Physicians quotes on cannabis rescheduling and clinical practice We are covering recent reporting on the U.S. federal move to reschedule marijuana. We are seeking quotes from physicians (from all specialities) to answer the following questions (If you prefer, we can quote you anonymously: 1. Which patient populations in your practice raise cannabis or CBD questions most often, and what are they usually trying to treat? 2. What counselling points do you routinely cover with patients about safety and drug interactions when they use THC products or CBD? 3. What downstream effects could this move have in your everyday practice?

Pregnant patients and those planning pregnancy most often ask about cannabis and CBD. I counsel them to maintain open, honest communication with their obstetric provider, emphasize that every pregnancy is unique and requires personalized guidance, and review safety, the limits of current evidence, and possible interactions with existing medications. As cannabis is rescheduled, clearer research and standardized guidance could help me offer more precise counseling in these visits, but there is a huge volume of existing research that is important for practicing clinicians to read. The Doctor-Approved Cannabis Handbook is a good start, and CEDclinic.com has thousands of pages of evidence for doctors and patients alike.

the patients who ask about THC or CBD most are those with chronic itch, eczema, psoriasis, and nerve type pain after shingles or surgery. Some bring it up for sleep or anxiety because flare ups follow bad nights. I also hear about CBD creams after lasers or fillers, usually for soreness, redness, or "calming" acne. My counseling is simple. Tell me every product and dose. Do not mix THC with alcohol or sedatives. Avoid driving. Skip it in pregnancy and in teens. I also review other meds that can interact because CBD can inhibit CYP2C19 and CYP3A4, which may raise levels of drugs such as clobazam, warfarin, or tacrolimus. If rescheduling moves forward, I expect more research quality, clearer labeling, and more patients asking for a documented plan instead of guessing.

From a mental health clinician's perspective, the U.S. federal move to reschedule marijuana is a great step because it will help in viewing cannabis through a more scientific point. In clinical practice, cannabis use is already widespread, particularly among patients who are undergoing psychological distress, sleep problems, chronic anxiety, and stress. 1. Which patient populations in your practice raise cannabis or CBD questions most often, and what are they usually trying to treat? From my practice, the most common questions come from patients suffering with anxiety, insomnia, stress, and depression due to sexual problems like low desire and performance anxiety. There are also some patients that are looking to quit alcohol and come up with asking about cannabis or CBD. Some of them come from seeking a natural alternative to hearing claims on social media or the internet. 2. What counseling points do you routinely cover about safety and drug interactions? As a psychiatrist, I mainly focus on caution. People who have a family history of psychosis, bipolar disorders, or anxiety should either take it with caution or completely avoid it. CBD can cause a lot of drug interactions with commonly prescribed psychiatric medications by affecting liver enzymes (CYP450), potentially altering drug levels. I also advise people to not take it while driving, in the workplace, or during pregnancy and adolescence. 3. What downstream effects could this move have on your everyday practice? This move may come up as a source of more knowledge on cannabis and CBD products. It can encourage better research, clear formulations, and transparency. It can help in making more informed decisions. Because without proper information available, people take the risk of self-medicating and considering it as a cure.

I'm a triple board-certified surgeon practicing cosmetic, bariatric, and wound care in Las Vegas. In my eight years doing body contouring, I've noticed a very specific pattern with cannabis questions--they come primarily from my post-bariatric patients who've lost 100+ pounds and are preparing for body lift surgeries. These patients often switched from prescription pain meds to cannabis during their weight loss journey and want to continue using it through their cosmetic procedures. My biggest concern with these patients is wound healing. THC significantly impacts collagen synthesis and tissue regeneration, which is critical when I'm removing massive amounts of excess skin. I had one tummy tuck patient who continued using edibles against my advice and ended up with delayed wound healing that required three additional months of wound care visits. Since I also practice burn and wound surgery, I see this pattern repeatedly--cannabis users have measurably slower epithelialization rates. The rescheduling issue hits different in cosmetic surgery because these are elective procedures that insurance doesn't cover. Right now, if a patient tests positive for THC in pre-op screening, some anesthesiologists in Vegas won't touch the case due to liability concerns around increased anesthesia requirements and potential cardiovascular complications. I've had to postpone two BBL procedures this year alone because patients didn't disclose their daily vaping habits. Rescheduling might reduce that stigma barrier and give me accurate medical histories before someone's on my operating table.

I run a longevity and hormone optimization clinic in Clearwater, FL where I see a lot of patients on testosterone replacement therapy and peptides. The cannabis questions come up most with two specific groups: women on hormone therapy asking about CBD for sleep and hot flashes, and middle-aged men combining TRT with THC products who wonder why their recovery isn't what they expected. They're usually shocked when I tell them chronic THC use can suppress natural LH and FSH production--basically working against what we're trying to accomplish hormonally. My main counseling point is about the cortisol and testosterone relationship. High-dose THC, especially daily use, can spike cortisol chronically which tanks free testosterone levels even when you're on replacement therapy. I've had guys come back at their 8-week follow-up with great total T numbers but feeling worse because their cortisol is through the roof from nightly edibles. I also warn about CBD competing for liver enzymes with certain peptides and medications we use--it can change how quickly things metabolize. Rescheduling would probably mean I finally get to see actual pharmaceutical-grade products with consistent dosing instead of patients bringing me packaging from random Florida dispensaries asking if it's "clean." Right now when someone says they take CBD for joint pain before we do PRP injections, I have zero idea what's actually in their system or how it might affect healing response. Having FDA oversight would make my pre-procedure protocols way cleaner since I could actually give specific guidance on timing instead of just saying "stop all supplements a week before."

I'm a double board-certified PM&R and pain medicine physician serving as Chief Medical Officer at Pain Arizona, and I've performed tens of thousands of regenerative and interventional procedures over my career. The cannabis conversation in my practice looks completely different than most specialties because my patients are already deep into complex pain management--many are actively trying to *reduce* opioid use or avoid it entirely. The patients asking about cannabis most are those in our IOP program treating tri-diagnosis cases: chronic pain, substance use disorder, and mental health conditions simultaneously. They see CBD as a "natural" bridge off opioids, but what they don't realize is that introducing another psychoactive substance while we're using medication-assisted treatment creates unpredictable interactions. I've had patients on buprenorphine whose withdrawal symptoms suddenly worsened because high-dose THC altered their opioid receptor response--something we couldn't predict or dose around because there's zero standardization in the products they're buying at dispensaries. My safety counseling focuses on procedure timing that other specialties don't deal with. Before epidural steroid injections or radiofrequency ablations, I need patients completely clear of THC for 72 hours minimum because it affects pain threshold perception during conscious sedation--I can't accurately assess their response to test stimulation if their nervous system is already altered. I've had to abort procedures mid-way when patients admitted they used a gummy "just to relax" that morning, which wastes everyone's time and delays their pain relief by weeks. Rescheduling would let me actually *prescribe* standardized formulations instead of patients self-dosing with random dispensary products while I'm trying to taper their gabapentin or adjust their spinal cord stimulator settings. Right now I'm managing chronic pain blind to half of what's affecting their nervous system, and our regenerative medicine protocols can't show clean efficacy data when patients are mixing in untracked variables.