The U.S. Food and Drug Administration (FDA) supports the reclassification of botanical cannabis (Cannabis sativa L.) as a Schedule III substance, according to documents released by the Department of Health and Human Services (HHS).

2023-01171 - Supplemental Release. Department of Health and Human Services.

The drug is currently listed as a Schedule I controlled substance, according to the FDA and United States Drug Enforcement Administration (DEA).

Marijuana/Cannabis. Department of Justice/United States Drug Enforcement Administration.

The decision to reschedule cannabis is based on eight factors: its actual or relative potential for abuse; scientific evidence of its pharmacological effect; the state of current scientific knowledge regarding the drug; its history and current pattern of abuse; the scope, duration, and significance of abuse; what, if any, risk there is to public health; its psychic or physiological dependence liability; and whether the substance is an immediate precursor of a substance already controlled.

To support the rescheduling, documents state that the FDA’s Controlled Substance Staff say that cannabis meets three key criteria, including the drug’s lower potential for abuse (compared to other substances), its current medical applications, and its low to moderate risk of causing physical dependence. The documents say that the National Institute on Drug Abuse agrees.

Given the recommendation for reclassification, should physicians be allowed to use cannabis recreationally?

According to a systematic review and meta-analysis on the prevalence of cannabis use by medical doctors (MDs) and medical students published in Medicines (Basel), cannabis use by physicians is a public health issue. In fact, the study finds  that cannabis use by physicians “can be detrimental for them and their patients.”

Naillon PL, Flaudias V, Brousse G, et al. Cannabis use in physicians: a systematic review and meta-analysis. Medicines (Basel). 2023;10(5):29.

The researchers reviewed data across several sources, including PubMed, Cochrane, Embase, PsycInfo and ScienceDirect. They found that lifetime use of marijuana by MDs and medical students is “high,” at  37%. Only 1.1% smoked marijuana daily, however. The researchers found that medical students—primarily males— use it the most.

The authors say that MDs—who often face stressors associated with life-and-death emergencies and long work hours—should not use the drug. “Stress may lead to addictive behavior, and consequently the medical profession seems more subjected to drug abuse and psychiatric disorders,” the authors write. “Cannabis may be used by physicians to decrease their stress, such as in post-traumatic stress syndrome. Interestingly, consumers using cannabis as a stress-coping strategy are those with the greatest risk of addiction.”

Not every clinician agrees that cannabis should be completely off the table for physicians. David Feifel, MD, PhD, Professor Emeritus of Psychiatry at the University of California, San Diego, and Director of the Kadima Neuropsychiatry Institute, says that it’s simply not a binary issue.

“A good way to understand this is by replacing marijuana with alcohol in the question,” Dr. Feifel says. “Since it's well-known that the amount and the timing of alcohol ingestion makes all the difference in whether it would impair a physician’s professional performance, very few people would feel there needs to be a total alcohol prohibition for physicians.”

He goes on to say that no reasonable person would feel that a physician enjoying a glass of wine or beer after work is compromising their patients’ safety. However, people would likely take issue with their doctor having a couple of beers over their lunch break, especially if they’re going to be performing a critical procedure on a patient afterward.

Dr. Feifel notes that marijuana, unlike alcohol, also offers some medicinal benefits—like reducing pain—that could even potentially enhance a physician’s professional performance. “[This] makes the question about marijuana use by physicians even more context-dependent than alcohol use,” he stresses.