States, Not the FDA, Are Winning the Drug War

President Trump’s recent executive order directing federal agencies to finalize the rescheduling of cannabis from Schedule I to Schedule III marks a watershed moment in American drug policy. If completed, federal law will acknowledge what 47 states and millions of medical cannabis patients already recognize: Marijuana has accepted medical use.

Moving cannabis to Schedule III will ease federal barriers to research and commercialization while substantially decreasing criminal punishment. But the real lesson of this moment extends beyond cannabis. It reveals an underappreciated way that drug policy can change in America that could have important implications for the next frontier: psychedelics.

Drug Rescheduling

Drug rescheduling can follow two distinct paths. The first is the “FDA backdoor”: a drug wins FDA approval for a specific indication, and that clinical finding becomes the predicate for shifting that FDA-approved product to a lower schedule. The second is the federalism track: states deregulate first, national regulations remain stricter but leave room for the experiment to run (by, for example, limiting enforcement). If all goes well, the federal government reschedules when the evidence ­(and politics) catch up.

Federalism, in this context, means a division of regulatory authority where states can adopt policies the federal government hasn’t endorsed — and where the federal government’s response isn’t to preempt or prosecute, but to observe and eventually adapt. The federal government could have cracked down on state cannabis programs. Instead, through enforcement discretion (the Cole Memo, for instance) and political calculation, it let the experiment run.

Medicalized Rescheduling: A False Promise?        

For years, many drug policy reformers (myself included) have championed the “medicalized” route for psychedelics: FDA approval establishes “accepted medical use,” forcing DEA rescheduling. For example, as psychedelic decriminalization efforts stalled in some states, the industry pivoted toward this strategy — get FDA approval and federal legality will follow.

Yet, the FDA approved a cannabis-based medicine nearly 40 years ago: Marinol (synthetic THC) entered the market in 1985 for two specific indications — nausea for chemotherapy and appetite loss in AIDS patients — and was moved to Schedule III in 1999. While this approval made the pill broadly available for prescription (including for off-label uses beyond those original indications), the cannabis plant itself remained on Schedule I. Why? Because federal rescheduling via the FDA is usually formulation-specific. Approve a pill, and the DEA reschedules the pill — not the plant it came from. This is the trap the “medicalized” pathway walks into.

For this reason, many advocates argue that the ultimate goal is to move past scheduling altogether — “descheduling” rather than just rescheduling. State experimentation is the best bet for this because it normalizes the substance itself, not just a narrow clinical application. While FDA approval keeps access tethered to a medical gatekeeper (i.e., by requiring a doctor and a prescription), state markets demonstrate that these plants can be integrated safely into society directly — building the necessary political capital to eventually dismantle prohibition entirely.

So, what finally forced the government’s hand for marijuana? It wasn’t any medical breakthrough, but a shift in perception, driven by state experimentation. It was, in other words, good old-fashioned federalism: states served as experiments, and the federal government eventually decided to follow suit.

Drug Experimentation Federalism

When California passed Proposition 215 in 1996, it launched the national experiment. Colorado and Washington followed with recreational legalization in 2012. State by state, Americans watched as predictions of societal collapse failed to materialize. The experiment, as they say, showed positive results.

This is what Supreme Court Justice Louis Brandeis called “laboratories of democracy” in action. States can take risks the federal government won’t, generate evidence it can’t ignore, and shift public opinion in ways no clinical trial ever could.

For marijuana proponents, the experiment worked. Nationwide support for cannabis legalization jumped from around 25 percent in the 1990s to 70 percent by 2023. Perhaps most significantly, the Baby Boomers got on board. Cannabis use among Americans 65 and older increased twenty-fold between 2007 and 2022. As older voters warmed to legalization, the political calculus shifted. Support for marijuana snowballed and, voilà, a Republican president has now ordered it rescheduled. 

Lessons for Psychedelics

Now consider where psychedelics stand today.

Oregon launched the nation’s first regulated psilocybin program in 2023. The results so far are promising: over 10,000 participants with an incident-free rate exceeding 99.6 percent. Colorado opened its first licensed psilocybin services this past June. New Mexico became the first state to create a psilocybin access pathway by legislation rather than ballot initiative, with bipartisan supermajorities in both chambers.

There have been notable hiccups, and access remains a problem — cost and demographics risk turning a public-health experiment into a boutique service. But these state programs are generating the kind of real-world evidence that moved the needle for cannabis.

Meanwhile, the medicalized pathway has been less predictable: In 2024 an FDA advisory committee votedoverwhelmingly against MDMA-assisted therapy, pushing any approval years into the future. FDA approval for other psychedelics like psilocybin (“magic mushrooms”) is, at best, years away. And, even once a psychedelic is approved, the same rescheduling risk applies: FDA approval of a psychedelic formulation could leave the compound itself — and state-regulated programs using natural mushrooms — in legal limbo.

As cannabis shows, the federalist model — state experimentation snowballing into broader acceptance — may be the better near-term path. 

FDA approval still matters — it can bring standardized products into mainstream medicine and typically increases insurance coverage. But cannabis shows FDA approval alone won’t necessarily deliver broad reform. The better bet is parallel tracks: FDA-approved psychedelics for clinical settings, and state programs that build real-world evidence.

Conclusion: Drug Policy Follows State Experimentation

If cannabis teaches us anything, it is that federal drug policy follows state experimentation, not the other way around. For psychedelics, states like Oregon, Colorado, and New Mexico are all building the evidence base, refining the regulatory framework, and proving bipartisan coalitions are possible.

Trump’s order validates three decades of state-level cannabis reform. The question now is whether policymakers, advocates, and voters will apply that lesson to psychedelics — or spend another generation waiting for regulators to catch up.