Policy Studies Harm Reduction

Better Policy Is Needed to Improve Access to Medical Cannabis

Stacey McKenna
Resident Senior Fellow, Integrated Harm Reduction

Key Points

Restrictions on medical cannabis purchase and possession force many patients to choose between effectively treating their health condition and breaking the law, despite the drug being legal for medicinal use in their state.

A range of policies––including local bans on delivery as well as excessively bureaucratic and expensive hurdles for medical cannabis businesses––may reduce patients’ geographic access to dispensaries, choice of dispensaries and the range of products available in dispensaries.

Unlike pharmaceutical medications, medical cannabis is not covered by insurance, resulting in out-of-pocket costs that are prohibitively high for many people. This cost is further exacerbated by retail regulatory requirements, purchase and possession limits, and––in some states––excessive taxation.


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It is critical that cannabis be descheduled at the federal level and that policy changes be implemented at the state level to improve access and choice for patients who require medical cannabis to maintain their quality of life.

Executive summary

After decades of strict prohibition that ignored cannabis’ long therapeutic history, efforts to legalize the plant have been gaining considerable traction in the United States. Although cannabis remains illegal at the federal level, as of December 2022, roughly three-quarters of states have operational, legal markets for medical use. This study draws on interviews with patients who use medical cannabis in four states: California, Colorado, Florida and Virginia. We focused on patients from these states to elucidate how different states’ policy environments and the persistent conflict with federal prohibition affect patients’ access to medical cannabis in distinct ways.

Study participants reported the following barriers to access: restrictions on purchase and consumption; limited choice of dispensaries and products; and cost. All of these factors were affected to some degree by policies, although the connection between policy and access was often indirect or unintentional. For example, expensive licensing fees for medical dispensaries may both driveup the cost of medical cannabis and make it much harder for businesses to operate in the medical market than in emerging recreational adult use markets, potentially reducing the variety of medically oriented products available.

To combat these issues, which stem from overregulation, overtaxation and federal prohibition, we propose the implementation of smart medical cannabis policies that promote a safe, competitive market and facilitate patient choice. We recommend limited taxation; federal descheduling; the approval or protection of delivery and other innovative retail mechanisms; the elimination of too-low caps on purchase and possession; and licensing protections for health care providers who recommend medical cannabis in alignment with state law.

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