Why Aren’t More Patients Utilizing Medical Cannabis Reciprocity Programs?

Reciprocity, the legal process allowing a state-issued license to be accepted in other states, is relatively common among medical cannabis states. 

But it seems that not that many people actually use reciprocity, particularly in high bar states like Oklahoma.

About half a dozen medical cannabis states recognize medical cards from other states, according to the Marijuana Policy Project, including Arkansas, Hawaii, Missouri, Rhode Island, Arizona and Oklahoma. New Mexico is the latest state to add reciprocity, having recently passed it into law, and Washington DC also accepts medical licenses from legal states.

But it’s hard to find a patient who’s actually taken advantage of the program, which seems to be underused, possibly because of unwieldy regulations in some states.

“I know of some people using it, but it’s hard to see how widespread it is,” said Karen O’Keefe, director of state policy use for the Marijuana Policy Project. She said that some states like Hawaii accept out-of-state licenses without additional paperwork. But in a state like Oklahoma, the reciprocity process requires additional bureaucracy. 

Obstacles in Oklahoma

Oklahoma is one of the newest entries to the roster of medical cannabis states, and certainly one of the most enthusiastic. By the time Oklahoma completed its first year of legalization in September, the state had approved more than 7,300 medical cannabis business licenses, including 1,848 dispensaries, 1,173 processors, and 4,287 growers. The state had approved more than 178,000 patients by September. 

“The growth in Oklahoma is due in part to high consumer demand coupled by low barriers to market entry and comparatively fewer regulatory hurdles compared to other states,” said NORML Deputy Director Paul Armentano.

The Oklahoma Medical Marijuana Authority allows out-of-state holders of medical cannabis cards to obtain temporary medical cards allowing them to buy, use, possess, and grow cannabis. But the Authority could not be reached to provide a number of how many patients have actually done this.

According to Norma Sapp, Oklahoma state director for NORML, the number of medical cannabis patients is now closer to 222,000, in a state with a population of less than 4 million. She said that reciprocity has been part of the state’s program since it was incepted last year. She said the reciprocity makes sense in a system where federal restrictions do not allow the transport of medical cannabis between states where it’s legal. But she’s only aware of one out-of-state patient who actually tried to get a temporary Oklahoma license.

“I know of one person who tried it but she was gone before the weekend was out so she didn’t get to use it,” said Sapp. She said that temporary licenses have to be applied for a month in advance and cost $100, so it doesn’t do much good for a weekend visitor.

Waleed Nasir, co-owner of the Herbal Cure dispensary in Okmulgee, Oklahoma, said he was not aware of anyone trying to use an out-of-state license in his year-and-a-half of doing business.

“It’s a lengthy procedure,” said Waleed, whose company is expanding, with the recent addition of a second dispensary. “It hasn’t been used much.”

He said that out-of-staters might be taking advantage of “a big off-market,” in the latest example of illicit market competition versus the struggling, higher-cost legal cannabis industry.

In some ways, the system for cannabis reciprocity resembles the system that gun advocates have been trying, and failing, to get through Congress, where concealed carry permits from some states would be accepted in others. But this runs into hurdles because some states set a higher bar. Just as New York and Massachusetts have more rigid restrictions for concealed carry permits than Florida or Texas, some states do not allow the same qualifying conditions for medical cannabis as other states. A resident of California or New Jersey with a medical cannabis card for anxiety won’t get that accepted in a dispensary in Oklahoma or Hawaii, which does not accept anxiety as a qualifying condition.

Dr. William Levine, CEO of CannRx, a tech company focused on the consistency of therapeutic effects from delivery systems like vaping, said that reciprocity is a challenging but necessary system for achieving state-to-state standards of medical cannabis.

“It’s not an easy thing, the reciprocity, but it’s a positive,” he said. “It will harmonize the states with other states, allowing for better regulations. I think the industry is morphing into that space, but the regulators are all trying catch up with what the public voted on.”