Jun 12, 2025
By Elisabeth Mack, MBA, BSN, RN & Member of the SCC Media Response Committee

When Adult-Use Eclipses Medical: How Recreational Cannabis Legalization Has Undermined Patient Care
Cannabis reform began as a medical movement. Patients with cancer, HIV, epilepsy, and chronic pain fought for the right to use plant-based therapies with fewer side effects than pharmaceuticals. Over time, those voices helped shift policy, building compassionate-use programs and regulated medical cannabis systems across the country.

But today, that original patient-centered mission is under siege. As adult-use (recreational) cannabis legalization sweeps through states, the infrastructure that once supported medical cannabis is eroding—fast. What was once a movement focused on wellness, nuanced care, and access has been replaced by a market chasing profits, dominated by high-potency products and engineered cannabinoids that do not belong in medical treatment plans. The very patients who sparked legalization efforts are now being left behind.

This essay explores how the rise of adult-use cannabis markets has harmed medical patients—through market dynamics, regulatory neglect, and a public narrative that no longer recognizes cannabis as legitimate medicine.

The Vicious Cycle: When Patients Stop Shopping
The legal adult-use market was supposed to coexist with medical access, but the opposite is happening. The recreational market’s demand for high-THC flower, vapes, beverages, and edibles has completely transformed product development. Low-dose, high-CBD, or balanced THC:CBD ratios—essential tools in a medical provider’s toolkit—are disappearing from dispensary shelves.
In Oregon, The Guardian reported that medical patients were struggling to find appropriate products after the state opened its adult-use market in 2015. One patient, dealing with multiple chronic conditions, said, “You used to be able to get the plant in many forms… now it’s just the stuff that gets you high” (The Guardian, 2018). As dispensaries shifted their product lines to follow recreational demand, they stopped stocking therapeutic formulations. Medical patients, finding fewer and fewer usable products, stopped coming. Dispensaries, in turn, dropped even more medical SKUs. And so the cycle deepened.

Patients need formulations like 20:1, 4:1, and 1:1 CBD:THC tinctures, CBDA-rich softgels, CBG or CBN capsules, or THC microdose options. But recreational buyers rarely seek these out. And most adult-use dispensary staff—budtenders—aren’t trained to support medical needs. What you’re left with is a warehouse of high-potency products and no one left looking out for the actual patients.

The Regulatory Machine Only Cares About Taxes
While dispensaries race to meet demand, government regulators have focused almost entirely on diversion and crime, and tax revenues. In theory, medical cannabis patients should be shielded from high excise taxes—just as prescriptions from CVS aren’t taxed. But many states do the opposite: they treat medical patients like adult-use consumers, taxing their purchases up to 40% even when products are clearly used for treatment.

The problem isn’t just financial. It’s systemic. As the American Journal of Managed Care notes, “the distinction between medical and recreational cannabis is becoming increasingly blurred,” leading to diminished support for medical-specific products, patients, and providers (AJMC, 2022). State agencies are more interested in enforcing track-and-trace systems and collecting their cut than they are in ensuring quality-of-care standards for medical patients.

Few jurisdictions still incentivize dispensaries to maintain a dedicated medical license, or to carry formulations beyond the most popular rec items. And while taxes are sky-high for everyone, there is little enforcement of exemptions for patients with qualifying medical cards. In some markets, those programs have disappeared altogether.

No One Is Training the Doctors (Or the Budtenders)
The medical cannabis market has always suffered from a lack of clinical integration. Most physicians, nurses, or other licensed providers still don’t know how the endocannabinoid system works, much less how to guide patients in using cannabinoids as medicine. The result? Patients self-medicate or turn to undertrained dispensary staff for advice.

In the recreational era, this problem has worsened. Few states require any medical cannabis education for healthcare providers—or for budtenders, who are often the first point of contact for patients in dispensaries. Patients with serious conditions like epilepsy, Crohn’s, PTSD, or cancer walk into adult-use dispensaries looking for help, only to be met with blank stares or recommendations for the highest-THC gummy on the shelf. Budtenders are trained to maximize retail value for the dollar, not the nuanced effects of medicinal formulations.
In the absence of a formal healthcare framework, patients are forced to navigate cannabis treatments alone. The system no longer respects the legitimacy of cannabis as medicine—and certainly doesn’t offer the protections or education that patients deserve.

The Rise of Unregulated Synthetic Cannabinoids
As if the loss of therapeutic products weren’t enough, the market is now flooded with synthetically derived or chemically modified cannabinoids—HHC, THCP, delta-10, and others. These compounds are designed for maximum psychoactivity, not therapeutic precision. They’re largely unregulated, poorly studied, and sold in colorful packaging with almost no quality oversight.
A study published in ScienceDirect warned of the risks: “Unregulated cannabinoid products can carry significantly higher risks of dependence, psychiatric symptoms, and toxic exposures—especially among vulnerable populations” (2021). These compounds have no place in a therapeutic framework. They’re not designed to support healing; they’re designed to mimic the high of THC while avoiding legal oversight.

