The need for a statewide medical-marijuana program won’t go away if the Illinois General Assembly and Gov.-elect J.B. Pritzker approve recreational use of cannabis in 2019, advocates of marijuana legalization say.

Those crafting legislation to allow production and sales of recreational marijuana plan to include provisions ensuring that patients in the medical pilot program have an adequate selection of products specifically geared for medical use, according to state Sen. Heather Steans, D-Chicago.

It’s unknown how the startup of a recreational marijuana market in Illinois will affect enrollment in the state’s highly regulated medical-marijuana program, said Steans, a leader in the push to make recreational use legal.

But supporters of recreational use don’t want to put medical-marijuana patients in a bind, she said.

“We are going to touch the medical program as little as possible,” Steans told The State Journal-Register last week.

Advocates expect recreational sales to quickly overtake medical sales. But they say people in the medical program likely would pay less for cannabis products because excise taxes on recreational products are expected to be significantly higher than for medical-marijuana products.

“We haven’t seen huge drop-offs right in the beginning,” said Karmen Hanson, a Denver-based cannabis policy analyst for the National Conference of State Legislatures.

Enrollment cards that currently cost medical-marijuana patients $100 per year in Illinois also give those patients access to certain products that may not be produced for recreational users or popular among them, marijuana advocates said.

Those products include cannabis-infused suppositories, lotions, nasal sprays and transdermal patches.

Products geared toward the medical market also include marijuana with extra-high levels of THC — the chemical compound that causes the drug’s “high” — and marijuana with high levels of CBD, a compound with purported medical benefits but not causing euphoria.

“I think a lot of people will remain in the medical program,” said Chris Stone, chief executive officer of HCI Alternatives. HCI operates medical marijuana dispensaries in Springfield and Collinsville.

Stone and Dan Linn, executive director of the Illinois chapter of the National Organization for the Reform of Marijuana Laws, both expect excise taxes on recreational pot to be substantially higher, though Steans said the levels to be proposed still are being worked out.

Because of the high tax levels envisioned, the “economic development element” of recreational marijuana “could be substantial for the state,” Stone said.

New tax revenue for state and local governments could exceed an estimated $500 million per year, and Stone said marijuana could become a $5 billion annual industry in Illinois when including taxes, product sales and employment.

As of Dec. 11, 49,366 patients — most of them adults — were enrolled in the state’s medical-marijuana pilot program, which is set to expire in 2020, and there has been about $123 million in total sales through 55 licensed dispensaries this year.

Total patients could increase by six-fold or more, to at least 300,000, after patients taking prescription opioid painkillers are allowed to buy medical marijuana in late January and beyond because of a bill signed into law by Gov. Bruce Rauner.

But even that total would be dwarfed by the total potential customer base for recreational marijuana, Linn said. An estimated 13 percent of adults 18 and older in the United States regularly or occasionally use or smoke marijuana, according to a recent Gallup poll.

The legislation being considered in Illinois would allow recreational use only for people 21 and older. But if 13 percent of the 9.4 million Illinoisans 21 and older began buying marijuana legally, potential customers would total 1.2 million people.

In Colorado, a state of 5.6 million people where commercial production and sales of medical marijuana was first authorized in 2010, 85,200 patients are enrolled in the medical-cannabis program.

Sales of recreational marijuana for Colorado adults 21 and older began in 2014. The number of patients in the medical program didn’t drop much at first, according to Dr. Tista Ghosh, acting chief medical officer for the Colorado Department of Public Health and Environment.

Medical program enrollment in Colorado totaled 103,906 in 2016, 88,417 in 2017 and 85,207 so far in 2018. That’s a total drop of 18 percent from 2016 to the present day.

Colorado officials don’t know the reason for the drop, Ghosh said, noting that medical-marijuana products still are taxed less than recreational products.

Whether medical-marijuana enrollment drops in a state after recreational use is allowed can depend on the price difference for products and the state’s annual charge for a medical-marijuana card. That’s according to Karen O’Keefe, state policies director for the pro-legalization Marijuana Policy Project in Washington, D.C.

Linn said he hopes Illinois lawmakers reduce the annual cost of medical marijuana cards when they consider making the medical program permanent.

Legislation dealing with recreational use is expected to allow existing medical marijuana dispensaries and cultivation centers in Illinois to add recreational marijuana to their products, Steans said.

Additional rules would need to be developed to allow other producers and sellers to enter the market, she said.

HCI Alternatives employs a total of 45 people at its dispensaries in Springfield and Collinsville and serves a total of 2,560 patients. HCI is considering adding about 20 more employees to handle additional customers when opioid patients become eligible for medical marijuana in January, Stone said.

Approval of recreational marijuana probably would increase demand enough to allow HCI to eventually hire 20 more employees at each location, he said.

The increased capacity is expected to reduce marijuana prices for current medical-marijuana patients as producers and suppliers benefit from greater efficiencies, Steans said.

Approval of recreational use can make a safer, more-predictable supply of marijuana products available to customers who use cannabis to relieve symptoms of medical ailments but don’t have conditions that qualify them for medical-marijuana programs in their state, O’Keefe said.

Such customers also may be unable to find doctors willing to sign documents to help them get into medical-cannabis programs, O’Keefe said.

Illinois law allows patients to qualify if they have one of more than 40 medical conditions. But Illinois doesn’t allow patients into its medical-marijuana program for “severe pain,” “muscle spasms” or “severe nausea” — Colorado’s top three qualifying conditions.

Tisha Smith, a 47-year-old Springfield resident, is in Illinois’ medical marijuana program because of a traumatic brain injury and post-traumatic stress disorder.

She said she supports legalization of recreational use but probably will remain in the medical program even if sales of recreational cannabis are allowed.

In addition to the price break medical patients are expected to receive, Smith said she likes that her Illinois card is honored by dispensaries in Michigan, where she has traveled in the past, and in some of the approximately 30 other states that allow medical-marijuana sales.

Smith said she believes medical-marijuana patients will be less likely than recreational users to be prosecuted by federal officials for possessing a substance that remains illegal under federal law.

However, participation in a medical program offers no additional protection from federal prosecution, according to Hanson, the NCSL analyst. But Hanson said federal officials have shown little interest in charging buyers of marijuana with crimes if the purchases are part of state-level medical or recreational marijuana programs.

Smith, who works full-time driving for a ride-sharing service but doesn’t use marijuana while she’s driving, said she spends $300 to $500 every two weeks on medical marijuana.

The marijuana she gets is more expensive than the pot available on the black market, she said, but she feels safer using marijuana from a licensed dispensary.

“I know where it’s coming from,” she said.

Contact Dean Olsen: dean.olsen@sj-r.com, 788-1543, twitter.com/DeanOlsenSJR.