Spatial analysis of cannabis dispensaries and primary care access across Oklahoma's socioeconomic gradient

Background: Cannabis dispensaries and primary care providers exist within complex spatial and socioeconomic landscapes that influence community health outcomes. Oklahoma's implementation of the nation's least restrictive medical cannabis program in 2018 created an unprecedented market growth, making it an ideal case study to examine how these establishments distribute across neighborhoods with varying levels of socioeconomic advantage and disadvantage. Methods: This spatial analysis examined 1,846 verified cannabis dispensaries and 3,911 primary care providers across Oklahoma census tracts. Geographic Information Systems were used to analyze dispensary clustering using Getis-Ord Gi* hot spot analysis. The Enhanced Two-Step Floating Catchment Area method measured spatial accessibility to primary care. The Index of Concentration at the Extremes quantified socioeconomic polarization. Negative binomial regression and Spatial Durbin models examined relationships between dispensary density, healthcare availability, and neighborhood socioeconomic status. Results: Cannabis dispensaries demonstrated significant spatial clustering (10% hot spots, 3% cold spots), with hot spots found in areas of lower socioeconomic status. Census tracts in the highest income quintile had 65% fewer dispensaries than those in the lowest quintile. Primary care availability showed significant spatial heterogeneity and was negatively associated with dispensary density. Rural areas had 30% higher dispensary density than urban areas after controlling for other factors. Conclusion: Oklahoma's cannabis retail establishments concentrate primarily in socioeconomically disadvantaged areas with limited primary care availability, creating a concerning dynamic where communities with the greatest healthcare needs face heightened exposure to cannabis while experiencing restricted accessibility to primary care providers. The rural concentration of dispensaries further complicates this picture. Future research should monitor public health impacts of these spatial relationships on cannabis use patterns, healthcare utilization, and community health outcomes.