Tuesday, December 7, 2021

State Medical Marijuana Laws (Updated)

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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.)

 

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April 14, 2021: South Dakota’s overturned nonmedical (adult-use) ballot measure is currently under appeal as of March 11, 2021.
United States map of State Cannabis Programs

* = 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

A doctor holds a container of medical marijuana.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

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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.

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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.

Table 1. State Medical Marijuana/Cannabis Program Laws
State
(click state name to jump to program information)
Statutory Language (yearPatient Registry or ID cardsAllows DispensariesSpecifies ConditionsRecognizes Patients from other statesState Allows for Retail Sales/Nonmedical (Adult) Use
AlabamaSB46 (2021)YesYesYesNo
AlaskaMeasure 8 (1998) SB 94 (1999) Statute Title 17, Chapter 37YesYesYesNo, but adults 21 and older may purchase at nonmedical retail dispensaries.Ballot Measure 2 (2014) Marijuana Regulations
ArizonaProposition 203 (2010)YesYesYesYes, for AZ-approved conditions, but not for dispensary purchases.Proposition 207 (2020)
ArkansasIssue 6 (2016)YesYesYesYes
CaliforniaProposition 215 (1996)  SB 420 (2003)YesYes (cooperatives and collectives)NoNoProposition 64 (2016)
Colorado   Medical program info   -Nonmedical use infoAmendment 20 (2000)YesYesYesNoAmendment 64 (2012) Task Force Implementation Recommendations (2013)
Analysis of CO Amendment 64 (2013)
Colorado Marijuana Sales and Tax Reports 2014 “Edibles” regulation measure FAQ about CO cannabis laws by the Denver Post. 
ConnecticutHB 5389 (2012)
Nonmedical use legislation SB 1201 (2021)
YesYesYesSB 1201 (2021)
DelawareSB 17 (2011)YesYesYes Yes, for DE-approved conditions.
District of ColumbiaInitiative 59 (1998)  L18-0210 (2010)YesYesYesInitiative 71 (2014)
FloridaAmendment 2 (2016)YesYesYesNo
GuamProposal 14A Approved in Nov. 2014, fully operational.- home growing currently allowed until dispensaries open Draft rules released in July 2015   Nonmedical use- 2019 Bill No. 32-35 signed by governor in April, 2019YesYesYesNoYes. Nonmedical use- 2019 Bill No. 32-35 signed by governor in April, 2019
HawaiiSB 862 (2000)YesYesYesNo
IllinoisHB 1 (2013) Eff. 1/1/2014 Rules
Nonmedical use legalization SB 0007 bill passed legislature May, 2019, signed by governor June 25, 2019, Effective Jan. 1, 2020.
YesYesYesNoMeasure approved by legislature in May, 2019, signed by governor June 25, 2019. Effective Jan. 1, 2020.
LouisianaSB 271 (2017) (not yet in effect)NoYesYesNo
MaineQuestion 2 (1999)  LD 611 (2002)   Question 5 (2009)   LD 1811 (2010) LD 1296 (2011)YesYesYesYes, but not for dispensary purchases. Adults 21 and older may purchase from nonmedical retail dispensaries.Question 1 (2016) page 4 Chapter 409 (2018)
MarylandHB 702 (2003) SB 308 (2011) HB 180/SB 580 (2013)  HB 1101- Chapter 403 (2013) SB 923 (signed 4/14/14)
HB 881- similar to SB 923
YesYesYesNo
MassachusettsQuestion 3 (2012)
Regulations (2013)
YesYesYesNoQuestion 4 (2016)
MichiganProposal 1 (2008)YesYesYesYes, for legal protection of possession, but not for dispensary purchases. Adults 21 and older may purchase from nonmedical retail dispensaries.Proposal 18-1 (2018)
MinnesotaSF 2471, Chapter 311 (2014)YesYes, limited, liquid extract products onlyYesNo
Mississippi
*overturned May 14, 2021
Initiative 65 (2020)
News: Mississippi Supreme Court Overturns Medical Marijuana Amendment 65
YesYesYesYet to be determined
MissouriAmendment 2 (2018)YesYesYesYes
MontanaInitiative 148 (2004) SB 423 (2011)
Initiative 182 (2016)
Yes

