Medical marijuana users will get dibs if supply wanes, but evidence from other states indicates some may turn to recreational pot once it is legal in Illinois

By Jamie Munks for the Chicago Tribune

“Anybody who’s really suffering should not be prohibited access to this product.” - David Mangone

Illinois’ new recreational cannabis program calls for dispensaries to prioritize medical patients in the event of a marijuana shortage, addressing a concern that has cropped up in other states that have seen a high demand when recreational sales start.

Gov. J.B. Pritzker last Tuesday signed a measure that opens up marijuana to recreational use. Still on his desk is a bill passed by state lawmakers that makes the state’s medical marijuana pilot program permanent and also opens it up to an array of new qualifying conditions including autism, chronic pain and anorexia nervosa.

That bill, along with the protections for medical users that are part of the recreational pot bill, makes Illinois’ medical marijuana program "one of the stronger ones in the country,” said David Mangone, director of government affairs for Americans for Safe Access, which advocates for legal cannabis for therapeutic use and research.

The experience of the 10 states that have previously legalized recreational marijuana has shown that increased demand from recreational users can create supply issues for existing medical users. In addition, some of those states saw their medical cannabis program participation rates drop steeply as some medical users see no value in maintaining their medical card status and turn to recreational pot.

Medical users have at times struggled to find the particular marijuana product they use as the industry shifts to the forms of pot that have wider recreational appeal, Mangone said.

More than 70,000 people are currently participating in the Illinois medical marijuana program, which has been operating as a pilot since 2014 and was due to end next year.

The main goal behind the bill that makes permanent and expands medical cannabis is providing “stability” for the program and to prioritize medical patients, those who rely on cannabis to manage pain or other symptoms from a range of medical conditions, in the event of a demand issue, said bill sponsor Rep. Bob Morgan, a Deerfield Democrat.

In other states that have legalized recreational marijuana, the medical programs have suffered, Morgan said.

“A number of states have had shortages. There was a real recognition that this needs to be slowly expanding — businesses, licenses, cultivators,” Morgan said. “As we ramp up to Jan. 1, 2020, there is a very real possibility of a shortage.”

The adult-use recreational law that takes effect Jan. 1 calls for dispensing organizations that hold medical cannabis licenses issued under the medical pilot program to maintain “an adequate supply of cannabis and cannabis-infused products for purchase by qualifying patients and caregivers.”

An adequate supply is defined as an amount comparable to the average monthly inventory for the six months leading up to the January effective date of the recreational law.

If there’s a shortage of cannabis or cannabis-infused products, a dispensary that has dual medical and recreational licenses “shall prioritize serving qualifying patients and caregivers before serving purchasers,” the recreational legislation states.

In Alaska, participation in the medical pot program decreased by nearly two-thirds when recreational use was legalized. Participation also dropped in Washington, where the medical and recreational programs were combined, a move that has since faced pushback from lawmakers and through citizen initiatives, Mangone said.

Illinois will likely see a drop-off in medical marijuana use, but Mangone said he doesn’t anticipate it being as significant as in some other states, in part because the laws here afford medical users some privileges recreational users won’t have.

“I think the intent in Illinois is to maintain a strong medical program and continue to serve the patients that it currently serves, as well as welcoming new patients,” Mangone said.

Under the medical cannabis pilot program in Illinois, qualifying patients pay a $100 fee for a one-year registry card, $200 for a two-year card or $250 for a three-year card. Those fees can be reduced for veterans and those on disability.

When recreational use becomes available, some medical users no longer find their cardholder fees worthwhile, or find easier access to cannabis outside of the medical program, Mangone said.

Even in states like Nevada, which saw a steep participation drop-off in the medical marijuana program after recreational sales began in 2017 — close to 40 percent — the medical program remains viable, Mangone said.

“There are a lot of producers who got into this industry from a compassionate care angle, and they want to stay in the medical space and don’t have any interest in moving into the adult-use model,” Mangone said.

Illinois’ medical marijuana bill allows participants to grow their own cannabis. An earlier bill proposal included a limited allowance for home grow for recreational users, too, but that became a sticking point in the debate and was ultimately removed by the bill sponsors to garner broader support for the measure. Certified medical marijuana patients will be able to grow up to five plants at home.

“I think Illinois did this the right way,” Mangone said. “It still really incentivizes patients who need to participate in this program with the appropriate incentives.”

It also provides an opportunity for people in the state who would have qualified for the pilot program under statute, but have been unable to access medical cannabis because of cost, a doctor who refused to prescribe or some other factor.

“Anybody who’s really suffering should not be prohibited access to this product,” Morgan said.

Rep. Celina Villanueva’s mother was diagnosed with cancer last August. Her mother, who is undergoing chemotherapy, expressed interest in using medical cannabis for pain management, but hasn’t been able to participate because she wasn’t able to find a doctor at the facility where she receives treatment to sign off, Villanueva said.

“She’s one of many people throughout this state and one of many people throughout this country that could not find relief within the cannabis program,” said Villanueva, one of the sponsors of the recreational cannabis bill. “And that’s something that I carry with me every single day. I did this for her. And for those people that unfortunately fall outside of that program that don’t want to be on opioids in order to help the symptoms of their diseases.”