What Happened to Medical Cannabis in CA?

California had a thriving medical cannabis ecosystem for 20 years, created for and by medical cannabis patients. They embraced a collective model built on equity, compassion, sharing, and making sure everyone had access to the medicine they needed. The access, industry, and community we enjoy today were built on the foundation they created and sustained for decades.

Somewhere along the path to legalization, however, we seem to have lost sight of medical cannabis patients and their needs. We disconnected from our roots. Nowhere is that more apparent right now than with the current disparity between MMICs and Doctor’s Recommendations in California.

Medical cannabis in California started with a mission to advocate for and support patient equity and compassion. In memory of his partner, Johnathon West, who used medical cannabis to battle AIDS symptoms, Dennis Peron, a San Francisco cannabis activist, began a journey that would shape the industry as we know it today.

Despite facing personal health battles, Dennis worked alongside Dr. Tod Mikuriya to put forward Proposition P and later Proposition 215, which permitted the use of medical cannabis to patients with a Doctor’s Recommendation in California and revolutionized the landscape of compassionate care. For over 20 years, the doctor’s recommendation was the gold standard. Just as with prescription medications, a recommendation from a doctor was all one needed to qualify as a patient and access cannabis as medicine.

When Prop 64 and adult-use sales came to California, a distinct shift happened. Access opened up wide to customers across the state. It was easier than ever for an average Californian to find an impressive array of flowers, tinctures, edibles, topicals, concentrates, and more - all tested, legal, and available at their local dispensary. But for patients, their access contracted. The same medicine they had been buying for years was now marked up by 30-45% in their local dispensaries. ??

At the same time, a Doctor’s Recommendation suddenly wasn’t enough to exempt patients’ medicine from sales tax. Now, an official medical “card” was needed from the State to declare that their cannabis was considered medicine and therefore not subject to sales tax. The tax on tax on tax burdens and obstacles just kept piling up. For some, this made the medicine they had relied on for years no longer accessible. The options often became: submit to the arduous and expensive MMIC process, shoulder the extra financial burden, or find sources outside the legal market, where products can be inconsistent, untested, and unsafe for medical use.

This disparity created a 2-tier system when it comes to medical cannabis and patient benefits. If a patient wants to get the sales tax waived on their cannabis medicine (a benefit bestowed on all medication prescribed by a doctor in CA), then they have to go through the process of obtaining an MMIC.

For those of you wondering - ‘what’s the deal with MMICs anyway?’ - I’ll break it down for you. If patients want sales tax waived on their medical cannabis in California, they need to obtain and pay for a state-issued MMIC (Medical Marijuana Identification Card) in addition to their Doctor's Recommendation. Here’s what they have to do to get one:

• Step 1: Get (and pay for) a Doctor’s Recommendation.
• Step 2: Make an appointment with their local Department of Public Health.
• Step 3: Fill out an MMIC application
• Step 4: Bring the application, the doctor’s recommendation, a valid government-issued ID, and in some cases, a passport photo, and proof of residency, to their Department of Public Health appointment.
• Step 5: Pay an additional fee; usually $100.
• Step 6: Then go home and wait and hope that the application will be approved and they will eventually receive an MMIC in the mail in a few weeks.

While there are other protections and advantages an MMIC provides, like increasing personal grow limits and allowing law enforcement to verify the cardholder as able to legally possess larger quantities of cannabis, this process is excessively time-consuming and expensive for patients who just want to buy their medical cannabis through legal channels. Step 1 alone was, and should still be, enough to waive sales tax on their medicine. We should be taking care of all patients regardless of whether they have a recommendation or a Card - they're still a patient. This approach undermines the very essence of compassion and equitable access that drove the medical cannabis movement.

It really comes down to this: Cannabis is Medicine. I have witnessed firsthand the transformative power of medical cannabis in the lives of patients. In 2015 we launched Meadow MD—a platform connecting cannabis doctors to patients for a medical cannabis recommendation. The first physician we partnered with was Dr. Dan Price who had been an emergency physician at Highland Hospital & Trauma Center in Oakland for 14 years. His interest in medical cannabis arose from his own experience with chronic back pain and from seeing patients in the ER who could safely be helped by medical cannabis but instead were prescribed medications that often had limited efficacy and severe side effects.

Dr. Dan helped patients treat insomnia, chronic pain, side effects from cancer treatments, anxiety, depression, migraines, and more. These are real and often debilitating health issues that significantly impact the daily lives of individuals seeking relief. By recognizing cannabis as a viable treatment option, patients have been able to manage their symptoms more effectively, improving their overall quality of life and reducing their reliance on conventional medications with potentially harmful side effects.

