When it comes to the medical marijuana era—including understanding compassionate care—it pays to know a bit of history.
Far from being a mere historical footnote in the long march towards legalization, the advent of state-sanctioned medical cannabis markets represented a game-changing victory on multiple fronts. From a policy perspective, the success of California’s Prop 215 in 1996 set in motion a domino effect that inspired numerous other states to follow suit by subsequently enacting medical marijuana laws of their own.
What these laws accomplished was nothing short of radical: They allowed those suffering from a variety of medical ailments to purchase, consume and benefit from cannabis without fear of legal repercussion. But it didn’t go off quite so cleanly. Many licensed operations endured frequent, aggressive raids from federal authorities. Despite such challenges, some craft cannabis cultivators in California’s Emerald Triangle still pine for the medical-only days.
It makes sense. As a far looser market, requirements for testing, taxes, packaging and licensing all still existed but were notably less stringent than they’d ultimately become following California’s move to legalize recreational cannabis sales in 2018.
Another reason for these laments stems from the highly lucrative, rapidly growing cannabis industry, with its focus clearly shifting from medicine to money. Case in point: It took a monumental effort from advocates to fix a loophole in Prop 64 (California’s adult-use bill) that essentially killed the state’s landmark compassionate care program. To understand what happened, one needs to look at how these programs work and who they were originally designed to help.
The underlying concept behind compassionate care programs is that those in need should always have access to safe, quality medicine—regardless of whether they can afford it. At the onset, this group was largely composed of those living with HIV/AIDS, and cannabis had been deemed a potentially effective treatment for related symptoms, such as nausea, loss of appetite, pain relief and depression. With some hope in sight,
brave individuals, including Prop 215 co-author Dennis Peron and the legendary “Brownie” Mary Rathbun, risked prison time to ensure patients hospitalized in San Francisco-area hospital AIDS wards were able to access cannabis.
When Prop 215 became law in 1996, it established the basic tenets for how cannabis compassionate care programs should operate. It’s a blueprint that basically continues to this day: Cultivators donate flower to licensed dispensaries, which in turn offer it to qualified patients at discounted rates, or for no charge at all. One of the reasons these programs worked was because, as a charitable enterprise, donations of cannabis weren’t subject to tax fees. Unfortunately, as mentioned above, this became a big problem after California enacted Prop 64 in 2016.
The issue became that in addition to requiring licensed growers to pay high taxes on cannabis cultivated for sale, Prop 64 failed to exempt flower grown for compassionate care from taxation. Normally happy to donate, cultivators understandably balked at being asked to pay for giving away free product. Thankfully, the issue was resolved in 2020 when Gov. Gavin Newsom signed the Dennis Peron and Brownie Mary Act, once again making it possible for operators to distribute medical cannabis without the brutal taxes.
But as more and more states opt to evolve their industries from medical-only to a hybrid of adult-use and medical sales, are all patients being given the care and attention they deserve?
Making Room for Medicine
Barring federal policy reform and the establishment of a new nationwide set of standards, to gain the most accurate picture, one must approach this issue on a state-by-state level. As things stand today, there are now medical-only states, states with laws supporting both medical and recreational markets, and states where all products with more than a trace of THC continue to be fully prohibited.
Fortunately, a combination of thoughtful policymakers, seasoned advocates and generous cannabis companies are working to ensure patients continue to be an overall priority in the industry. In Oregon, for example, many dispensaries are dual-licensed—a quirk of the state’s legislation, but also a testament to the stores’ own values and desire to take care of their medical customers.
(To clarify, being a medical patient doesn’t automatically make someone a compassionate care patient, though there’s certainly overlap between these groups.)
How compassionate care programs will figure into federal legalization policy when such a day eventually arrives will be a matter of which bill gets the favor of Congress. If those in charge do attempt to forget the rights of individuals needing access to free or discounted cannabis, one can expect cannabis advocates to fight for patient rights, as they have since the days of Prop 215.