Cost and Supply Concerns Drive Medical Cannabis Patients to Buy From Illicit Sources

Among 211 medical cannabis program participants in Utah, 11.9% (24 patients) reported using illicit cannabis within the past two weeks. The most common reasons were product cost (79%) and assurance of adequate supply (45.8%). Patients experiencing MC access barriers were 4.73 times more likely to use illicit cannabis. Those who trusted and relied on the state program for information were significantly less likely to seek illicit sources.

Exploratory analysis of baseline survey data from 211 newly registered adults in Utah's medical cannabis program (diagnosed with chronic pain, PTSD, and/or cancer). Surveys assessed health, program experience, barriers, and illicit cannabis use. Descriptive statistics, chi-squared analysis, and logistic regression identified factors influencing illicit use.

Medical cannabis programs succeed only if patients can access their medicine through legal channels. This study reveals that cost and supply barriers push patients toward unregulated products, undermining the safety benefits of regulated programs. Making legal cannabis more affordable and accessible could reduce illicit market participation.

The persistence of illicit cannabis use among medical patients highlights a fundamental challenge for legal cannabis programs: if regulated products are too expensive or unavailable, patients will find alternatives. This is particularly concerning because illicit products lack quality controls, testing, and consistent dosing.

Small sample from a single state program. Self-reported illicit use may be underreported. Convenience sample may not represent all program participants. Cross-sectional design. Utah's program may differ from other state programs in structure and pricing.