By Megan R. Wilson

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In today’s issue: The great cannabis debate. … Cracking down on “designer Xanax.” … A new rural health fund breakdown shows money might not go to states with the most need … and more.

TGIF. Welcome to the Health Brief newsletter. Do you have any tips, scoops or health policy intel? Reach out. You can find me at megan.wilson@washpost.com, or message me securely on Signal at megan.434. Also: It’s Feedback Friday! How are you liking the new formatting at the top? Any topics you want to hear about next week? Let me know.

This newsletter is published by WP Intelligence, The Washington Post’s subscription service for professionals that provides business, policy and thought leaders with actionable insights. WP Intelligence operates independently from the Washington Post newsroom. Learn more about WP Intelligence.

President Donald Trump is mulling massive changes to cannabis policy. (Melina Mara/The Washington Post)

	The Lead Brief

President Donald Trump is expected to direct regulators to dramatically loosen federal restrictions on marijuana, Jacob Bogage, Dan Diamond and David Ovalle report from The Washington Post newsroom.

While Trump can’t reschedule the drug himself, he can issue an executive order directing the Justice Department to move forward with the rulemaking, according to my colleagues’ reporting.

Trump discussed the plan to reclassify marijuana during a meeting this week with Health Secretary Robert F. Kennedy Jr., Centers for Medicare and Medicaid Services leader Mehmet Oz and marijuana industry executives, according to my Post colleagues, citing multiple people with knowledge granted anonymity to provide details about the huddle. Trump included Speaker Mike Johnson (R-Louisiana) via phone.

NEW: Trump is also interested in pushing Medicare to allow for the reimbursement of CBD products, a person with direct knowledge of the meeting tells me. It’s a priority of Trump’s longtime friend and Mar-a-Lago club member Howard Kessler, who was among those in attendance at the Oval Office meeting. In September, Trump posted a video created by a group Kessler founded that endorsed Medicare coverage of CBD.

Other industry execs who were part of the discussion at the White House, according to the person with direct knowledge, who was granted anonymity to share details about the private meeting: Kim Rivers from cannabis company Trulieve and Jim Hagedorn from ScottsMiracle-Gro, which makes fertilizer.

Other top White House staff were in the room, including Heidi Overton from the Domestic Policy Council and Chief of Staff Susie Wiles, in addition to Food and Drug Administration head Marty Makary, I’m told.

The White House wouldn’t comment on the details of the meeting or the attendees, only saying that a final decision about whether to reclassify marijuana hasn’t been made. The Department of Health and Human Services deferred questions to the White House. ScottsMiracle-Gro didn’t immediately respond to a request for comment. Trulieve declined to comment on the meeting.

THE LANDSCAPE

→ Marijuana is currently classified as a Schedule I substance, which means it has not been accepted as a medical treatment and is considered to have high potential for abuse. Trump is mulling whether to push to reclassify the drug as a Schedule III substance, putting it on the same level as prescription painkillers such as Tylenol with codeine and certain hormone treatments.

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Why it matters: The move to reclassify the drug, which has been sought by pro-marijuana activists and industry groups for years, and has garnered support from Republicans and Democrats, wouldn’t legalize or decriminalize marijuana. However, it would ease barriers to research and boost the bottom lines of legal businesses.

Cannabis has become a multibillion-dollar industry as dozens of states have legalized marijuana, either on a medical or recreational basis. Forty-two states, plus D.C., have legalized medical marijuana and 24 allow recreational use.

→ Separately, CBD products — such as beverages, gummies and creams — are made from a non-intoxicating compound found in cannabis. While some products do contain THC, the high-inducing compound, others don’t get a person high and are used to help with pain, sleep and other health conditions. Kessler and other advocates tout CBD as an alternative to opioids. Bloomberg reported last month that CMS is working on a coverage proposal. The report says Kessler met with Kennedy about the issue in October.

Hemp-derived CBD products are currently in limbo following language in a recent government spending bill Trump signed that the industry argues is tantamount to a ban. The hemp industry is now fighting to overturn it.

BEHIND THE CURTAIN

Johnson reportedly pushed back on the idea of rescheduling marijuana, citing multiple studies to back up his views, The Post reported Thursday. Then, the marijuana execs — who were gathered around Trump’s desk — countered Johnson’s claims. Sources told my colleagues that Trump seemed ready to push for the reclassification after the meeting, but cautioned that he could change his mind.

Key quote:

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	Agency alert

The Drug Enforcement Administration is moving to temporarily classify a drug called bromazolam, which is known as “designer Xanax,” as a Schedule I substance, putting it alongside heroin, ecstasy and LSD. States have been warning that overdoses and deaths involving the drug have been on the rise.

