U.S. politics has its share of mysteries. Why doesn't the popular vote matter? What's the difference between a caucus and the electoral college? Still, the federal drug classification system might be the most pervasive of all conundrums. More than 40 states have legalized cannabis for recreational or medical use, yet the federal government still classifies marijuana as the most dangerous drug you could possibly encounter.

 

Unraveling this enigma requires examining the DEA's current classification categories, the history behind the Controlled Substances Act, and why cannabis declassification is continually on the table.

 

Here we review U.S. drug classification 101 and explore the prospects of cannabis decriminalization.

 

Federal drug classification: What are the categories and why?

The Federal Government's Controlled Substances Act organized drugs (and the chemicals used to make them) into five distinct categories called "schedules," ranging from 1 to 5. Schedule 1 includes substances the government deemed the highest risk for abuse without any therapeutic value. Schedule 5 contains substances the government determined to have the least abuse potential and most negligible medical value.

 

• Schedule 1: (most addictive and no medical value): Marijuana (cannabis), heroin, LSD, ecstasy (MDMA, Molly), and magic mushrooms
• Schedule 2: Cocaine, meth, oxycodone, fentanyl, Adderall, Ritalin, and Vicodin
• Schedule 3: Tylenol with codeine, ketamine, anabolic steroids, and testosterone
• Schedule 4: Xanax, Soma, Darvocet, Valium, and Ambien
• Schedule 5: (least addictive, with medical value): Robitussin A.C., Lomotil, Motofen, Lyrica, and Parepectolin

 

The Drug Enforcement Agency (DEA) regulates everything listed in the Controlled Substances Act. However, it makes the most "addictive" and "medically useless" drugs the hardest to access and study. As a result, scientists have limited or no ability to research Schedule 1 and 2 drugs, and patients cannot utilize these substances to treat their ailments. 

 

Where cannabis stands: What put it on Schedule 1?

One of the most bewildering aspects of the federal drug scheduling system is why marijuana (cannabis) was ever listed under Schedule 1—the same level as heroin. And why cocaine and meth, clearly more dangerous, were listed in Schedule 2. To solve the mystery, it's important to remember how the classification system began.

 

Congress passed the Controlled Substances Act (CSA) in 1970 after President Richard Nixon declared a "war on drugs." Nixon's conservative administration viewed marijuana as particularly dangerous, but not for the reasons you might think. Instead, their perception of cannabis—partially rooted in racial prejudices—was that the plant made people immoral, lazy, and violent. At the time, the country was in the throes of Vietnam War protests, and the government associated marijuana smokers with anti-war "hippies" and anti-establishment violence. Under that context, Attorney General John Mitchell placed marijuana in the Schedule 1 highest-risk category in 1972 as part of the CSA's drug ranking.

 

Fifty years later, cannabis remains in the same classification. Now, that's the biggest head-scratcher of all.

 

Cannabis and other drugs: How the risks compare

Let's look at how cannabis compares to heroin and MDMA, all Schedule 1 drugs.

Heroin

Heroin is an opioid made from morphine, making it highly addictive. Nearly a third of all opioid deaths involve heroin. According to the CDC, more than 14,000 people died in the United States from drug overdoses involving heroin in 2019—seven times more than in 1999. Effects from heroin include:

 

• Nausea and vomiting
• Severe itching
• Clouded mental functioning
• Insomnia
• Infection of the heart lining and valves
• Constipation and stomach cramping
• Liver and kidney disease
• Lung complications, including pneumonia
• Mental disorders, such as depression and antisocial personality disorder
   

Ecstasy (MDMA)

Ecstasy (MDMA, Molly) is a synthetic, psychoactive drug that poses many of the same risks as stimulants like cocaine and amphetamines. It can lead to a sharp increase in body temperature in high doses, causing liver, kidney, or cardiovascular failure. The CDC reports that more than 16,000 Americans died from an overdose involving psychostimulants like ecstasy in 2019, a 28% increase from the previous year. Physical and psychological effects include:

 

• Confusion
• Depression
• Sleep problems
• Increases in heart rate and blood pressure
• Nausea, blurred vision, and faintness
• Involuntary teeth clenching
• Drug craving
• Severe anxiety
  
   

How does cannabis compare in adverse effects, addictiveness, and therapeutic value?

