Legalizing marijuana is a “no-brainer” move to help ward off a “fiscal time bomb” in Iowa that could otherwise lead to cuts in funding for education and public safety in the state, the Democratic candidate for governor says.

“I think we should treat it the way we treat alcohol. That seems like a no-brainer to me, right?” Rob Sand, the Democratic gubernatorial nominee, said at a town hall event in Dallas County on Wednesday in response to a question from a voter who said Iowa is “losing money” to other states that have legalized cannabis.

“Alcohol is a dangerous drug. You shouldn’t abuse it. Also, we’re not going to throw you in prison for having a beer,” Sand said. “Why is it any different for marijuana? It is a dangerous drug. You shouldn’t abuse it. We shouldn’t be throwing people in prison just for using it.”

The Democratic candidate said that “when I say treat it like alcohol, I literally mean treat it like alcohol.”

He then went through a list of common objections to cannabis legalization and explained how he would respond to them.

“So when I hear people say, ‘Well, I don’t want to smell it.’ Same. You shouldn’t be allowed to smoke it in public. Simple rule: you can’t drink alcohol in public, right?

People say, ‘Well, I’m worried about kids. I’ve heard cases in Colorado where they got colorful gummies, and the kids find them, and then the kids get sick.’ I agree. You shouldn’t be able to market it to children. You shouldn’t be able to use colorful designs on your packages. And if you’re doing gummies, they can look like an eraser, right? They don’t need to be red and blue and green and look like gummy bears.

People say, ‘Well, I don’t know, Rob. It’s a lot stronger than the stuff that I was smoking in the 70s.’ To which I say, ‘I wasn’t there. Whatever you say, I believe you.’ I don’t have a basis for comparison then or now. I actually haven’t used it. But how do we handle that with alcohol? When you buy a beer, you can see what the alcohol content is on the beer, right? We treat hard liquor differently, but you can see when you buy hard liquor what the content is on that, and that way you know what you’re getting into. We can do that with marijuana as well.”

Sand, who is currently Iowa’s state auditor, said the state currently has a budget surplus, but that annual spending is overtaking revenue.

“I call this a fiscal time bomb. Our budget is nine and a half billion,” he said. “Imagine the cuts to public education and to public safety if we don’t take action to fix this.”

“So we need to do something now,” he said, arguing that legalizing marijuana is “one of the things that we should do.”

“We would have hundreds of millions of dollars every single year if we just treat marijuana the way we treat alcohol,” Sand said, adding that the thinks the state should also put an income limit on school vouchers and make data centers pay fair taxes.

“All three of those would save us hundreds of millions of dollars a year alone,” he said. “So if we do all three of them, we do them right away, all of a sudden, our time horizon on how long that surplus is going to last gets a lot longer, and we can think about other ways to help address that and get back to having a balanced budget.”

Sand also spoke about his support for legalizing marijuana at an earlier event last month, saying that he thinks cannabis should be legalized and treated like alcohol, even if he thinks it’s “dangerous.”

“Marijuana is a dangerous drug,” he said at the time. “You shouldn’t abuse it, but we also shouldn’t throw people in prison just for using it. We should treat it the way we treat alcohol. Alcohol is a dangerous drug. You shouldn’t abuse it, but we don’t throw you in prison just for having a beer when you get home.”

The Democratic gubernatorial candidate said that Iowa is “spending perfectly good tax dollars to lock people up” for marijuana while people who want to use it are driving across the border to purchase it in other states.

“They’re spending their money in Illinois, or they’re spending it in Missouri. And then they’re driving back without their money,” Sand said. “The money stays there, and the tax dollars stay there.”

Republican gubernatorial nominee Zach Lahn reportedly opposes legalizing cannabis but doesn’t appear to have spoken extensively about the issue.

Josh Turek, the Democratic nominee in a U.S. Senate race, said this month that cannabis’s longtime restrictive Schedule I status is “ridiculous.” Marijuana “should be legalized and regulated, and let’s tax it,” he said.

