Despite being one of the first states in the U.S. to legalize medical marijuana, Colorado gets a C+ when it comes to ensuring patient access to the drug, a national medical cannabis advocacy group said in a new assessment.
Americans for Safe Access said it downgraded Colorado this year because of a new law that limits access to high-potency THC products โ calling it โthe single biggest rollback of patient rightsโ in the country.
“Other states have rolled back some patient provisions, but not as severely, or quickly, as Colorado,โ said Abbey Roudebush, the groupโs government affairs director. The annual report evaluates medical marijuana programs across the U.S. and grades them based on factors like patientโs rights, consumer protection and product safety.
The report is the latest criticism of House Bill 1317, which went into effect in January after passing with broad bipartisan support.
The measure was intended to curb youth access to high-potency THC products by capping the daily amounts people can purchase and requiring patients 20 and younger to get signatures from two different physicians at two separate practices in order to obtain a medical card, among other rules. The bill was supported by parent groups that cited anecdotal evidence of youth who suffered negative mental health impacts, like anxiety or psychotic breaks, after consuming marijuana concentrates.
Critics say the law creates new barriers to access for all patients, including for young people who rely on cannabis for medical treatment and may have to travel long distances to find a doctor. Some doctors say they will no longer treat cannabis patients because of new requirements under the law, including a clinic in Colorado Springs which decided to shut down entirely.
The stateโs Marijuana Enforcement Division, which is responsible for licensing and regulating medical and recreational cannabis statewide, declined to comment on the report but noted the agency is responsible for implementing laws passed by the General Assembly.
One of the prime sponsors of the bill, House Speaker Alec Garnett, a Denver Democrat, did not respond to a request for comment. In recent weeks, Garnett has said he is monitoring concerns about the lawโs impacts and declined to comment further because of a lawsuit challenging the constitutionality of the law.ย

The Colorado attorney general, on behalf of the state, is seeking to have the lawsuit dismissed.
Americans for Safe Access, the largest national advocacy group for medical cannabis patients, doctors and industry groups, has issued an annual report card for state programs since 2014. As more states have legalized medical and recreational cannabis, the groupโs rubric changed this year to focus more on patient rights and experiences rather than giving states credit for legalization, said Steph Sherer, the groupโs president.
โWeโve come a long way โฆ but when you look at what patients need, weโre still a pretty far way off,โ Sherer said.
A total of 36 states and five U.S. territories have adopted laws that allow at least some access to medical cannabis, while another 13 states allow for use of certain cannabidiol, or CBD, products that contain little or no THC, the psychoactive substance found in cannabis. Another 18 states, plus the District of Columbia and Guam, have passed laws allowing recreational use by adults over 21.
In Colorado, sales at medical and recreational dispensaries hit a new record in 2021 at $2.2 billion. The state collected $423,486,053 in tax revenue, a more than 9% increase from the previous year.
Despite a middle-of-the-road grade, Colorado is considered to have a โfair medical cannabis programโ that still needs โsubstantial improvementโ in some areas. The stateโs rating dropped after receiving B marks from the organization over the past few years, although major changes in the reportโs methodology also contributed to that decrease, said Roudebush.
Among all U.S. states, the average grade was a D, reflecting โcritical and substantial deficiencies in access or patient rights,โ according to the groupโs rubric.
No states received an A in this yearโs report card. Maine, which implemented a new recreational cannabis program two years ago, received the highest grade with a solid B, picking up credit for improving patient access to cannabis, programs that allow people to see a doctor virtually and regulations that incorporate feedback from patients and providers. Illinois, which received a B-, was praised for granting sales tax breaks to medical patients and allowing medical cannabis registrations over multiple years, cutting down on doctor visits and fees.
California, Delaware, Maryland, Missouri, New Hampshire, New Jersey, Nevada, Ohio, Pennsylvania and Rhode Island also received C+ grades.
The report was sharply critical of Coloradoโs crackdown on high-potency THC products. The law should be repealed โbefore it devastates the stateโs patient population and creates a crisis of access,โ the report said.
The group, however, credited Colorado lawmakers with the passage of a law that expands rules for school staff to administer medical cannabis doses to minors on school grounds.
โThis is an important step forward in providing a safe and fair public education for Coloradoโs citizens and will take a great burden off of the stateโs parents who have been responsible for dosing up to this point,โ the report states.
The report also urged Colorado and other states to pass state-level protections for medical cannabis patients who could still lose their job or be discriminated against for housing because cannabis remains illegal under federal law.
Roudebush said lawmakers shouldnโt confuse recreational cannabis with medical cannabis.
โItโs very important for states and lawmakers โฆ not to forget about the very real patients who rely on the medical cannabis program,โ Roudebush said.
