Utahns voted to legalize medical cannabis in 2018. Since then, more than 150,000 patients have enrolled, and polls show nearly 90% of voters now support the program. That’s a rare consensus in our state. However, nearly a third of those enrolled no longer have an active medical card and are now purchasing cannabis outside Utah’s legal medical program.
New peer-reviewed research from Utah’s own medical cannabis program confirms this and shows the system is at risk. Unless lawmakers act, patients will continue turning to illicit markets — undermining the very program Utah built to give medical providers and their patients access to safe, medical-grade cannabis products.
Cost and access drive illicit use
Nearly 80% of patients who used illicit cannabis said cost was the primary reason. High prices aren’t just about business decisions. They’re driven by federal tax law (280E), which inflates costs, and by federal and state rules that restrict operational efficiencies. Add enrollment fees, frequent renewals, long wait times and longer travel distances, and barriers pile up. Unfortunately, many patients find driving to Nevada easier than keeping their card.
Studies show patients don’t stop using cannabis — they just step outside the regulated program. That’s not good for patients, law enforcement or lawmakers who want to preserve a medical-only model.
The most striking stat from the study found patients who reported difficulty understanding Utah’s renewal requirements were nearly 59 times more likely to turn to illicit cannabis. No other prescription medicine requires patients to navigate a maze of state rules just to keep treatment going.
Stigma makes things worse
Patients who feared stigma — whether in the workplace or in conversations with providers — were six times more likely to use illicit cannabis. Even family or cultural disapproval pushed people away from the state program.
This isn’t the fault of patients or providers. It’s the result of public messaging and pressure from prohibitionist groups that portray medical cannabis patients as something less than legitimate. That stigma doesn’t protect anyone or prevent illicit use. It drives people to the black market and increases legal risk to patients and those around them.
The research also found that patients who trusted the state program for information were 84% less likely to use illicit cannabis. Confidence in medical cannabis pharmacists also dramatically reduced illicit use.
The clearest path forward is to strengthen trust, not weaken it. A transparent, patient-first program keeps people in the system and results in the best outcomes for patients and the public.
A Utah-only warning sign
This isn’t national data. It’s Utah-specific research, conducted within our own program. Lawmakers can’t dismiss it as irrelevant. The warning is clear: without their support, illicit use will persist, safety will suffer and Utah’s medical program will continue to lose patients and credibility until a recreational campaign finishes it off.
Utah has a chance to be different; the choice for lawmakers is straightforward. Utah can make targeted reforms — simplify renewals, cut red tape, expand access and confront stigma — and in doing so, reinforce the medical-only model.
Or we can ignore the evidence, let patients drift into illicit markets and watch the program unravel.
Utah built this program carefully, and Utahns have embraced it. The research makes one thing clear: if lawmakers want to keep medical cannabis medical, the next step is reform.