Meanwhile, Iowa regulators are circulating proposed rules changes to remove the residency requirement for patients in the state’s medical cannabis program while also ensuring that military veterans qualify for reduced registration fees.

The residency-focused part of the regulatory change from the state Department of Health and Human Services is meant to comply with provisions of a bill that Reynolds signed into law in June.

In addition to allowing out-of-state residents to register in the medical cannabis program if they have a certification from an Iowa healthcare provider legislation, that legislation also doubles the number of medical cannabis dispensaries that are allowed to operate in the state.

Regulators said in the new rule filing that removing the residency requirement is expected to “primarily impact qualified Nebraska residents since Nebraska is the only bordering state that does not currently have an operational medical or adult-use cannabis program.”

“Although Nebraska has taken steps to establish a medical cannabidiol program, implementation has experienced significant delays and setbacks,” the regulatory explanation says.

Beyond the residency change that is part of the bill the governor signed this year, the new rule change also restores regulatory language that was “inadvertently removed during the 2023 Red Tape Review process” that allowed proof of military veteran status to be used to qualify for a reduced patient application fee of $25 instead of the standard $100.

Under prior law, Iowa’s limited medical marijuana program allowed only five dispensaries. That has doubled to 10 under HF 990, which the governor signed.

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The Iowa Medical Cannabidiol Board, which oversees the state’s medical marijuana program, recommended in a 2023 report that the state allow more licenses “in an effort to provide Iowans with greater geographical access to medical cannabis products.”

Under the program, patients with certain conditions can obtain cannabis products containing no more than at 4.5 grams of THC every 90 days. Flower and smoking are not allowed. Healthcare practitioners can allow greater amounts of THC for patients who are terminally ill or who have experience with the program and for whom the provider believes 4.5 grams is not enough.

Separately this session, Iowa lawmakers considered a bill to create a state-regulated therapeutic psilocybin program for patients with post-traumatic stress disorder (PTSD).

Last year, the governor vetoed earlier legislation that would have allowed doctors in the state to immediately prescribe a synthetic form of psilocybin in the event of federal approval of the psychedelic substance by the U.S. Food and Drug Administration (FDA), arguing that it “surrenders state authority to make an informed determination about classification to federal officials.”

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“Diagnoses are sometimes entered into medical records without…meaningful consideration of medically authorized cannabis use.”

By Etienne Fontan, Veterans Action Council

The 2013 release of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) introduced cannabis use disorder (CUD) as a new diagnosis, replacing the DSM-4 categories of Cannabis Abuse and Cannabis Dependence with a single, severity-based unified diagnosis.

This change was framed as a modernization of psychiatric classification, but it has had significant implications within systems such as the Veterans Health Administration (VHA) under the U.S. Department of Veterans Affairs (VA).

In Part 4 of our series on veterans’ cannabis issues that are illuminated by the Veterans Action Council’s (VAC) Freedom of Information Act (FOIA) request, we turn our focus toward a problem affecting many veterans: the improper diagnosis of CUD within VHA.

CUD is defined as a pattern of cannabis use that causes clinically significant impairment or distress, assessed through criteria including impaired control, cravings, continued use despite harm, tolerance and withdrawal. The DSM-5 places these criteria on a continuum, classifying severity as mild, moderate or severe according to the number of criteria met.

However, the decision by the American Psychiatric Association (APA) to merge cannabis abuse and dependence into a single diagnosis did more than streamline terminology. It fundamentally altered the threshold and breadth of diagnosis.

Under DSM-IV, abuse and dependence were distinct conditions with different clinical implications. Abuse generally referred to problematic patterns of use with social or legal consequences, while dependence suggested a more entrenched physiological and behavioral pattern.

By collapsing these into one category, DSM-5 widened the diagnostic net, capturing a broader range of individuals under a single label.

This shift was driven by concerns about inconsistency. Researchers and clinicians had long observed that the boundary between abuse and dependence was not always clear and that patients often moved between categories. DSM-5 sought to resolve this by treating substance use as a spectrum.

