NCSL - National Conference of State Legislatures
06/09/2023 | Press release | Distributed by Public on 06/09/2023 14:31
State Medical Cannabis Laws
Related Topic:Health
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Medical-Use Update
As of Apr. 24, 2023, 38 states, three territories and the District of Columbia allow the medical use of cannabis products. See Table 1 below for additional information.
Non-Medical/Adult-Use Update
As of June 1, 2023, 23 states, two territories and the District of Columbia have enacted measures to regulate cannabis for adult non medical use.
Low-THC Update
Approved measures in 9 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":
- Protection from criminal penalties for using cannabis for a medical purpose.
- Access to cannabis through home cultivation, dispensaries or some other system that is likely to be implemented.
- It allows a variety of strains or products, including those with more than "low THC."
- It allows either smoking or vaporization of some kind of cannabis products, plant material or extract.
- Is not a limited trial program. (Nebraska has a trial program that is not open to the public.)
MAP: State Regulated Cannabis Programs
Notes: The District of Columbia allows limited adult possession and growing, no regulated production or sales.
Modal title
×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.
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."
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.
Table 1. State Medical Marijuana/Cannabis Program Laws|
State (click state name to jump to program information) |
Statutory Language (year | Patient Registry or ID cards | Allows Dispensaries | Specifies Conditions | Recognizes Patients from other states | State Allows for Retail Sales/Non Medical Adult Use |
| Alabama | SB46 (2021) | Yes | Yes | Yes | No | |
| Alaska | Measure 8 (1998) SB 94 (1999) Statute Title 17, Chapter 37 | Yes | Yes | Yes | No, but adults 21 and older may purchase at non medical retail dispensaries. | Yes. Ballot Measure 2 (2014) Marijuana Regulations |
| Arizona | Proposition 203 (2010) | Yes | Yes | Yes | Yes, for AZ-approved conditions, but not for dispensary purchases. | Yes. Proposition 207 (2020) |
| Arkansas | Issue 6 (2016) | Yes | Yes | Yes | Yes | |
| California | Proposition 215 (1996) SB 420 (2003) | Yes | Yes (cooperatives and collectives) | No | No | Yes. Proposition 64 (2016) |
|
Colorado Medical program info -Non medical use info |
Amendment 20 (2000) | Yes | Yes | Yes | No |
Yes. Amendment 64 (2012) Task Force ImplementationRecommendations (2013) Analysis of CO Amendment 64 (2013) Colorado Marijuana Sales and Tax Reports2014 "Edibles" regulation measureFAQ about CO cannabis laws by the Denver Post. |
| Connecticut |
HB 5389 (2012) Non medical use legislation SB 1201 (2021) |
Yes |
Yes |
Yes | Yes. SB 1201 (2021) | |
| Delaware |
SB 17 (2011) Non medical adult-use legislation HB 1 and HB 2(2023) passed the legislature and enacted without governor's signature. |
Yes | Yes | Yes | Yes, for DE-approved conditions. | Yes. Non medicaladult-use legislation HB 1 and HB 2 (2023) HB 371 passed the legislature and enacted without governor's signature. 4/21/2023 |
| District of Columbia |
Initiative 59 (Passed by voters but blocked by the Barr Amendment in 1998) L18-0210 or Act B18-622 (2010) |
Yes | Yes | Yes | Yes. Initiative 71 (2014) | |
| Florida | Amendment 2 (2016) | Yes | Yes | Yes | No | |
| Guam |
Joaquin (KC) Concepcion II Compassionate Cannabis Use Act 2013 and Proposal 14A approved in Nov. 2014, fully operational.- home growing allowed. Non medical adult use- 2019 Bill No. 32-35 signed by governor in April, 2019 |
Yes | Yes | Yes | No | Yes. Non medical use- 2019 Bill No. 32-35 signed by governor in April, 2019 |
| Hawaii | SB 862 (2000) | Yes | Yes | Yes | No | |
| Illinois |
HB 1 (2013) Eff. 1/1/2014Rules Non medical use legalization SB 0007 bill passed legislature May, 2019, signed by governor June 25, 2019, Effective Jan. 1, 2020. |
Yes | Yes | Yes | No | Yes. Measure approved by legislature in May, 2019, signed by governor June 25, 2019. Effective Jan. 1, 2020. |
| Kentucky | SB 47 (2023) | Yes | Yes | Yes | Yes | |
| Louisiana | SB 271 (2017) | No | Yes | Yes | No | |
| Maine | Question 2 (1999) LD 611 (2002) Question 5 (2009) LD 1811 (2010) LD 1296 (2011) | Yes | Yes | Yes | Yes, but not for dispensary purchases. Adults 21 and older may purchase from non medical retail dispensaries. | Yes. Question 1 (2016) page 4 Chapter 409 (2018) |
| Maryland |
HB 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 |
Yes | Yes | Yes | No | Yes. Question 4 (2022) |
| Massachusetts |
Question 3 (2012) Regulations (2013) |
Yes | Yes | Yes | No | Yes. Question 4 (2016) |