Yes

Yes  YesYes   YesNoInitiative 190 (2020)
NevadaQuestion 9 (2000) NRS 453A NAC 453AYesYesYesYes, if the other state’s program are “substantially similar.” Patients must fill out Nevada paperwork. Adults 21 and older may purchase at nonmedical retail dispensaries.Question 2 (2016) page 25
New HampshireHB 573 (2013)
HB 89 (2021)
YesYesYesYes, with a note from their home state, but they cannot purchase through dispensaries.
New JerseySB 119 (2009)
Program information
YesYesYesNoPublic Question 1 passed by voters in 2020 to allow legislature to enact legislation
NJ AB 21 passed legislature, signed by governor March 1, 2021
New MexicoSB 523 (2007)
Medical Cannabis Program
YesYesYesNoHB 2 Cannabis regulation act passed legislature March 31, 2021 and signed by governor on 4/12/21.
 

New York

A6357 (2014) Signed by governor 7/5/14YesYes- Ingested doses may not contain more than 10 mg of THC, product may not be combusted (smoked).YesNoAB 1248A/SB 854 passed legislature, signed by governor on March 31, 2021.
North DakotaMeasure 5 (2016) NDCC 19-24.1 NDAC 33-44YesYesYesNo
Northern Mariana IslandsDoes not have a medical program.Yes, HB 20-178 HD 4- Public Law 20-66 (2018)
OhioHB 523 (2016) Approved by legislature, signed by governor 6/8/16YesYesYesYes- If approved by the Board of Pharmacy on a state-by-state basis.
OklahomaSQ 788 Approved by voters on 6/26/18YesYesYes, but list was not included in the initial ballot measure.Yes but must apply as a temporary patient
OregonOregon Medical Marijuana Act (1998) SB 161 (2007)YesYesYesNo, but adults over 21 may purchase at adult retail dispensaries.Measure 91 (2014)
PennsylvaniaSB 3 (2016) Signed by governor 4/17/16YesYesYesNo
Puerto RicoPublic Health Department Regulation 155 (2016) in SpanishYesYes- Cannot be smokedYesYes
Rhode IslandS 710 B (2006)- Legislature overturned governor’s veto.
SB 791 (2007)  SB 185 (2009)
YesYesYesYes
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

YesYesYesYet to be determinedAmendment A (2020)
OVERTURNED BY COURTS Feb. 8, 2021
NOT COUNTED IN STATE TALLY ABOVE
US Virgin IslandsSB 135 (2017) signed by governor 1/19/19
UtahProp 2 (2018) replaced by HB 3001 HB 3001 2018– Third Special SessionYesYesYesYes
VermontSB 76 (2004) SB 7 (2007) SB 17 (2011) H.511 (2018)YesYesYesNo, but adults 21 years old and older may purchase from the nonmedical market.H.511 approved by legislature, signed by governor 1/22/18.
Effective July 1, 2018.
S.54 (2020) establishes sales regulations. Effective Oct. 7, 2020.
Governor’s letter re: S. 54, going into effect without his signature.    Additional info:
Governor’s Marijuana Advisory Commission Final Report– December, 2018
VirginiaH 1460 (2020)

S 646 (2020)

H 1617 (2020)

S 976 (2020)

Legislative Timeline (2020)

Board of Pharmacy overview
Board of Pharmacy FAQ

YesYesNoNo, but allows for temporary residents to apply with approval from the Board of Pharmacy.Yes, legislature approved HB2312 and SB1406Signed by governor 4/7/21.
WashingtonInitiative 692(1998) SB 5798 (2010) SB 5073 (2011)Registry is voluntary.Yes, approved as of Nov. 2012, stores opened in July, 2014.YesNo, but adults 21 and older may purchase at nonmedical retail dispensaries.Initiative 502 (2012)
WAC Marijuana rules: Chapter 314-55 WAC
FAQ about WA cannabis laws by the Seattle Times.
West VirginiaSB 386 (2017)YesYes. No whole flower/cannot be smoked but can be vaporized.YesNo, but may allow their patients who are terminally ill to buy in other states. WV does not recognize other state cards.

*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.

