Is getting a medical cannabis card worth it? Ohioans and Kentuckians weighing those decisions have a lot to consider in the coming year. Recent data shows a staggering 43% decline in active Ohio medical patients since adult-use sales began. South of the river, Kentuckians who rushed to join the registry last year are facing a different kind of frustration—a program that exists on paper but nowhere to use your card.
With the full implementation of Ohio’s Senate Bill 56 in March* and looming federal scheduling policy changes, will patient and consumer behaviors surrounding cannabis change in 2026? Here’s what we understand:
The Divide between Patient and Consumer
For some context to what is happening in Ohio, we can look to our neighbor to the North. Michigan’s medical program often serves as the “canary in the coal mine” for states like Ohio and Kentucky. In 2026, the data shows that Michigan’s medical registry has plummeted by over 70% since its adult-use market launched in late 2019.
The reasons for Michiganders dropping their cards are nearly identical to the pressures now hitting Ohio, proving that when a state goes “Rec,” the medical program often experiences a drastic reduction in enrollment.
Why are patients walking away? The reasons go far beyond the cost of a doctor’s visit. While the convenience and anonymity of recreational shopping is tempting, the regulatory landscape of 2026 has created a massive divide between “consumers” and “patients.”
For those with chronic conditions, the medical card still offers major advantages that adult-use lacks:
1. Avoiding the 10% Excise Tax
Adult-use consumers in Ohio now pay a 10% excise tax on every purchase. Medical patients remain exempt from this. When you add up state and local sales taxes, recreational users often pay nearly 18% in total taxes. For a frequent shopper, the card (typically around $50) pays for itself in tax savings within weeks or months.
2. Discounts and Potentially Shorter Lines
Many Ohio dispensaries have instituted incentives for medical patients, including a separate, often shorter line for orders and discount days up to 30 percent off products for cardholders.
3. Regional Access: Reciprocity
If you live in the Cincinnati tri-state area or travel to Kentucky often, your Ohio medical card may also be valid for purchases in Kentucky dispensaries when they open. Kentucky officially accepts out-of-state medical cards for “Visiting Qualified Patients”. If you commute across the river or live near the border, your Ohio medical card may mean you have access to Kentucky’s emerging medical market.
4. Legal Protections Help Your Attorney Argue on your Behalf:
Traffic stops: In both Ohio and Kentucky, police can still charge you with an OVI/DUI if they suspect impairment, regardless of the law. However, a medical card provides a layer of protection that adult-use consumers lack. Having a medical card can assist your attorney in defending against “per se” charges (being over a specific THC limit) if you can prove you were using your medicine as directed by a physician.
In Kentucky, the Governer’s Executive 2022-798 covers only documented medical patients who are under the care of a physician. While the state’s formal medical cannabis program (established by Senate Bill 47) is now operational, this original executive order remains a vital “safety net” for patients, especially given the slow rollout of local dispensaries.
Custody Cases: Kentucky’s newer medical statutes (SB 47) explicitly state that a parent’s status as a medical marijuana patient cannot be the sole basis for determining that a child is neglected or for denying custody, which is also the law in Ohio. If an ex-partner accuses you of “drug abuse” due to using cannabis, it moves the argument from a criminal act to a healthcare choice, a shield that recreational users do not have.
Probation and parole: MedicateOH has previously covered the potential benefits of having a medical card if you are currently on probation or parole. A medical card can help your attorney argue that you need to use your cannabis medicine during your punishment period.
The Cons: Privacy, Stigma, and the “OARRS” Burden
Despite the perks, the Ohio medical program is facing lower enrollment than ever. There are several reasons keeping patients from signing up or renewing their cards:
The OARRS Privacy Trap
Every medical cannabis purchase in Ohio is still reported to OARRS (Ohio Automated Rx Reporting System).
- Pharmacist Backlash: Many Ohio pharmacists have been vocal that cannabis—which is not FDA-approved—does not belong in a database meant for high-risk narcotics. They argue it “clutters” the data and creates unnecessary red tape.
- The Clinical Guessing Game: Because your use is flagged in OARRS, every doctor you see (from surgeons to specialists) sees your cannabis history. Because of a lack of federal studies, many doctors “guess” at potential drug interactions, sometimes leading them to withhold other necessary medications out of an “abundance of caution.”
- Gun rights: Those who exercise their second amendment rights to carry firearms are technically in violation of federal law if they use cannabis or other controlled substances. Having a medical card means that all your cannabis purchases are documented, something that some gun owners have expressed concern over.
