Of the 39 medical cannabis states, 24 also allow adults who are 21 and older to use cannabis. As the below data shows, many — but not all — of those states have seen a substantial decrease in enrollment in medical cannabis programs post-legalization. This is likely because many patients prefer not to be on a government registry and to pay for a doctor’s certification when they have the option of using cannabis as an over-the-counter medicine.
While the number of patients enrolled in medical cannabis programs has declined in most legalization states, it has increased or held steady in two states. And in most mid-sized states with both medical cannabis and legalization laws, there are still tens of thousands of patients enrolled in medical cannabis programs. Some of the reasons patients remain in programs include:
Medical cannabis is typically exempt from the excise taxes charged on adult-use cannabis, as it should be
Some states have added legal protections for medical cannabis patients, such as against workplace discrimination
Medical cannabis programs sometimes allow greater amounts of cannabis and/or higher potency cannabis products
It is important that adult-use cannabis laws be crafted in a way that recognizes these realities. Adult-use legalization states should allow medical businesses to convert to also serve adult-use consumers (many of whom will actually be the same patients) as long as they pay a fee and prioritize patients. They should also exempt medical cannabis from excise fees, which are inappropriate for a doctor-certified medicine, and ensure patients can access and use the products that work best for them.
State
Adult-Use Sales Began
Patients Shortly Before Legal Sales Began
Most Recent Patient Count
Change In Patients Since Adult-Use Sales Began
Arizona
Jan. 2021
295,295
88,598
70% decrease
Colorado
Jan. 2014
110,979
62,320
44% decrease
Connecticut
Jan. 2023
48,896
35,205
28% decrease
Illinois
Jan. 2020
54,479 patients made purchases. There were also 1,955 registered Opioid Alternative Pilot Program (OAPP) patients.
56,127 patients made purchases. There were also 98 registered Opioid Alternative Pilot Program (OAPP) patients.
3% increase
Maryland
July 2023
162,401
102,477
37% decrease
Massachusetts
Nov. 2018
48,265
91,758
90% increase
Michigan
Dec. 2019
271,332
79,022
71% decrease
Missouri
Feb. 2023
202,314
120,510
40% decrease
Montana
Jan. 2022
40,291
13,987
65% decrease
Nevada
July 2017
26,519
10,634
60% decrease
New Jersey
April 2022
126,454
66,678
47% decrease
New Mexico
April 2022
133,113
78,682
41% decrease
New York
Dec. 2022
124,000
97,922
21% decrease
Ohio
Aug. 2024
174,591
122,493
30% decrease
Oregon
Oct. 2015
72,715
13,625
81% decrease
Rhode Island
Dec. 2022
16,552
7,842
53% decrease
Vermont
Oct. 2022
4,302
2,707
37% decrease
Note: This chart omits six adult-use legalization states. Alaska does not have medical cannabis sales — the state’s medical cannabis law only allows possession and home cultivation. California, Maine, and Washington do not have mandatory patient registries, so we cannot track changes. In the final two states, Delaware and Minnesota, adult-use sales have not begun as of this writing — in February 2025.
