The introduction of legal medical marijuana paved the way for broader decriminalization. Researchers believe the growing number of states that allow recreational weed simply wouldn’t exist if medical marijuana hadn’t happened as a first step. But in some areas, the legalization of recreational marijuana has crippled the medical marijuana industry, leaving those with debilitating medical conditions who rely on cannabis to get by in a frenzy as they search for affordable and easily accessible goods. 

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Benefits of Medical Marijuana Access

Being a medical marijuana patient isn’t just about gaining access to legal cannabis. It also grants certain rights, ensuring that your status as a medical marijuana patient and therefore a marijuana user can’t be held against you. Depending on the state, this may mean that you can’t be fired or discriminated against at work if you take a drug test that comes back positive for THC; you can’t have your marijuana use factored in during custody battles; or you can’t be discriminated against in access to fair housing. Further, recreational marijuana is only available to adults over the age of 21; medical cannabis can be given to children in many states, with the permission of their parent or guardian. 

Registration Numbers

It turns out, legalizing recreational marijuana leads to a mass exodus of medical marijuana patients. The Associated Press analyzed data that shows legalization for adult-use leads to a drop in medically registered patients by over half in just a few years. In Oregon, only a third of medical marijuana patients remained after recreational legalization.   There are a few theories for why this may be happening. One big one is that not everyone likes being on a government list that exposes them as pot smokers. Another is that not everyone who had a medical marijuana card had a legitimate ailment that they needed to treat medically. The Director of Government Affairs for Americans for Safe Access, Abbey Roudebush, says people simply don’t like to pay the registration fees and doctors’ bills for medical marijuana recommendations that aren’t covered by insurance just to get access to a medical marijuana program. The price of the cannabis is also an out-of-pocket expense.  “One thing we have found is that in the majority of states with medical cannabis programs, their programs have actually continued to grow year after year. But the states where we see a decline in patient enrollment are those states where recreational cannabis was legalized. It could be because of these high fees associated with being in the medical program,” explained Roudebush.

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Prices and Access

When voters choose to legalize recreational marijuana, states often rely on already-existing medical marijuana setups to ease the transition. Many states’ regulatory laws stipulate those already in the medical marijuana business are the only ones allowed to apply for recreational licenses in the first phase of new adult-use programs.  But broad legalization of marijuana has also led medical cannabis prices to skyrocket in some areas. In California, the cost of medical weed nearly tripled after the product became accessible to the masses.  Each year, Americans for Safe Access reviews all 50 states and U.S. territories and grades their medical marijuana programs. They combine those results with a survey in a State of the States report. The 2021 report isn’t being released until next week, but Roudebush says it shows affordability is the primary concern for medical marijuana patients.

Medical Marijuana lying on top of a credit card with a perscription bottle in the background Source: Shutterstock
Access becomes more difficult, too. Medical marijuana dispensaries start shifting their focus to also accommodate recreational sales, and patients often suffer as a result. The perfect example of that trend played out in Oregon, where there were once 400 dispensaries for medical marijuana; now, there are just two retail shops that cater to medical patients exclusively.  “Patients don’t always know when they go to dispensaries if they can get the same product that they have been using, so there’s a consistency problem there as well,” explained Roudebush. “With all of these new products and changing products, sometimes they may find something in a medical dispensary that works for them and they use for a while, and then all of the sudden they show up and it’s not available anymore. Then, they have to find something else that works just as well and there’s a little bit of trial and error there. Not having those consistent products harms patients.” 


Some states have struggled to increase their production and churn out enough weed to account for both the medical marijuana users and the influx of new recreational buyers.  Another problem is that people’s interests have shifted. There are fewer and fewer people looking to buy smokable marijuana flower, and instead the market is now focused on things like edibles and tinctures. Those are often more potent, and of course don’t do damage to your lungs, making them a crowd favorite among those with medical cards. Now that the market is flooded with new recreational users, those products are flying off the shelves. Since they’re more expensive to produce and more time-consuming to make, prices of those products have been skyrocketing as a result, and medical patients say they’re the ones suffering because of it. 

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Where Weed is Legal

In some cases, issues can arise when one state has legal recreational marijuana and a neighboring one has only a medical program or no legal cannabis at all. That may encourage people who’d like to use marijuana for a medical condition to drive across state lines to get the product if it’s more easily accessible or more affordable in a nearby state. However, it’s illegal to cross state lines with marijuana, as Wikileaf explained in our exploration of how legal marijuana impacts neighboring states. Roudebush says that issue can put medical marijuana patients in a bind.

Oregon welcomes you, state sign near by the road Source: Shutterstock
“Everyone who’s ever been on any kind of medication understands that your need for that medication doesn’t stop when you cross state lines, so people who are using cannabis as a treatment option are often left with the impossible choice of, ‘If I have to travel, do I forgo my treatment, or do I risk prosecution?’” 

Moving Forward

Americans for Safe Access has a number of goals they’d like to see moving forward, both for how medical marijuana programs can be improved upon and how they can work better with recreational programs.  Of course, pricing and access are big parts of the agency’s focus. Roudebush says Americans for Safe Access would like to see the registration fee for medical marijuana patients removed. She’d also like to make sure there are failsafe options like recalls to make sure the quality of the product is kept top-notch. “States need to be aware that the recreational market and the medical cannabis market are distinct,” said Roudebush. “They can both exist, they both should exist, but they’re not the same program, they don’t include the same rules or the same rights.” Roudebush says some states are moving toward letting medical cannabis programs die out as they focus more on recreational marijuana. Others, like Alaska, she says, have purposely combined the programs. Blurring those lines means you aren’t thinking about how to help patients. Roudebush says she would urge policymakers not to lose sight of the fact that medical marijuana programs have real patients with real conditions who have cannabis as a treatment option and need to maintain that.