In theory, this improved diagnostic reliability and aligned cannabis with other substance use disorders. In practice, however, it also created circumstances in which individuals who previously would not have received a diagnosis or would have received a less severe diagnosis could now be classified as having a disorder.

This distinction is not merely academic. A diagnosis carries weight. It shapes treatment decisions, becomes part of a patient’s permanent medical record and influences how future providers interpret that patient’s history.

Within the VHA system, the broader definition of CUD has intersected with institutional practices in ways that many veterans and advocates find troubling.

Reports have surfaced describing situations in which a positive THC test, often obtained through routine screening, is followed by the assignment of a CUD diagnosis without a comprehensive clinical evaluation.

Such practices raise an important question: Is CUD always being applied as a carefully considered medical diagnosis, or has it, in some cases, become an administrative label? In a proper clinical setting, diagnosis should follow a thorough assessment that considers symptoms, context, medical history and the patient’s own explanation of their cannabis use.

It should involve a conversation in which the patient understands the criteria being applied and has an opportunity to explain whether their cannabis use is therapeutic, medically supervised or otherwise clinically appropriate.

Yet many veterans report that this process is not consistently followed. Diagnoses are sometimes entered into medical records without prior discussion, without documentation of a structured DSM-5 assessment and without meaningful consideration of medically authorized cannabis use.

This gap between diagnostic standards and real-world application undermines the principles DSM-5 was intended to advance. When patients use cannabis daily under state medical cannabis laws to manage chronic pain, PTSD or other conditions, they may satisfy certain DSM criteria despite experiencing improved functioning rather than impairment.

Cannabis occupies a uniquely complex position within American healthcare. Although it remains federally prohibited, it is legal for medical use in many states and is widely used by veterans seeking alternatives to opioids or other medications.

The DSM-5 framework does not explicitly distinguish therapeutic cannabis use from problematic use. As a result, individuals using cannabis as physician-guided symptom management may nevertheless fall within a diagnostic framework originally intended to identify psychiatric illness.

The consolidation of abuse and dependence into a single diagnosis has also contributed to what many describe as diagnostic inflation. When criteria are broadened and applied without careful clinical judgment, prevalence rates may increase—not necessarily because more patients have a true disorder, but because more individuals satisfy an expanded definition.

In large systems such as VHA—where diagnostic coding serves administrative, research and reporting functions—this creates the risk that consistency may take precedence over individualized assessment.

The role of institutions cannot be overlooked. The APA establishes diagnostic criteria, but organizations such as the VHA operationalize those criteria on a national scale. Their implementation determines how these definitions affect veterans’ lives.

The increasing emphasis on CUD within the VHA system has coincided with expanded drug screening practices and a historically cautious institutional approach toward cannabis. What has not kept pace, however, is the rapid evolution of scientific research examining both the potential therapeutic benefits and the limitations of medical cannabis.

None of this is to suggest that CUD is not a legitimate diagnosis. For some individuals, cannabis use becomes harmful and requires clinical intervention. The concern is not the diagnosis itself, but proportionality, accuracy and adherence to accepted diagnostic standards.

Additional Evidence From VAC FOIA Records

Internal VA records obtained through the VAC’s FOIA request raise important questions about how VHA applies CUD. In 2022, VA correspondence reported 134,790 veterans with cannabis-positive urine drug screens and 139,336 veterans identified as having CUD. While these figures alone do not prove improper diagnoses, they warrant scrutiny when compared with national epidemiologic data.

Research cited within the same FOIA records from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) found that 7.3 percent of U.S. veterans reported cannabis use in the previous year, but only 1.8 percent met DSM criteria for CUD. This suggests that only a minority of cannabis users meet the diagnostic threshold and underscores the need for individualized clinical assessments rather than reliance on cannabis use alone.

The FOIA records also reveal that VA officials recognized the complexity of the issue.

In one email, VA Office of Research and Development Media Branch Chief Bruce I. Friedland acknowledged the need to “thread a needle” between addressing genuine cannabis-related substance use disorders and supporting research into cannabis as a potential therapeutic treatment.

In another email, Friedland sought guidance because VA lacked cannabis-specific resources for veterans who believed they had developed cannabis dependence.

