America's One Million Legal Marijuana Users
by Russ Belville, NORML Outreach Coordinator, host of NORML Live
 
We don't know his or her name, but somewhere in one of 16 states and the District of Columbia is America's 1,000,000th legal medical marijuana patient. We estimate the United States reached the million-patients mark sometime between the beginning of the year to when Arizona began issuingpatient registry identification cards online in April 2011.
Between 1 and 1.5 million people are legally authorized by their state to use marijuana in the United States, according to data compiled by NORMLfrom state medical marijuana registries and patient estimates. Assuming usage of one half to one gram of cannabis medicine per day per patient and an average retail price of $320 per ounce, these legal consumers represent a $2.3 to $6.2 billion market annually.
Based on state medical marijuana laws, the amounts of cannabis these legal marijuana users are entitled to possess means there are between 566,000 to 803,000 pounds of legal usable cannabis allowed under state law in America. These patients are allowed to cultivate 17 to 24 million legal cannabis plants. There may possibly be more, as California and New Mexico "limits" may be exceeded with doctor's permission and some California counties explicitly allow greater amounts; there may be as much as 1 million pounds of state-legal cannabis in America.
Yet after 15 years, 1 million patients and a million pounds of legal marijuana, few if any of the dire predictions by opponents of medical marijuana have come to fruition. Medical marijuana states like Oregon are experiencing their lowest-ever rates of workplace fatalities, injuries and accidents. States like Colorado are experiencing their lowest rates in three decades of fatal crashes per million miles driven. In medical marijuana states for which we have data (through Michigan in 2008), use by minor teenagers is down in all but Maine and down by at least 10 percent in states with the greatest proportion of their population using medical cannabis.
Fourteen of the 17 medical marijuana jurisdictions have mandatory registries while two (California and Colorado) offer optional registries and one (Washington) has no registry system. Estimating California's patient numbers is hampered by its registry system being on a county-by-county basis. California NORML's Director Dale Gieringer estimates that between 2 to 3 percent of the state's population hold medical marijuana recommendations -- meaning possibly over one million medical marijuana patients in California alone.
California's patient population can be estimated from data from other medical marijuana states where patients are required to register, shown in the table below. The top two of these are Colorado and Montana, which, like California, have a well developed network of cannabis clinics and dispensaries, and which report usage rates of 2.5% and 3.0%, respectively. Other states, where medical marijuana is less developed, report lower rates of 1% and less. However, California is likely to be on the high side because it has the oldest and most liberal law in the nation. Significantly, California is the only state that permits marijuana to be used for any condition for which it provides relief - in particular, psychiatric disorders, such as PTSD, bipolar disorder, ADD, anxiety and depression, which account for some 20%-25% of the total patient population. Adjusting for this, usage in California could be as much as 25% to 33% higher than in Colorado and Montana, which would put it well over 3% of the population (1,125,000).
A 2%+ patient population estimate is supported by data from the Oakland Patient ID Center, which has been issuing patient identification cards to its members since 1996. The OPIDC serves patients from all over the state, but especially the greater Oakland-East Bay area of Northern California, where its cards are honored by law enforcement. As of 2010, the OPIDC had issued ID's to 19,805 members from five East Bay cities (Oakland, Berkeley, Alameda, Hayward and Richmond), amounting to 2.4% of the local population. Because the cards were issued over a period of 14 years, they include numerous patients who have lapsed, moved, or deceased. On the other hand, they do not include many other local patients who have current recommendations but never registered with the OPIDC.

We have made a similar estimate for Washington State's patients, who are the only ones in the nation with no registry system in place (Gov. Gregoire recently signed a bill that initiates a voluntary registry). With a law very similar to Oregon's concerning qualifying conditions, applying Oregon's 1.04% patient population figure gives us about 69,000 patients in Washington. However, Washington State's larger urban centers (Seattle and Spokane), combined with a more liberal law than Oregon's regarding who can sign recommendations (osteopaths, naturopaths, and nurse practitioners can recommend in Washington) and the lack of a state registry's burden to patient compliance with the program suggests a higher estimate of 1.5%-2% may be appropriate. Numbers like Colorado's 2.5% and Montana's 3% are improbable as Washington lacks the greater patient access to dispensaries seen in those states.
Delaware, New Jersey, and D.C.'s programs are not operational yet, so they are not shown in our data table. Most of the other state's programs produce reports of patient registry numbers. With Arizona signing up over 3,600 patients since mid-April, when it's online-only registration went into effect, Arizona is on track to register over 30,000 patients this year.
Quick Facts about Medical Marijuana States:

• The 1.1 - 1.5 million estimated and registered medical marijuana patients in America are legally entitled to cultivate 17 - 24 million cannabis plants and possess 283 - 402 tons of harvested buds.
• The seventeen jurisdictions with medical marijuana encompass over 90 million Americans and 162 votes in the 2012 Electoral College.
• Patients make up over 3% of the population of Montana, almost 2.5% of Colorado, over 2% of California. and over 1% of Oregon, and Washington.
• After Michigan at 0.76% of population, every other medical marijuana state has less than 3 in 1,000 (0.3%) patients in its population.
• California, Colorado, Washington, Michigan, Oregon, and Montana comprise over 98% of the legal medical marijuana patients in America.
• More than 3 out of four (77% - 83%) of all medical marijuana patients live on the West Coast.
• Rhode Island and Vermont, two states where over 10% of the adult population uses marijuana monthly, have patient populations of 0.29% and 0.05%, respectively.
• Monthly teen use of marijuana is down in every medical marijuana state except Maine.
• Annual highway fatalities are down in every medical marijuana state except Rhode Island.
• Incidents of workplace injuries and illnesses are down in every medical marijuana state.