State Medical Marijuana Laws

State vs. Federal Perspective State Medical Marijuana/Cannabis | Program Laws- Table 1 Limited Access Cannabis Product Laws (low THC/high CBD)- Table 2 Additional Resource - NCSL Cannabis and Employment Laws Page

- NCSL Marijuana Deep Dive Page

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Karmen Hanson, Denver

MEDICAL-USE UPDATE: As of May 18, 2021, 36 states and four territories allow for the medical use of cannabis products. In November 2020, voters in Mississippi passed a ballot initiative to allow for medical use, but it was overturned by the state supreme court on May 14, 2021, and is not counted in the state totals on this page. Please see Table 1 for more information.

NONMEDICAL/ADULT-USE UPDATE: As of June 22, 2021, 18 states, two territories and the District of Columbia have enacted legislation to regulate cannabis for nonmedical use.

- Voters in Arizona, Montana, New Jersey and South Dakota approved measures to regulate cannabis for nonmedical use. - On Feb. 8, 2021, South Dakota Circuit Judge Christina Klinger ruled that the measure was unconstitutional. The decision is being appealed as of March 31, 2021. - New Jersey's governor signed enacting legislation on March 1, 2021. - New York's legislature and governor enacted AB 1248/SB 854 on March 31, 2021. - The Virginia General Assembly passed legislation on Feb. 27 and approved the governor's amendments on April 7, 2021. - The New Mexico legislature passed legislation on March 31 and the governor signed it on April 12, 2021. - The Connecticut General Assembly passed SB 1201 on June 17 and the governor signed it on June 22, 2021. These actions bring the number of states with nonmedical (adult-use) regulated cannabis to 18, plus two territories and the District of Columbia (D.C. does not regulate nonmedical sales). This total does NOT include South Dakota's court-over-turned measure, which is pending appeal.

Please see Table 1 below for more information.

A total of 36 states, the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands have approved comprehensive, publicly available medical marijuana/cannabis programs. Please see Table 1 below for more information.

Approved measures in 11 states allow the use of "low THC, high cannabidiol (CBD)" products for medical reasons in limited situations or as a legal defense. (See Table 2 below for more information). Low-THC programs are not counted as comprehensive medical cannabis programs. NCSL uses criteria similar to other organizations tracking this issue to determine if a program is "comprehensive":

1. Protection from criminal penalties for using cannabis for a medical purpose. 2. Access to cannabis through home cultivation, dispensaries or some other system that is likely to be implemented. 3. It allows a variety of strains or products, including those with more than "low THC." 4. It allows either smoking or vaporization of some kind of cannabis products, plant material or extract. 5. Is not a limited trial program. (Nebraska has a trial program that is not open to the public.)

April 14, 2021: South Dakota's overturned nonmedical (adult-use) ballot measure is currently under appeal as of March 11, 2021. 2020 measures in Mississippi for medical use. South Dakota for nonmedical use were overturned in 2021. Please see Table 1 below for more information.

Medical Uses of Cannabis

In response to California's Prop 215, the Institute of Medicine issued a report that examined potential therapeutic uses for cannabis. The report found that: "Scientific data indicate the potential therapeutic value of cannabinoid drugs, primarily THC, for pain relief, control of nausea and vomiting, and appetite stimulation; smoked marijuana, however, is a crude THC delivery system that also delivers harmful substances. The psychological effects of cannabinoids, such as anxiety reduction, sedation, and euphoria can influence their potential therapeutic value. Those effects are potentially undesirable for certain patients and situations and beneficial for others. In addition, psychological effects can complicate the interpretation of other aspects of the drug's effect."

Further studies have found that marijuana is effective in relieving some of the symptoms of HIV/AIDS, cancer, glaucoma, and multiple sclerosis.1

In early 2017, the National Academies of Sciences, Engineering, and Medicine released a report based on the review of over 10,000 scientific abstracts from cannabis health research. They also made 100 conclusions related to health. Suggest ways to improve cannabis research.

State vs Federal Perspective

At the federal level, cannabis remains classified as a Schedule I substance under the Controlled Substances Act, where Schedule I substances are considered to have a high potential for dependency and no accepted medical use, making distribution of cannabis a federal offense. In October of 2009, the Obama Administration sent a memo to federal prosecutors encouraging them not to prosecute people who distribute cannabis for medical purposes in accordance with state law.

