State Medical Marijuana Laws (Updated)

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 and 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 and 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 and 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” and 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.

*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.

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

Reprinted from Source: National Conference of State Legislatures

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.
  • “State-by-State Medical Marijuana Laws” Marijuana Policy Project, 2019
• Finances/Tax information
  • Regulating Marijuana: Taxes, Banking and Federal Laws, November 2015
  • “State Medical Marijuana Programs’ Financial Information,” Marijuana Policy Project, July 2015
  • “Medical Marijuana Dispensary Laws: Fees and Taxes,” Marijuana Policy Project 
  • Colorado Marijuana Sales and Tax Reports (updated monthly)
  • Washington State Sales and Tax Information (updated weekly)
  • “Taxing Marijuana: The Washington and Colorado Experience,” Tax Foundation, August 2014
• Law enforcement/crime information
  • “What Law Enforcement Can Learn from Marijuana Legalization in Colorado,” Prepared by American Military University, March, 2015
  • Statement by ONDCP Director Gil Kerlikowske regarding Federal guidelines for medical marijuana prosecution
• Medical marijuana research and reports
  • The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research, 2017
  • “Marijuana and Medicine: Assessing the Science Base,” Institute of Medicine, 1999
  • “Exposing the Myth of Smoked Medical Marijuana,” U.S. Drug Enforcement Administration
  • Treatment Research Institute’s (TRI) policy position statement regarding medical marijuana
  • ProCon.org’s resources on medical marijuana. Medical Marijuana ProCon.org presents laws, studies, statistics, surveys, government reports, and pro and con statements on questions related to marijuana as medicine
  • “Becoming a State-Authorized Patient,” Americans for Safe Access
• Nonmedical/Adult Use information and news
  • Regulating Marijuana: Taxes, Banking and Federal Laws, November 2015
  • Regulating Marijuana: A Year and a Half In, NCSL, October 2015
  • “State Legalization of Recreational Marijuana: Selected Legal Issues.” Congressional Research Service, April 2013
  • Analysis of CO Amendment 64 (rec use initiative) by Colorado State University, April 2013
  • Colorado Marijuana Sales and Tax Reports
  • Colorado Marijuana Enforcement Division Annual Update, February 2015
  • Public Health Law Research Law Atlas:  Recreational Marijuana Laws – Interactive Map
• Public health and youth information
  • Marijuana Joins Smoke-Free Laws, State Legislatures, March 2013
  • Regulating Recreational Use of Marijuana and the Role of Public Health Law Prepared by the Network for Public Health Law
  • Marijuana Impact on Public Health and Safety in Colorado: conference by CO Association of Chiefs of Police, January 14-16, 2015
  • Smart Colorado: Protecting youth from marijuana
• Interest groups, position statements, opinions, and model regulation examples
  • SAM: Smart Approaches to Marijuana
  • Smart Colorado: Protecting youth from marijuana
  • Resources from the Public Health Institute
  • Treatment Research Institute’s (TRI) policy position statement regarding medical marijuana
  • National Families in Action: Marijuana Studies Program “Marijuana Report”
  • “Medical Cannabis as a Tool to Combat Pain and the Opioid Crisis: A Blueprint for State Policy” Americans for Safe Access
  • “State-by-State Medical Marijuana Laws” Marijuana Policy Project, 2016
  • “Key Aspects of State and DC Medical Marijuana Laws,” Marijuana Policy ProjectSave
  • “Becoming a State-Authorized Patient,” Americans for Safe Access
  • Brookings Institution: Colorado’s Rollout of Legal Marijuana Is Succeeding