Patients Need More Medically Focused Cannabis Dispensaries (Op-Ed)

*“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with recreational options, has been stymied by out-of-date and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:

- Licensing structures that treat medical service as an optional add-on
to recreational stores, rather than as a distinct health-care function with
its own standards and incentives.
- Fees and tax policies that make medical operations financially
marginal compared with recreational sales, pushing operators to focus on
tourists and high-volume nonmedical consumers.
- Lack of tax and other incentives to consumers to encourage them to
seek medical care for their illnesses. Current incentives only encourage
high volume users to seek “certification” in order to obtain excessive
amounts of product.
- Lack of mandated prescribing by trained cannabinoid clinicians, so
“medical” offerings are often little more than branding, with no real
clinical guidance or follow-up.

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:

- Dispensaries that commit to medical programs with binding
prescriptions, documentation standards and coordination with the patient’s
Cannabinoid Specialist clinicians.
- Clinicians who understand dosing paradigms, interactions and risk
mitigation, and who can tailor regimens to complex comorbidities.
- Product lines that are consistent, labeled to medical standards and
available reliably over time so that titration and monitoring are
meaningful.

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:

- Maintaining distinct medical licenses with fees reduced below those of
recreational stores, streamlined applications and regulatory stability in
exchange for meeting higher clinical standards.
- Requiring formal prescriptions to be written by qualified cannabinoid
clinicians, including written care protocols and documented patient
education, and requiring that licensed medical dispensaries honor those
prescriptions without modification or addition.
- Establishing product standards and testing tailored to medical use,
such as tighter tolerances on labeled cannabinoid content and clear
guidance on excipients. Further, such products must always be available to
patients.

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.*

The post Patients Need More Medically Focused Cannabis Dispensaries (Op-Ed)
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