Adverse effects

Cannabis can have adverse side effects for some people. For example, it can exacerbate mental health issues, temporarily impair brain function, and increase the risk of getting into a car accident while under the influence. Still, marijuana is the most common illicit drug in the U.S., with 48.2 million saying they smoked or ingested cannabis at least once in 2019. And unlike heroin and ecstasy, marijuana does not have a proven link to overdose deaths.

 

The Independent Scientific Committee on Drugs published a report ranking drugs according to risk level. After a comprehensive review, the committee determined alcohol was the most harmful, followed by heroin and crack cocaine. In the United States, cocaine caused around 19,447 deaths in 2020. Interestingly, the CDC doesn't even have a category to report cannabis deaths.
 

Addictiveness

The U.S. government's drug scheduling system ranks substances based on addictiveness, defined by the drug's ability to cause withdrawal symptoms and tolerance. According to the American Addiction Centers, the top five most addictive drugs are:

 

1. Cocaine
2. Heroin
3. Alcohol
4. Nicotine
5. Methamphetamine

 

Notably, three of the most addictive drugs—cocaine, meth, and nicotine—are listed on lower schedules than cannabis. And the DEA doesn't register alcohol in its scheduling system at all. So how does cannabis stack up in addictiveness?

 

The National Institute on Drug Abuse indicates about 9% of people who consume marijuana will become dependent on it, rising to about 17% for people who started in their teens. In comparison, at least 61% of people who try a cigarette become daily smokers. Further, cannabis withdrawal symptoms are often mild, such as restlessness and decreased appetite that subsides after a short time.
 

Therapeutic value

Studies show that cannabis can potentially treat numerous health-related issues, including chronic pain, insomnia, and anxiety. Below is just a snippet of the growing body of cannabis research:

 

• Lessens tremors in Parkinson's disease
• Manages nerve pain in multiple sclerosis patients
• Decreases seizures in childhood epilepsy
• Manage nausea and weight loss in cancer and HIV patients
• Helps with PTSD in veterans

 

When it comes to pain management, cannabis also exhibits mild side effects and reduced abuse risks compared to prescription drugs like opioids. Cannabis compounds are so undeniably valuable that the FDA approved two THC-based drugs to treat cancer patients with nausea and vomiting. In addition, the FDA approved Epidiolex for seizures, which contains a purified form of CBD.

 

The wealth of data on cannabis safety, addictiveness, and therapeutic value proves that the U.S. drug classification system is not reality-based. But where does that leave Americans and their hope for a legal cannabis future?

 

Cannabis and the future

Currently, adult-use cannabis is legal in 18 states and allowed medically in 37. Earlier this year, New York passed the most progressive cannabis legalization in the country. And Oregon became the first state to decriminalize all drugs. All signs point to shifting tides in favor of cannabis legalization. However, imminent change seems unlikely.

 

Recently, the House of Representatives passed legislation to decriminalize marijuana. The Marijuana Opportunity Reinvestment and Expungement (MORE) Act is a necessary step toward building consensus. However, there are significant caveats. First, political pundits say the MORE Act will not receive the 60 votes needed to pass the Senate—if it ever makes it to the Senate floor at all. Additionally, cannabis advocates have serious criticisms of the bill’s current language.  For instance, they say the MORE Act removes cannabis possession punishments only to add others, like fines and sentencing for cannabis businesses operating without permits or failing to pay taxes. Critics say the bill as its written does not serve the greater good.

 

The bottom line

If we want to live in a free and equitable society, adults need to have a choice in what they consume, especially well-tolerated substances like cannabis that have established therapeutic value. It's time for the federal government to stop blocking efforts to take cannabis off its extreme Schedule 1 classification and update the list to reflect reality.

 

While this MORE Act rendition may not be the bill to shift the United States’ stance, we're confident that federal cannabis legalization is inevitable, likely during this decade.