 

Table 2. Limited Access Cannabis Product Laws (low THC/high CBD- cannabidiol)
StateProgram Name and Statutory Language (year)Patient Registry or ID cardsDispensaries or Source of Product(s)Specifies ConditionsRecognizes Patients from other statesDefinition of Products AllowedAllows for Legal DefenseAllowed for Minors
Alabama 

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

SB 174 “Carly’s Law” (Act 2014-277) Allows University of Alabama Birmingham to conduct effectiveness research using low-THC products for treating seizure disorders for up to 5 years.  HB 61 (2016) Leni’s Law allows more physicians to refer patients to use CBD for more conditions.NoProvides legal defense for possession and/or use of CBD oil.  Does not create an in-state production method.Yes, debilitating epileptic conditions, life-threatening seizures, wasting syndrome, chronic pain, nausea, muscle spasms, any other sever condition resistant to conventional medicine.NoExtracts that are low THC= below 3% THCYesYes
Florida
(NEW comprehensive program approved in 2016, included in table above)
Compassionate Medical Cannabis Act of 2014 CS for SB 1030 (2014) Patient treatment information and outcomes will be collected and used for intractable childhood epilepsy researchYesYes, 5 registered nurseries across the state by region, which have been in business at least 30 years in Florida.Yes, cancer, medical condition or seizure disorders that chronically produces symptoms that can be alleviated by low-THC productsNoCannabis with low THC= below .8% THC and above 10% CBD by weightYes, with approval from 2 doctors
GeorgiaHB 1 (2015) (signed by governor 4/16/15)YesLaw allows University System of Georgia to develop a lot THC oil clinical research program that meets FDA trial compliance.Yes, end stage cancer, ALS, MS, seizure disorders, Crohn’s, mitochondrial disease, Parkinson’s, Sickle Cell diseaseNoCannabis oils with low THC= below 5% THC and at least an equal amount of CDB.YesYes
 Idaho- VETOED BY GOVERNORSB 1146 (VETOED by governor 4/16/15)NoDoesn’t define.The possessor has, or is a parent or guardian of a person that has, cancer, amyotrophic lateral sclerosis, seizure disorders, multiple sclerosis, Crohn’s disease, mitochondrial disease, fibromyalgia, Parkinson’s disease or sickle cell disease;NoIs composed of no more than three-tenths percent (0.3%)  tetrahydrocannabidiol by weight;  is composed of at least fifteen (15) times more cannabidiol than tetrahydrocannabidiol by weight; and contains no other psychoactive substance.YesYes
IndianaHB 1148 (2017)YesDoesn’t define.Treatment resistant epilepsy.NoAt least 5 percent CBD by weight. No more than .3 percent THC by weight.YesYes
IowaSF 2360, Medical Cannabidiol Act of 2014 (Effective 7/1/14 and repealed in 2017 and replaced)
HF 524 of 2017 now Section 124E
YesYesYesYes, for possession or use only, not for purchasing CBD in Iowa.Less than 3 percent THCYesYes
KentuckySB 124 (2014) Clara Madeline Gilliam Act Exempt cannabidiol from the definition of marijuana and allows it to be administered by a public university or school of medicine in Kentucky for clinical trial or expanded access program approved by the FDA.NoUniversities in Kentucky with medical schools that are able to get a research trial. Doesn’t allow for in-state production of CBD product.Intractable seizure disordersNoNo, only “cannabidiol”.
Mississippi
(Overturned Amendment 65 from 2020 included in table above.)
HB 1231 “Harper Grace’s Law” 2014All provided through National Center for Natural Products Research at the Univ. of Mississippi and dispensed by the Dept. of Pharmacy Services at the Univ. of Mississippi Medical CenterYes, debilitating epileptic condition or related illnessNo“CBD oil” – processed cannabis plant extract, oil or resin that contains more than 15% cannabidiol, or a dilution of the resin that contains at least 50 milligrams of cannabidiol (CBD) per milliliter, but not more than one-half of one percent (0.5%) of tetrahydrocannabinol (THC)Yes, if an authorized patient or guardianYes
Missouri  (NEW comprehensive program approved in 2018, included in table above)HB 2238 (2014)YesYes, creates cannabidiol oil care centers and cultivation and production facilities/laboratories.Yes, intractable epilepsy that has not responded to three or more other treatment options.No“Hemp extracts” equal or less than .3% THC and at least 5% CBD by weight.YesYes
North CarolinaHB 1220 (2014) Epilepsy Alternative Treatment Act- Pilot Study HB 766 (2015) Removes Pilot Study designationYesUniversity research studies with a hemp extract registration card from the state DHHS or obtained from another jurisdiction that allows removal of the products from the state.Yes, intractable epilepsyNo“Hemp extracts” with less than nine-tenths of one percent (0.9%) tetrahydrocannabinol (THC) by weight. Is composed of at least five percent (5%) cannabidiol by weight.
Contains no other psychoactive substance.
YesYes
Oklahoma (NEW comprehensive medical program approved in 2018 and listed above) HB 2154 (2015)YesNo in-state production allowed, so products would have to be brought in. Any formal distribution system would require federal approval.People under 18 (minors) Minors with Lennox-Gastaut Syndrome, Dravet Syndrome, or other severe epilepsy that is not adequately treated by traditional medical therapiesNoA preparation of cannabis with no more than .3% THC in liquid form.YesYes, only allowed for minors
South Carolina SB 1035 (2014) Medical Cannabis Therapeutic Treatment Act- Julian’s LawYesMust use CBD product from an approved source; and (2)    approved by the United States Food and Drug Administration to be used for treatment of a condition specified in an investigational new drug application. -The principal investigator and any subinvestigator may receive cannabidiol directly from an approved source or authorized distributor for an approved source for use in the expanded access clinical trials. Some have interpreted the law to allow patients and caregivers to produce their own products.Lennox-Gastaut Syndrome, Dravet Syndrome, also known as severe myoclonic epilepsy of infancy, or any other form of refractory epilepsy that is not adequately treated by traditional medical therapies.NoCannabidiol or derivative of marijuana that contains 0.9% THC and over 15% CBD, or least 98 percent cannabidiol (CBD) and not more than 0.90% tetrahydrocannabinol (THC) by volume that has been extracted from marijuana or synthesized in a laboratoryYesYes
TennesseeSB 2531 (2014)
Creates a four-year study of high CBD/low THC cannabis at Tenn. Tech Univ. 

