? While federal legalization of cannabis remains politically uncertain and unlikely to advance in the House in the near term, clinicians should remain aware that cannabis use is already legal in most states and increasingly normalized in patient populations. The disconnect between federal Schedule I status and state-level legalization creates a complex clinical landscape where providers must navigate conflicting legal frameworks, limited clinical evidence, and patients’ own varying assumptions about safety and legality. This regulatory gridlock also impedes research progress, making it difficult for clinicians to access high-quality evidence on efficacy, optimal dosing, and long-term safety for specific conditions. Regardless of federal policy trajectory, providers should proactively assess cannabis use in patient histories, understand their state’s legal framework and medical marijuana programs, and counsel patients using an evidence-based approach that acknowledges both potential symptom relief in select conditions and documented risks—particularly for adolescent brain development, driving safety, and cannabis use disorder—while docum