When California took on adult-use legalization, we knew things weren’t going to be perfect. And they certainly aren’t; but It’s our job as the stewards and custodians of this industry to bring awareness to the things that aren't working - the things that don't serve our industry and community. This 2-tier system of Doctors’ Recommendations vs MMICs is not serving patients or the community. It is either driving up patients’ medical costs astronomically or driving them to get cannabis from the unregulated market.

Our stance is simple: cannabis patients with a Doctor’s Recommendation should get the same tax treatment as patients with an MMIC.

So what can we do about it?

On behalf of California's leading cannabis trade, labor, advocacy, veterans, and patient organizations, as well as individual stakeholders throughout the industry, we've drafted?this letter to help further Medical Cannabis Patient Equity and Access and sent it to Governor Newsom, President Atkins, and Speaker Rendon requesting an exemption of sales tax on medical cannabis for anyone with a valid Doctor’s Recommendation. Please join us in signing to show your support.

Before I sign off, I want to extend a big thank you to everyone who has already signed. Your support and advocacy are what this industry and community need to grow, thrive, and stay connected to our roots. Thank you for showing up and participating - you make our community stronger. ??

Special shout out to Senator Scott Wiener for his work on CA Compassion and for moving CA’s cannabis industry closer to a more equitable, inclusive, and compassionate industry. I also want to recognize the incredible folks at NORML and Americans For Safe Access . Thank you for all you do and for fighting the good fight! I am honored to work alongside you.

Thank you as well to all of Meadow MD's incredible doctors, including Dr Dan (Daniel Price MD) , Dr. Cheryl Bugailiskis , and Dr. Dr. Ahimsa Porter Sumchai MD .

As we close out PRIDE month, a special shout out as well to the LGBTQ+ community, which has long been at the forefront of social justice movements, fighting for equality. Cannabis has been no exception. Thank you for making our industry, our community, and our world a better, more inclusive place. Let’s keep fighting in the spirit of Dennis Peron toward compassion, equity, and medical cannabis access for all who need it. ??

A big THANK YOU to everyone who has already signed, including: Kenny Morrison , Lauren Cote , Johnny Delaplane , Jonatan Cvetko , David Goldman , Kandice Hawes-Lopez , Sarah Armstrong , Keith Cich , Erin Johnson Gore , Robert Vecchio , Vince C. Ning , Stacey Hronowski , Ted Lichtenberger , Steve Albarran , Bert Vick, Nohtal Partansky , Steven Jung , Ryan Miller , Aaron Newsom , Eric Goepel , Hirsh Jain , Shabnam Malek , Nicole Howell (she/they) , David Belsky , Amber Morelli, Gretchen Miller, Lara DeCaro , Sara Payan, SME , Andrea Greenberg, Joyce Cenali , Justin Pressfield , Darren Story , Wesley Hein , Andrew DeAngelo , Ezra Malmuth , Ben Larson , Joe Sweetleaf , Whitney Beatty , Tiffany Devitt , Ron Gershoni , Judy Yee (Chen) , Jamie Feaster , Tuan Le, Nate Landau , Jason Horst , Colleen King , Dylan Ferman, Neil Dellacava , Tegan Thompson, Jordan Kuhl , Dustin Gibbens , Alexa Goldberg, Terryn Buxton , Elissa Hagopian Hambrecht , Leah Cerri , Frances Villanueva, Ariel Clark , Amanda Tingler , Amanda Reiman PhD MSW , Jimmy Levi , Morris Kelly , Omar Figueroa , Chelsea Sutula , Michael Kraft , Dana Leigh Cisneros , Jesus Sahagun, Konstantine Kostas, Randy Cruzado , MIKE MEKK , Sean Kali-rai , Hilary O'Brien , Michael Kray, Jessica Bray , Zachary Pitts , Carly Ekenstam , Mina Mishrikey , Cristina Arantes , Anthony Jenkins Jr., MBA , Stephanie Pangelinan, Julie Germenis , Mary Aigner, Gillian Levy , Dawn Bazurto CPB , Jakki Hernandez , Dana Leigh Cisneros , Tiffany Wright , Kip Clifton, CFA , Kevin Watts , Micah Anderson , Zachary Selvin, Nikkita Baranovskiy, Brooke Rosel , Joe Airone, Christina de Sousa, Mario Barajas , Kevin Reed, Nancy Do , Aaron Justis , and Kimberly Cargile . ??