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“If cannabis is medicine, why is the system built as if it were only a retail commodity?”
By Jordan Tishler, MD, Association of Cannabinoid Specialists
Currently, medical cannabis programs across the United States are dwindling. This is directly a result of these programs being deprioritized in favor of recreational programs and being regulated in a manner that neither provides support to clinicians to do their jobs, nor value to patients who need safe, effective products and expert medical guidance to achieve benefit.
Among the many problems baked into these medical cannabis programs, the financial requirements to become a medical dispensary actually disincentivize dispensaries from participating.
States must overhaul cannabis rules to make it feasible—and attractive—for dispensaries to prioritize medical patients instead of treating them as an afterthought in a recreational market.
What Eastham Shows Us
A recent article in the Provincetown Independent discusses the issues confronting the owners of a dispensary in Eastham, Massachusetts who have decided to swim upstream and apply for a medical license—a truly rare occurrence these days. It has to be asked why new medical dispensaries are so rarely opened these days. In fact, Massachusetts has lost a significant number of medical dispensaries in the past year.
Emerald Grove’s plan to add medical marijuana services, in a market crowded with recreational options, has been stymied by out-of-date and disincentivizing state regulation. The article notes that critics of state rules argue that a shift toward prioritizing medicinal use is needed, underscoring that current policy treats medical access as incidental to the non-therapeutic (aka recreational) industry rather than as a core public health service.
Medical patients on the Outer Cape, like elsewhere in Massachusetts, often travel long distances or navigate complex systems to find knowledgeable clinicians, consistent products and medically oriented counseling—needs that are not reliably met in a purely recreational framework.
When a single dispensary’s decision to add medical services becomes newsworthy, that is not a sign of healthy access; it is a red flag that the system is failing patients.
How Current Rules Undermine Medical Care
From the perspective of practicing cannabinoid medicine, several regulatory features consistently undermine the development of robust medical programs.
These include:
Association of Cannabinoid Specialists (ACS) was founded precisely because patients are uniquely vulnerable in this space and have very different needs from recreational users. When regulations blur or ignore that distinction, patients with cancer, chronic pain, PTSD, and other conditions are left to self-experiment under the guise of “advice” from untrained retail staff.
What Patients Actually Need
For cannabis to function as medicine, patients need access not just to products, but to a system designed around clinical care.
That means:
States that treat cannabis primarily as a tax-revenue generator will not get this kind of system by accident. It must be built intentionally through regulation that privileges patient care over volume sales.
Regulatory Changes States Should Enact
From ACS’s perspective, several concrete reforms are essential if states want medical dispensaries like the one in Eastham to flourish rather than watching these programs dwindle and disappear.
Key changes include:
These are not theoretical tweaks; they are practical tools for building a stable ecosystem in which operators have a reason to invest in medical services instead of quietly abandoning them when margins tighten.
A Call to Lawmakers and Regulators
The Eastham example should prompt state policymakers to ask a simple question: if cannabis is medicine, why is the system built as if it were only a retail commodity? Legislators, regulators and municipal officials must partner with organizations like ACS to redesign rules so that medical care is not a side project of the recreational industry, but its own pillar of the health-care system.
Patients deserve access to knowledgeable clinicians, medically focused dispensaries and products that support real treatment, not just trial-and-error self-use. States that are willing to revise their regulations accordingly will see more Emerald Groves choosing to offer true medical cannabis services—and more patients getting the care they were promised when medical legalization first passed.
Jordan Tishler, MD is the president of the Association of Cannabinoid Specialists.
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