High costs and limited access drive mass exodus from NY medical cannabis program

Patient enrollment in state medical cannabis programs typically declines after the legalization and implementation of adult-use programs, yet the reasons driving attrition are poorly understood. In 2021, New York State enacted the Marihuana Regulation and Taxation Act (MRTA), simultaneously legalizing adult-use cannabis and expanding provisions of the Medical Cannabis Program. This study analyzes two consecutive statewide surveys of program participants to characterize challenges to participation and perceived impacts of adult-use market availability. The New York State Office of Cannabis Management (the Office) administered anonymous cross-sectional surveys via email to registered patients with active, expired, or canceled certifications in June 2023 (N = 123,075 contacted; 10,781 responses) and July 2024 (N = 151,202 contacted; 5451 responses). The surveys captured demographics, program participation, cannabis consumption patterns, perceived therapeutic impacts, adverse effects, costs, provider engagement, and access barriers. Survey questions were tailored by self-identified active versus inactive status. County of residence was added in 2024. Across both surveys, between 20% and 30% of respondents (21% in 2023 and 30% in 2024) indicated they may not renew or would discontinue certification. Among these in 2024, 34% preferred purchasing at adult-use dispensaries, 32% cited excessive distance to a medical dispensary and 11% preferred home cultivation. Among reasons patients preferred adult-use retailers, 31% reported closer proximity, 31% greater affordability, and 20% cited preferred product types at adult-use dispensaries. Geographic access became more limited in 2024 with the closures of 10 medical dispensaries, leaving 32 medical dispensaries operating statewide. In 2024, 48% of respondents reported travel times <30 minutes to a medical dispensary, 31% reported between 31 and 60 minutes, and 5% used delivery services. Cost was one of the main barriers with 49% of all patient respondents reporting they are unable to afford sufficient product to manage symptoms. In 2024, 58% of respondents uncertain about certification renewal cited high product cost (vs 33% in 2023). 70% reported paying out-of-pocket for certification consultations (45%: $0-$100; 44%: $101-$200; 11%: >$200), despite state policies indicating insurance coverage is often applicable when visits are not solely for certification. In New York State, geographic inaccessibility of medical dispensaries and the high costs of certification and cannabis products are central barriers to medical cannabis program participation.