinoids can help with inflammatory bowel disease — colitis in particular.

Lastly, we’re studying how these drugs interact with the body — what receptors they bind to, how they are metabolized, what are the mechanisms behind their effect — so we can better understand how they might be used to benefit disease and human health.

Q: Are there other major implications of reclassifying marijuana outside of research?

Vrana: Aside from making it easier to conduct research, rescheduling could also make it easier for patients to access medical marijuana. It could open the door for insurance companies to cover it because they currently won’t cover Schedule I drugs.

It would also have a major impact on the growth of the industry. Because of marijuana’s Schedule I status, the industry is a cash-based system. You can’t use credit cards because the federal government oversees the banking system. Businesses also can’t write off business expenses or get tax deductions. In that way, rescheduling could help grow the industry as a whole.