Beyond False Choices: A Rational Framework for Cannabis Regulation

Dr. Rachel Knox, MD, MBA, Endocannabinologist and Cannabinoid Medicine Specialist, President, Association for Comprehensive Health Equity & Medicine (ACHEM)

Editors’ Note: The most clear-eyed views are often the same views unaccompanied by advertising, social media boosts, and PR. Given that, we intend to occasionally use this platform to lift up independent expert opinions that we believe deserve more attention. The following is a proposed federal framework by Dr. Rachel Knox, republished with permission.

Federal hemp policy has become a flashpoint exposing the fundamental irrationality of our cannabis regulatory framework. All stakeholders are trapped fighting over a fundamentally broken framework.

The 2018 Farm Bill created hemp cannabinoid markets that competed with state-licensed marijuana operators—but without equivalent barriers to entry or regulatory oversight. This set up the current crisis: an oversaturation of hemp operators in the cannabinoid space while diverting industry investment away from viable non-cannabinoid applications like fiber, construction materials, and sustainable agriculture.

The real problem isn’t whether to ban hemp-derived cannabinoid products or leave them unregulated—both approaches leave an entire market criminalized with no regulatory remedy in sight. The problem is that we’re still pretending “hemp” and “marijuana” are different things, that we can regulate identical molecules differently based on botanical origin, and that this serves anyone except those positioned to consolidate and criminalize.

What follows is a framework that transcends the hemp-vs-marijuana fiction, addresses every legitimate stakeholder concern, and offers a path forward beyond prohibition or chaos.

Cannabis Regulation: A Rational Framework for Public Health, Economic Justice, and Liberty

The Language Shell Game

For years, we’ve allowed policymakers to weaponize language as regulatory sleight-of-hand. “Hemp” vs. “marijuana.” “Psychoactive” vs. “non-psychoactive.” “Intoxicating” vs. “non-intoxicating.” These aren’t scientific distinctions—they’re political fabrications designed to create artificial market divisions that serve neither public health nor economic justice.

Let’s be clear: Cannabis is cannabis. Hemp is not a different plant—it’s a regulatory fiction. Delta-8 THC doesn’t magically become less concerning because it’s synthesized from CBD extracted from a plant with <0.3% delta-9 THC. And CBD isn’t “non-psychoactive” just because it doesn’t produce euphoria—it treats seizures, anxiety, and depression (and sedation at high enough doses) by acting on the psyche. These are psychoactive effects; they’re just not intoxicating in the euphoric sense.

We’ve allowed ourselves to be divided by these linguistic tricks, and now we’re watching the inevitable endgame unfold.

The Trap We’re In

Civil libertarians were right to oppose the Miller Amendment as prohibition recrudescence. Public health advocates were right that unregulated intoxicating cannabinoids flooding convenience stores creates serious harms. Both positions were valid because the underlying framework is broken.

The 2018 Farm Bill didn’t create a loophole—it created a legal fiction that was always going to collapse under its own contradictions. You cannot rationally regulate molecules based on which cultivar they came from or how they were synthesized. Science doesn’t work that way. Public health doesn’t work that way.

The evidence is everywhere. Hemp flower with high THCA content sits on shelves next to candy, exploiting the technicality that it contains less than 0.3% delta-9 THC—until someone heats it and the THCA converts to fully intoxicating THC. Gummies can pack 10-25mg of delta-9 THC per piece while remaining “hemp-compliant” by weight. Synthetic and semi-synthetic cannabinoids derived from CBD proliferate with no oversight. These aren’t theoretical concerns—they’re the predictable result of regulating by botanical origin rather than pharmacological effect.

What we’re witnessing is the predictable outcome of a divide-and-conquer strategy. Hemp operators vs. cannabis operators. Medical vs. adult-use. State-licensed dispensaries vs. gas station entrepreneurs. While we fight each other over crumbs, Big Pharma, Big Alcohol, and Big Tobacco sharpen their knives, and this administration signals its intent to consolidate what they want and criminalize the rest.

I’ve been warning about this trajectory for years. The Miller Amendment, and even the Harris Amendment—these weren’t about protecting kids or public health. They’re about market consolidation and re-criminalization disguised as consumer protection. And if we don’t recognize the pattern, we’ll wake up to find cannabinoids rescheduled under FDA control, locked behind pharmaceutical distribution, with everything else driven back underground where it’s most dangerous.

The Rational Path Forward

The solution isn’t tweaking hemp definitions or parsing what’s “non-intoxicating.” It’s starting from first principles:

Regulate by effect, not by origin.

