Adult-use legalization expands access to cannabis, but it can also weaken the value proposition of the medical market. Connecticut is experiencing that tension firsthand.
Erin Gorman Kirk serves as Connecticut’s Cannabis Ombudsman (Ombuds), leading what she describes as the country’s only dedicated cannabis patient advocacy office. In a recent conversation with Emerald Intel Chief Economist Ed Keating, Kirk drew on two years of direct patient advocacy—and a much longer history working around cannabis policy—to explain where Connecticut’s market is succeeding and where patients are still being underserved.
Her perspective is especially relevant for operators because she sits at the intersection of patients, regulators, retailers, manufacturers, and policymakers. What she sees is not simply a patient-access problem. It is a market-design problem involving product economics, retail education, competition, and the future structure of the industry.
What Happens to Medical Cannabis After Adult Use Arrives?
Connecticut created the Cannabis Ombuds office partly because policymakers anticipated what adult-use legalization could do to the medical program. That concern has proven justified. Kirk says Connecticut’s medical patient population has fallen from roughly 60,000 to around 30,000 since adult use arrived.
That decline changes the economics of serving medical consumers. Manufacturers have less incentive to produce specialized products for a shrinking population, while patients have less incentive to maintain medical status if the experience increasingly resembles ordinary adult-use retail.
Kirk has heard the consequences directly from patients, including people weighing the cost of cannabis against prescription alternatives. She recalled one older patient explaining why rising costs had forced her to return to opioids: “I’m an 80-year-old woman and I was using opioids for pain relief, but now I’m using cannabis. However, it’s become too costly for me. And so now I’m back to opioids.”
Kirk went on to explain that the patient also faced transportation costs because she could not drive while using opioids. It is a powerful example of why cannabis affordability cannot always be evaluated through retail price alone. For some patients, the real calculation includes mobility, independence, alternative medications, transportation, and quality of life.
That is also why Kirk believes medical programs need a genuine reason to exist alongside adult use. Connecticut has extended medical card durations, introduced reciprocity, and maintained tax and product advantages for patients. But those benefits only work if operators continue producing products patients need and providing an experience that is meaningfully different from recreational retail.
Are Cannabis Companies Making the Products Patients Actually Need?
Kirk’s office has tried to answer that question with data rather than anecdotes alone. Working with a University of Connecticut graduate student, her office surveyed approximately 36,000 medical patients and conducted follow-up interviews. Three concerns consistently emerged: affordability, availability, and consistency.
Consistency is particularly important because a product disappearing from a menu can have different consequences for a patient than for an adult-use consumer. Kirk cited the disappearance of products such as THCA drops used by a young epilepsy patient and described contacting manufacturers to understand why certain medical products were no longer being made. Sometimes the answer is straightforward: return on investment.
That puts operators in a difficult but important position. A product serving a small medical population may not produce attractive unit economics, particularly as the overall patient base contracts. But removing those products can accelerate the very decline that makes medical production less economical.
The strategic question is therefore larger than whether an individual SKU sells enough units. Operators serving medical markets should understand which products create patient dependency and retention, whether reasonable substitutes exist, and what happens to the medical channel when those products disappear.
Kirk is not suggesting manufacturers ignore economics. She is asking them to recognize that medical cannabis has a different set of economics—and responsibilities—than conventional consumer packaged goods.
Has Cannabis Retail Lost Too Much of Its Medical Identity?
Kirk is equally concerned about what happens after the patient reaches the dispensary.
Connecticut’s original medical model included pharmacists and opportunities for private consultation. As hybrid medical/adult-use stores have expanded, some operators have moved away from keeping pharmacists physically on-site. Kirk sees that as more than a staffing decision.
Patients regularly ask her why they should maintain a medical card when their dispensary experience no longer feels particularly medical. Her response has been to push for stronger education throughout the retail environment, including responsible-vendor training and greater knowledge among frontline employees.
She also tests that knowledge herself: “I go into stores and I say, can you tell me what myrcene is? Can you tell me what a terpene is? Can you tell me what the difference between this hybrid and that hybrid is? I ask, do you know what the endocannabinoid system is?”
Those questions reveal Kirk’s larger point: regulated access is not the same as informed access. A store can have hundreds of compliant products on the menu and still leave consumers without enough information to make useful choices.
