Earlier this month, Joe Biden revealed that he would not aim to legalize cannabis if he were to win the Democratic primary, and repeated the long-debunked myth that cannabis is a “gateway drug.” He would be greatly disappointed to learn that as we continue to stall on legalizing, lots of drugs to which weed is the supposed “gateway” are already making their way to the market: Spravato, an “esketamine nasal spray” whose active ingredient is essentially the same thing as the club drug ketamine, is now FDA-approved, which means it’s available for interstate commerce because the regulatory agency has determined “the benefits of the product outweigh the known risks for the intended use.”
It’s not that FDA approval of a ketamine-like nasal spray should be cause for alarm: Ketamine has been used as a DIY treatment for PTSD symptoms, particularly depression, and veterans in particular have been encouraged to use it. Researchers are generally taking psychedelic drugs more seriously as mental health treatment options. Clinical trials for MDMA as a PTSD treatment and psilocybin as a treatment for depression both got speedy FDA approval thanks to a “breakthrough” designation.
But given the fact that cannabis has also proved effective at treating the same symptoms, it’s striking that one is federally approved while the other languishes in gray area, state-level legality, which means doctors who approve it and patients who use it have historically shouldered additional legal risks. Earlier this month, a new study confirmed what a lot of people living with post-traumatic stress disorder have known for years: People with PTSD who had used cannabis at least once in the past year reported significantly lower instances of two of PTSD’s symptoms: Non-users were seven times more likely to have experienced a depressive episode, and more than four times as likely to have considered taking their own lives within the past year.
According to the Marijuana Policy Project, doctors can only greenlight cannabis (since it still can’t be “prescribed,” per federal law) as part of a treatment for the disorder in 32 states, along with Guam and Washington, D.C. Veterans, who have a higher PTSD diagnosis rate than the general population, are still denied access to cannabis if they utilize health services from the U.S. Department of Veterans Affairs, because VA doctors are not allowed to approve medical cannabis for their patients—though The Baffler reported that Trump himself encouraged the VA to order Spravato “by the ‘truckloads.’”
Though Trump’s FDA has been notoriously lax, the agency has only approved four medications that contain anything remotely related to cannabis since he took office in 2017. Cannabis is somehow still a Schedule I drug, along with acid, peyote, and heroin. This means that under federal law it has “no currently accepted medical use and a high potential for abuse,” despite the fact that 47 U.S. states have some kind of medicinal cannabis law on the books. Ketamine, on the other hand, is a Schedule III Drug, despite the fact that anybody who’s used both substances knows which one is more associated serious side effects when used recreationally. You can’t toke your way into a dissociative fugue on the scale of a k-hole, basically. This institutional obstinance clashes with the viewpoints of the majority of Americans, two-thirds of whom support federal cannabis legalization. To be fair, cannabis use has potential negative side effects of paranoia and anxiety, and if used long-term, depression and psychosis (though instances of the latter have often been inflated) Spravato’s side effects, on the other hand, include dissociation, suicidal ideation, vertigo, increases in blood pressure, numbness, and lethargy.
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