The ecosystem of cannabis is growing as more and more people start to understand its many health benefits. With more people come more obstacles and barriers that advocates have had to break through so that patients everywhere can have access. Because each state has different legislative and regulatory conditions for access, this leaves out millions of people who should be able to obtain and use cannabis for medical purposes without access. Barriers include: federal employees, veterans who utilize the VA, people in jurisdictions with restrictive lists of qualifying conditions, employees subject to drug testing in jurisdictions that don’t provide employment protections, patients in treatment or hospice centers, school-age minors, people living in poverty, and people on organ transplant lists. This presentation will explore the real story of access for patients in the U.S. and the barriers that still exist for patients even in states with robust medical cannabis programs and adult use and how we can improve these programs so that patients everywhere can have access.