Additional correspondence from UCSF physician Dr. Salomeh Keyhani recommended that veterans identified through urine drug screening be individually assessed for high-risk cannabis use and offered treatment when appropriate, consistent with the DSM-5 requirement for a comprehensive clinical evaluation rather than diagnosis based solely on laboratory findings.

VA research contained in the FOIA materials also found that nearly one third of reviewed patient records contained no documented discussion of cannabis between providers and patients. Of those that did, nearly half involved medical cannabis use rather than discussions of risks or harm reduction.

These findings reinforce the importance of patient-provider dialogue and individualized clinical judgment before assigning a psychiatric diagnosis.

For veterans managing complex medical conditions, inaccurate psychiatric diagnoses can affect treatment decisions, disability evaluations, provider perceptions and confidence in the medical record. Restoring integrity to CUD diagnosis requires rigorous application of DSM-5 criteria, informed patient participation, consideration of therapeutic cannabis use and periodic review of institutional practices to ensure administrative efficiency never replaces sound clinical judgment.

A diagnosis should ultimately serve the patient by guiding treatment and accurately reflecting clinical reality. The value of DSM-5 depends not only on how its criteria are written, but on how faithfully they are applied.

Etienne Fontan is a U.S. Army Desert Storm combat veteran and co-owner of Berkeley Patients Group, one of the nation’s longest-operating medical cannabis dispensaries. He serves on the Veterans Action Council, where he works on veterans’ access to cannabis, federal policy reform and international drug policy issues.

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Mental health advocate and one half of music duo Rizzle Kicks, Jordan Stephens, is collaborating with medical cannabis clinic, Alternaleaf, to shed light on the role of alternative treatments in supporting mental wellbeing.

Stephens, who is currently touring with Rizzle Kicks as part of their comeback tour, has written and performed a powerful spoken word piece exploring nature’s role in supporting men’s mental health.

Statistics suggest that around 12.5% of men in the UK have a mental health disorder and remain statistically less likely to seek help for mental health concerns, often waiting until a crisis point before exploring treatment options. 

The collaboration aims to shine a light on the challenges men face when speaking openly about their mental wellbeing, while also highlighting the role alternative treatments, such as medical cannabis, can play.

Stephens, who has spoken candidly about his own mental health, recently became a patient with Alternaleaf. His performance of the poem ‘The Alternative Path’, filmed in a field outside of London, has been released on Alternative Leaf’s YouTube and social channels through September. 

“I’ve been open about my own struggles with mental health and have been diagnosed with ADHD twice,” Stephens commented.

“For me, this campaign is about showing that men don’t need to stay silent about what they’re going through. Speaking up and exploring different forms of support, whether that’s creativity, community, or medical help, can make a huge difference.”

Alternaleaf also rolled out a nationwide billboard campaign in September, which centres on the real-life stories of medical cannabis patients to raise awareness of medical cannabis. 

Since medical cannabis was legalised in the UK in 2018, awareness and access have grown significantly, though it remains under-prescribed by the NHS. Though this could be set to change – in a recent study conducted by Alternaleaf, almost 7 in 10 (68%) NHS doctors surveyed would consider prescribing medical cannabis for mental health conditions such as anxiety and depression.

Nabila Chaudhri, Medical Director at Alternaleaf, added: “Men are often less likely to seek support for their mental health, which can mean many go without the help they need. At Alternaleaf, we want to change that by raising awareness of the options available, including medical cannabis, which has already helped thousands of our patients.

“In a recent survey, 97% of patients reported improvements in their well-being and happiness, underlining the growing role of medical cannabis in patient care. Working with Jordan allows us to bring this important message to a wider audience in a way that feels both accessible and engaging.”

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UK cannabinoid-based medicines manufacturer, 113 Botanicals, is raising £2 million to help launch its first controlled-release capsule, designed to improve dosing consistency and expand options for patients and prescribers.

Working in partnership with scientists at the University of Sussex since 2020, the company is developing new product formats which it believes could ‘revolutionise’ how cannabis-based medicines are prescribed in the UK.

