Why Carolina Doctors are Hesitant to Recommend Schedule III Substances

Doctors in the Carolinas have become extremely cautious when recommending Schedule III substances such as medical cannabis and certain psychedelics to their patients. These medications are recognized as having medical use under U.S. law. However, ongoing scientific, legal, and clinical concerns make many clinicians cautious about prescribing them. This article explains the reasons behind that hesitation and what it means for patients and healthcare providers.

What Are Schedule III Substances?

Under the Controlled Substances Act, Schedule III drugs are considered to have a moderate to low risk of dependence and an accepted medical use with limits. Examples of these drugs are medications like Tylenol with codeine and ketamine, which are now being studied and used more often for depression.

Recently, federal officials have started to shift cannabis from Schedule I to Schedule III. In December 2025, an executive order directed federal agencies to begin the reclassification process. This step could change how marijuana is treated under federal law.

However, changing the legal status of a drug does not automatically change medical practice. Many physicians still approach these substances with caution.

Limited Scientific Evidence and Clinical Guidelines

One primary reason why doctors hesitate is weak or incomplete scientific evidence.

Lack of Robust Clinical Trials

Many Schedule III substances, like cannabis and some psychedelics, lack large and controlled clinical trials. Doctors usually need these trials to guide how they prescribe medicine. A 2025 analysis found that federal authorities now recognize the medical uses of cannabis. However, there is still not enough data on its safety, its proper dosing, or how it should be used in treatment.

This lack of hard evidence makes it difficult for doctors to recommend these substances with confidence. Most physicians are trained to use set doses and proven treatment plans. Currently, many cannabis products cannot meet these high medical standards.

Poor Standardization in Products

Unlike traditional medicines, many cannabis and psychedelic products are not consistent. They often differ in their strength, how they are made, and how they are taken.

These differences make it very hard for doctors to prescribe them correctly. Because there is no set standard, the responsibility for deciding the right dose often falls on the patient instead of the doctor.

Educational and Training Gaps

Another big reason for hesitation is a lack of education.

Limited Medical Training

Public interest and laws are changing, but most medical training programs still do not teach enough about cannabis or psychedelics. A 2026 survey found that fewer than 15% of U.S. medical schools provide a solid education on how these substances work or how to use them clinically.

Because of this, doctors often feel unprepared to give patients safe advice. One study showed that many healthcare providers across the U.S. feel they lack the necessary knowledge to advise on medical cannabis. They specifically struggle with understanding correct doses and how cannabis might interact with other drugs.

Without proper training, many physicians avoid prescribing these medicines. This is especially true for substances that have psychoactive effects.

Legal and Regulatory Uncertainty

Even though the federal government is moving cannabis to Schedule III, doctors still face legal uncertainty. This ambiguity affects how they make clinical decisions for their patients.

Federal vs State Law Conflicts

Several states, including North Carolina and South Carolina, are currently debating medical cannabis laws. However, these state laws often do not match federal standards.

Because of this gap, doctors may worry about legal trouble or risks to their careers. They often fear recommending a substance that is controlled by the federal government, especially in states where local policies are still behind.

Professional Liability Concerns

Doctors must follow standard medical practice rules. Recommending substances that lack FDA approval or strong evidence could lead to malpractice risks or professional scrutiny.

Until federal regulators like the FDA fully approve specific Schedule III products, many doctors do not want to take the risk. They avoid prescribing drugs that they see as legally uncertain or medically unproven.

Cultural and Institutional Barriers

A doctor's personal beliefs and the rules of their workplace also affect how they prescribe medicine.

Stigma and Perception

Cannabis and psychedelics have a long history of being linked to recreational use and legal bans. Because of this, some doctors may still associate these substances with drug abuse or social stigma. These unconscious feelings can remain even as our scientific understanding of the drugs improves.

Hospital and Clinic Policies

Large healthcare institutions often have strict lists of approved medicines and clear rules for prescribing them. Many hospital systems still do not include cannabis or related Schedule III substances in their official treatment plans. These rules at the institutional level limit what individual doctors are allowed to recommend to their patients.

Patient Expectations and Clinical Practice Challenges

Doctors also struggle to manage the practical challenges that occur when patients express interest in these therapies.

Patients Using Cannabis Independently

Many patients already use cannabis or psychedelics on their own to treat conditions like pain, anxiety, or PTSD. This use often happens without a doctor's supervision. Because of this, doctors may be unsure how to include these substances in a patient's care plan or how to judge their effects.

Communication Gap

Patients may not fully admit to using these substances because they fear being judged or facing legal trouble. This lack of information can make doctors hesitant to start conversations about these treatments. It also makes them less likely to recommend options they do not feel confident managing.

What Could Change the Hesitation?

Several factors could change how doctors see these treatments over time.

Better Research Funding

If federal rescheduling makes it easier to conduct clinical research, better evidence for using Schedule III substances could emerge. Experts believe that reclassifying these drugs will not solve every problem. However, it could lower the barriers to controlled studies and encourage doctors to use treatments based on more solid evidence.

Formal Medical Education

Integrating cannabinoid and psychedelic medicine into medical school curriculum and continuing physician education could increase clinician confidence and safety in prescribing these substances.

Regulatory Clarity and Support

If the FDA provides clearer approved uses and creates standardized drug formulas, doctors would feel more comfortable writing prescriptions. This would also reduce their concerns regarding legal and ethical risks.

Conclusion

Doctors in the Carolinas are hesitant to recommend Schedule III substances because of incomplete scientific data, a lack of formal education, legal uncertainty, and cultural barriers.

Even with federal rescheduling, these treatments will only be widely used if there is better research, clearer guidelines, and improved training for physicians. These steps are necessary to bridge the gap between new drug policies and everyday medical care.