12/08/2025 David Secord, DPM
Implications of Cannabis Use on Diabetes and Diabetic Ulcers
I thought that I’d offer a correction in the
published “Implications of Cannabis Use on
Diabetes and Diabetic Ulcers It’s important to
understand its use in wound healing”, BY Zanib
Cheena, DPM, MS AND Stephanie Wu, DPM, MSC.
In that article, they state that “According to the
Center for Disease Control (CDC), cannabis is the
most commonly used federally illegal drug in the
United States as it is currently legal in 24
states for recreational use and in 40 states for
medical use.” Marijuana is still a Schedule I
narcotic and is not legal in any State of the
Union. It has been decriminalized in these States,
but it is still a felony to grow, process, sell
and distribute or possess this narcotic.
To quote from Congress.gov: Marijuana is a
psychoactive drug that generally consists of
leaves and flowers of the cannabis sativa plant.
Its history dates back thousands of years, but in
the United States it became popular as a
recreational drug in the early 20th century. Not
long after its rise in popularity, the federal
government began to exercise control over
marijuana and other substances through its taxing
authority, and it enacted criminal penalties for
violations of drug laws.
In 1970, the federal government enacted the
Controlled Substances Act (CSA), which imposed a
unified legal framework at the federal level to
regulate certain drugs—whether medical or
recreational, and legally or illicitly
distributed. The CSA criminalized the manufacture,
distribution, dispensation, and possession of
marijuana, which included all of varieties of
cannabis at the time (in 2018, the farm bill [P.L.
115-334] amended the CSA to exclude hemp—plant
material that contains no more than 0.3% delta-9-
tetrahydrocannabinol [delta-9-THC] on a dry weight
basis).
Under the CSA, marijuana and its derivatives are
classified as Schedule I controlled substances,
which means the cultivation (or manufacture),
possession, and distribution of marijuana are
illegal except for the purposes of sanctioned
research. While the CSA definition of marijuana
changed in 2018, which resulted in the removal of
hemp from the definition of marijuana, the status
of marijuana as a Schedule I substance has
remained unchanged for over 50 years.
Many states, however, have established a range of
laws and policies allowing for the medical and
recreational use of marijuana over the last
several decades. Most of these states have
deviated from an across-the-board prohibition of
marijuana, and it is now more the rule than the
exception that states have laws and policies
allowing for some cultivation, sale, distribution,
and possession of marijuana or low-THC cannabis—
many of which are contrary to the CSA.
As of April 1, 2022, 37 states, as well as Puerto
Rico, Guam, the U.S. Virgin Islands, and the
District of Columbia, allow for the comprehensive
medical use of marijuana, while 11 additional
states allow for the medical use of low-THC
cannabis. Also, 18 states, the District of
Columbia, Guam, and the Northern Mariana Islands
allow for recreational use of marijuana. These
developments have spurred a number of questions
regarding potential implications of the federal
and state marijuana policy gap for federal law
enforcement activities, for individuals who comply
with state marijuana law but violate federal
marijuana law, and for the nation's drug policies
as a whole.
Under the principles of federalism, [established
by the Supremacy Clause of the Constitution and
the Supreme Court decision in Ogden vs Gibbons]
the federal government may preempt state marijuana
laws and enforce the CSA. Thus far, the federal
response to state actions to legalize marijuana
has largely been to allow states to implement
their own laws on the drug. The gap between
federal marijuana law and federal enforcement
policy and the issues it creates continue each
year, although Congress has partly addressed this
gap by restricting the Department of Justice's
(DOJ's) ability to expend funds to enforce the CSA
in states that allow medical marijuana.
DOJ has nonetheless reaffirmed that marijuana
growth, trafficking, and possession remain crimes
under federal law irrespective of states'
marijuana laws. To date, federal law enforcement
has generally focused its efforts on criminal
networks involved in the illicit marijuana trade.
https://www.congress.gov/crs-product/R44782
David Secord, DPM, McAllen, TX
