Federal Rescheduling of Medical Cannabis: A Long-Overdue Opportunity to Lead with Science and Patient Care Realities

Cannabis has re-emerged as a widely used therapeutic medicine amid rapid expansion of state medical programs and historic United States (US) rescheduling to Schedule III, yet a century of US prohibition and global control-driven policy has left major gaps in the policy and evidence base. This commentary discusses historic and contemporary reforms within the global and US history of cannabis control and prohibition, outlines how federal rescheduling lowers barriers to research, and argues that states with mature medical markets and strong scientific and healthcare infrastructure are uniquely positioned to lead the next phase of medical cannabis science. This task requires a concerted effort across stakeholders and political independence of research from policy and regulation. We propose that state-authorized but independent research centers, supported by enabling legislation, sustained funding, and cross-sector partnerships, are essential to centralize data infrastructure, standardize metrics and documentation, and embed applied, equity-focused cannabis research into traditional healthcare. By leveraging existing infrastructure and multistakeholder partnerships to generate robust real-world evidence on therapeutic use, safety, and implementation, states can help realign cannabis policy with contemporary science and clinical need to shape the emerging national framework and rescheduling for evidence-informed cannabis policy and healthcare integration.