Patient Experiences and Access Barriers in the New York State Medical Cannabis Program: Findings from Two Consecutive Cross-Sectional Surveys, 2023 to 2024

PURPOSE: Patient enrollment in state medical cannabis programs typically declines after the legalization and implementation of adult-use programs, yet the reasons driving attrition are poorly understood. In 2021, New York State enacted the Marihuana Regulation and Taxation Act (MRTA), simultaneously legalizing adult-use cannabis and expanding provisions of the Medical Cannabis Program. This study analyzes two consecutive statewide surveys of program participants to characterize challenges to participation and perceived impacts of adult-use market availability. METHODS: The New York State Office of Cannabis Management (the Office) administered anonymous cross-sectional surveys via email to registered patients with active, expired, or canceled certifications in June 2023 (N = 123,075 contacted; 10,781 responses) and July 2024 (N = 151,202 contacted; 5451 responses). The surveys captured demographics, program participation, cannabis consumption patterns, perceived therapeutic impacts, adverse effects, costs, provider engagement, and access barriers. Survey questions were tailored by self-identified active versus inactive status. County of residence was added in 2024. FINDINGS: Across both surveys, between 20% and 30% of respondents (21% in 2023 and 30% in 2024) indicated they may not renew or would discontinue certification. Among these in 2024, 34% preferred purchasing at adult-use dispensaries, 32% cited excessive distance to a medical dispensary and 11% preferred home cultivation. Among reasons patients preferred adult-use retailers, 31% reported closer proximity, 31% greater affordability, and 20% cited preferred product types at adult-use dispensaries. Geographic access became more limited in 2024 with the closures of 10 medical dispensaries, leaving 32 medical dispensaries operating statewide. In 2024, 48% of respondents reported travel times $200), despite state policies indicating insurance coverage is often applicable when visits are not solely for certification. IMPLICATIONS: In New York State, geographic inaccessibility of medical dispensaries and the high costs of certification and cannabis products are central barriers to medical cannabis program participation.