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Improvement Needed


In its annual “State of the States” report, Americans for Safe Access (ASA) gave 13 state medical cannabis programs failing grades.

In the report, the ASA gave failing grades to Georgia, Idaho, Indiana, Kansas, Kentucky, Mississippi, Nebraska, North Carolina, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. Idaho and Nebraska, the last two states without medical cannabis access, both got a zero.

No state earned an A, but Connecticut, Illinois, Maryland, Michigan, and Rhode Island got the highest grade on the ASA report card, a B+.

Massachusetts earned a C+. According to the report, “medical cannabis sales in Massachusetts have reached almost $1 billion since the medical cannabis program was approved in 2018. Despite this promising sales number, Massachusetts did not make any noticeable improvements to the medical cannabis program in the past year.

“In 2023, ASA recommends that legislators in the state expand protections provided under the law for patients. As it stands, employment protections only exist through case law and should be formalized by the state Legislature. The Legislature should also seek to protect patients rights within housing, education, and family court as well.”

The ASA did commend Massachusetts for not requiring a fee with patient registrations and encourages policymakers to extend patient registrations to cover multi-year periods in order to cut down on administrative paperwork for patients.

According to patient feedback gathered for the Massachusetts report, “patients surveyed expressed concern regarding inflated pricing, a concentration on potential harm rather than potential benefits, and that the adult use/recreational market is undermining the medical market. They also reported a lack of pediatric access.”

While states continue to slowly adapt their laws to meet the needs of patients, the ASA noted, “we have noticed a big shift in states prioritizing adult use. Recreational adult-use programs and medical cannabis programs are not the same and should not be treated as such. A state may have both recreational, adult-use laws and medical cannabis laws, but those programs must remain separate in order to serve the distinct needs of the population. Cannabis patients rely on medical cannabis products for their health and well-being and should be treated as patients by the state — not as recreational consumers.”

This includes protections that may not exist in the recreational market, the report explained, such as excise and sales tax breaks on medical cannabis products, continued access to medical cannabis for minor patients, civil-rights protections for employment, housing, parental rights, and even alternative accessibility methods.

“Medical cannabis programs are essential to patient health and well-being and should be maintained and improved upon regardless of the legality of recreational adult use in the state,” the ASA argued. “While adult-use models can expand access to a larger population of people and may even increase the number of legal cannabis retailers, these systems and associated businesses are often not held to the same standards as authorized medical cannabis businesses.

“For example, laboratory testing of adult-use products may not have to undergo screening for the full array of heavy metals and contaminants that medical products require. It is also uncommon that states ask adult-use retailers to maintain staff competent about medical cannabis products or their applications to ensure patients have a trained advisor to consult with when they purchase medicine. It is critical to patient health that states maintain focus on addressing medical cannabis program challenges and patient needs before, during, and after developing adult-use programs.”

The ASA also gave grades to the medical cannabis programs of U.S. territories, such as the Commonwealth of the Northern Mariana Islands (D+), Guam (C-), Puerto Rico (D), and the Virgin Islands (D+).

According to a report by Ganjapreneur, “even in states with full medical cannabis programs, each state differs greatly in how patients can access their medicine, where they can access it, or even what types of products they can access.” Because medical cannabis remains prohibited federally, it added, “most state programs leave out millions of potential patients due to issues with affordability, patient rights, and civil protections, or product-safety standardization.”

The ASA gave no state a grade higher than a B+ because none of them “include the entire range of protections and rights that should be afforded to patients under the law, with some lagging far behind others.”

The ASA believes there are more than 6 million medical cannabis users in the U.S., which is about 1 million more than in its report from 2021.