State Medical Cannabis Laws

MEDICAL-USE UPDATE: As of February 3, 2022, 37 states, three territories and the District of Columbia allow 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. The legislature passed new legislation which was signed by the governor Feb. 2, 2022. See Table 1 below.
 

NON MEDICAL/ADULT-USE UPDATE: As of May 27, 2022, 19 states, two territories and the District of Columbia have enacted measures to regulate cannabis for adult non medical use.

• Voters in Arizona, Montana, New Jersey and South Dakota approved measures to regulate cannabis for non medical use. 
• On Feb. 8, 2021, South Dakota Circuit Judge Christina Klinger ruled that the measure was unconstitutional. The South Dakota Supreme Court upheld this decision on November 24, 2021 by a vote of 4-1. 
• 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.
• The Rhode Island General Assembly passed the Rhode Island Cannabis Act, measures 2022-S 2430Aaa and 2022-H 7593Aaa, and the governor signed them on May 25, 2022.
• These actions bring the number of states with non medical (adult-use) regulated cannabis to 19, plus two territories and the District of Columbia (D.C. does not regulate non medical sales).
• This total does NOT include South Dakota’s court-over-turned measure. 

Please see Table 1 below for more information.

A total of 37 states, the District of Columbia, Guam, Puerto Rico and the U.S. Virgin Islands regulate cannabis for medical use by qualified individuals.. 

Approved measures in 10 states allow the use of “low THC, high cannabidiol (CBD)” products for medical reasons in limited situations or as a legal defense. 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.)

* = Measures approved by voters in Mississippi for medical use and South Dakota for non medical use were overturned in 2021. The Mississippi legislature passed new medical cannabis legislation which the governor signed on Feb. 2, 2022.
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. 

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