The smell of sausage frying in a pan filled Deborah Boggs’ home when her husband Barry cooked breakfast, but it repelled her from eating for hours. 

Deborah, 48, has lived for over 20 years with Crohn’s disease, a chronic condition causing severe inflammation in her stomach and requires regular medication.

Medical cannabis lessens her symptoms. Within 45 minutes, the nausea subsides, and she is able to eat a full meal. The tension and pain in her body eases. 

But to buy cannabis, she has to drive an hour from her house in Roane County. Her only form of income is a monthly Social Security payment.

“Sometimes I don’t have the gas money to get there,” she said.

Deborah isn’t alone. West Virginia patients are struggling to afford medical cannabis.

Neighboring states have legalized recreational use in recent years, creating larger markets and cheaper prices. In West Virginia, lawmakers have only allowed the medical sale of cannabis, fostering an industry with limited patient access and high costs.

Around 35,000 West Virginians have a medical cannabis card. Patient growth has plateaued in the last six months, according to state data. 

West Virginia is one of the poorest states in the nation and has the highest rate of residents living with multiple chronic illnesses and on Social Security or disability programs. The medical cannabis program was created to offer an effective, alternative treatment recommended by licensed physicians for severe and chronic conditions. 

Cannabis is still illegal on the federal level. At the same time, a patchwork of state laws governs who can buy and sell it for medical and recreational purposes. 

Rusty Williams, advocacy director at the ACLU of West Virginia, spent years in the Capitol pushing for a medical cannabis program before it was legalized in 2017. 

Since then, Williams has served as the patient advocate on the program’s advisory board. He said patients drive to other states for cheaper products and edibles, which are illegal in West Virginia. 

“West Virginians know full well that it is not legal to cross state lines with cannabis,” he said. “But they’re doing it anyway.”

Cannabis flower is the most popular product in West Virginia, followed by vape cartridges, which contain cannabis oil that is vaporized when inhaling. A vape cartridge listed for $60 in West Virginia was available for just $20 in Ohio for anyone over 21 years old, he said. 

“Patients are absolutely getting hosed here in West Virginia,” he said.

Over the last year, vapes have been more expensive in West Virginia than Ohio or Maryland, neighboring states that have legalized recreational use. Flower is cheaper in Ohio and slightly more expensive in Maryland, according to state price data.

For both products, West Virginia prices are more than double the cost in Michigan.

Harold Tolbert, a Fayette County resident who previously lived in Michigan, uses medical cannabis instead of pain medications for a neck injury from whitewater rafting. 

Spending $50 on cannabis bought him a month’s worth in Michigan, but only a week’s worth in West Virginia. 

“You’ve got to have a six-figure job to be able to afford your medicine comfortably down here,” he said.

Each state has its own closed market because shipping products across state lines is illegal, said Steve Mazeika, spokesperson for Verano, a cannabis company with dispensaries in multiple states. Prices are widely set by supply and demand factors, as well as state regulations, Mazeika said. 

Michigan’s law allows for unlimited licenses across the industry, resulting in higher supply than demand and ultimately driving prices to be far cheaper than the rest of the country, he said.

Matthew Coffman, regional vice president of Kanacare, a cannabis company with dispensaries in Charleston, Fairmont and Parkersburg, said West Virginia’s program is not built to sustain companies selling incredibly cheap products. 

The state’s program doesn’t allow outdoor growing, so the overhead costs for things like operating a greenhouse or powering grow lamps drives up prices.  

Dispensaries also pay a 10% tax on sales, cutting into their profit, and are not subject to tax exemptions due to the federal status of marijuana.

A Mountain State Spotlight investigation found that the West Virginia medical cannabis program has accumulated roughly $34 million from the taxes paid by dispensaries, but the money hasn’t been spent.

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Some patients don’t initially understand that health insurance doesn’t cover medical cannabis, because the drug is illegal on the federal level, said Megan Mullins, a dispensary employee.

She said she does her best to point low-income patients toward product sales and help them use their loyalty points, but it’s only a short-term solution. 

“We really just try to go with what they can afford and how they like it,” she said.

George Booth, a disabled veteran in Berkeley County, uses medical cannabis for relief from chronic pain. He can hardly move without it. 

“Cannabis has kind of been a godsend,” he said.

Now on disability leave and with his wife facing financial instability from the recent shutdown as a government worker, he struggled to afford the amount of product he typically purchased. 

And although his finances were secure most of his life, he said he hopes the market will open to lower prices for medical patients to enjoy. Right now, he pays $70 for a gram of a concentrated product.

“That is really expensive,” he said.

Country Grown dispensaries offer veteran, senior and various product discounts to account for West Virginians’ income. Josh Chaffin, director of retail operations at Harvest Care Medical, the West Virginia-based parent company of Country Grown, said he is aware of the pressures many patients face from high prices. 

But his goal, along with many others in the state, is to expand West Virginia’s medical cannabis program to a recreational-use market. He said it would broaden patient access by allowing edibles and different brands of products. It could also ease the costs for patients who pay over $100 to get or renew a medical card each year.

“If they can go across the border and obtain a wider selection of products, why would they pay to get their medical cannabis card in West Virginia?” he said.

Under state medical cannabis law, the Department of Health can cap prices for  six months if it determines costs to be excessive or unreasonable. But it hasn’t.

“Pricing is always a concern so that patients are able to obtain products at a reasonable price,” said Gailyn Markham, a spokesperson for the state Department of Health, which includes the Office of Medical Cannabis.

State officials don’t see a large difference in prices compared to other states and have not considered implementing price caps, Markham said. 

Since the first dispensary opened in 2021, lawmakers have not changed or expanded the Medical Cannabis Act. Patients have requested legalizing edibles, widening qualifying conditions and growing cannabis for personal use, said Williams, the patient advocate.

“That is all due to the lack of political will,” he said. 

For patients like Deborah, medical cannabis is a necessity. She said it’s not about a “high,” but a return to normal function.

On the living room wall in her mother-in-law’s home, a photo from her wedding day with Barry hangs nestled among family portraits. 

Barry pointed to it, remembering she weighed a mere 97 pounds from not eating. He looks at her now, 21 years later, a fuller version of herself after using medical cannabis.

“We’re poor. We can only afford so much,” he said. “I wish they could do a little more along those lines, because it is a medicine.”