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The U.S. Drug Enforcement Agency announced in late April 2024 that it plans to , reclassifying it from a Schedule I drug to the less restricted Schedule III, which includes drugs such as Tylenol with codeine, testosterone and other . This historic shift signals an acknowledgment of the .

The move comes in tandem with growing interest in the use of psilocybin, the active component in magic mushrooms, for , . In 2018 and 2019, the U.S. Food and Drug Administration granted a , meant to expedite drug development given that preliminary studies suggest it may have over currently available therapies for and .

Both of these developments represent a dramatic change from long-standing federal policy around these substances that has and into their therapeutic potential.

As an and a pain researcher, I , including cannabis and psychedelics.

I also have a personal stake in improving chronic pain treatment: I was diagnosed with , a by widespread pain throughout the body, sleep disturbances and generalized sensory sensitivity.

I see cannabis and psilocybin as promising therapies that can contribute to bridging that need. Given that an estimated – meaning pain that persists for three months or more – I want to help understand how to effectively use cannabis and psilocybin as potential tools for pain management.

Cannabis versus other pain medications

, also known as marijuana, is an ancient medicinal plant. Cannabis-based medicines have been used for applications such as arthritis and pain control during and after surgery.

This use extended through antiquity to modern times, with contemporary cannabis-based medications , promoting weight gain for and .

As with anything you put in your body, cannabis does have health risks: may increase risk of accidents. Some people develop , while others develop , especially with .

That said, lethal overdoses from cannabis . This is remarkable considering that nearly .

In contrast, opioids, which are often prescribed for chronic pain, have over the past few decades. Even like nonsteroidal anti-inflammatory drugs, such as ibuprofen, cause tens of thousands of hospitalizations from gastrointestinal damage.

Furthermore, both opioids and nonopioid pain medications for treating chronic pain. Medications used for chronic pain can in some people, but many ultimately cause side effects that outweigh any gains.

These safety issues and limited benefit have led many people with chronic pain to try cannabis as a chronic pain treatment alternative. Indeed, , my colleagues and I show that people often .

However, more rigorous research on cannabis for chronic pain is needed. So far, clinical trials – considered the gold standard – have been short in length and focused on . What’s more, my colleagues and I have shown that these studies employ medications and dosing regimes from from state-licensed cannabis dispensaries. Cannabis also causes recognizable effects such as euphoria, altered perceptions and thinking differently, so it is .

Despite these challenges, a group of cannabis and pain specialists published a in early 2024 to synthesize existing evidence and help guide clinical practice. This guideline recommended that cannabis products be used when pain is coupled with sleep problems, muscle spasticity and anxiety. These multiple benefits mean that cannabis could potentially help people avoid taking a separate medication for each symptom.

Traditional hurdles to studying cannabis

Since the in 1970, the federal government has designated cannabis as a , along with other drugs such as heroin and LSD. Possession of these drugs is criminalized, and under the federal definition they have “no currently accepted medical use, with a high potential for abuse.” Because of this designation and the limits placed on drug manufacturing, cannabis is very .

State and federal regulatory barriers also delay or prevent studies from being approved and conducted. For example, I can purchase cannabis from state-licensed dispensaries in my hometown of Ann Arbor, Michigan. As a scientist, however, it is very challenging to .

Reclassifying cannabis as a Schedule III drug has the potential to substantially open up this research landscape and help overcome these barriers.

The emerging role of psychedelics

Psychedelics, such as psilocybin-containing mushrooms, occupy an eerily similar as cannabis. Used for thousands of years , psilocybin is also classified as a Schedule I drug. It can cause substantial changes in that can lead to therapeutic benefits. And, like cannabis, psilocybin has .

Clinical trials combining psilocybin with psychotherapy in the weeks before and after taking the drug report substantial improvements in symptoms of psychiatric conditions such as and .

Risks are typically psychological. A small number of people report suicidal thoughts or self-harm behaviors after taking psilocybin. Some also experience , which can be .

There are few published clinical trials of psilocybin therapy for chronic pain, , including a conducted by our team at the University of Michigan. This treatment may help people develop a healthier relationship with their pain by and often related to negative thoughts and feelings around pain.

As with cannabis, some states, such as and , have decriminalized psilocybin and are building infrastructure to increase accessibility to psilocybin-assisted therapy. One recent analysis suggests that if psychedelics follow a similar legalization pattern to cannabis, the majority of states will .

Challenges ahead

These ancient yet relatively “new” treatments offer a unique glimpse into the messy intersection of drugs, medicine and society. The justifiable excitement about cannabis and psilocybin has led to state policies that have increased access for some people, yet federal criminalization and substantial barriers to scientific investigation remain. In the years ahead, I hope to contribute toward pragmatic studies that work within these difficult parameters.

For example, our team to help veterans use commercially available cannabis products to more effectively treat their pain. Coaches emphasize how judicious use can minimize side effects while maximizing benefits. Should our approach work, health care providers and cannabis dispensaries everywhere could use this treatment to help clients in chronic pain.

Approaches like these can supplement more traditional clinical trials to help researchers determine whether these drug classes offer benefit and whether they have comparable or less harm than current treatments. As our society connects to the rich history of healing using these ancient drugs, these proposed changes may offer safer and substantive options for the 50 million Americans living with chronic pain.

a series examining the impact of a decade of recreational cannabis use.

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Kevin F. Boehnke receives funding from the ³Ô¹ÏÍøÕ¾ Institutes of Health, the State of Michigan Veteran Marijuana Research Program, and has received grants from Tryp Therapeutics and Journey Biosciences. He is affiliated with Doctors for Drug Policy Reform as an unpaid expert. He also has received honoraria for speaking at conferences as well as for participating in a podcast on fibromyalgia from the European Medical Journal funded by Viatris Inc.