Op-Ed: Cannabis Policy Needs Pharmacists | Cannabis Law Report

On December 18, 2025, the White House issued an executive order aimed at modernizing US policy on medical marijuana and cannabidiol (CBD).¹ The order emphasized expanding research, improving safety, and initiating regulatory reform.

For pharmacists, the announcement reopened a familiar concern. Cannabis remains one of the few therapeutic agents widely used by patients without pharmacist oversight, standardized dispensing, or routine medication management. This raises a critical question: If cannabis is used as medicine, how should it actually be delivered to patients?

Canada faced this same question nearly a decade ago. Its experience offers a cautionary case study for US policy makers and for the pharmacy profession.

A Cautionary Case Study From Canada

In 2016, Canada expanded nationwide access to medical cannabis under the Access to Cannabis for Medical Purposes Regulations.² At the time, I was working at Shoppers Drug Mart, Canada’s largest pharmacy retailer, focusing on new health care ventures. I am a licensed pharmacist by training, and I later launched and led a national medical cannabis distribution platform under the Shoppers banner.

Like many pharmacists, I was initially skeptical of cannabis as a therapeutic agent. That skepticism began to change as I met patients and caregivers managing severe, treatment-resistant conditions. One story that profoundly shaped my thinking was that of Charlotte Figi, a child with Dravet syndrome, a rare and catastrophic form of epilepsy characterized by hundreds of seizures per week. Conventional therapies failed her, but a CBD-based cannabis extract significantly reduced her seizures. Although initially anecdotal, cases like Figi’s later aligned with emerging clinical and preclinical evidence, an association subsequently recognized by federal research bodies including the National Institutes of Health.³ What stood out was not only the therapy’s potential but also the system failure surrounding access. Families were forced to navigate legal uncertainty, inconsistent product quality, and minimal clinical oversight to obtain treatment.

Canada’s decision to federally legalize medical cannabis was significant and, in many ways, forward-thinking. However, the regulatory framework excluded pharmacists from direct patient care, a decision that carried lasting consequences.

Medical Access Without Medical Care

In 2018, Canada legalized recreational cannabis under the Cannabis Act.⁴ Many health care professionals expected this shift to finally integrate pharmacies into medical cannabis distribution. That did not happen.

Physicians remained unable to write prescriptions for cannabis. Instead, they issued medical documents, authorizations to purchase cannabis that lacked standardized information on dosing, formulation, route of administration, or therapeutic intent. Patients were still required to purchase products directly from licensed producers, by mail, without pharmacist involvement.

At the same time, recreational cannabis became widely available through retail storefronts and online platforms, often with extended hours and faster access. Predictably, many patients, particularly those managing chronic pain, nausea, or neurologic symptoms, began bypassing the medical system altogether. Convenience replaced clinical oversight.

Cannabis, however, is not a benign consumer product for many patients. Appropriate use requires guidance on dosing, drug interactions, contraindications, and adverse effects—areas routinely managed by pharmacists across other therapeutic categories (see Figure 1).

Figure 1.^5,6 Cannabis drug interactions, contraindications, and side effects

What Pharmacist-Led Care Made Possible

Within our platform, we attempted to fill the gap left by regulation. Because cannabis could not be dispensed through pharmacies, we operated through e-commerce channels and staffed our patient support operations with licensed pharmacists. Patients could speak directly with a pharmacist about dosing strategies, routes of administration, adverse effects, and potential drug interactions. Pharmacists routinely advised against smoking or inhalation, instead recommending oral or sublingual formulations that offered more predictable pharmacokinetics and reduced respiratory risk. We also applied pharmaceutical quality standards in a category that largely lacked them, reviewing manufacturer claims, assessing batch consistency, and prioritizing dosage forms aligned with Good Manufacturing Practices.

This experience reinforced a simple truth: When pharmacists are involved, cannabis is treated as medicine rather than a retail commodity.

Tax Policy Accelerated the Breakdown

Canada’s tax policy further undermined the medical system. When recreational cannabis was legalized, medical cannabis was taxed at the same rate as adult-use products.⁷ For many patients, medically authorized cannabis became more expensive, not less.

This pricing dynamic, combined with restricted distribution models, pushed patients further toward recreational channels. Despite clear therapeutic intent, patients increasingly sourced products outside any clinical framework.

A Work-around That Proved Unsustainable

We attempted to preserve pharmacist involvement through centralized counseling models, and patients consistently valued the guidance. Pharmacist interventions most commonly involved dose titration, avoidance of inhalation routes, and identification of potential CYP-mediated drug interactions, particularly with antidepressants and antiepileptics. However, providing clinical counseling while patients accessed products through nonmedical retail channels proved economically and operationally unsustainable. Ultimately, the business was spun out, not because of lack of patient demand, but because policy design made true medical delivery impossible.

A Choice the US Can Still Make

The US now stands at a similar inflection point. Federal policy is evolving to expand research, improve safety, and modernize cannabis regulation.

The question is no longer whether cannabis should be available for medical use. The question is how it should be delivered. Pharmacists must be part of the answer.

A framework that allows pharmacists to dispense and counsel on medical cannabis would immediately raise the standard of care. It would normalize evidence-based discussions about dosing, administration routes, adverse effects, and drug interactions. It would also create natural mechanisms for ensuring labeling accuracy, manufacturing quality, and patient education, functions that pharmacists already perform daily for other controlled and noncontrolled substances.

Canada’s experience demonstrates the risks of sidelining pharmacy in medical cannabis policy. The US has the opportunity to take a different path. If cannabis is to be treated as medicine, pharmacists must be involved in delivering that care.

References

1. Increasing Medical Marijuana and Cannabidiol Research. The White House. December 18, 2025. Accessed January 15, 2026. https://www.whitehouse.gov/presidential-actions/2025/12/increasing-medical-marijuana-and-cannabidiol-research/

2. Access to Cannabis for Medical Purposes Regulations. Health Canada. Accessed January 15, 2026. https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/information-medical-practitioners/cannabis-medical-purposes-regulations-daily-amount-fact-sheet-dosage.html

3. Dravet Syndrome. National Institutes of Health Genetic and Rare Diseases Information Center. Accessed January 15, 2026. https://rarediseases.info.nih.gov/diseases/10430/dravet-syndrome

4. Cannabis Act, SC 2018, c 16. Government of Canada. Accessed January 15, 2026. https://laws-lois.justice.gc.ca/eng/acts/c-24.5/

5. Volkow ND, Baler RD, Compton WM, Weiss SRB. Adverse health effects of marijuana use. N Engl J Med. 2014;370(23):2219-2227. doi:10.1056/NEJMra1402309

6. Ho JJY, Goh C, Leong CSA, Ng KY, Bakhtiar A. Evaluation of potential drug–drug interactions with medical cannabis. Clin Transl Sci. 2024;17(5):e13812. doi:10.1111/cts.13812

7. Canada Revenue Agency. Cannabis duties and excise taxes. Government of Canada. Accessed January 15, 2026. https://www.canada.ca/en/revenue-agency/services/tax/businesses/topics/excise-duties-levies/cannabis-duty.html