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. As regulators implemented Initiative 502 (i502) framework for adult-use cannabis sales in Washington state, patients and medical dispensaries were slowly dismembered to make room for the recreational market.
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Over a decade later, the developed industry has isolated both former medical patients and those curious about trying cannabis for their symptoms. The process of getting a medical card is expensive and labor intensive, and even after it’s acquired, few budtenders are informed about the tax breaks. Now, the amount of cannabis patients in the state is cut in half, and other states seem to be making the same mistakes.
Patients are being left behind
Getting a medical card in Washington is a multi-step process. First, patients must seek out a doctor willing to write a recommendation for weed, which can take online research and multiple calls. The doctor provides the rec, then potential patients have to find a Medically Endorsed Approved store while a Medical Marijuana Consultant is working.
Once acquired, many patients feel their needs aren’t met by many budtenders, and they must educate many on their right to no sales tax. These barriers, from time to cost, may be driving the continued medical patient decrease.
The Washington Department of Health (DOH) data displays the number of people who apply for medical cannabis certifications each year. Cards expire yearly, but after a peak of over 20,000 cards in 2017, just shy of 12,000 patients registered cards by 2023. This year, only 2,400 people have applied for their medical marijuana cards. This doesn’t mean fewer people are medical patients, just that fewer are claiming their rights.
Following the release of patient numbers in New Jersey, it seems the new recreational state is on the same path. Patient counts have slowly decreased in New Jersey since the first adult-use stores opened their doors. Numbers peaked in May 2022 with more than 129,000 patients, but it has decreased rapidly since, with only about 78,000 patients in May 2024.
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Lawmaker fixes lead the way
The state of New Jersey has created incentives for patients to continue using the program, lowering card fees from $200 to $10. Unfortunately, this doesn’t lower the high cost of an often non-insured doctor’s visit. The effort is made in good faith—but may not be enough.
After a decade, Washington is also considering incentives for patient involvement. State Representative Sharon Wylie saw HB 1453 to the governor’s desk that removed the full 37 percent excise tax for medical patients. This legislation goes into effect June 6th, and by 2025 it should be clear if the move was good incentive to draw patients back to the program.
Unfortunately, the barrier to entry only addresses one portion of the issues of being a medical patient in a recreational world.
Being a cannabis patient in a recreational world
For many, buying cannabis from the legal market and paying the sales tax is better than the headache of getting a medical card. Patients have to shop in the same market anyway, posing problems.
The retail space has 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.
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Additionally, many patients seek specialty tinctures or extracts that may require a knowledgeable staff member. While many budtenders are highly educated on weed, not everyone is, and patients don’t have a specified space to turn to for the type of service they require.
Even if patients go through the process of getting a medical card, it’s probable the challenges are only just beginning. However, there is a way forward if patient advocates speak up to lawmakers.
Moving forward together
The Washington and New Jersey experiences are singular, but bits of each echo in other states. 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.
Patient rights vary by state, but lawmakers should consider patients during the legalization process. Legislators in other states could learn from how things shook out for medical patients in Washington following recreational legalization, but if New Jersey is any indicator–they aren’t.
Despite efforts, the current system forces medical patients to be their doctors, pharmacists, and advocates. Medical cannabis programs are slowly being forgotten.
