WASHINGTON — Americans for Safe Access (ASA), joined by scientists, clinicians, educators, patient advocates, and health organizations, on August 12 released an open letter and practical guidance urging the U.S. Department of Health and Human Services (HHS) and medical schools to include the endocannabinoid system (ECS) in the United States’ expanding medical nutrition education initiative.
According to HHS, diet-related chronic diseases are responsible for nearly 60 percent of U.S. deaths, and an estimated one million Americans die from them each year. HHS has identified limited nutrition education among medical professionals as a gap in the nation’s capacity to address chronic disease.
On March 5, 2026, HHS and the U.S. Department of Education launched Advancing Nutrition Education Across the Medical Continuum. HHS cited research finding that 75 percent of U.S. medical schools had no required clinical nutrition coursework and only 14 percent of residency programs required nutrition training. The initiative now includes 76 committed institutions across 36 states, reaching more than 52,000 medical students, with participating schools expanding nutrition education beginning this fall.
The ad-hoc coalition argues that stronger nutrition education should also include the physiological systems through which diet influences chronic disease. The ECS is an endogenous lipid-signaling and homeostatic system involved in fatty-acid metabolism, appetite and energy regulation, inflammation, gut signaling, stress adaptation, metabolic control, immune function, and pain. The guidance identifies the ECS as an important part of the physiological relationship among nutrition, metabolism, and chronic disease.
“HHS is strengthening nutrition education because chronic disease is taking an enormous toll on patients and the healthcare system,” said Steph Sherer, founder and president of Americans for Safe Access. “If future clinicians are going to understand how nutrition affects chronic disease, they also need the physiological foundation that helps explain that relationship. We are not asking schools to create a cannabis course. We are asking them to teach the physiology.”
The Centers for Disease Control and Prevention reported three in four U.S. adults have at least one chronic condition, and more than half have two or more. For people managing multiple conditions, polypharmacy can increase risks of adverse drug events, drug interactions, falls, and hospitalization. Adults aged 65 and older make more than 600,000 emergency-department visits each year because of adverse drug events.
“Teaching the endocannabinoid system in medical training will help future physicians better understand a key regulator of human physiology and communicate more clearly with the millions of Americans who use cannabis in one form or another,” said letter signatory Stephen Dahmer, MD, director at the University of Arizona Andrew Weil Center for Integrative Medicine. “That knowledge is empowering, practical, and essential to truly informed care.”
The guidance shows how ECS concepts can be incorporated into existing nutrition, physiology, metabolism, and chronic-disease coursework without creating a standalone ECS or cannabis course. It maps suggested content into HHS’s 10-domain competency framework and provides teaching examples based on publicly available course structures from Johns Hopkins, Stanford, Penn, Yale, and the University of California, Berkeley. The examples are not official university curricula or endorsements.
“Integrating the ECS into HHS’s Advancing Nutrition Education initiative is a practical step toward aligning medical education more closely with current science and patient needs,” the coalition wrote in its sign-on letter. “We offer this guidance document not only as a recommendation, but as an open invitation to work together to ensure that medical education reflects current science and better prepares clinicians and health care staff to meet patient needs.”
According to Codi Peterson, PharmD, associate clinical professor at UC Irvine and co-founder of Pharmacists’ Cannabis Coalition of California, “The endocannabinoid system may be an important missing link in how we teach the relationship between nutrition and health. Giving clinicians a stronger foundation in ECS science can improve their understanding of how diet, physiology, and disease intersect.”
The letter asks HHS and medical educators to:
- Include core ECS concepts in HHS’s voluntary Medical Education Nutrition Competency Framework.
- Integrate ECS science into existing nutrition, physiology, metabolism, and chronic-disease instruction where it is directly relevant.
- Work with ECS scientists, clinicians, educators, curriculum leaders, and patient experts to develop accurate, evidence-informed teaching materials and implementation strategies.
ASA and participating experts are offering to work with HHS, medical, nursing, and pharmacy schools, curriculum leaders, accrediting organizations, and other health-professions education institutions to identify appropriate competencies, refine course content, recommend literature, and support implementation.
“Whether you are training elite athletes or preparing Marines for combat, stress physiology and nutrition are inseparable,” said Steve Philpott, Jr., co-founder and CEO of Anzisha Consulting. “The endocannabinoid system is the thread that ties them together, and it has been missing from medical and general biological science education for far too long.”