The raise, which has been launched via Crowdcube, comes as the team prepares to reach a major regulatory milestone and bring its lead product to market in early 2026.

In development for two years, the SpheriCann capsule uses patent-protected technology to deliver a controlled and sustained release effect, which is designed to allow for more consistent absorption and precise dosing of cannabinoid medicines, avoiding the need for multiple doses throughout the day. 

‘Higher bioavailability’

Cannabis plant extracts generally have poor water solubility, meaning it can be “challenging” to deliver clinically viable doses into the body in a “reliable, controlled and predictable manner”, explained 113 Co-Founder and Chief Technical Officer, Mazin Nicola, a chartered chemist and visiting research fellow at the University of Sussex, who spent over 20 years in drug process development at GSK.

SpheriCann is said to have a higher bioavailability than standard capsules and other ingestible administration methods, with University of Sussex-based research showing 75%-95% dissolution into the blood, in a time-controlled release over several hours.

“Standard capsules and other ingestible administration methods have serious drawbacks, including high losses of therapeutic activity to gastric acid degradation and poor dissolution into the bloodstream,” said Nicola.

“Our Sphericann technology addresses the problem of providing relatively high unit dosage forms of CBPM compositions whilst enabling the release of the active pharmaceutical ingredients (APIs) from the dosage form in a linear and prolonged fashion, for example, up to seven hours. Thus, avoiding the need for frequent multi-dosing or delivering a large hit of the cannabis in the composition too quickly.”

Photo: 113 Botanicals

He explained: “This is achieved by formulating a cohesive mass of cannabis extract, a liquid vehicle plus special excipients within a polymeric matrix material. The wet mass is treated to form uniform spheroidal pellets, uniquely identified as ‘Liquipellets’, which are finally contained in gastric acid-resistant capsules. The liquipellets comprise a disintegrant that allows the release of the APIs at a controlled rate.”

According to Nicola, this is different to most known methods of pharmaceutical production, and aims to enable clinicians to prescribe more accurate and controlled dosing of CBMPs, which can be self-administered by the patient with low or no risk of accidental overdose.

Growing demand for alternative product formats 

As access to medical cannabis continues to expand, with some estimates suggesting that up to 80,000 patients will have received treatment in 2025, there is a growing demand for alternative product formats outside of flower and oils.

“We are addressing the lack of meaningful format choice for patients,” said Kate Cook, Co-Founder and COO of 113 Botanicals, speaking to Cannabis Health.

“We have developed delivery formats that are designed for precise dosing and sustained-release, but that also offer convenience, discretion and accessibility.”

The company has forecasted it will reach 5,000 patients in the first 12 months, generating an estimated £8.5 million in revenue.

Cook continued: “We believe that presenting CBMPs in more standardised, pharmaceutically acceptable formats will inspire more confidence in prescribers and have the potential to open up whole new patient groups to the potential benefits of medical cannabis.”

Photo: 113 Botanicals

A regulatory milestone

With Home Office Controlled Drugs Licences at both its R&D laboratory and production facility, 113 is now in the validation phase of its ‘Manufacturers’ Specials’ (MS) license approval from the Medicines and Healthcare Regulatory Agency (MHRA) following a successful remote inspection.

Cook has found the regulator to be “very helpful” throughout the process and is aiming to gain full licence approval following the final inspection, which has been requested for early 2026.

She believes once approved, this will make them one of only a handful of UK medical cannabis companies with an MS licence and the only one to have a licence for a ‘defined novel finished product’.

The Crowdcube campaign follows earlier funding rounds totalling more than £2.8 million, from angels, founders and early supporters to build the manufacturing site, complete R&D work, and prepare for licensing.

Running for three weeks, it aims to raise an additional £2 million to support the launch of SpheriCann and advance its other products, including a 24-hour transdermal patch, VetiCann, to market.

“Above all, we see 113 as an innovator,” Cook added.

“One that harnesses exemplary research and development to create products that revolutionise the way patients can take medical cannabis.”

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