Two categories. That’s it:

1. Cannabinoid Regulation (by impairment potential/liability)

• Non-intoxicating doses/products: Available through general retail (online, traditional stores, pharmacies)

  • Think: Any product with CBD and/or minor cannabinoids at doses NOT liable to cause sedation, euphoria, or psychomotor impairment

• Intoxicating doses/products: Restricted to licensed specialty retail (dispensaries)

  • Think: Any product with sufficient THC, THCA, or other cannabinoids (including CBD) at doses liable to cause sedation, euphoria, or psychomotor impairment

2. Industrial Cannabis Regulation (non-cannabinoid applications)

• Fiber, seed, grain, construction materials, etc.

• Standard agricultural and food product regulations

That’s it. No arbitrary 0.3% threshold. No hemp vs. marijuana fiction. No synthetic vs. natural. Just: Does this product contain cannabinoids? What’s the impairment potential at the labeled dose? (And supply chain logistics would flow naturally from this principle: breeders, seed producers, cultivators, processors, manufacturers, distributors, and retailers all licensed by intended use; crops route based on actual chemistry; and effect-based categorization applies at the final product stage—whether that’s dried flower or finished formulations.)

Why This Framework Works

This approach is the only one that simultaneously protects small and medium operators, addresses legitimate public health concerns, and preserves individual liberty.

Protects small and medium operators:

• Stops the pointless hemp vs. cannabis industry warfare

• Ends the regulatory arbitrage that lets gas stations compete with licensed dispensaries

• Prevents Big Pharma from monopolizing all cannabinoids behind prescription walls

Addresses public health concerns:

• Creates clear, enforceable standards based on actual effects

• Establishes consistent quality and testing requirements for all cannabinoid products

• Enables age-appropriate access restrictions where warranted

Preserves individual liberty:

• Preserves legal access to non-intoxicating and intoxicating cannabinoid products through appropriate retail channels

• Honors adult autonomy to make informed decisions about cannabinoid use Anything more complex than this perpetuates an environment of confusion and chaos that

  makes handing the entire sector to corporate consolidators that much easier.

Critically, this framework must include non-negotiable criminal justice principles: No one—adult or minor—should face arrest or imprisonment for responsible personal use or possession of cannabis. We regulate the supply chain from breeding through labeling, sale, and retail access points. We do not indiscriminately criminalize possession or consumption. This extends to personal cultivation and home preparation where states permit it—individuals growing for personal use and non-commercial sharing exercise the same liberty principles, operating outside the commercial supply chain but within legal protection and guardrails. Informed adults have the fundamental right to make their own decisions about what they put in their bodies. This principle is foundational—without it, any regulatory framework simply becomes prohibition by another name.

Of course, comprehensive criminal and social justice reform requires far more than what I outline here. But like so many aspects of cannabis policy, meaningful progress on justice issues must build from a rational regulatory foundation. We cannot achieve equitable outcomes from an irrational starting point.

What about the obvious implementation challenges? Determining impairment thresholds for diverse cannabinoid combinations and delivery methods is complex. Individual responses to cannabinoids vary. No single universal test for impairment exists—we don’t even have (and likely never will have) consensus on roadside testing for well-studied delta-9 THC.

But here’s what matters: We already navigate this successfully with countless over-the-counter medications. Antihistamines, sleep aids, decongestants, cough suppressants—all can cause drowsiness, impairment, even intoxication when misused. We don’t require prescriptions for everything or ban these products. We establish dosage guidelines, require clear labeling about effects and warnings, implement age restrictions at point of sale, and trust that most people will use them responsibly.

The existence of complexity doesn’t justify regulatory paralysis or prohibition; it demands reasonable, workable standards. When the goal is to be sensible rather than perfect, everything is figureoutable. And frankly, the perfect shouldn’t be the enemy of the good—especially when the alternative is the chaos we have now.

And regarding roadside impairment testing for a moment, here’s where we see the same linguistic misdirection: Impairment is impairment, regardless of cause. We already have field sobriety tests that detect whether someone can safely operate a vehicle—improve those for all-cause impairment instead of obsessing over cannabis-specific detection. This fixation on THC levels is yet another example of regulatory sleight-of-hand and criminalization obsession that misses the real question—can this person drive safely right now?—to focus on what substance to blame and prosecute. The answer to the question doesn’t require knowing what’s in their bloodstream. If the impairment is caused by a substance, the substance causing the impairment is a secondary question.

