The number of patients in Michigan's medical marijuana program declined for the second year in a row in 2014, according to state statistics reviewed by The Detroit News.
Last year, the number of identification cards for patients in the program totaled 96,408, according to the Michigan Department of Licensing and Regulatory Affairs. That compares with 119,470 patients in 2011, and 118,368 in 2013.
The downward trend continued in Metro Detroit, too, with the number of medical marijuana patients falling in Wayne, Oakland and Macomb counties for a third straight year.
In Wayne County, the number dropped from 14,169 in 2013 to 12,258 last year. Since 2011, participation has dropped 20 percent, from 15,385.
Oakland County's patient ranks declined from 10,741 in 2013 to 9,330 in 2014. Since 2011, participation has dropped 22 percent, from 12,083.
Macomb County's number of patients in the state medical marijuana program dipped from 7,997 in 2013 to 7,644 last year. Since 2011, participation has fallen 10 percent, from 8,499.
Michigan's Medical Marihuana Act, which allows residents with debilitating medical conditions to legally use the drug, was approved by the state's voters in 2008.
Under the law, Michiganians can apply for and obtain licenses to use and grow marijuana for medicinal purposes.
Officials with the Department of Licensing and Regulatory Affairs said the agency does not speculate on why the number of patients is down.
Morgan Fox, a spokesman for the Marijuana Policy Project, said it's not clear what's behind the decline.
"The number of patients in Michigan has been fluctuating and it's tough to say if there's a direct cause," he said.
Based in Washington, D.C., the organization advocates and lobbies for the legalization of marijuana use.
Fox said many reasons may be driving the trend. A big one is probably that patients don't feel the state law protects them from prosecution, he said.
Michigan allows licensed people to use, grow and sell marijuana for medicinal purposes, but the drug is still illegal under federal law, and patients with state-issued cards have been prosecuted.
In one instance, an Okemos businessman who followed state law when leasing warehouse space to licensed medical marijuana growers was arrested by federal authorities, tried and convicted for his role in the operation. He's serving a three-year federal prison sentence.
And in Lansing in 2013, police and Children's Protective Services removed a couple's 6-month-old daughter from their home for six weeks because the parents used marijuana to treat medical conditions. Both had state-issued medical marijuana patient cards.
"A lot of these patients may have just given up on Michigan's system and moved somewhere with a more robust law," Fox said. "And the issue of safe access in Michigan is still very much in the air, in terms of whether dispensaries are allowed and how they're supposed to operate."
Michael Komorn, president of the Michigan Medical Marijuana Association, also said the decline is likely due to the inconsistent way police and courts handle medical marijuana cases, which has made people afraid to get the cards.
The association is an advocacy group for patients and caregivers and educates government officials and the public about medical marijuana.
"People see expectations of the (state medical marijuana card) protecting them from being arrest are not being met," said Komorn, who is also a Southfield-based attorney. "There's been no incentive for people to register."
Jamie Lowell, chairman of the Michigan Chapter of Americans For Safe Access, agreed.
"There's very aggressive law enforcement against medical marijuana activity in some areas," he said. "In some places, it appears very difficult to use the protection and defenses the (Medical Marihauna Act) was intended to create and the cards don't mean a whole lot to some people.
"They figure, why go through all the steps to get a card when it doesn't appear to provide the type of protections it was intended to."
Based in Washington, D.C., Americans For Safe Access works to ensure safe and legal access to (marijuana) for therapeutic uses and research.
Lowell said another likely factor is lawmakers' 2012 decision to extend the period for which medical marijuana cards are valid.
"The licenses are now good for two years instead of one," Lowell said. "So the people reregistering the following year won't show up (in the state's reports)."
Since the state's voters legalized medical marijuana, some communities have passed ordinances decriminalizing possession or the use of the drug so that violations are treated like parking tickets.
Ferndale, Jackson and Lansing went a step further in 2013 and made it legal to possess, use or transfer up to an ounce of marijuana on private property.
In addition to Ferndale, Oakland County has five communities with eased marijuana restrictions.
Voters in three of the county's communities — Berkley, Huntington Woods and Pleasant Ridge — loosened marijuana use laws in November.
Berkley and Huntington Woods both passed ordinances to decriminalize the drug's use. Pleasant Ridge residents approved amending the city's charter to make some marijuana-related crimes a low priority for police.
Hazel Park and Oak Park previously decriminalized the drug.
Statewide, 13 communities have liberalized laws against marijuana, possibly signaling a growing acceptance of its use.