How adult-use laws affect medical cannabis access

Medical cannabis patients: Photo of couple dosing out CBD oil.

For many people, cannabis access is better than ever. But to some medical cannabis patients navigating states with adult-use regulations, safe access can feel slim.

When I started budtending in Washington state, adult-use had been legal for five years after a tenuous adoption of voter-approved Initiative 502 (i502). As regulators implemented the framework for adult-use cannabis sales, patients and medical dispensaries were slowly dismembered to make room for the recreational market. Over a decade later, the way the industry has developed isolates new consumers curious about the medical applications of the plant.

Patients are being left behind

As an outsider stepping into Washington’s recreational retail space in 2017, there was a reverence for the somewhat defunct medical program that made way for i-502. There was also an ignorance of the medical cannabis rights that still exist. Patients who visited the counter no longer went through the state to register their prescriptions despite the fact that registered patients don’t have to pay the 37% tax on i-502 products.

Medical cannabis patients must also navigate a retail space with very little shelf continuity; it’s common to get accustomed to medicating with one product only to be unable to find it on dispensary shelves for the months following. For someone using cannabis therapeutically, this forces patients to find a similar product (which can be difficult) and then re-negotiate how to dose the candy, drink, oil, vape, concentrate, or flower. This system forces medical patients to be their own doctor, pharmacist, and advocate.

They have been forgotten.

Implementing i-502 and patient protection efforts

Washington medical patients cited ineffective DUI provisions in a strong push against i-502. In addition, the Initiative didn’t grant rights to grow the plant–a recreational home grow ban is still in place today. Before i-502 voting day in 2012, NORML released a response to “Patients Against i-502” recognizing the issue with the Initiative but urging voters to legalize adult-use on November 6th.

The Initiative passed, but what came next for medical dispensaries wasn’t compassionate. The license fees and cost to renovate medical dispensary spaces up to new codes caused most medical shops to cease operations, according to sources in my network.

After voters ushered adult-use in, Washington lawmakers built a framework of commerce and regulation. In 2015 Washington lawmakers passed Cannabis Patient Protection Act (SB 5052) which set patient protections, and Marijuana Taxation Reform (HB 2136) to build out taxation and financial parameters.

SB5052 regulates the medical use of cannabis for patients 18 and up, and sets “consistent testing, labeling, and product standards.” The Department of Health (DOH) set up a reporting mechanism, created authorization forms, and wrote rules pertaining to product compliance and medical cannabis consultant certification.

The DOH put Medical cannabis consultants in place to guide patients through adult-use stores and products–but by 2017, it was impossible to find a store with a medical consultant. If there was a medical consultant on staff, it wasn’t advertised online or to guests upon entry. And that’s still the case today.

My experience is in Washington, but medical programs in other states faced a similar fate. In Oregon, stores reserve some high-dose products for patients, but most products are regulated for the adult-use market. In Illinois, the bill to legalize recreational use preserved the medical program–requiring cultivators to reserve sufficient products for medical patients.

The preservation of patient rights varies by state, but they should consider medical cannabis in the process of legalizing adult use. Legislators in other states could learn from the way things shook out for medical patients in Washington following recreational legalization.

As the state adopted adult-use laws and familiar medical dispensary owners got priced out of adult-use licenses, patients were forced to adapt to the recreational retail market. In that process, medical products shifted into sugar-filled drinks, and medical cannabis patients stopped getting prescriptions as it didn’t seem the medical market existed anymore. This led to ignorance regarding patient rights and created a market that caters solely to the recreational user–isolating patients and the cannabis curious alike.

Cara Wietstock is Senior Content Producer of and has been working in the cannabis space since 2011. She has covered the cannabis business beat for Ganjapreneur and The Spokesman Review. You can find her living in Bellingham, Washington with her husband, son, and a small zoo of pets.