I am a geriatrics and hospice and palliative medicine physician with over 20 years of experience. Over the years, I have seen how cannabis has helped my patients, and I am very comfortable with my patients using cannabis.

But like many physicians, I was not formally trained in cannabis medicine. In fact, for the longest time I thought people smoked the leaves. It was only much later that I learned that people smoked the flowers.

Since then, I’ve learned a lot about cannabis. And I also learned that many other doctors I talked to also believed people smoked the leaves. In fact, most doctors have very little knowledge about cannabis or the endocannabinoid system.

The endocannabinoid system is a major system that works with other body systems to keep our body in balance, yet most doctors do not learn about it in medical school. Many doctors treat CBD as “cannabis light,” when in fact it has completely different effects than THC. And most concerning, most don’t know about dosage, formulation, or drug interactions of cannabis. The only training they get is in the harms of cannabis abuse.

Meanwhile, studies say that most patients do not tell their doctors about cannabis, often out of fear of being judged. After all, when patients use cannabis, we list it in the “social history” section, next to smoking, drinking, and drug abuse.

The prohibition of cannabis, the lack of medical education concerning it, and patients’ fear in talking about it has created a system where patients treat themselves. What’s more, where state medical programs developed, doctors were sidelined from truly caring for patients who use medical cannabis. Our DEA license meant we faced significant penalties if we prescribed a Schedule I drug, so most doctors are scared to even give the slightest guidelines. So, states sidestepped this concern by creating medical card certifications.

But doctors were not writing prescriptions. We were certifying that the patient had a qualifying condition for the state medical program. In many states, medical certification for cannabis was treated the same way we treat certification for a handicap parking placard. And in doing it this way, any conversation about cannabis ended the minute the form was signed.

Many physicians who wrote for cannabis cards trusted the dispensary to guide patients in dose and form, and in states that require pharmacists to be present at dispensaries, this might be fine. But in many states, the only person giving guidance was a 25-year-old budtender, who often knew a lot about the product but wouldn’t know anything about the patient’s health care or which medications the patient was taking.

THC and CBD interact with the liver’s metabolism of other drugs, meaning it can affect the amount of certain other drugs in your body. So, especially as more older patients are using cannabis, the risk of people experiencing drug interactions grows.

What’s more, older people often need much lower doses of cannabis. And while many people in cannabis know the phrase “start low, go slow,” the low dose for a 30-year-old is not the same as the low dose for an 80-year-old. One such patient of mine took a gummy at an unknown dose and slept for a day and a half.

With the rising use of recreational cannabis, we are seeing an increase in serious side effects such as cannabis hyperemesis syndrome and cannabis psychosis. Many of my colleagues who are in emergency medicine, gastroenterology, or psychiatry feel cannabis should remain banned because they see these conditions regularly.

But I disagree with them. I think the Schedule I prohibition has been part of what has created these problems. Yes, as mentioned, patients don’t talk to their doctors and doctors don’t have the knowledge they need to guide patients toward safe use. But patients don’t either, so they will sometimes use it for the wrong medical reasons and slip into overuse, side effects, and trouble.

Imagine a world where ACE inhibitors were available at the store with no formal guidance. People had to self-treat their hypertension on their own. Some neurologists and cardiologists would swear it was a great drug for the heart and kidney. But emergency physicians would complain that this drug caused several cases of hypotension and occasionally life-threatening swelling of the mouth and face. Obstetrician-gynecologists would complain about its relationship to birth defects. That’s analogous to the world we live in with cannabis.

The answer is not continued restriction. It is to increase the role of the physician in the care of patients who use cannabis. We need to build trust with patients who use cannabis so we can better guide them in safe use, and in some patients, the discontinuation of cannabis.

On April 23, 2026, the DEA announced that not only would FDA-approved cannabis products be rescheduled to Schedule III, they would also reschedule the cannabis available at medical cannabis dispensaries. That means that right now, medical cannabis from dispensaries is Schedule III.

It remains to be seen how the states will treat this new designation. But Schedule III is not over the counter. You need a prescription. So, I speculate that most states, in an attempt to be federally compliant, will require a pharmacist to be present at medical dispensaries and that the patient gets some sort of “prescription” for cannabis.

That means that physicians will be able to treat cannabis like other drugs. We can talk openly about it and educate our patients on doses, formulation, side effects, benefits, and risks. We can monitor their response to treatment, adjust treatment as needed, and help them avoid problematic use in the first place. We can have honest conversations with our patients, without fear or judgments.

But before all that can happen, physicians have to learn about how to have these conversations. Because we were never taught about this in medical school. As this new policy rolls out, health care providers need to take time to educate themselves about cannabis. Otherwise, how can we help our patients?

Janice Makela is a hospice and palliative care physician.