For decades, patients have used cannabis and cannabinoid products for health-related reasons, often while navigating that use largely outside of the traditional healthcare system.

 

They may or may not tell a physician what they are taking. It is possible that they may receive guidance about potential drug interactions, dosing, or product quality, however they often are left to figure those things out on their own.

 

That separation has created one of the more complicated realities of cannabinoid care: patients are using these products, but their use does not always exist within the same systems we rely on to monitor other healthcare decisions.

 

What would happen if that began to change? A recent program evaluation from Colorado offers an interesting glimpse.

 

A Different Kind of Workers’ Compensation Study

 

In 2026, researchers from the Colorado Division of Workers’ Compensation published an evaluation of a medical cannabis reimbursement program for chronic pain.

 

The study was small with just one patient completing the 12-month program. And it should be understood for what it was: an evaluation of whether medicinal cannabis reimbursement could feasibly operate within a coordinated workers’ compensation care model, not a clinical trial proving that cannabis treats chronic pain.

 

Medical cannabis was not simply recommended and left for the patient to navigate independently. The program included reimbursement, care coordination, clinical oversight, and ongoing outcome measurement.

 

At the end of the program, the patient reported meaningful reductions in pain, improvements in function and quality of life, and psychosocial stability. A modest reduction in opioid use was also observed, with no reported adverse safety events. The takeaway is not that one case proves cannabis should replace opioids, it’s that Cannabinoid therapy can be brought into a healthcare framework where a clinician knows what a patient is taking, monitors what happens next, considers other medications, evaluates safety, and determines whether continued use makes sense. This idea may prove to be just as important as any individual outcome.

 

Does a Treatment Have to Be Transformative to Matter?

 

Healthcare decisions are rarely as simple as this treatment works or this treatment does not work.

 

For someone living with chronic pain, cancer-related symptoms, sleep disruption, or multiple conditions at once, even a modest improvement may matter. Perhaps pain decreases enough to make daily activity easier, sleep improves, another medication does not need to be added, an opioid dose does not need to increase, a treatment with undesirable side effects is discontinued. Or perhaps it provides no meaningful benefit at all.

 

Every one of those outcomes gives a clinician and patient information they can use to make the next decision. The standard should not have to be that cannabis is a miracle, nor should we assume that it is an appropriate alternative for every patient.

 

The more useful question we can ask is: For which patients might cannabinoid therapy provide enough benefit, with acceptable risk, to earn a place in their care plan?

 

Increasingly, parts of the healthcare system may have an opportunity to help answer that question.

 

Medicare Is Testing a New Pathway

 

In April 2026, the Centers for Medicare & Medicaid Services (CMS) introduced the Substance Access Beneficiary Engagement Incentive, or Substance Access BEI, within select CMS Innovation Center models.

 

The optional program allows participating organizations in the ACO REACH and Enhancing Oncology models, and eventually eligible participants in the upcoming 2027 LEAD Model, to incorporate certain federally legal hemp-derived products into clinician-guided care for eligible beneficiaries.

 

This all means that a participating healthcare organization can identify an eligible patient, determine with the patient whether a qualifying hemp product may be appropriate, review potential risks and benefits and current medications, procure the product, furnish it through the required clinical pathway, follow the patient, and report information back to CMS.

 

Products must also meet specific eligibility and quality requirements, including third-party testing for cannabinoid potency and contaminants.

 

That is fundamentally different from telling a patient, “You can try CBD if you want” by bringing the conversation inside healthcare.

 

Creating Access Is Only the First Step

 

The Substance Access BEI is an important opening, but creating a pathway does not automatically mean that pathway will be practical for every patient or healthcare organization.

 

Participating organizations currently bear the cost of the products themselves. CMS does not reimburse them for that expense, and eligible products may be furnished at a value (currently) of up to $500 per beneficiary per year. Oral products containing more than 3 milligrams of total tetrahydrocannabinols per serving are excluded from the program.

 

Those safeguards create an opportunity to begin carefully while creating questions a thoughtfully designed healthcare program can help answer, such as:

 

• Does $500 provide enough product for a patient to complete a meaningful therapeutic trial?
• How long should a clinician and patient evaluate a product before deciding whether it is helping?
• Do current product parameters correspond with the formulations and dosing patients may need to evaluate?
• What outcomes should determine whether therapy continues?
• And what happens when a patient experiences no meaningful improvement?

 

Signals Worth Studying

 

The Colorado workers’ compensation case is not the only reason to ask these questions.

 

A 2025 Workers Compensation Research Institute analysis examined workers’ compensation claims across 31 states following implementation of adult-use marijuana laws. Researchers found lower medical payments per claim and reductions in prescription use and prescription spending, including fewer pain medication prescriptions and a lower proportion of claims involving opioids.

 

Those findings do not demonstrate that cannabis caused the reductions. Population-level policy studies cannot tell us whether a particular patient used cannabis instead of an opioid, why medication use changed, or what clinical decisions were involved. But rather than overstating what these studies tell us, we can use them to ask better questions that deserve evidence:

 

• What changes when cannabinoid therapy is not happening on the sidelines of healthcare, but within it?
• Can clinician guidance improve safety?
• Can better product information improve decision-making?
• Can physicians identify patients for whom cannabinoid therapy provides modest but meaningful benefit?
• Can we determine when it does not?
• And can healthcare systems measure whether those outcomes affect medication burden, quality of life, healthcare utilization, or cost?

 

This Is What Responsible Access Can Look Like

 

At Realm of Caring, we have spent years helping individuals and families navigate cannabinoid therapy while also working with researchers to better understand their experiences.

 

Again and again, the lesson that has become clear is that access is about more than whether someone can purchase a product.

 

Meaningful access means being able to ask questions, understanding what is in a product, considering medications that may interact with it, having realistic expectations about cannabinoid therapy, and having the conversation with healthcare professionals responsible for your care. 

 

The emergence of programs like Colorado’s workers’ compensation initiative and CMS’s Substance Access BEI does not mean every unanswered question about cannabinoid therapy has suddenly been resolved. It means we may finally have new opportunities to answer some of those questions while caring for patients at the same time.

 

We do not need healthcare systems to begin with the assumption that cannabinoid therapy will work. We need healthcare systems willing to carefully evaluate whether it works. Because patients deserve more than access to a product. They deserve access to informed care.

 

Have questions about cannabinoid therapy? Realm of Caring’s Care Team provides free, one-on-one education and support to individuals, families, caregivers, and healthcare professionals navigating cannabinoid use. Our research programs also give participants an opportunity to help build the evidence needed to improve cannabinoid care for the patients who come next.