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

The takeaway

About 12% of Utah medical cannabis patients also purchased illicit cannabis, primarily due to high costs and supply concerns, with access barriers nearly 5 times increasing illicit use odds.

Medical cannabis program administrators, health policy researchers, cannabis regulators designing accessible programs.

Access barriers: 4.73x higher illicit use odds

What the researchers found

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.

Why it matters

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 numbers in context

211 survey respondents. 11.9% (24) reported illicit cannabis use. Cost barrier: 79%. Supply concern: 45.8%. Access barriers: OR 4.73 for illicit use (p <.001). Reliance on state program for info: AOR 0.16 (reduced illicit use, p <.05).

How the study worked

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.

What this study cannot tell us

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.

How to read the evidence

Preliminary: small exploratory analysis from a single state program, though findings are consistent with known access barriers in regulated markets.

When this study was published

2025 study

The bigger picture

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.

Questions still open

Would lowering medical cannabis prices reduce illicit use? Are supply shortages a common problem across state programs? Could better patient education about program benefits reduce illicit sourcing?

Common questions

Why do medical cannabis patients buy from the black market?

High product costs (cited by 79% of illicit users) and concerns about adequate supply (45.8%) were the top reasons. Patients who faced access barriers to legal cannabis were nearly 5 times more likely to buy from illicit sources.

What would reduce illicit cannabis use among medical patients?

The study suggests that reducing costs, ensuring reliable supply, and providing trustworthy program information would decrease illicit market participation. Patients who relied on the state program for information were significantly less likely to buy illicit cannabis.

Read the original research

Understanding motives for illicit medicinal cannabis use: an exploratory analysis in a medical cannabis program.

Journal of cannabis research, 7(1), 48

View on PubMed ↗Publisher’s paper ↗

Citation

Reeves, Carter; Franks, Lirit; Kelley, A Taylor; Incze, Michael; Gordon, Adam J; Yu, Ziji; Flake, Eden; Cochran, Gerald. (2025). Understanding motives for illicit medicinal cannabis use: an exploratory analysis in a medical cannabis program.. Journal of cannabis research, 7(1), 48. https://doi.org/10.1186/s42238-025-00284-w