The drug is a benzodiazepine, a class of drugs used to treat conditions including anxiety, but — unlike Xanax — it has not been approved as a treatment by the FDA. Six states have designated bromazolam as a Schedule I controlled substance.

In August, 21 Republican attorneys general asked the Trump administration to schedule the drug on the federal level, citing “a growing threat to public health.”

“Taking emergency action to schedule bromazolam will help law enforcement remove it from circulation, give prosecutors the tools to hold traffickers accountable, and send a clear signal that this dangerous substance has no place on our streets,” reads the letter, led by Kentucky Attorney General Russell Coleman.

→ Now, the DEA is issuing a notice that the drug will be considered as a Schedule I substance for two years, issuing the emergency classification because it’s necessary “to avoid an imminent hazard to the public safety.”

Why it matters: States have reported an increase in overdoses and deaths linked to the drug, including 170 deaths in Tennessee where the deceased had bromazolam in their system in 2023. According to the DEA’s notice — set to publish Monday — the agency tracked at least 240 overdoses involving the drug between April 2021 and July 2025. Of those, nearly 190 people died. The DEA said those numbers likely undercount the issue, citing figures reported by other states: In 2024, there were 47 overdose deaths involving bromazolam in Kentucky that hadn’t been captured by the agency.

	State scan

First in Health Brief: An analysis from the Leonard Davis Institute of Health Economics at the University of Pennsylvania found more evidence that federal cash from the Rural Health Transformation Program may not be going to the states with the most need.

The fund was created by Republicans’ domestic policy law enacted in July, and will distribute $50 billion to states over the next five years — aiming to help rural health providers modernize and care for patients. Democrats and some policy analysts have criticized the funding as insufficient to offset anticipated revenue losses spurred by the law’s estimated $1 trillion in Medicaid cuts over the next decade.

The timing element: The report, commissioned by Senate Finance Committee Ranking Member Ron Wyden (D-Oregon), comes weeks before CMS is expected to announce how much states will receive from the fund. The agency said it would announce awards by Dec. 31.

→ The analysis dives deeper into public data to estimate which states will receive the largest share of the cash. Many of the findings show the grants are unlikely to fill in funding gaps.

A necessary caveat: Researchers were only able to calculate about 75 percent of where the allocated funds are likely to go, as CMS is still reviewing how to distribute the rest. The report notes that the outcomes could change slightly once those decisions are announced.

Top-line figures:

• States with the lowest rural mortality rates — including Connecticut, Delaware and North Dakota — are estimated to receive roughly $233 per rural resident. That’s more than twice the amount (about $104 per rural resident) that researchers estimate states with the highest rural mortality rate — including Kentucky, Mississippi and Tennessee — will receive.
• Five states — Alaska, North Dakota, South Dakota, Vermont and Wyoming — could receive grants from the fund that “meet or exceed their projected annualized reductions in federal Medicaid spending,” according to researchers.
• States expected to receive the largest Medicaid funding cuts — averaging $4.1 billion per year — are anticipated to receive $155 million in rural health fund grants annually.

→ But it’s not all bad: Researchers have identified that states with more older adults and children living in rural areas will receive more estimated funding from the program than states with the fewest number of these populations — roughly $160 million versus $138 million, respectively.

A reminder about CMS’s rubric for getting additional funds: Back in September, I wrote in Health Brief about how CMS planned to weight responses from states applying for some of the extra $25 billion — including whether they had implemented some of the administration’s policy priorities.

ICYMI: Rebecca Adams, WP Intelligence’s lead health care analyst, wrote a report last month about how money from the fund may not be the boon to rural hospitals that lawmakers originally intended.

	Document Drop

Texas sued medical records company Epic — which developed the MyChart patient portal used by many providers — alleging anticompetitive practices.

	What We’re Reading

“Robot smaller than grain of salt can ‘sense, think and act’,” writes The Washington Post’s Mark Johnson.

“New study questions what we know about who should get mammograms and when,” Akilah Johnson and Ariana Eunjung Cha write in The Washington Post.

“FDA staff fear Tracy Beth Høeg will bring bias and instability to embattled drug center,” Lizzy Lawrence writes at STAT.

“Hawleys launch dark money group to revive anti-abortion politics,” Stef W. Kight reports at Axios.

“FDA intends to put its most serious warning on Covid vaccines, sources say,” report CNN’s Ben Tinker, Brenda Goodman and Meg Tirrell.