 

Researchers need to track patient information and outcomesOnly products produced by Tennessee Tech University.
Patients may possess low THC oils only if they are purchased “legally in the United States and outside of Tennessee,” from an assumed medical cannabis state, however most states do not allow products to leave the state.
Yes, intractable seizure conditions.

 

 

No

 

 

 

 

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

 

 

YesYes
HB 197 (2015)NoAllows for legal defense for having the product as long as it was obtained legally in the US or other medical cannabis state.Yes, intractable seizure conditions.NoSame as above.YesYes
TexasSB 339 (2015)
Texas Compassionate Use ActHB 3703 (2019)
YesYes, licensed by the Department of Public Safety.Yes, intractable epilepsy, incurable neurodegenerative disease, terminal cancer, multiple sclerosis, spasticity, ALS, autism.No“Low-THC Cannabis” with not more than 0.5 percent by weight of tetrahydrocannabinols.YesYes
Utah (NEW comprehensive program approved in 2018, included in table above)HB 105 (2014) Hemp Extract Registration ActYesNot completely clear, however it may allow higher education institutions to grow or cultivate industrial hemp.Yes, intractable epilepsy that hasn’t responded to three or more treatment options suggested by a neurologist.No“Hemp extracts” with less than .3% THC by weight and at least 15% CBD by weight and contains no other psychoactive substancesYesYes
 Virginia
(NEW comprehensive medical program approved in 2020 and listed above)
HB 1445– no longer in effectNoNo in-state means of acquiring cannabis products.Intractable epilepsyNoCannabis oils with at least 15% CBD or THC-A and no more than 5% THC.YesYes
WisconsinAB 726 (2013 Act 267)NoPhysicians and pharmacies with an investigational drug permit by the FDA could dispense cannabidiol. Qualified patients would also be allowed to access CBD from an out-of-state medical cannabis dispensary that allows for out-of-state patients to use their dispensaries as well as remove the products from the state. No in-state production/manufacturing mechanism provided.Seizure disordersException to the definition of prohibited THC by state law, allows for possession of “cannabidiol in a form without a psychoactive effect.”  THC or CBD levels are not defined.NoYes
WyomingHB 32 (2015)
Supervised medical use of hemp extracts. Effective 7/1/2015
YesNo in-state production or purchase method defined.Intractable epilepsy or seizure disordersNo“Hemp extracts” with less than 0.3% THC and at least 5% CBD by weight.YesYes

*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

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