From prohibition to conditional demedicalization: a clinician-informed policy pathway for cannabis use disorder in Iran.

Sayyah M.; Namazi H. · Health policy OPEN · 2026

**Background & Methods** This is a policy commentary and review drawing on the first qualitative study of Iranian psychiatrists' views regarding cannabis use disorder (CUD) management in a full criminalization context. The authors translate clinical perspectives into a testable policy hypothesis for Iranian health authorities, proposing a phased pilot model of "conditional demedicalization" for mild-to-moderate CUD in Iran, where no pharmacotherapy is currently approved and the treatment system is fragmented. **Key Findings** - The proposed conditional demedicalization model comprises five key elements: (1) reframing mild-to-moderate CUD as a psychosocial rather than biomedical problem while preserving medical pathways for severe and comorbid presentations; (2) incrementally substituting therapeutic-supportive referral for criminal sanctions, informed by the Portuguese dissuasion experience; (3) redirecting resources from pharmacological management toward evidence-based psychosocial interventions; (4) implementing evidence-based prevention programs for adolescents as a precondition of reclassification; and (5) establishing intersectoral governance with explicit monitoring indicators and pre-registered stopping rules. - The authors argue that conditional demedicalization represents a harm-reduction strategy specifically designed for prohibition contexts, intended to lower barriers to help-seeking while maintaining safeguards against premature normalization and monitoring for potential harms through pre-registered stopping rules. - The approach addresses the current Iranian context of rising cannabis use among young people, full criminalization, treatment system fragmentation, and absence of approved pharmacotherapies for CUD. **Dosage & Administration** Not reported. **Safety & Adverse Effects** Not reported. The model includes explicit monitoring indicators and pre-registered stopping rules designed to allow the reform to be paused if harms emerge. **Evidence Quality** This is a policy commentary with moderate evidence quality. Limitations include: (1) reliance on a single qualitative study of Iranian psychiatrists' perspectives rather than empirical outcome data; (2) lack of pilot study results; (3) hypothetical nature of the proposed model; (4) adaptation of the Portuguese model to a different cultural and legal context requires validation; and (5) absence of direct comparison groups or randomized evidence. The authors acknowledge this as a "testable policy hypothesis" requiring pilot data, limiting current generalizability. The framework is clinician-informed but requires prospective implementation and evaluation.

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