It’s common for states that legalize adult-use sales to see a decline in medical marijuana patients, as current and potential patients take advantage of the convenience of the adult-use market. But two Midwest states where only medical marijuana is legal saw lower per patient than in adult-use states, when comparing Illinois, Michigan, Missouri, and Ohio.

Missouri saw the largest percentage of the population become medical marijuana patients in the Midwest, despite having the lowest number of qualifying conditions. This could be because it is mostly surrounded by states that do not have an adult-use market.


Over 2.5% of Missouri’s population is a medical marijuana patient – the highest of all the Midwest states reviewed. There were 158,169 medical marijuana patients as of December 2021.

The average Missouri patient spent over $1,300 in 2021, according to a Grown In analysis. That’s over $110 per month – the lowest of all four states reviewed. 

Sales in the state almost met Ohio’s December 2021 sales, earning $28.9 million and ending the year with over $209.75 million in sales. However, Missouri has 183 dispensaries, while Ohio only has 57 dispensaries as of January. 

Missouri voters approved medical marijuana in November 2018 and the law went to effect in December of that year.

The cost of a medical marijuana patient application is $50. There are over 600 physicians certifying patients. There are 20 qualifying conditions in Missouri, the least of all the states in the Midwest.

There were 3,283 active caregivers in Missouri’s program as of December 2021. 


Over 2.35% of Michigan’s 10 million residents call themselves medical marijuana patients in the state – the highest in the Midwest region. Michigan has an adult-use market, yet this is double that of Illinois, another state in the Midwest with an adult-use market. 

The law allows medical marijuana caregivers to grow cannabis for up to five patients and allows 12 plants per patient.

Total medical marijuana sales in the state exceeded $481 million in 2021. That’s an average annual spending of over $2,000 per patient – nearly $170 per month. 

There are 27 qualifying conditions in the Michigan program. 

In December 2021, 62% of qualifying patients reported chronic pain, and 38% said severe and chronic pain, according to the Michigan Regulatory Agency’s December Report. In December alone, the agency received over 4,600 applications and denied 442 of them – nearly 10%. For renewal applications, 104 out of the 1,601, or 6.5 %, were denied. As of December, there were 337 physicians providing certifications in the state.

The revenue collected from applicants in December exceeded $225,000, the Michigan Regulatory Agency reported. 

Michigan legalized medical marijuana In 2008 and sales were legalized in 2016. Adult-use sales were legalized in 2018.


In Illinois, 1% of the population is a registered medical marijuana patient. But here, patients spent an average of $2,941 per year on medical marijuana – the highest of all four states reviewed. That’s about $245 per month, per patient.

Illinois passed the $1 billion mark in legal cannabis sales in August 2021. Its highest per capita spending was in July of that year, when it hit $16.26. That’s also when legislation removed a requirement that patients designate one dispensary at a time, allowing patients to purchase at any dispensary. 

To qualify as a patient in Illinois, residents need to not only have a qualifying condition, but they must also complete a fingerprint background check. If they are convinced of a violent crime or a felony under the Illinois Controlled Substances Act, Cannabis Control Act, or Methamphetamine Control and Community Protection Act – they may not qualify unless the department waives it. 

Medical marijuana patients can grow their own cannabis in Illinois – five plants at a time. 

The fee to apply to become a patient in Illinois is $100. Patients enrolled in Social Security Disability Income or Supplemental Security Income can qualify for a reduced price. 

There are 38 qualifying conditions in the program. The state also has an adult-use program. Over 6% of registered patients are veterans, according to the Ohio Medical Marijuana Control Program. 


Like Missouri, Ohio only has a medical market. Sales began in January 2019 with over 1% of the state’s population registered as a medical marijuana cardholder. There were 130,641  active medical marijuana patients as of January 27, 2022. 

The average patient spent about $2,800 on medical marijuana in 2021, around $230 per month. 

The fee to become a patient in Ohio is $50. There are 25 qualifying medical conditions in Ohio. 

There are 57 dispensaries in the state. In April 2021 the Board of Pharmacy approved increasing the number of dispensary licenses in the state by 73. License awards are expected next week.

“With these new 73 licensed dispensaries coming into the state, which will make a total of 130, that would drop the prices, allowing the patients to want to participate in the program even more,” said Ally Reaves, founder and president of Midwest CannaWomen, in a November interview.

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Brad Spirrison is a journalist, serial entrepreneur and media ecologist. He lives in Chicago with his son. Interests include music, meditation and Miles Davis.