Disclaimer: This opinion editorial (Op-Ed) is provided for informational purposes only and does not constitute legal advice. Readers should consult a qualified attorney for guidance specific to their legal issues or concerns. No attorney-client relationship is established between J.D. Lauritzen, Salt Baked City, and its readers through this article.
Around the time of the last election, a poll was conducted regarding the favorability of adult-use cannabis in Utah. The results of the poll may have come as a shock to some, with 50% of Utah voters supporting the legalization of recreational cannabis. While the polling results are encouraging as opinions towards cannabis in Utah are becoming more and more favorable, the results should hopefully encourage policymakers to make changes to Utah’s medical cannabis program before it goes adult-use. Such changes will likely lead to increased patient counts, which should result in lower prices for patients both at their doctor’s office and at the pharmacy.
The Prevailing Winds of Adult-Use Legalization
Opinions related to the legalization of recreational cannabis in Utah largely cFome down to a person’s age. According to the polling done by Noble Predictive Insights around the election, younger voters (60%) are in favor of an adult-use cannabis program. Those over age 65 are seemingly only supportive of medical cannabis, with only 29% of voters 65+ supporting recreational cannabis. The polling showed that middle-aged Utahns may be more persuadable on the issue, as 49% of those voters support recreational cannabis.
The polling discussed above shows that cannabis is a generational issue, and those generations born further and further away from the days of Reefer Madness and the height of the failed War on Drugs have very different opinions on cannabis legalization. When you look at national statistics, 88% of Americans believe that cannabis should be legal for medical and adult-use purposes according to a poll from Pew Research Center in 2024. As with the statistics in Utah, pro-recreational cannabis sentiments across the country skew more heavily amongst younger voters. For comparison, those 18-29 favor the adult-use legalization overwhelmingly (71%), while those over age 75 overwhelmingly oppose recreational cannabis (31%).
What is clear is that attitudes towards cannabis are shifting. As almost 90% of Americans favor some form of cannabis legalization, it is no longer a question amongst voters as to whether cannabis should be legal. Instead, the question is what type of legalization is most preferable, and how do policymakers shape their preferred type of program in a way that is good for both consumers and industry. These concepts are undoubtedly something that policymakers, especially those in medical-only states like Utah, should be paying keen attention to. Those policy ideas that may have once been seen as likely driving a medical program to adult-use may now be seen as a way to preserve a state’s medical cannabis program. Put somewhat differently, increasing access to medical cannabis in a way that is focused on patient and operator alike is likely the best way to stave off an adult-use cannabis ballot initiative.
Cost Seen as a Top Issue for Patients
In May of 2023, the Utah Department of Health and Human Services (DHHS) sent out a survey to over 14,000 individuals that had once held a medical cannabis card in Utah. The survey asked patients to identify the reasons why they did not renew their medical card, prompting patients to select from one or more reasons why they may not have renewed.
The reasons that patients could choose from were set around cost (both for a medical card and products at a pharmacy), the process to renew a medical cannabis card, product types available at Utah pharmacies, whether the patient no longer needed cannabis or that cannabis was not right for the patient, and possible negative outcomes that cannabis may have had in a patient’s life. Almost 40% of respondents stated that the high cost of seeing a qualified medical provider (QMP) was a reason for why they did not renew. A close second (~35%) said that the cost of products at the pharmacy contributed to their decision not to renew. Other things like being able to source products more cheaply from out of state or a personal source ranked higher among the reasons that patients did not renew.
While cost was top of mind for patients that responded to the survey, things like quality, cannabis causing issues with family or friends, or other medications working better than cannabis ranked extremely low on the list of reasons why patients did not renew. Indeed, only 1.08% of patients reported that the lack of quality factored into their decision not to renew. Likewise, cannabis causing issues with family or friends was cited as a reason not to renew by only 0.71% of patients, while only 0.88% of respondents said that other medications working better than cannabis factored into them not renewing.
More Pharmacies May Mean Lower Prices, but at What Cost
On the heels of the survey by DHHS, the Utah Department of Agriculture and Food (UDAF) conducted its own analysis of the medical cannabis program. In conjunction with the group Cannabis Public Policy Consulting (CPPC), UDAF sought to survey patients and non-patients in relation to the demand for cannabis in Utah. Using three waves of surveys, CPPC collected data regarding total past-month cannabis spending, sources of cannabis and vapes, time proximity to cannabis sources, the frequency of interstate travel for sourcing cannabis, and perceptions of the medical cannabis supply in Utah.
The findings from the analysis show several interesting things about Utah’s cannabis market and conclude that adding more pharmacy licenses may not be necessary to meet current patient demand. Initially, the report concluded that Utah’s robust illicit market, when coupled with the several surrounding adult-use legal markets and the supply of hemp-derived products in the state, are compromising the utilization of Utah’s medical cannabis market. Because Utah’s medical market is a limited participation program and subject to other regulatory and tax costs that are not associated with the illicit and hemp-derived markets, Utah operators find it difficult to capture all of the demand for cannabis in Utah as it is impossible, or almost nearly impossible, to match price with those markets.
