Of the 29 states that have effective medical marijuana laws, only three restrict patients to pills, oils, and other products derived from cannabis, but do not permit the actual plant itself.  This limitation drives up prices and deprives patients of the medicine that works best for them.
Research has shown marijuana in its natural, flower form is an effective treatment.
Dozens of studies demonstrate the medical benefits of cannabis in its natural form. In contrast, oils and liquids available under more limited programs have not been tested. There is no good reason to deny an incredibly sick individual access to a product that has been studied and proven to alleviate a variety of medical conditions.
Flower marijuana has the “entourage effect.”
As reported by CNN’s Dr. Sanjay Gupta, marijuana contains more than 480 natural components, including cannabinoids and terpenes. “[A]ll these components of the cannabis plant likely exert some therapeutic effect, more than any single compound alone. … Unlike other drugs that may work well as single compounds, synthesized in a lab, cannabis may offer its most profound benefit as a whole plant, if we let the entourage effect flower.”
While some of these components have been isolated, like CBD and THC, many others have not. Israeli researcher Raphael Mechoulam and his colleagues believe using whole plant marijuana allows all of the components found in marijuana to work together, resulting in a greater therapeutic effect than any single compound accomplishes on its own. Most liquid cannabis does not contain the terpenes found in raw, whole plant marijuana, which could weaken the potential therapeutic effect. In addition, many patients find eating raw, whole plant marijuana is an effective way to derive the therapeutic benefits of the plant without the high associated with smoking or vaporizing it.
Flower allows patients to better titrate their dosages.
Allowing patients to vaporize dried marijuana flower gives them the ability to better control their dose. A patient can use a small amount and wait mere moments to determine if he or she needs more. This is because once inhaled, cannabinoids rapidly pass from the lungs to the blood stream. By contrast, the liver must first metabolize pills over a period of up to several hours before the patient feels the effects, leaving an already vulnerable individual guessing at how much to ingest. While oils can be vaporized, there is no need to force patients to use extracts that have different concentrations of cannabinoids. They simply do not work for some patients.
Dried flower is the most affordable option for patients.
Seriously ill patients frequently face tremendous medical costs, but often have no income or rely on government disability benefits. Government-issued and private medical insurance will not cover the cost of medical cannabis, forcing patients to pay the full price for their treatment. Cannabis in its natural, flower form is significantly less expensive than products that have been processed, and access to it would ease the financial burden on patients. The two states with operational programs that did not allow flower — Minnesota and New York — have had exorbitant prices, resulting in many families paying hundreds of dollars each month. (Following regulatory changes in late 2017, New York will be allowing flower but only in ground, metered doses.)
As medical cannabis expert Sunil Kumar Aggarwal, MD, Ph.D., explains, flower is more effective than processed medical cannabis:
Extracts often leave out therapeutically important terpenoids that are needed for the full medical cannabis “entourage” effect produced by whole plant botanical material. They may also be too potent for some patients to tolerate, compared to the whole plant botanical material (due to a concentration effect and because the terpenoids that strongly modulate the effects of the cannabinoids may be reduced or absent from the extract) and may not be effective for all or allow for careful dose titration.
If only extracts and other processed products are available, there will be a strong incentive for companies to produce only a limited number of strains of cannabis. It is highly unlikely that they would make available the scores of strains needed for different cannabis-responsive diseases because they would have to process each of those strains, which would cut into profits. This would make it impossible for patients to gain legal access to the types of strains that they need, be it one of scores of subtypes of varietals found to be effective.
It is axiomatic that whenever companies process a product, they have to charge more for the processed product than for the unprocessed product. Therefore, this requirement would be horrendous (and unfair) for patients with terminal or debilitating diseases who are of limited means (due to being “working poor,” the disease leaving them unable to work, or medical bankruptcy from the costs of their or their child’s illness). These people will not be able to afford either the processed product or the devices for using it and will be forced either to go to the black market and risk being arrested or to suffer needlessly.
Robin Schneider, medical marijuana patient and executive director of the National Patients Rights Association, explains:
Allowing medical marijuana patients to access and use marijuana flower, in addition to pills and oils derived from the plant, is a key component to workable medical marijuana laws. Raw marijuana flowers do not need to be produced into oils or liquids in order to be therapeutic. In fact, consuming raw or juiced fresh marijuana flowers is an incredibly effective way for patients to introduce THCA, a precursor to THC that has anti-inflammatory and neuroprotective effects, into their bodies. THCA degrades and loses its benefits if it is frozen or stored too long, so oils and liquids can be far less effective at delivering this important cannabinoid. For patients who need immediate relief, vaporizing dried marijuana flower allows them to more easily control their dosage than vaporizing oils derived from marijuana doses. This allows patients to consume enough medical marijuana to relieve their symptoms without becoming intoxicated.