Harm Reduction Begins With Rational Policy

True harm reduction—for everyone, and especially for children—starts with a rational regulatory framework. Prohibitionist organizations are already mobilizing fear-based campaigns about “addiction industries” and “protecting our children,” demanding immediate bans on hemp-derived intoxicants. But this playbook gave us mass incarceration, the war on drugs, and actually increased youth access by driving products into unregulated black markets.

You cannot protect minors with irrational policy. Age-restricted retail locations with ID requirements demonstrably work better than convenience store free-for-alls or criminalized black markets. Clear, accurate product labeling enables informed decisions by adults and oversight by parents. Distinguishing intoxicating from non-intoxicating products creates appropriate guardrails.

This framework addresses every legitimate public health concern—youth protection, product safety, preventing impaired driving—without recreating the failures of prohibition. The question isn’t whether we care about protecting kids. The question is whether we’re willing to use policies that actually work.

Medical Use Programs: Extension of Rational Regulation

This rational regulatory framework doesn’t just permit states to develop medical use programs—it enables them to function properly for the first time.

Because here’s where language matters yet again: There is no such thing as “medical cannabis”—only medical USE of cannabis. The same CBD oil, the same THC flower—one person uses it therapeutically, another socially. The distinction isn’t in the product; it’s in the purpose and context of use. (Yes, certain form factors or delivery devices may be more conducive to medical applications, but that doesn’t make them molecularly different products.)

Medical use transcends the regulatory market fiction. Our patients benefit from products across the entire cannabinoid spectrum—from microdoses of CBD to megadoses of THC, vice versa, and everything in between. Therapeutic dosing is profoundly subjective, wide-ranging, and context-dependent. This is precisely why medical use should not be confined to a fictional, siloed vertical of “medical cannabis,” as though these products are molecularly distinct from “adult-use cannabis” or “hemp.” They’re not. That artificial separation has only added confusion, perpetuated stigma, and created arbitrary barriers to patient care.

Instead, medical use programs should exist as public health infrastructure—entirely distinct from but working alongside the unified cannabinoid market. Think of them as:

• Education and guidance systems for patients, caregivers, parents, healthcare providers, and the public—including age-appropriate information for families navigating pediatric medical use

• Access and affordability mechanisms (pricing protections, insurance pathways, subsidies where appropriate)

• Clinical care standards and protocols that inform best practices across all populations, with particular attention to vulnerable groups including minors

• Research and outcomes tracking that feeds back into evidence-based regulation

  This model preserves what matters most: autonomy and support, not gatekeeping. Medical use programs provide clinical guidance, therapeutic protocols, and potential insurance coverage pathways—they don’t restrict access or create paternalistic assumptions that only “medically approved” use is legitimate. They enable parents and caregivers to make informed decisions about pediatric use with proper medical oversight when desired. They help patients navigate a unified, rationally regulated market rather than forcing them through fragmented, arbitrary silos.

These programs interface with the cannabinoid market (both non-intoxicating and intoxicating products) AND with FDA-approved pharmaceutical cannabinoid medications—without creating yet another fragmentary category.

A patient working with a physician shouldn’t face different products, testing standards, or access points based on whether they’re at a “medical dispensary,” “recreational dispensary,” or “hemp shop.” They should have clinical support navigating one rationally regulated market, with pharmaceutical options available when appropriate.

It’s simple math: 2 regulated markets (cannabinoids and industrial cannabis) + medical use programs = comprehensive access without fragmentation.

This is how we achieve market clarity, protect public health—including meaningful youth protection through education and appropriate oversight rather than criminalization—preserve therapeutic access beyond Big Pharma’s clutches, and end the chaos.

The question of which agency oversees cannabinoids still needs debate. But that conversation should follow establishing what we’re actually regulating. Implementation details matter, but they’re meaningless without a coherent framework.

The Stakes

The problem is that we’ve been debating within a fundamentally irrational framework. If we keep arguing over which molecules from which plants should go where, we’re just giving the prohibitionists and the consolidators exactly what they want.

We need to stop fighting each other and start advocating for a scientifically coherent, publicly protective, and economically just regulatory framework. One that treats cannabinoids as cannabinoids—regardless of which Cannabis sativa cultivar they came from or how they were extracted.

The question is: Are we ready to stop playing their game and start advocating for rational policy?

Because if not, this debate will be moot. We’ll all be watching from the sidelines while the industry we’ve fought to build gets carved up and distributed to those who had the capital and political connections to survive the chaos we allowed them to engineer.

We can do better. There desperately needs to be a shift in this conversation. It’s rather long overdue.