“The medicinal properties of the cannabis plant have been known for millennia.” Lambert Initiative for Cannabinoid Therapeutics, History of cannabis, The University of Sydney.
Iowa classified cannabis as a habit-forming drug with accepted medical use in 1921. 1921 Acts ch. 282.
In 1967, the United States entered into an international agreement classifying cannabis as having no medical use. Single Convention on Narcotic Drugs, May 25, 1967, 18 U.S.T. 1407, 520 U.N.T.S. 151. The Single Convention allows exceptions. Article 36(2):
Subject to the constitutional limitations of a Party, its legal system and domestic law, …
Congress classified cannabis as having no medical use in 1970. Controlled Substances Act, Pub. L. 91-513, 84 Stat. 1242 (Federal CSA). The Federal CSA allows exceptions. 21 U.S.C. § 822(d):
The Attorney General may, by regulation, waive the requirement for registration of certain manufacturers, distributors, or dispensers if he finds it consistent with the public health and safety.
Iowa classified cannabis as having no medical use in 1971. Uniform Controlled Substances Act, 1971 Acts ch. 148 (Iowa CSA). The Iowa CSA allows exceptions but only by enacting further legislation. Iowa enacted further legislation in 2014 authorizing medical use of cannabis extacts. 2014 Acts ch. 1125. Iowa enacted further legislation in 2017 authorizing manufacture and distribution of cannabis extracts. 2017 Acts ch. 162.
Iowa has not requested a waiver from the Attorney General
Over the past thirty (30) years, forty-eight (48) states and several federal territories have reversed course, accepting what they had previously forbidden, medical use of cannabis. The National Conference of State Legislatures (NCSL) has a map (click here or click on the map):
The map shows Iowa as a low-THC state, which was true from 2014 to 2020. Iowa removed its three percent limit on THC in 2020, 2020 Acts ch. 1116.
The first states to change their laws allowed patients to possess cannabis on the advice of a physician, but without any state authorized source. California was the first state to enact such a law in 1996. Patients had to figure out on their own how to get cannabis and coops began growing it for them.
In 2001, the U.S. Supreme Court held that medical necessity was not a valid defense for a coop growing cannabis for patients in California. United States v. Oakland Cannabis Buyers’ Cooperative, 532 U.S. 483 (2001).
In 2002, the U.S. Court of Appeals for the Ninth Circuit held that physicians in California recommending medical use of cannabis to their patients were exercising free speech protected by the First Amendment. Conant v. Walters, 309 F.3d 629 (9th Cir. 2002), cert. denied, Walters v. Conant, 540 U.S. 946 (2003).
In 2005, the U.S. Supreme Court held that patients in California could not grow their own medical cannabis. Gonzales v. Raich, 545 U.S. 1 (2005).
States began licensing cannabis growers and dispensaries. The U.S. Department of Justice gave these commercial enterprises a green light, “the existence of a strong and effective state regulatory system, and an operation’s compliance with such a system, may allay the threat that an operation’s size poses to federal enforcement interests.” James M. Cole Deputy Attorney General, Memorandum for All United States Attorneys August 29, 2013, at p. 3.
The Congressional Research Service reports, “In each fiscal year since FY2015, Congress has included provisions in appropriations acts that prohibit DOJ from using appropriated funds to prevent certain states, territories, and DC from ‘implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana’ (for the most recent provision, see the Consolidated Appropriations Act, 2024, P.L. 118-42).” Congressional Research Service, The Federal Status of Marijuana and the Policy Gap with States (2025).
Under the federal CSA, users do not register. 21 U.S.C. § 822(c)(3). See Raich, 545 U.S. at 28 (“The CSA requires manufacturers, physicians, pharmacies, and other handlers of controlled substances to comply with statutory and regulatory provisions mandating registration with the DEA”). The exception under the Federal CSA only applies to registration. 21 U.S.C. § 822(d) (waiving registration requirements “consistent with the public health and safety”).
Ignoring this protection and placing patients in federal jeopardy violates their civil rights. The state has a duty to provide its citizens with the protection that federalism defines, 21 U.S.C. § 822(d).
Bond v. United States, 564 U.S. 211, 220 (2011) (“The individual, in a proper case, can assert injury from governmental action taken in excess of the authority that federalism defines. Her rights in this regard do not belong to a State.”). Bond , 564 U.S. at 221 (“federalism secures to citizens the liberties that derive from the diffusion of sovereign power”). Bond , 564 U.S. at 223 (“If the constitutional structure of our Government that protects individual liberty is compromised, individuals who suffer otherwise justiciable injury may object”).
As Supreme Court Justice Clarence Thomas has pointed out, “This contradictory and unstable state of affairs strains basic principles of federalism and conceals traps for the unwary.” Standing Akimbo v. United States, 594 U.S. ___ (June 28, 2021) (Statement of Justice Thomas), slip op. at 1.
Forcing patients to choose between violating federal drug law or going without treatment is a betrayal of fundamental rights and exposes the public to danger without justification. Safe Streets Alliance v. Hickenlooper, 859 F.3d 865, 884 (10th Cir. 2017) (“Marijuana is a controlled substance under the CSA. 21 U.S.C. § 802(16). So the manufacture, distribution, and sale of that substance is, by definition, racketeering activity under RICO. 18 U.S.C. § 1961(1)(A), (D)”).
REQUIRED REPORTS: Iowa Code § 124E.5(5) (“On or before January 1 of each year, beginning January 1, 2018, the medical cannabidiol board shall submit a report detailing the activities of the board”).
2022 Annual Report: “The Board recommends that a task force of legal experts be authorized, similar to the current board of medical experts, to assist the department in navigating the legal issues involved with requesting an exemption for Iowa’s program from necessary Federal agencies. This is related to a recommendation in the Board’s 2019 Annual Report and the passage of HF2589 in June, 2020.”
2023 Annual Report: “The Board recommends that a task force of legal experts be authorized, similar to the current board of medical experts, to assist the Department in navigating the legal issues involved with requesting an exemption for Iowa’s program from necessary Federal agencies. This is related to a recommendation in the Board’s 2019 Annual Report and the passage of HF2589 in June, 2020.”
2024 Annual Report: The Board recommends that a task force of legal experts be authorized, similar to the current board of medical experts, to assist the department in navigating the legal issues involved with requesting an exemption for Iowa’s program from necessary Federal agencies. This is related to a recommendation in the Board’s 2019 Annual Report and the passage of HF2589 in June, 2020.”