The “Revenue over Relief” Shift
In 2026, it is clear that the DCC’s rules are being written for the billion-dollar adult-use market.
- Vanishing Medicine: Cultivators are abandoning low-THC/high-minor-cannabinoid (CBG, CBN) strains because they don’t sell, even though these are the products patients say they need.
- Stripped Protections: SB 56 stripped away many non-discrimination protections for adult-use consumers. While medical patients have a slightly stronger legal standing, the state is moving toward a “workplace-first” policy.
What Benefits Does a Medical Program Bring to the Market?
When a patient participates in the medical program, their journey is documented in a way that goes far beyond a simple sales receipt. This data creates a bridge between anecdotal “stoner lore” and legitimate clinical science.
- Benefits for Patients: Personalized Care and Proof of Progress
By tracking which terpene profiles, cannabinoid ratios, and delivery methods work for specific qualifying conditions, the state creates a collective knowledge base. New patients can benefit from aggregated data showing, for example, that 75% of patients with PTSD found better symptom management with a specific ratio of THC to CBD rather than high-potency flower alone.
Data from the Ohio and Kentucky registries is also used to prove the “Opioid Substitution Effect.” Recent studies from the Ohio State University Drug Enforcement and Policy Center show that 79% of patients reported that medical cannabis reduced their need for prescription painkillers. This hard data is needed for evidence, advocacy, and changing the stigma.
- Benefits for Consumers: Safety and Quality Control
Even if a consumer chooses the recreational route, they are standing on the shoulders of the medical program’s data standards. The strict testing data required for medical products—tracking heavy metals, pesticides, and mold—sets the floor for the entire market. Because medical transactions are linked to patient files, it is much easier to track and identify adverse reactions. This data allows for rapid recalls that protect everyone in the market, not just cardholders.
- Benefits for Companies: Growing for the Patient, Not the Hype
For local operators, medical data is an important factor for product development. Instead of guessing which strains to stock, companies can use data to see an unmet need for minor cannabinoids like CBN for sleep or CBG for inflammation. This prevents a situation where therapeutic products are pushed off the shelves by high-THC recreational flower that sells more quickly.
Cultivators use patient feedback data to refine their genetics. If data shows a specific cultivar is highly effective for migraines, they can prioritize that crop, ensuring a stable supply for those who rely on it as a primary medicine.
What Would an “Ideal” Patient Program Look Like?
As patients move toward anonymous adult-use purchases, companies are driving with a blindfold on. They know what is being sold, but lose the ability to track why it was bought or how it helped the person who bought it.
Staying committed to the medical side of the business is a way to stay connected to this data. It ensures that the industry continues to evolve as a healthcare solution, rather than just a retail commodity. Ohio could make some key changes to preserve the program:
- Sever the OARRS Link: Move medical records to a private, HIPAA-compliant database that isn’t shared with the Board of Pharmacy.
- Mandatory Medical Menus: Require dispensaries to carry a minimum percentage of therapeutic ratios.
- True Employment Protection: Treat a medical recommendation like a legal prescription that HR departments must accommodate.
Some of these changes might already be in the works as Ohio bends to the proposed federal reclassification of cannabis, although there is no timeline for implementation of that. Read more on the federal rescheduling in our story here.
MedicateOH Patient Survey
Have more to share about your own experiences with the Ohio Medical Marijuana program? Fill out our survey here: https://docs.google.com/forms/u/0/d/e/1FAIpQLSeLvfMeqPfuGCHL3iBcPtIgGinnQlCNAOFq8gwgcpOGKVwYrA/viewform?usp=publish-editor&pli=1&authuser=0
Efforts to Overturn in Ohio, Expand Access in Kentucky
*In March, Ohio’s Senate Bill 56 is scheduled to be implemented, but one Ohio advocacy group is trying to stop them. Ohioans for Cannabis Choice is arguing that the bill defies the will of the 57% of voters who approved the adult-use initiative (Issue 2) in November 2023. The group filed a referendum in December. They will now need to collect roughly 250000 signatures from across the state to block the bill in the next 90 days. If they are successful, the portions of SB 56 that they oppose would not be implemented in March and instead put to voters on November’s ballot.
In Kentucky, a new bill has been filed that would expand access to all adults. HB 199 would decriminalize cannabis in the Bluegrass state. While this bill is not expected to advance, advocates may want to reach out to their legislators to express support.
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