Puerto Rico faces a new era of cannabis: the essential role of cannabis coaching

Puerto Rico is experiencing a historic moment for medical cannabis. At the federal level, the process of reclassifying the plant began with President Trump's executive order in December 2015 and was formalized in April 2016, when the Department of Justice moved medical cannabis regulated by state licenses to Schedule III of the Controlled Substances Act. That process is not yet complete: as of mid-August 2016, the administrative hearing before the DEA for a broader reclassification is still in the post-hearing briefing stage, with no firm date for a final decision. In short: the change is real, but incomplete. State-licensed medical cannabis has already been removed from federal Schedule I; the plant as a whole has not yet.

In Puerto Rico, interestingly, we are already several years ahead in this regard. Since the approval of Law 42-2017 (“Medicinal Law”), medicinal cannabis has been classified locally under Schedule II of the Puerto Rico Controlled Substances Act (Law No. 4 of 1971), meaning a substance with recognized medical use but subject to severe restrictions, quite different from Schedule I, under which cannabis still operates at the federal level for most uses. This local reclassification is precisely what allows thousands of registered patients to access dispensaries without facing criminal penalties under state law. The medicinal cannabis program regulated under that same Law 42-2017 and Regulation 9038 is now undergoing its own transition.

According to data presented this year to the Senate Health Committee, the number of active patients has stabilized at around 110,000, after declining from a record high of over 124,000 patients in 2022. The Office of Medical Cannabis announced that it is reviewing Regulation 9038 with the purpose of modernizing the regulatory framework and putting patient welfare at the center.

It's a real window of opportunity. But a window of opportunity isn't the same as a change that has been achieved, and that's where cannabis coaching has something to offer.

Between change and doubt: the current state of the program and the stabilization of patient enrollment is not just an administrative matter. Behind that number are thousands of people, most with degenerative, debilitating, and/or disabling conditions, many

Among those who are elderly, who registered at some point but didn't continue, or who never considered medical cannabis as an option, Puerto Rico faces a sustained social health crisis: limited access to specialists, long wait times, and a system under constant pressure. Globally, medical cannabis has proven to be a real therapeutic tool for chronic pain, insomnia, and anxiety, among other common conditions in the program. Even so, mistrust persists: the education received by patients and industry professionals has not kept pace with the science, regulation, or the real needs of those seeking relief.

This is where the cannabis coach comes in: a professional dedicated to supporting the patient, and often their caregiver, from the moment they consider medicinal cannabis as an option until they develop a conscious and informed consumption regimen. They don't replace the doctor or the dispensary; they fill the gap between medical recommendations and the patient's daily experience: how to choose the method of consumption, understand THC and CBD ratios, manage side effects, and adapt the treatment over time.

Programs specifically designed for veterans and older adults. However, not all cannabis coaches work within a large network or platform. Many practice independently, guiding their patients one-on-one with the same care and rigor, just on a smaller scale. Both paths, institutional and independent, aim for the same thing: professional support that, when recognized and encouraged, improves treatment adherence and patient confidence. Exactly what Puerto Rico needs in this time of transition.

The urgency of reforming basic education

One of the program's most pressing problems, and perhaps the least discussed publicly, is the state of mandatory cannabis education for those working in the industry. The certification courses offered today haven't been significantly updated in years, while knowledge about medical cannabis, its formulations, interactions, and regulation has advanced considerably during that same period. An employee certified under an outdated curriculum is ill-equipped to properly guide a skeptical patient or caregiver with legitimate questions about safety and efficacy. This educational gap directly undermines public trust in the program.

Reforming basic education must be an immediate priority. But simply updating the minimum content required for licensing is not enough. A second, more advanced and comprehensive layer of education is also needed, aimed at those already working in the industry who want to deepen their knowledge, as well as patients and caregivers seeking information beyond the basics. This advanced education must be accessible in terms of cost, format, and language, so that it truly reaches those who need it and is not limited to those who already have the resources or connections to access it.

Cannabis coaching as an institutional ally, not as competition

For cannabis coaching to reach its full potential to transform the experience of Puerto Rican patients, it needs the institutional support of the Office of Medicinal Cannabis and the Department of Health. This does not represent an additional regulatory burden. On the contrary, it is an alliance that recognizes the cannabis coach as part of the patient support infrastructure, capable of alleviating pressure on an already overburdened healthcare system, improving patient retention in the program, and, above all, enhancing the quality-of-life outcomes that the program was designed to provide from its inception.

The ongoing review of Regulation 9038 presents the ideal opportunity to formalize this recognition. Incorporating cannabis coaching into discussions about regulatory modernization, along with curricular reform of certification courses, would send a clear message: Puerto Rico is not only seeking to meet the minimum regulatory requirements, but also to position itself as a model for a genuinely patient-centered medicinal program, both on and off the island.

Towards a future that we have already begun to build

The current context presents a rare opportunity: a program under review, a shifting federal framework, and a patient population that is stabilizing but has not yet reached its full potential. Cannabis coaching , supported by up-to-date and accessible education, and institutionally recognized as part of the patient care ecosystem, may be precisely the piece that transforms this regulatory transition into a real improvement in the quality of life for thousands of Puerto Ricans. That is the future that, as a patient, educator, and coach, I aspire to continue building alongside this community.

Verónica Pérez Reyes

Consultant, Educator and Coach for Medical Cannabis Patients