Similar to the foregoing, lower cannabis consumption in tandem with competing markets has likely kept prices high for legal medical cannabis in Utah according to the report from CPPC. With patients able to drive over the border to source cheaper products, and Utahns generally consuming much less cannabis than the rest of the nation, retailers have not been able to drop prices as fast as consumers would like (as sustaining sufficient revenue in such a climate is no easy feat).
While the pressures created by other cheaper markets have had an overall impact on price compression, or the lack thereof, in the Utah market, the report from CPPC did show that Utahns are generally satisfied with medical cannabis products in Utah, and that the supply of products is likely adequate. Despite those findings, patients are still mostly focused on the cost of their medicine when making the decision as to where to source their cannabis.
At the end of the report, CPPC states that an increase in the number of retail pharmacies could drive more demand, “but only if this is a mechanism to reduce prices.” With that said, the report does state that without a “dramatic increase” in access to new pharmacies, existing Utah pharmacies can likely never compete with the pricing in the other markets discussed above. Further, due to Utah’s smaller than average medical cannabis market, current operators are “facing highly pressured margins, meaning any increase in supply through new regulated access points must be handled with informed decision-making and seek to strategically fill gaps in access.” Or, in other words, unless new retail locations are strategically placed, then it may have a negative impact on a program that is already facing cross-pricing pressures from three markets capable of selling products to consumers at much lower costs. What is more is that the report does not necessarily support the theory that more retail pharmacies will bring more patients into the program (whether in the form of net new or returning patients).
Legislative Proposals to Help Preserve Utah’s Medical Cannabis Program
From everything discussed above, it is clear that while Utahns favor cannabis legalization in some form, there are still concerns over the costs associated with becoming and staying a patient. It should likely go without saying that more patients in the Utah medical cannabis program will lead to lower costs for patients. Indeed, program data shows that over the last two years, most form factors have seen prices fall by over 20% on a per gram or per milligram basis as the patient population has grown by tens of thousands over that same time. It is unlikely that anyone can point to another consumer good that has seen that type of price compression in the last two years. Nevertheless, patients’ concerns around pricing are valid, especially in the current economic climate we all live in. Patient concerns over cost must be balanced against the backdrop painted by the CPPC market analysis, which concluded that Utah’s medical cannabis market faces some unique challenges from other markets across the country. With all of that in mind, the question then is, what is the best way to reduce prices to patients without putting existing businesses in jeopardy or without issuing a dramatic number of new licenses?
If more people can access the medical cannabis program, more medical providers can recommend cannabis, and those consuming cannabis can feel more normal about their medical choices, then there likely will not be a need to resort to an adult-use ballot initiative for the foreseeable future. Here is a list of proposed legislative changes that could lead to more patients in the program (leading to lower costs) and which will continue to normalize cannabis as a medicine:
- Authorizing telehealth visits for all new and renewing patients
- Giving QMPs discretion to recommend medical cannabis for conditions other than those listed in the law (or otherwise expanding the list of qualifying conditions to include things like sleep disturbance, anxiety, depression, or other conditions)
- Allowing those over age 65, the disabled, or those with a terminal illness to self-certify for medical cannabis
- Allowing QMPs to self-certify to be able to recommend medical cannabis
- Giving producers and retailers the ability to advertise in ways that are akin to other medicines (especially as Schedule III approaches) or hemp-derived products
- Allowing for more cannabis product types, especially those that patients can purchase in the illicit market or in another legal state
- Funding education initiatives that champion the safety and efficacy of legal, regulated medical cannabis
- Legalizing the ability for patients to home grow, giving patients the right to source and control their own medicine
- Decriminalizing the possession of cannabis, making it a civil penalty only
- Passing other reforms that put cannabis on par with other controlled substances
We must act now to preserve Utah’s medical cannabis program. As it stands today, more than 60,000 patients have now left the program, with many of those patients leaving due to the expensive multi-layered process to gain access to cannabis and the other hurdles identified by the DHHS survey and the market analysis from UDAF. To address these issues, we should be encouraged to take an approach where operators continue scaling their operations to produce high-quality products at lower prices, and policymakers institute changes that will bring and keep more patients in the program. We should not perpetuate the stigmas of the past by making the process to be a patient (or a provider) so cumbersome, time-consuming, expensive, and limiting.
Make Your Voice Heard
By the time this article is published, the 2025 Legislative Session will be upon us. If you want to make your thoughts known on ways that Utah can improve or otherwise preserve its medical cannabis program, please consider contacting your local lawmakers. You can find their contact information here under the ‘Legislators’ tab. Utah’s medical cannabis program needs your voice now more than ever.