 Those states are Minnesota, Pennsylvania, and West Virginia. New York, which originally banned flower, recently changed the regulations.
 “Early Results of Office of Medical Cannabis Surveys,” Minnesota Health Department, May 2016. (Most patients reported medical cannabis is not affordable, with 35% saying the cost was “very prohibitive” — a 7 out of 7 for its lack of affordability. One parent wrote, “Our son has life threatening seizures and we are spending close to $1000 per month not including travel costs and caregiver expenses.”); “Assessing New York’s Medical Marijuana Program: Problems of Patient Access and Affordability,” Drug Policy Alliance. (77% of patients and caregivers who bought cannabis from a dispensary said they couldn’t afford the monthly costs; 79% reported monthly costs of $300 or more.)
Patients Need Access to Medical Cannabis Flower: Lessons from Minnesota and New York
Of the 29 states with effective medical marijuana programs, only three currently prohibit patient access to marijuana in its natural, flower form — Minnesota, Pennsylvania, and West Virginia. In those three states, patients are only allowed to use marijuana that has been processed into an extract or other product. Data from Minnesota and New York, which initially banned flower, illustrates the negative impact such programs have on patients and businesses. In the only other states that prohibit whole plant cannabis in flower form — Pennsylvania and West Virginia — dispensaries have not begun selling cannabis to patients as of this writing.
Banning Flower Drives Up Costs to Patients
Affordability is a major concern for patients because insurance does not cover the cost of medical marijuana. Unprocessed flower is the cheapest option for patients.
To illustrate this point, compare prices of flower versus extracts at a dispensary in Illinois, a state that has a fairly strict medical program and does not allow non-medical adult use. One gram of flower containing 26% THC and THCA cost $15, meaning that a patient would pay about $58 per gram of THC. Another type of flower cost $300 for 28 grams and contained 22% THC/A, costing a patient about $49 per gram of THC. Compare that to the cost for a gram of THC in extracts — one extract was $60 for half a gram and had just 22% THC/A, costing about $400 for a gram of THC; another was 90% THC/A and cost $55 for half a gram, meaning the patient would pay $122 per gram of THC. Thus, even buying the extremely potent extract in this scenario, a patient would pay $3,458.63 for the same amount of medicine in an extract versus $1,644.27 if the medicine was in flower form.
In both New York and Minnesota, many patients registered for the program but ultimately either turned to the illicit market or stopped treatment altogether because they could not afford dispensary prices. In New York, half the patients who visited a dispensary never returned.
Minnesota opened its patient registry in July 2015. After the first year of the program, 92% of patients reported some benefit from their treatment, and 67% reported a great deal of benefit. However, of the patients that enrolled in the first month of the program, only 45% renewed their enrollment. Over half of patients who registered and made purchases within the first six months stopped purchasing medical cannabis from dispensaries by the end of 2016. In the same survey, 86% of patients reported that they found medical cannabis to be at least somewhat unaffordable, with 29% reporting prices as very prohibitive.
Allowing Flower is Better for Businesses
When patients are not buying their cannabis from dispensaries, medical marijuana businesses face significant losses. When those businesses fail, patients will be left with no legal options for treatment.
A study by New Frontier, which surveyed 300 dispensaries in 10 states, found cannabis flower is the single largest source of revenue for dispensaries, representing 47% of total sales volume.
Minnesota’s two licensed medical marijuana manufacturers lost a combined $11 million in just two years of sales. Minnesota Medical Solutions posted a $1.2 million loss in 2016 and $3 million in 2015. LeafLine Labs lost $4.7 million in 2016, after losing $2.2 million in 2015.
The New York Medical Cannabis Industry Association said companies have invested more than $50 million to build out their operations. Nearly two years after the launch of the program, the state’s five medical marijuana companies were still struggling to generate revenue, combining for a gross total of merely $16 million from April 2016 through August 2017.
In December 2017, the New York Health Department approved allowing at least some types of flower preparations.
New York and Minnesota’s programs are considered the two worst medical marijuana programs in the country, largely because of the problems created when patients cannot access flower. Patients cannot afford their medications and businesses cannot afford to operate. New York has already taken steps to address the issue. When other states consider prohibiting flower, they are risking the health of patients and the success of the program. Based on the available data, there is no reason for another state to make the same mistakes made by New York and Minnesota.
 Data is not yet available for Pennsylvania and West Virginia because the programs are not yet operational.
 See https://weedmaps.com/dispensaries/floramedex#/menu (last accessed 9/14/17)
 THCA turns into THC when the cannabis is vaporized.
 17% died within 18 months of initial enrollment.
 “Cannabis Industry Annual Report: 2017 Legal Marijuana Outlook” New Frontier, July 2017.