For patients seeking symptom relief—not intoxication—the proliferation of these products is a nightmare. Now you have to navigate past THCP vapes and “zombie gummies” just to find something remotely helpful. It’s extremely difficult to find legitimate full-spectrum CBD, especially with state bans that have thrown the baby out with the bathwater in an attempt to rid the market of the dangers.

When Public Opinion Turns Away from Medicine
In the early years of legalization, the public saw cannabis as a lifeline for the sick. That image has faded. The recreational boom has reshaped public perception: cannabis is now a lifestyle product, not a medicine. This cultural shift is deeply damaging to patients.

Leafwell’s 2023 analysis notes that recreational legalization has contributed to “a significant reduction in public support for the medical use of cannabis, even in states where medical programs still exist.” Why? Because the public mostly sees billboards, Instagram ads, and TikTok influencers pushing THC-laced treats—not clinicians discussing cannabinoid ratios or ECS balancing.
The absence of a strong clinical voice in the cannabis space has allowed the conversation to drift toward profit, potency, and personality branding. As a result, patients are again left out. The average voter has no idea that a 10mg THC gummy is far too much for someone with chemo-induced nausea or MS tremors. They assume cannabis is just for getting high. And that’s a tragedy—for patients and for the movement that once aimed to serve them.

Restoring a True Medical Cannabis System
The damage is real—but not irreversible. To restore the dignity and effectiveness of medical cannabis, we need to rebuild infrastructure and public trust. That means:

• Protecting tax exemptions for all certified medical cannabis patients Requiring medical dispensaries to stock diverse cannabinoid formulations, including high-CBD, the minors (CBG, CBN, THCV, CBC) and acidic cannabinoids (CBDA, THCA), and terpene-rich products
• Mandating and funding clinician education on the ECS, cannabinoids, and patient-centered treatment
• Regulating synthetic and novel cannabinoids like HHC and THCP to prevent therapeutic confusion and patient harm
• Restoring full-spectrum CBD products with less than 0.3% THC to their place on store shelves with no threat to online retailers
• Supporting nurse-led models of care and cannabis coaching programs (like diabetes care) to guide patients toward the right formulations and doses
• Above all, we must reassert cannabis as a valid medical therapy—not just a recreational substance. This means recognizing the needs of real patients: people living with pain, insomnia, seizures, cancer, neurodegenerative disease, autoimmune disease, mental health issues and trauma.

Shopping as a Medical Cannabis Patient: A Future-Focused Vision
Medical cannabis patients need a safe, predictable path to care. That means bypassing adult-use hype and seeking out providers and companies committed to therapeutic outcomes.
We need a CBD marketplace filled with targeted formulations designed for managing symptoms—not sensations. Products like dry herb vaporizers, softgels, tinctures, extracts, gummies, and transdermal patches to offer a range of ECS-modulating options for real health conditions. No artificial cannabinoids. No psychoactive gimmicks. Just plant-based care that actually works.
Medical cannabis educational certificate programs are needed to teach both patients and providers how to navigate this changing landscape—what questions to ask at dispensaries, what formulations to look for, and how to safely combine cannabinoids with other treatments. That’s the future we should be investing in—not more THC-drenched marketing campaigns.

Conclusion: A Call to Protect Patients
The original cannabis movement was built on compassion, science, and the fight for access. We must not forget that. As recreational markets continue to grow, we have a responsibility to ensure that medical patients are not cast aside.

Legalization should not mean abandonment. It should mean progress—for all. That includes regulation rooted in science, education for providers, access to the right formulations, and respect for cannabis as a legitimate, tax-free medicine.

Let’s stop letting the market define what cannabis is. Let patients and practitioners decide what it should be.

Elisabeth Mack, MBA, BSN, RN
Co-founder of Holistic Caring & The Green Nurse and Bloom Hemp CBD

References
The Guardian. (2018). ‘It’s just the stuff that gets you high’: how legal weed is leaving patients behind.
https://www.theguardian.com/society/2018/jul/31/oregon-cannabis-medical-marijuana-problems-sick-people

AJMC. (2022). Legalizing Marijuana: How Recreational Marijuana Legalization Changes the Medical Use Landscape.
https://www.ajmc.com/view/legalizing-marijuana-how-recreational-marijuana-legalization-changes-the-medical-use-landscape

Leafwell. (2023). Recreational Cannabis Legalization Study.
https://leafwell.com/blog/recreational-cannabis-legalization-study

ScienceDirect. (2021). The public health consequences of the commercialization of cannabinoid products.
https://www.sciencedirect.com/science/article/abs/pii/S0955395921004497

ScienceDirect. (2023). Medical versus recreational cannabis use: Trends in product selection and risk.
https://www.sciencedirect.com/science/article/abs/pii/S0149291823000383