In late August 2013, the U.S. Department of Justice announced an update to their marijuana enforcement policy. The statement read that while cannabis remains illegal federally, the USDOJ expects states like Colorado and Washington to create "strong, state-based enforcement efforts.... and will defer the right to challenge their legalization laws at this time." The department also reserves the right to challenge the states at any time they feel it's necessary.

More recently, in January 2018, former Attorney General Sessions issued a Marijuana Enforcement Memorandum that rescinded the Cole Memorandum, and allows federal prosecutors to decide how to prioritize enforcement of federal cannabis laws. Specifically, the Sessions memorandum directs U.S. Attorneys to “weigh all relevant considerations, including federal law enforcement priorities set by the Attorney General, the seriousness of the crime, the deterrent effect of criminal prosecution, and the cumulative impact of particular crimes on the community.” Text of the memo can be found here: https://www.justice.gov/opa/pr/justice-department-issues-memo-marijuana-enforcement

NCSL's policy on state cannabis laws can be found under Additional Resources below.

Arizona and the District of Columbia voters passed initiatives to allow for medical use, only to have them overturned. In 1998, voters in the District of Columbia passed Initiative 59. However, Congress blocked the initiative from becoming law. In 2009, Congress reversed its previous decision, allowing the initiative to become law. The D.C. Council then put Initiative 59 on hold temporarily. Unanimously approved modifications to the law. C. Council then put Initiative 59 on hold temporarily. Unanimously approved modifications to the law. Council then put Initiative 59 on hold temporarily. Unanimously approved modifications to the law.

Before passing Proposition 203 in 2010, Arizona voters originally passed a ballot initiative in 1996. However, the initiative stated that doctors would be allowed to write a "prescription" for cannabis. Since cannabis is a Schedule I substance, federal law prohibits its prescription, making the initiative invalid. Medical cannabis "prescriptions" are more often called "recommendations" or "referrals" because of the federal prescription prohibition.

States with medical cannabis laws generally have some form of patient registry, which may provide some protection against arrest for possession up to a certain amount of products for personal medicinal use.

Some of the most common policy questions regarding medical cannabis include how to regulate its recommendation, dispensing, and registration of approved patients. Some small cannabis growers or are often called "caregivers". May grow a certain number of plants per patient. This issue may also be regulated on a local level, in addition to any state regulation.

Yes

Initiative 65 (2020)

News: Mississippi Supreme Court Overturns Medical Marijuana Amendment 65

South Dakota

*Nonmedical measure ruled unconstitutional as of Feb. 9, 2021.

Initiated Measure 26 (2020)

News: Court rules measure unconstitutional Feb. 8, 2021

News: AG will not appeal court decision Feb. 12, 2021

News: Legislature considering legislation Feb. 9, 2021

H 1460 (2020)

S 646 (2020)

H 1617 (2020)

S 976 (2020)

Legislative Timeline (2020)

Board of Pharmacy overview Board of Pharmacy FAQ

Alabama

(SB46 of 2021 created a new medical cannabis law enacted on May 17, 2021 and is listed in Table 1.)

Idaho- VETOED BY GOVERNOR

SB 2531 (2014) Creates a four-year study of high CBD/low THC cannabis at Tenn. Tech Univ.

Yes, intractable seizure conditions.

No

"Cannabis oil" with less than .9% THC as part of a clinical research study.

SB 339 (2015) Texas Compassionate Use Act

HB 3703 (2019)

Virginia (NEW comprehensive medical program approved in 2020 and listed above)

*The links and resources are provided for information purposes only. NCSL does not endorse the views expressed in any of the articles linked from this page.

Additional Resources

NCSL's Cannabis & Employment Laws page. NCSL's Marijuana Deep Dive page featuring marijuana and cannabis laws on criminal justice, health and other resources. - NCSL FY 2018 letter the LCJPS Committee sent to the Hill opposing the withholding of funding for state with medical marijuana laws: NCSL FY 2018 CJS Appropriations Support Letter. (May 16, 2017)

- State Marijuana Policy covered in Episode 4 of NCSL’s podcast, Our American States. You can find it on our website or subscribe to the podcast in iTunes, Google Play or your favorite podcast app.

- Comparisons of programs Comparison of all state medical marijuana programs with contact information. Prepared by the Network for Public Health Law as of Feb. 2019 Comparison of state limited access medical marijuana programs. Prepared by the Network for Public Health Law as of June 2018.