In its latest State of the States Report, ASA said that Arizona's passing grade is largely because of its emphasis on recreational adult-use cannabis diverting resources away from the medical cannabis program.
“As the state rolls out its adult-use program over the top of the existing medical infrastructure, products for medical patients (high dosage edibles, lotions, suppositories, RSO) have become scarce while products for adult-use consumers have become ubiquitous,” the report stated.
The report highlights many of the issues raised by Arizona patients concerning the performance of the medical cannabis program, including rising costs to consumers and low accessibility, especially for those living in rural areas.
The group scored individual states on how well their cannabis laws and regulations accommodate patient needs based on seven categories, including patient rights, accessibility, program functionality, affordability, and consumer protection.
ASA gave the 55 states and territories assessed a collective average grade of D. Arizona's C- rating places it in the middle of the pack, but in the top half, with 18 state programs better, 32 worse, and four others the same.
The highest score went to Maine, which garnered a B grade for its high program functionality, lab operations, and the ratio of patients to dispensaries. The report cites Maine’s reasonable requirements for caregivers and physicians, and for “allowing telemedicine for certification.”
Idaho and Nebraska both received an F because they are the only two states left in the country that prohibit both medical and adult-use cannabis.
On individual criteria, ASA gave Arizona better-than-average marks for all but one: program administration. The Arizona Department of Health Services, which regulates the state's medical marijuana industry, declined to comment.
Since California became the first state to legalize medical use 25 years ago, 48 states and territories have followed suit. The number of patients has ballooned to 5.1 million, with 276,000 registered patients in Arizona, according to the report.
War on Drug Access: Medical vs. Recreational
Only 80 days after Arizona voted in favor of Proposition 207 in November 2020, recreational retail cannabis became legally available to anyone over the age of 21.
When it comes to bureaucracy, this is Olympic gold medal speed, and credit for that goes to an existing medical cannabis infrastructure. In fact, this launch marks one of the fastest recreational adult-use rollouts from voter approval to sales in any U.S. cannabis market, according to press reports.
Prop 207 called for a transfer of $39 million from the medical cannabis coffers to establish operations for the recreational adult-use side.
Existing medical dispensaries were also authorized to apply for early applicant licensing so they could transform into dual-purpose shops, serving both medical and adult-use consumers at the same location.
“Arizona has fallen into the trap of concentrating on the adult-use market at the expense of the medical cannabis department,” said Abbey Roudebush, Director of Government Affairs at ASA. “This includes the decision to allow dispensaries to act as co-located retailers for both adult-use and medical, negatively impacting access for patients.”
ASA’s survey of Arizona patients found that while the rollout of the adult-use program has given them access to a wider variety of products, “what they need has become more expensive or is frequently sold out.”
The report notes that COVID-19 restrictions have forced patients to wait longer than normal, leading to long lines outside of dispensaries in Arizona’s summer heat.
"I’ll buy a bunch at a time so I don’t have to go back,” Danny Gibbons, an Arizona medical marijuana patient, said. To avoid lines that form toward the end of the workday, he finds time in the early afternoon to visit the dispensary.
In theory, adult-use and medical consumption should be able to live harmoniously under one roof, but prioritizing recreational users over medical patients with medical needs has been an ongoing issue across the nation. As Phoenix New Times reported, state legalization has made cannabis less accessible for medical marijuana patients.
Accessibility for Medical Cannabis
According to Roudebush, states should have one dispensary for no more than every 500 patients.
Arizona has one dispensary for every 2,126 patients.
“Arizona's structure of having [only] two rural licenses is definitely limiting patients' access,” said Demitri Downing, founder of the Marijuana Industry Trade Association in Arizona (MITA AZ). “If I’m a patient in the middle of Tempe, I have four to five choices within a number of miles."
By comparison, smaller cities like Willcox, Benson and Sierra Vista don’t have the same level of accessibility, so individuals must drive hundreds of miles for the nearest retail cannabis operation.
Across the country, the ratio of patients to dispensaries varies widely. States with favorable ratios are Colorado, which has one dispensary for every 187 patients. In Maine, the ratio is 223 to one; in Oregon, it's 50 to one.
States with less than favorable access include New Jersey, which has 5,351 patients for every dispensary; New York, with 3,977; and Missouri, with a whopping 22,740 patients per dispensary.
Advocates at ASA also pointed out that Arizona qualifies patients with just 12 medical conditions to use medicinal cannabis. The organization lists 132 diagnoses suitable for medical pot.
Prices Are Too Damn High
Aside from affecting product accessibility across the nation, the acceleration of the recreational adult-use market is making affordable cannabis a long-lost dream.
“When you see potatoes, cantaloupe, and radishes grown for under $10 a pound, and cannabis is in the hundreds of dollars per pound, something is not right here,” said Downing, who believes the high price of cannabis for patients is one of the biggest challenges facing the industry.
“The price has definitely gone up,” said Cody Allen, who's been a local MMJ patient for five years. He's noticed that the price of an eighth of an ounce of cannabis has gradually increased over time from $40 to $60. To avoid overpaying, Allen finds himself strategizing his retail visits to take advantage of weekly specials.
According to ASA’s report, affordability remains a top concern raised by patients in almost every state. Both Downing and Roudebush are hopeful that prices will begin to fall and product availability will pick up in the medium term. But given the extensive testing and regulation involved in producing cannabis, along with markets ramping up to serve both the medical and recreational adult-use sides, prices will remain high for now, they added.
Policy Recommendations for Arizona
Advocates pointed out that states have work to do before medical marijuana patients can have adequate service, despite the almost nationwide adoption of programs to help them.
On average, the 55 states and territories assessed received a combined grade of 44.38% on ASA’s grading scale.
“While we can acknowledge that we have come a long way since the first medical cannabis law passed in 1996,” the ASA report states, “we must also recognize that none of the state laws adopted thus far can be considered ideal from a patient’s standpoint.”
Roudebush spotlighted some areas Arizona could improve.
“It is surprising that Arizona does not have a medical cannabis advisory group made up of patients and physicians,” said Roudebush, adding that allowing patients and physicians to work together to provide input on program efficacy is an example of a working system.
The report says that action must be taken to allow access for minors who rely on medical cannabis to medicate on school grounds with help from school staff such as a nurse.
Reducing dispensary registration fees is a key factor in reducing prices for consumers. According to the Marijuana Policy Project, an organization dedicated to legalizing cannabis across the U.S., dispensary registration fees are typically between $5,000 and $20,000 per year, and these costs tend to be passed down to the customer in the form of higher-priced products.
“With the influx of revenue from the adult-use market,” said Roudebush, “the state no longer has an excuse to put the financial burden of the market on patients’ shoulders."
Other simple measures that are helping balance the scale of adult-use and medical consumption include implementing medical patient-specific shopping hours, online pickup orders for shorter wait times, and separate lines for medical cannabis users at dispensaries.
Arizona continues to see growth in patient enrollment. It is one of the top five states for the number of registered medical marijuana patients.
“Twenty years ago, there was zero access,” notes Downing, “so being an optimist, my God, things have come a long way.”
