Medical Cannabis Program Sustainability in the Era of Recreational Cannabis.

Since October 2022, a total of 21 states have enacted both medical-use and adult-use cannabis legalization, each with their own unique set of laws, regulations, implementation, structures, and enforcement ("policies"). Unlike adult-use programs, medical-use programs often represent a safer and affordable option for patients with diverse needs; however, current evidence suggests that medical-use program activity decreases after implementation of adult-use retail. The current study compares medical patient registration data and medical- and adult-use retail data from 3 distinct medical- and adult-use states (Colorado, Massachusetts, and Oregon) in the time after adult-use retail implementation in each state. To investigate changes in medical cannabis programs with simultaneous adult-use legalization, correlation and linear regression analyses were used to assess outcome measures: (1) medical-use retail sales; (2) adult-use retail sales; and (3) number of registered medical patients in all fiscal quarters after adult-use retail sales were implemented in each state to September 2022. Adult-use cannabis sales increased significantly over time in all 3 states. However, both medical-use sales and number of medical patients registered in the states increased only in Massachusetts. Results indicate that states' preexisting medical-use programs may undergo critical changes after adult-use cannabis legalization is enacted and implemented. Key policy and program differences, such as regulatory differences in the implementation of adult-use retail sales, may have differential impacts on medical-use programs. For continued patient access, it is critical that future research assess the differences within and between states' medical-use and adult-use programs that permit sustainability of medical-use programs alongside adult-use legalization and implementation.

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Copyright © 2023. Published by Elsevier Inc.

Déclaration de conflit d'intérêts

Declaration of Interest None declared. Three authors work for the Cannabis Control Commission, Commonwealth of Massachusetts, the regulatory agency for cannabis laws in the Massachusetts Commonwealth as staff (Mr Colby, H. Pensky, and J.K. Johnson). One author works for the Program Design and Evaluation Services of Multnomah County of the Oregon Public Health Division (J.A. Dilley).