It’s almost spring break here at Stanford, and in that vein, I thought I’d talk about a topic that is likely to be on at least a few spring breakers’ minds: marijuana.* Last week, a bipartisan trio – Senators Booker, Gillibrand, and Paul – proposed the Compassionate Access, Research Expansion, and Respect States (CARERS) Act, which has been described as the “first ever” Senate bill to “legalize” medical marijuana.

Although in recent years there have been numerous state efforts aimed at legalizing medical marijuana, federal action is needed to truly legalize it. This is because federal law trumps conflicting state law. And the federal Controlled Substances Act (CSA) prohibits the possession, cultivation, and distribution of marijuana, including for medicinal purposes, and classifies marijuana as a “Schedule I” drug—a drug with no currently acceptable medical use and a high potential for abuse.

The CARERS Act would change this approach to regulating marijuana. To accomplish its purpose of “extend[ing] the principle of federalism to State drug policy, provid[ing] access to medical marijuana, and enable[ing] research into the medicinal properties of marijuana,” the CARERS Act, among other things, would: (1) amend the CSA to make clear that it does not apply to individuals producing, possessing, or dispensing medical marijuana in compliance with state law, and; (2) re-classify marijuana as a less-restricted Schedule II drug, and make other changes to facilitate medical research with marijuana.

So far so good, if you’re a believer in medical marijuana. But the CARERS Act doesn’t address another elephant, or 800-pound gorilla, or some other example of a large, imposing creature, in the room: FDA.

Under the Federal Food, Drug, and Cosmetic Act, a substance generally cannot be marketed as a treatment for a disease or condition until FDA determines that it is safe and effective for its intended use. There are some limits to FDA’s jurisdiction that may provide loopholes for medical marijuana, at least in some circumstances. For example, for FDA to have jurisdiction, a drug – or its components – must move in interstate commerce at some point. This means that if a marijuana product was wholly produced and used intrastate, it might escape FDA’s oversight. That said, for many marijuana products – for example, edibles – there will at least be components of the product that have traveled across state lines.

In short, what this means – as High Times noted, but many mainstream media outlets, such as Slate and the Washington Post, neglected to – is that, even if the CARERS Act were to become law, medical marijuana may not be legal under federal law unless it is approved by FDA.

From a public health perspective, I don’t see that as a bad thing. There doesn’t seem to me to be any reason to treat medical marijuana differently than we treat any other drug marketed as a therapeutic. In line with this thinking, removing the extra requirements for conducting marijuana clinical trials that don’t exist for other drug trials seems like a good idea. But just as we want more traditional medicines to actually do what companies purport that they do, we should want marijuana to only be marketed for diseases and conditions for which there is strong evidence that it is safe and effective. From quack cancer cures before the modern FDA era to bogus dietary supplements today, history does not give me much confidence that an unregulated medical marijuana industry would so limit itself.

*Admittedly, it’s probably not medical marijuana that spring breakers have on their minds…