Although sales of medical marijuana have been declining across Colorado since high use during the pandemic, El Paso County continues to lead the state, by far, in having the most medical marijuana cardholders.

As of March, Colorado’s Medical Marijuana Registry program lists 22,634 patients countywide, according to the state Department of Public Health and Environment.

That’s about 3% of the county’s population and more than triple the amount of medical cardholders in Denver County, which is comparable in overall population. Denver County’s count last month was 7,327 registrants — about 1% of its population.

There’s a simple reason for the numbers, said Mason Tvert, spokesman for Colorado Leads, a cannabis industry organization.

“Colorado Springs has repeatedly refused to regulate the sale of adult-use cannabis, and as a result many people are still relying on medical cannabis cards to access cannabis legally and safely,” he said.

With 54% in opposition, Colorado Springs voters rejected a 2022 ballot measure to legalize recreational sales in city limits and give the 114 medical marijuana stores at the time the option to add or convert to recreational sales.

A companion measure that would have taxed recreational marijuana at 5% and earmarked tax collections for public safety, mental health and veterans’ stress-related programs passed but was nullified with the defeat of recreational transactions.

A majority of Colorado Springs City Council members opposed that attempt, as well as previous bids seeking approval of retail recreational marijuana. Colorado voters approved recreational sales in November 2012, but each county and municipality can decide whether to allow medical and recreational businesses in their boundaries.

Colorado Springs is the largest city in the state that does not permit recreational sales, Tvert said.

“There are a lot of localities that have not regulated adult use, but they make up a fraction of the state’s overall population,” he said. “Local communities increasingly have been lifting prohibitions and choosing to regulate these businesses and collect the taxes.”

Two of El Paso County’s eight incorporated cities and towns offer recreational pot: Manitou Springs has two shops and Palmer Lake has two medicinal shops that also sell recreational products, following voter approval in 2022.

The absence of recreational stores in Colorado Springs has not stopped residents from obtaining marijuana.

“There’s this common misconception that not having recreational marijuana in El Paso County is suppressing the amount of marijuana in Colorado Springs, which couldn’t be further from the truth,” said Levi Hays, chief innovation officer for Terp Labs, a manufacturer of medical marijuana items that primarily are sold in El Paso County.

“There’s no one in Colorado Springs that wants marijuana and has the money to pay for it that isn’t getting it,” he said.

Some have turned to dispensaries for their weed supply: of 64,899 medicinal cardholders statewide as of March, more than one-third live in El Paso County.

El Paso County is mirroring the state in decreases of medicinal users — losing nearly 3,100 local cardholders from March 2021 to now, according to data.

Still, there are about 1,500 more local medical cardholders in El Paso County today than in March 2019, when the pandemic began spreading.

Longtime Colorado Springs resident Cyndi Kulp has been a patient for the past decade. Severe arthritis necessitated having three joint replacements in recent years, and medical marijuana helps, she said.

“The medical products are different from recreational, and if you have a medical ailment that responds to marijuana, you really need to go to a medical dispensary,” Kulp said. “They have combinations that create a synergistic relationship that work better and are effective.”

Annual renewal can be a hassle, she said, which industry leaders also cite as a restriction.

“You’re in for about $100 a year to renew your card, but to me it’s worth it because I want the products they sell at the medical stores,” Kulp said. “I don’t want to have to go the recreational shops that are so crowded and don’t have the same products.”

Hays believes many Colorado Springs residents are buying from illegal dealers. Neither the El Paso County Sheriff’s Office nor the Colorado Springs Police Department could confirm that’s the case.

The number of medical providers also continues to shrink statewide, with 289 individual doctors, dentists and other practitioners writing recommendations for medicinal cardholders last year. That’s down from 326 in 2021.

Kulp said doctors are leery of prescribing medical marijuana.

“Anyone with a medical license can renew your card or evaluate you, but most places won’t do it,” she said. “I think they think they’re going to get in trouble. Everybody is so accepting of alcohol, but it’s still a totally different thing when it comes to marijuana.”

About three out of four medical cardholders in Colorado seek cannabis for pain relief, while taking cannabis “in lieu of opioids” is the second most prevalent reason listed.

Colorado Springs has 93 licensed medical marijuana stores operating in city limits as of Friday, said city spokesman Max D’Onofrio. That’s down from 105 at this time last year. In November 2022, when the ballot measure failed, there were 114 medical dispensaries.

Collectively, Colorado Springs medical stores posted $6.8 million in sales in January, with total retail sales in Denver’s medical market of $5.1 million in January, according to the Colorado Department of Revenue.

Medical dispensaries are closing rapidly, Hays said.

Among the recent casualties, marijuana cultivator and retailer Maggie’s Farm in February shut down a medical dispensary in Colorado Springs, along with four stores in other towns, citing on Facebook “unforeseen challenges” that were threatening the company’s solvency.

Other closures in Colorado Springs include two TweedLeaf dispensaries, High Country Healing, HeadMaster MMJ, High Hopes and two CannaMeds sites. The company had its medical sales license suspended last year by the Marijuana Enforcement Division for unspecified violation of the Colorado marijuana code.

Owners also have attributed business demise to expensive government taxes, the cost of compliance and reduced market share.

Also, Tvert said, “Ultimately there is an oversupply of cannabis in Colorado that has driven down prices and reduced the average market rate, and as a result a lot of businesses aren’t able to make ends meet and cover their operating costs.”

Hays said a movement to bring another ballot measure for legalizing recreational marijuana sales to Colorado Springs voters is afoot.

Opponents, including the group Smart Approaches to Marijuana, say legalization of marijuana has undermined physical and mental health, with data that shows such effects as IQ loss, depression, suicide, psychosis, stroke and schizophrenia.

Also of concern, the organization points to consequences to public safety, such as impairment while driving, and negative effects on education and employment, particularly among underage youth who obtain cannabis products they are not authorized to use.