Does Legalizing Adult Use Put the Kibosh on Medical Cannabis?


Medical cannabis is now mainstream in the U.S. More than three-dozen states and the District of Columbia have seen to that. In addition, just under two-dozen states have chosen to decriminalize adult use. But that leaves me wondering about something: does legalizing adult use put the kibosh on medical cannabis?

Common sense would seem to indicate that it does. But common sense is one thing in short supply when it comes to the ongoing debate over cannabis and its legal status. What we need is scientific data. We have it, or at least a little bit of it, by way of a study published in the Annals of Internal Medicine in April 2024.

The study shows two trends, neither of which are surprising to me. First, overall enrollment in state medical cannabis programs rose substantially between 2020 and 2022. However, in states with legal adult use, enrollment declined.

More About the Study

The study was conducted by researchers at the University of Michigan Medical School. It looked at data from 39 jurisdictions (38 states and DC), some of which reported patient numbers, qualifying conditions, and participating clinicians. Here is what they found:

  • Overall enrollment increased 33.3%.
  • Population prevalence increased by 23%.
  • Enrollment decreased in most adult used jurisdictions.

The total number of medical cannabis enrollees increased from 3.09 million in 2020 to 4.1 million in 2022. Remember that these numbers account only for patients who use medical cannabis under the authority of a state-issued medical cannabis card. There are no hard numbers on users who consumed medical cannabis they purchased illicitly.

To me, the big takeaway here is that 13 out of 15 jurisdictions with legalized adult use reported decreased medical cannabis enrollment during the study period. It makes perfect sense to me.

Not Worth the Hassle

Utah is one of the medical-only states. Regulators there have created a tightly controlled program that includes a list of qualifying conditions along with strict licensing requirements for growers, processors, and distributors.

Distributors are essentially licensed medical cannabis pharmacies. The operators of one such pharmacy, Cedar City’s Zion Medicinal, say that there are only 15 pharmacies serving the entire state. Utah’s medical cannabis program is nothing like the wild west scenario that exists in some other states.

Utah patients are happy to take advantage of their state’s medical cannabis program because they have no other options. But if the Beehive State were to ever approve adult use, what would be the incentive to continue going through the hassle of seeing a medical provider, obtaining or renewing a medical cannabis card, and driving some distance to find a pharmacy?

Opening the door to adult use also opens the door to a lot more cannabis retail. You end up with abundant dispensaries legally allowed to sell to anyone of adult age – no card or medical recommendation required. The net effect for patients is access to cannabis with little to no hassle.

Maintaining a Higher Quality

The logic behind maintaining separate medical and adult use programs is to control quality. In theory, regulators want medical users to have access to higher quality products. But theory and practice tend to be far different. When faced with convenience and price concerns, medical cannabis patients are like anyone else: they prefer easy access and cheap products.

We now have at least some evidence suggesting that legalizing adult use harms the medical market. Is the harm enough to completely shut down medical cannabis? No, at least not yet. But everything could change if Washington legalizes cannabis across the board.

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