After twenty years in this field I have learned something. The line between “medical” and “recreational” cannabis is not a wall. It is a blurry, crowded space — and a huge number of people are living right inside it.
On paper the difference is simple: medical cannabis is prescribed for a diagnosed condition, dispensed through a regulated channel, and used to a protocol. Recreational cannabis is bought and used for enjoyment. In practice, an enormous population sits between the two systems and belongs fully to neither.
I call them RecreMedical. And they split into two groups who are usually — and very unfairly — thrown into the same bucket.
One has the medical need but not the access. The other has the access but not the need. I call the first a RecreMedical Patient and the second a RecreMedical User. The words matter.
This is someone genuinely medical. Real condition, real symptoms, a real therapeutic reason to use cannabis. But they are locked out of the legal system. It could be their country's laws, the cost, a doctor who will not sign, a diagnosis that does not “qualify” — or honestly, sometimes just where they happened to be born. So they go to the recreational or illicit market, because that is the only door open to them.
They are patients in everything except the paperwork.
And here is the weight nobody talks about. They carry a fear with them every day. Where they live, recreational use is illegal — but medically, they are exactly the person the law was written to protect. So they are breaking a rule that, by any honest reading, was never meant for them. They medicate looking over their shoulder: fear of being caught, of a record, of consequences that could touch their job, their family, their standing — all sitting on top of an illness they are already trying to manage.
Imagine being legitimately sick and still having to hide your medicine like a criminal. That fear does not heal anyone. It does the opposite.
The practical problem is that they get no guidance, no consistency, no lab-tested product, no dosing structure, and nobody watching for interactions with their other medications. They carry all the risk of medical use with none of the support, improvising with whatever they can get hold of. That is exactly how good people end up with the wrong dose, the wrong timing, the wrong chemovar.
Is there a benefit? In a way. Access at all. Relief they would not otherwise have. And occasionally a freedom to experiment that an over-cautious medical system would have taken from them anyway.
My issue is not with these people. My issue is with the system that abandons them.
Now flip it. This person holds the prescription or the licence — but is not really treating anything. They are using recreationally while wearing a medical badge. The licence was never about a therapeutic process; it was a route to clean, legal, convenient supply.
They are users in everything except the paperwork.
For them the benefit is obvious and, to be fair, fairly rational: legal access, tested product, often cheaper, and no fear of consequences. In a market where recreational access is restricted and medical access is not, it is a smart move.
The problem is what it does to everyone else. Every recreational user sitting inside the medical system muddies the data, feeds the old stigma that “medical is just an excuse”, and hands regulators a reason to tighten the screws on the genuinely sick. They consume clinical attention and supply built for patients. And they are usually not even getting good results themselves — because you cannot treat a medical tool like a lifestyle product. No protocol, no titration, no goal beyond the experience.
This is the group that makes my work harder and makes the genuinely medical patient look less credible. Not because of who they are as people. Purely because of where they sit in the system.
Here is the uncomfortable truth. From the outside, both look identical. Both are “not really in the medical system”. So regulators, doctors and the public treat them as one suspicious category.
But they are opposites. One is a patient who was denied a system. The other is a user who borrowed one.
When we confuse the two, we punish the wrong person every time. We make it harder for the locked-out patient to get in, while the recreational user is already sitting comfortably inside with his feet up. We build policy around the abuse, and the genuinely sick pay for it.
Naming RecreMedical is my way of finally pulling these two apart, so we can stop treating medical need and medical pretence as the same thing.
The goal was never to police who deserves cannabis. The goal is to get the right people into a real medical framework — with structure, with guidance, with safety. To take them out of that life between two worlds, and into one where somebody is actually walking the journey beside them.
A version of this piece first appeared on LinkedIn. This version has been rewritten and expanded.
The free WIZDOM Self-Check is nine questions, takes about ninety seconds, and sends you a personalised four-document toolkit.
Take the free Self-Check