| Michigan | Proposal 1 (2008) | Yes | Yes | Yes | Yes, for legal protection of possession, but not for dispensary purchases. Adults 21 and older may purchase from non medical retail dispensaries. | Yes. Proposal 18-1 (2018) |
| Minnesota | SF 2471, Chapter 311 (2014) | Yes | Yes, limited, liquid extract products only | Yes | No | Yes. HF 100 (2023) |
|
|
SB 2095 (2022) News: Mississippi Supreme Court Overturns Medical Marijuana Amendment 65 |
Yes Yes |
Yes Yes |
Yes Yes |
Yes- must apply to MDOH. Yet to be determined |
|
| Missouri | Yes | Yes | Yes | Yes | Yes. Amendment 3 (2022) | |
| Montana |
Initiative 148 (2004) SB 423 (2011) Initiative 182 (2016) |
Yes Yes |
Yes Yes | Yes Yes | No | Yes. Initiative 190 (2020) |
| Nevada | Question 9 (2000) NRS 453ANAC 453A | Yes | Yes | Yes | Yes, if the other state's program are "substantially similar." Patients must fill out Nevada paperwork. Adults 21 and older may purchase at non medical retail dispensaries. | Yes. Question 2 (2016) page 25 |
| New Hampshire |
HB 573 (2013) HB 89 (2021) |
Yes | Yes | Yes | Yes, with a note from their home state, but they cannot purchase through dispensaries. | |
| New Jersey |
SB 119 (2010) Program information |
Yes | Yes | Yes | No |
Yes. Public 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 Mexico |
SB 523 (2007) Medical Cannabis Program |
Yes | Yes | Yes | No | Yes. HB 2 Cannabis regulation act passed legislature March 31, 2021 and signed by governor on 4/12/21. |
| New York | A6357 (2014) Signed by governor 7/5/14 | Yes | Yes- Ingested doses may not contain more than 10 mg of THC, product may not be combusted (smoked). | Yes | No | Yes. AB 1248A/SB 854 passed legislature, signed by governor on March 31, 2021. |
| North Dakota | Measure 5 (2016) NDCC 19-24.1NDAC 33-44 | Yes | Yes | Yes | No | |
| Northern Mariana Islands | Does not have a medical program. | Yes. HB 20-178 HD 4- Public Law 20-66 (2018) | ||||
| Ohio | HB 523 (2016) Approved by legislature, signed by governor 6/8/16 | Yes | Yes | Yes | Yes- If approved by the Board of Pharmacy on a state-by-state basis. | |
| Oklahoma | SQ 788 Approved by voters on 6/26/18 | Yes | Yes | Yes, but list was not included in the initial ballot measure. | Yes but must apply as a temporary patient | |
| Oregon | Oregon Medical Marijuana Act (1998) SB 161 (2007) | Yes | Yes | Yes | No, but adults over 21 may purchase at adult retail dispensaries. | Yes. Measure 91 (2014) |
| Pennsylvania | SB 3 (2016) Signed by governor 4/17/16 | Yes | Yes | Yes | No | |
| Puerto Rico | Public Health Department Regulation 155 (2016) in Spanish | Yes | Yes- Cannot be smoked | Yes | Yes | |
| Rhode Island |
S 710 B (2006)- Legislature overturned governor's veto.
2022-S 2430Aaa and 2022-H 7593Aaa (2022) |
Yes |
Yes | Yes | Yes | Yes. Rhode Island Cannabis Act 2022-S 2430Aaa and 2022-H 7593Aaa (2022) |
|
South Dakota *Non medical use measure ruled unconstitutional as of Feb. 9, 2021. |
Initiated Measure 26 (2020) |
Yes | Yes | Yes | Yet to be determined |
Amendment A (2020) OVERTURNED BY COURTS Feb. 8, 2021 NOT COUNTED IN STATE TALLY ABOVE |
| US Virgin Islands | SB 135 (2017) signed by governor 1/19/19 | |||||
| Utah | Prop 2 (2018) replaced by HB 3001 HB 3001 2018- Third Special Session | Yes | Yes | Yes | Yes | |
| Vermont | SB 76 (2004) SB 7 (2007) SB 17 (2011) H.511 (2018) | Yes | Yes | Yes | No, but adults 21 years old and older may purchase from the non medical 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 |
| Virginia | Yes | Yes | No | No, but allows for temporary residents to apply with approval from the Board of Pharmacy. | Yes, legislature approved HB2312 and SB1406. Signed by governor 4/7/21. | |
| Washington | Initiative 692(1998) SB 5798 (2010) SB 5073 (2011) | Registry is voluntary. | Yes, approved as of Nov. 2012, stores opened in July, 2014. | Yes | No, but adults 21 and older may purchase at non medical retail dispensaries. |
Initiative 502 (2012) WAC Marijuana rules: Chapter 314-55 WAC FAQ about WA cannabis laws by the Seattle Times. |
| West Virginia | SB 386 (2017) | Yes | Yes. No whole flower/cannot be smoked but can be vaporized. | Yes | No, but may allow their patients who are terminally ill to buy in other states. WV does not recognize other state cards. |
| State | Program Name and Statutory Language (year) | Patient Registry or ID cards | Dispensaries or Source of Product(s) | Specifies Conditions | Recognizes Patients from other states | Definition of Products Allowed | Allows for Legal Defense | Allowed 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. | No | Provides 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. | No | Extracts that are low THC= below 3% THC | Yes | Yes |
|
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 research | Yes | Yes, 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 products | No | Cannabis with low THC= below .8% THC and above 10% CBD by weight | Yes, with approval from 2 doctors | |
