What Cannabis Rescheduling Means for Pharmacists, Patients, and Psychiatric Care

In this episode of Psychiatric Pharmacy Pulse, host Megan Maroney, PharmD, BCPP, FAAPP, talks with Mary Bridgeman, PharmD, a pharmacist and clinical professor at the Ernest Mario School of Pharmacy at Rutgers, about the federal effort to move cannabis from Schedule I to Schedule III of the Controlled Substances Act. Bridgeman explains that the federal order covers FDA-approved cannabis products and those dispensed under state medical marijuana licenses. Adult-use cannabis, bulk plant material, and synthetically derived THC remain in Schedule I while the broader rescheduling goes through the hearing process. Because state rules vary so widely, Bridgeman says pharmacists in any practice setting should expect questions from patients and colleagues about cannabis use, its legal status, and its potential benefits and harms.

Maroney goes over the main cytochrome P450 interactions for CBD and THC and notes that smoking cannabis induces CYP1A2. Bridgeman adds that pharmacodynamic effects, such as more sedation and anticholinergic effects, matter too. Drawing on Canada’s lower-risk cannabis guidelines, Maroney outlines harm reduction counseling: avoid driving for 6 to 8 hours after inhaling and longer after oral use, delay use until after adolescence, choose lower-potency or higher CBD-to-THC products, and avoid smoking. Bridgeman cites the 2025 SAMHSA National Survey on Drug Use and Health. It estimates that 21 million Americans use cannabis daily or near daily, more than the number who drink alcohol daily, and that 19.3 million had cannabis use disorder in the past year.

Maroney also covers higher-risk groups. These include people with severe mental illness, among whom cannabis use rose after recreational legalization, and people who are pregnant or trying to conceive. She cites Danish data showing that 47.4% of patients with cannabis-induced psychosis were later diagnosed with schizophrenia or bipolar disorder. On the positive side, both guests expect rescheduling to lower research barriers and improve access for patients who may benefit, such as those with chronic pain, chemotherapy-induced nausea and vomiting, or multiple sclerosis spasticity. Bridgeman’s main advice is for pharmacists to keep up with the changing federal rules and the evidence.

REFERENCES

1. US Drug Enforcement Administration. Marijuana Rescheduling Regulatory Actions. Published 2026. Accessed October 14, 2026. https://www.dea.gov/marijuana-rescheduling-regulatory-actions

2. Public Health Agency of Canada. Canada’s Lower-Risk Cannabis Use Guidelines. Published May 10, 2019. Updated January 22, 2020. Accessed October 14, 2026. https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/resources/lower-risk-cannabis-use-guidelines.html

3. Substance Abuse and Mental Health Services Administration. 2025 National Survey on Drug Use and Health (NSDUH) Releases. Updated August 17, 2026. Accessed October 14, 2026. https://www.samhsa.gov/data/data-we-collect/nsduh-national-survey-drug-use-and-health/national-releases/2025

4. VERTANICAL. FDA grants Breakthrough Therapy Designation to VERTANICAL’s VER-01, a first-in-class non-opioid investigational treatment for chronic low back pain. PR Newswire. May 18, 2026. Accessed October 14, 2026. https://www.prnewswire.com/news-releases/fda-grants-breakthrough-therapy-designation-to-vertanicals-ver-01-a-first-in-class-non-opioid-investigational-treatment-for-chronic-low-back-pain-302774621.html

5. Hyatt AS, Flores MW, Johnson J, et al. Cannabis use among individuals with psychosis after state-level commercial cannabis legalization. JAMA Psychiatry. 2026;83(1):74-77. doi:10.1001/jamapsychiatry.2026

6. Kansagara D, Terry GE, Ayers CK, D’Souza DC. Cannabis and mental health: a review. JAMA Intern Med. 2026;186(5):618-628. doi:10.1001/jamainternmed.2026

7. Sheth S, Maroney M, Bridgeman MB. Cannabis at a crossroads: pharmacist care considerations in the context of a changing cannabis regulatory landscape. J Am Pharm Assoc (2003). 2025;65(3):102361. doi:10.1016/j.japh.2025.102361

8. Young-Wolff KC, Cortez CA, Alexeeff SE, et al. Adolescent cannabis use and risk of psychotic, bipolar, depressive, and anxiety disorders. JAMA Health Forum. 2026;7(2):e256839. doi:10.1001/jamahealthforum.2026.6839

9. Starzer MSK, Nordentoft M, Hjorthøj C. Rates and predictors of conversion to schizophrenia or bipolar disorder following substance-induced psychosis. Am J Psychiatry. 2018;175(4):343-350. doi:10.1176/appi.ajp.2017.17050535

10. Daniel NM, Maroney M. Rates of conversion from substance-associated psychotic disorder to bipolar or schizophrenia spectrum disorder in a community-based teaching hospital. J Clin Psychopharmacol. 2020;40(2):212-213. doi:10.1097/JCP.0000000000001187

To provide feedback or suggest topics of discussion for Psychiatric Pharmacy Pulse, please reach out to Gillian McGovern, Editor (gmcgovern@pharmacytimes.com).