For retailers, that gap represents an opportunity. Kirk described visiting one dispensary where an employee proactively engaged customers, asked questions, and helped several older women navigate the experience. She was impressed enough to contact the company afterward.
Her message to management was simple: “If you can train everybody like that, you’re going to become the standard.”
That is where patient advocacy and retail strategy converge. Better education can improve trust and product discovery while giving medical consumers a reason to remain in the regulated medical channel. In a market facing increasing price competition, knowledgeable service may be one of the few advantages that is difficult for competitors to immediately copy.
Are Licensed Cannabis Businesses Competing on a Level Playing Field?
Kirk becomes particularly animated when discussing competition between licensed cannabis businesses and smoke or vape shops selling products outside Connecticut’s regulated cannabis framework.
Licensed operators have invested substantial capital to satisfy state requirements. When other retailers can sell competing intoxicating products without bearing comparable regulatory costs, Kirk argues that weak enforcement does more than create a compliance problem. It undermines the economics of the licensed system.
“If you really cared and you wanted to support the businesses that have paid into the licensing scheme at great personal cost and monetary impact, then you’d close the smoke shops down and you’d help us educate people.”
Her criticism highlights a structural problem facing regulated markets nationwide. Compliance only functions as intended when the rules meaningfully distinguish licensed businesses from businesses operating outside them. Otherwise, testing, licensing, security, and other regulatory costs become disadvantages borne primarily by companies following the rules.
Kirk believes education needs to accompany enforcement. Consumers need to understand the difference between a licensed cannabis dispensary and another storefront selling intoxicating products. For operators, that distinction directly affects consumer trust, pricing power, and the value of holding a license.
Could Connecticut Compete in an Interstate Cannabis Market?
Kirk’s thinking extends well beyond Connecticut’s current market. Her background includes maritime commerce, supply chains, military work, and international trade, and she brings that perspective to one of the cannabis industry’s biggest long-term questions: interstate commerce.
Rather than viewing Connecticut, Massachusetts, New York, New Jersey, Rhode Island, and other Northeast states exclusively as separate cannabis economies, Kirk sees the possibility of a connected regional market.
“Connecticut has three deep water ports and five universities studying cannabis. And we are geographically located in a beautiful position to not only do domestic but also international commerce.”
That is a very different way of thinking about Connecticut’s cannabis industry. Today, state borders protect operators from direct interstate competition while simultaneously restricting their addressable markets. If those barriers eventually fall, geography, logistics, production costs, intellectual property, brands, and distribution infrastructure could become much more important competitive variables.
Whether that vision arrives quickly or takes considerably longer, operators can begin asking the strategic question now: Is the business designed to succeed because of Connecticut’s current regulatory boundaries, or could it compete without them?
What Kind of Federal Reform Does Kirk Actually Want?
Kirk’s position on federal cannabis reform is similarly nuanced. She wants more research, broader normalization, and greater potential for insurance coverage. But she is wary of reform that simply moves control of cannabis from one restrictive system into another.
“I would love to see the research. I would love to see the insurance coverage, love to see normalization. But I don’t want this to become something I can only get at CVS. I don’t want the pharmaceuticalization of this plant.”
Federal reform is often discussed as an unqualified catalyst for the cannabis industry, but different reforms could produce dramatically different market structures. Rescheduling, descheduling, pharmaceutical involvement, interstate commerce, insurance reimbursement, and continued state control do not lead to the same outcome.
Kirk ultimately favors a much more fundamental change. Asked what she would do if Connecticut Governor handed her a pen and allowed her to change one cannabis law, she did not hesitate: “Decriminalize. Take it off schedule. It’s a plant.”
Kirk wants cannabis normalized, but she does not want patients forgotten in the process. She wants businesses to succeed, but she expects the regulated system to justify the costs imposed on legitimate operators. And she supports a larger cannabis economy while insisting that education, transparency, and patient needs remain part of its foundation.
For cannabis operators, Connecticut offers a useful preview of the questions that emerge after legalization. Access is only the beginning. The harder work is building a market in which patients still see value, licensed businesses can compete, employees understand what they are selling, and operators are prepared for regulatory boundaries that may eventually look very different.
Watch the full Emerald Insights conversation with Ed Keating and Erin Gorman Kirk for her perspective on where Connecticut’s cannabis market is working, where it is falling short, and what she believes should come next.