| Georgia | HB 1 (2015) (signed by governor 4/16/15) | Yes | Law 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 disease | No | Cannabis oils with low THC= below 5% THC and at least an equal amount of CDB. | Yes | Yes |
|
Idaho- VETOED BY GOVERNOR |
SB 1146 (VETOED by governor 4/16/15) | No | Doesn'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; | No | Is 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. | Yes | Yes |
| Indiana | HB 1148 (2017) | Yes | Doesn't define. | Treatment resistant epilepsy. | No | At least 5 percent CBD by weight. No more than .3 percent THC by weight. | Yes | Yes |
| Iowa |
SF 2360, Medical Cannabidiol Act of 2014 (Effective 7/1/14 and repealed in 2017 and replaced) HF 524 of 2017 now Section 124E |
Yes | Yes | Yes | Yes, for possession or use only, not for purchasing CBD in Iowa. | Less than 3 percent THC | Yes | Yes |
|
Kansas* |
SB 28 Clare and Lola's law (5/20/2019) | No | No | No | No, may use possession of low-THC product from another state for a medical reason as as "affirmable defense to prosecution." | Concentrated cannabidiol with THC of no more than 5% relative of weight by third party testing. | Yes | Yes |
|
Kentucky (New comprehensive medical program approved in 2023 and listed in Table 1 above) |
SB 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. | No | Universities 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 disorders | No | No, only "cannabidiol". | ||
|
Mississippi (Overturned Amendment 65 from 2020 included in table above.) |
HB 1231 "Harper Grace's Law" 2014 | All 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 Center | Yes, debilitating epileptic condition or related illness | No | "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 guardian | Yes | |
| Missouri(NEW comprehensive program approved in 2018, included in table above) | HB 2238 (2014) | Yes | Yes, 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. | Yes | Yes |
| North Carolina | HB 1220 (2014) Epilepsy Alternative Treatment Act- Pilot Study HB 766 (2015) Removes Pilot Study designation | Yes | University 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 epilepsy | No |
"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. |
Yes | Yes |
| Oklahoma(NEW comprehensive medical program approved in 2018 and listed above) | HB 2154 (2015) | Yes | No 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 therapies | No | A preparation of cannabis with no more than .3% THC in liquid form. | Yes | Yes, only allowed for minors |
| South Carolina | SB 1035 (2014) Medical Cannabis Therapeutic Treatment Act- Julian's Law | Yes | Must 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. | No | Cannabidiol or derivative of marijuana that contains 0.9% THC and over 15% CBD, or at east 98 percent cannabidiol (CBD) and not more than 0.90% tetrahydrocannabinol (THC) by volume that has been extracted from marijuana or synthesized in a laboratory | Yes | Yes |
| Tennessee |
SB 2531 (2014) |
Researchers need to track patient information and outcomes |
Only 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. |
Yes | Yes |
| HB 197 (2015) | No | Allows 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. | No | Same as above. | Yes | Yes | |
| Texas |
SB 339 (2015) HB 3703 (2019) |
Yes | Yes, 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. | Yes | Yes |
| Utah(NEW comprehensive program approved in 2018, included in table above) | HB 105 (2014) Hemp Extract Registration Act | Yes | Not 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 substances | Yes | Yes |
|
Virginia |
HB 1445- no longer in effect | No | No in-state means of acquiring cannabis products. | Intractable epilepsy | No | Cannabis oils with at least 15% CBD or THC-A and no more than 5% THC. | Yes | Yes |
| Wisconsin | AB 726 (2013 Act 267) | No | Physicians 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 disorders | Exception 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. | No | Yes | |
|
Wyoming |
HB 32 (2015) Supervised medical use of hemp extracts. Effective 7/1/2015 |
Yes | No in-state production or purchase method defined. | Intractable epilepsy or seizure disorders | No | "Hemp extracts" with less than 0.3% THC and at least 5% CBD by weight. | Yes | Yes |
*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:
-
How Four States Incorporated Public Health Into Cannabis Policy(Report):
Executive summary
Full report - State cannabis policy enactment database for 2022-2023(database)
- Cannabis and employment issues(report)
- Civil and criminal justice cannabis overview (report)
- Cannabis and banking(brief)
- State Cannabis Taxation(report) https://www.ncsl.org/fiscal/state-cannabis-taxationand https://www.ncsl.org/fiscal/update-on-state-cannabis-taxation
- Marijuana impaired driving(report)