Vermont is preparing to embark on a major overhaul of its struggling medical cannabis program, which has steadily lost registered patients since the state made it legal for people to grow weed at home in 2018.
The decrease has accelerated since late 2022, when stores selling cannabis legally to all adults began to open in Vermont. The medical program now counts 2,700 patients, down from a high of about 5,700.
Patients who live with one or more of about a dozen conditions recognized by the state can pay $50 for a medical card that’s good for three years. They do not pay taxes on cannabis products, have access to higher-potency concentrates and other specialized items, and are allowed to exceed the one-ounce limit on a single purchase that applies to recreational buyers in Vermont. Medical cannabis dispensaries can also deliver their merchandise and bring it curbside to patients’ vehicles, unlike shops in the recreational, or adult-use, market.
But there will be just two medical-only dispensaries left in the state — in Brandon and Montpelier — after a South Burlington dispensary, Ceres Collaborative, closes soon.
A new law scheduled to take effect on July 1 would allow any of the 100-plus shops in the recreational market to apply for a “medical use endorsement.” With that permission, a shop could also operate as a medical dispensary and thus sell and deliver high-potency, tax-free weed to registered patients. The control board has published proposed rules to carry out the new law, subject to a review this winter and spring that includes a public hearing and comment period.
“This, to me, is not about injecting new life into the program,” said James Pepper, chair of the Vermont Cannabis Control Board, which regulates the industry. “It’s about making sure that the existing patients and the people that the legislature has deemed are qualified to access medical cannabis still have that access.”
The Vermont Medical Society has raised concerns about potential abuse of the proposed cannabis rules.
It’s unclear how many of the dozens of licensed recreational shops will participate. Given the small number of registered patients, people in the industry say selling medical cannabis will not be a moneymaker. The endorsement costs $250 each year, on top of the $10,000 annual retailer license fee, and budtenders would have to complete training on how to serve this new clientele.
Shops would have to provide patients a private space for confidential consultations, if asked, and must keep medical products “physically segregated” from recreational weed. The tax-free sales would be tracked separately, too.
The Vermont Medical Society has raised concerns about potential abuse of the proposed cannabis rules. Vermont is one of a few states that have imposed a limit on the amount of THC, the psychoactive ingredient in cannabis, allowed in certain products for recreational use. Consumers, manufacturers and retailers have complained about the cap for years, saying it pushes patrons into the black market, where higher potency cannabis concentrates are readily available.
The new changes, the medical advocacy group has said, could encourage a recreational customer to register as a patient to win access to more potent merchandise. And the medical program — unlike recreational sales — is available to patients under 21, provided their doctor approves. (About 40 patients under the age of 21 are now enrolled in the medical program.)
Pepper said regulators are aware of these potential loopholes. He said certain rules will provide a check, such as one that requires a patient to get a physical exam and have at least a three-month “bona fide” relationship with their doctor. If a particular physician is signing up lots of patients, for instance, the control board can alert state licensing boards to a potential violation, Pepper said.
“It’s going to be incumbent on us to really make sure that this is rolling out the way that we intended and it’s serving the people that it’s intended for,” he said.
About a dozen retailers have expressed interest in the endorsement, according to Pepper, and several others were enthusiastic about the program in interviews with Seven Days. They described their commitment to providing what they consider medicine to sick people who have found that cannabis soothes their symptoms — chronic pain, most commonly. Many proprietors already provide medical customers with a 20 percent discount that covers the sales and excise taxes on recreational cannabis.
Dove Sharp, co-owner of the Gas Station in Rutland, is one of those. During what she described as a typical week earlier this month, about 57 customers showed their medical cards and got a discount on their purchases. She’s looking forward to providing them with the specialized items that are now available only at the medical dispensaries.
“There’s just not a lot of options for medical grade right now,” Sharp said. “Even though it may seem like a small population, it’s still an important one.”
An example of the new rules in action is sprouting in a storefront in downtown Winooski. Hello, Hi opened last week as a “co-located” dispensary that sells both recreational and medical cannabis. Inside the bright, 1,700-square-foot space, a sliding door hides a small soundproof and windowless room. That’s where patients can privately confer with budtenders about their options and openly discuss their medical conditions, according to Christopher Walsh, a veteran of the cannabis industry who is president and CEO of Grassroots Vermont, which owns Hello, Hi.
Grassroots, which is based in Brandon and delivers to patients all over the state, is one of the two remaining companies with a state medical cannabis license. Vermont law gave those businesses access to an integrated license, which enables them to grow, wholesale, test, manufacture and sell both medical and recreational cannabis.
“We are kind of the OGs in medical, and I take it very seriously,” said Walsh, who noted that Grassroots opened its Brandon dispensary in 2013. “The idea, like, ‘Oh, I’ll just pay a little extra for a medical license, get stronger product, and it’ll be more revenue’ — there’s so much more to it.”
He said he’s supportive of the medical use endorsement as a way of increasing access, but he wants more restrictions on who can obtain it. He fears some recreational shops will get into the business for the wrong reasons and thinks there should be limits on how many shops in a given geographical area can sell to medical customers.
Over the years, patients have collaborated with Grassroots budtenders to figure out what products — and what dosages — work for them, Walsh said. Because they’ve provided the service for so long, Walsh said, his budtenders have anecdotal evidence about the best treatments for certain conditions or symptoms.
“Adult use, and there’s nothing wrong with this, but it’s just purely transactional,” Walsh said. “So if that’s what you’re doing 90 percent of the time, do you have the experience, the patience and the willingness to do a lot of hand-holding?”
Eddie Furci, co-owner of the Winooski Organics cannabis store, says he’s up for the challenge. Patients have been coming to his store and venting about the poor experiences they’ve had at the small number of medical dispensaries, he said. They’ve asked for specific products, such as transdermal patches, suppositories and custom formulations, that Furci would be able to sell once he has the medical endorsement. All products will need to be tested by a third party and registered with the state.
“The program has obviously been losing a lot of patients, and I think that’s just because of the quality of the program,” Furci said. “Patients who let their med cards lapse would probably get them again because now they have an actual reason.”
Amy Lems has been a patient for 10 years, but she’s one of those who has found little reason to use the medical program. The Norwich resident has Ehlers-Danlos syndrome, a disorder that affects the body’s connective tissues, and got her card because cannabis helped alleviate her symptoms.
But she was disappointed in the quality and selection of medical cannabis products and couldn’t get the higher-dose concentrates that she wanted. She rarely bought from a dispensary.
Instead, she mostly made her own stuff. But she said the new regime will allow her to shop for a wider variety of medical-grade extracts that take more skill and equipment to produce.
Lems has ideas for other changes she’d like to see, such as direct-to-consumer sales, which would allow manufacturers to circumvent retail shops and bring down prices.
But for now, she said, “this is a really good step forward.”
The original print version of this article was headlined “Going Hybrid | Vermont will allow recreational cannabis dispensaries to sell tax-free, high-potency product to medical patients”
This article appears in The Wellness Issue 2025.
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