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More recently, in January 2018, former Attorney General Sessions issued a Marijuana Enforcement Memorandum that rescinded the Cole Memorandum, and allows federal prosecutors to decide how to prioritize enforcement of federal cannabis laws.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 |
State Allows for Retail Sales/Non Medical Adult Use |
| Alabama |
SB46 (2021) |
|
| Alaska |
Measure 8 (1998) SB 94 (1999) Statute Title 17, Chapter 37 |
Yes. Ballot Measure 2 (2014) Marijuana Regulations |
| Arizona |
Proposition 203 (2010) |
Yes. Proposition 207 (2020) |
| Arkansas |
Issue 6 (2016) |
|
| California |
Proposition 215 (1996) SB 420 (2003) |
Yes. Proposition 64 (2016) |
Colorado
Medical program info
-Non medical use info |
Amendment 20 (2000) |
Yes. Amendment 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. |
| Connecticut |
HB 5389 (2012)
Non medical use legislation SB 1201 (2021) |
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. Non medical adult-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. Initiative 71 (2014) |
| Florida |
Amendment 2 (2016) |
|
| 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. Non medical use- 2019 Bill No. 32-35 signed by governor in April, 2019 |
| Hawaii |
SB 862 (2000) |
|
| Illinois |
HB 1 (2013) Eff. 1/1/2014 Rules
Non medical use legalization SB 0007 bill passed legislature May, 2019, signed by governor June 25, 2019, Effective Jan. 1, 2020. |
Yes. Measure approved by legislature in May, 2019, signed by governor June 25, 2019. Effective Jan. 1, 2020. |
| Kentucky |
SB 47 (2023) |
|
| Louisiana |
SB 271 (2017) |
|
| Maine |
Question 2 (1999) LD 611 (2002) Question 5 (2009) LD 1811 (2010) LD 1296 (2011) |
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. Question 4 (2022) |
| Massachusetts |
Question 3 (2012)
Regulations (2013) |
Yes. Question 4 (2016) |
| Michigan |
Proposal 1 (2008) |
Yes. Proposal 18-1 (2018) |
| Minnesota |
SF 2471, Chapter 311 (2014) |
Yes. HF 100 (2023) |
|
Mississippi
*overturned May 14, 2021
|
SB 2095 (2022)
Initiative 65 (2020)*
News: Mississippi Supreme Court Overturns Medical Marijuana Amendment 65
|
|
| Missouri |
Amendment 2 (2018)
|
Yes. Amendment 3 (2022) |
| Montana |
Initiative 148 (2004) SB 423 (2011)
Initiative 182 (2016) |
Yes. Initiative 190 (2020) |
| Nevada |
Question 9 (2000) NRS 453A NAC 453A |
Yes. Question 2 (2016) page 25 |
| New Hampshire |
HB 573 (2013)
HB 89 (2021) |
|
| New Jersey |
SB 119 (2010)
Program information |
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. 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. AB 1248A/SB 854 passed legislature, signed by governor on March 31, 2021. |
| North Dakota |
Measure 5 (2016) NDCC 19-24.1 NDAC 33-44 |
|
| 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. Issue 2 enacted by voters Nov. 8, 2023. |
| Oklahoma |
SQ 788 Approved by voters on 6/26/18 |
|
| Oregon |
Oregon Medical Marijuana Act (1998) SB 161 (2007) |
Yes. Measure 91 (2014) |
| Pennsylvania |
SB 3 (2016) Signed by governor 4/17/16 |
|
| Puerto Rico |
Public Health Department Regulation 155 (2016) in Spanish |
|
| Rhode Island |
S 710 B (2006)- Legislature overturned governor's veto.
SB 791 (2007) SB 185 (2009)
2022-S 2430Aaa and 2022-H 7593Aaa (2022)
Rhode Island Cannabis Act
|
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)
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
|
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 |
Yes. The Virgin Islands Cannabis Use Act 34-0345 (2022) |
| Utah |
Prop 2 (2018) replaced by HB 3001 HB 3001 2018- Third Special Session |
|
| Vermont |
SB 76 (2004) SB 7 (2007) SB 17 (2011) H.511 (2018) |
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 |
H 1460 (2020)
S 646 (2020)
H 1617 (2020)
S 976 (2020)
Legislative Timeline (2020)
Board of Pharmacy overview
Board of Pharmacy FAQ
|
Yes, legislature approved HB2312 and SB1406. Signed by governor 4/7/21. |
| Washington |
Initiative 692(1998) SB 5798 (2010) SB 5073 (2011) |
Initiative 502 (2012)
WAC Marijuana rules: Chapter 314-55 WAC
FAQ about WA cannabis laws by the Seattle Times. |
| West Virginia |
SB 386 (2017) |
|
Table 2. Limited Access Cannabis Product Laws (low THC/high CBD- cannabidiol)
| State |
Program Name and Statutory Language (year) |
Definition of Products Allowed |
|
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. |
Extracts that are low THC= below 3% THC |
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 |
Cannabis with low THC= below .8% THC and above 10% CBD by weight |
| Georgia |
HB 1 (2015) (signed by governor 4/16/15) |
Cannabis oils with low THC= below 5% THC and at least an equal amount of CDB. |
|
Idaho- VETOED BY GOVERNOR
|
SB 1146 (VETOED by governor 4/16/15) |
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. |
| Indiana |
HB 1148 (2017) |
At least 5 percent CBD by weight. No more than .3 percent THC by weight. |
| 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 |
Less than 3 percent THC |
|
Kansas*
(Not marked on map above because the state does not regulate the production or sale of low-CBD products.)
|
SB 28 Clare and Lola’s law (5/20/2019) |
Concentrated cannabidiol with THC of no more than 5% relative of weight by third party testing. |
|
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, only "cannabidiol". |
Mississippi
(Overturned Amendment 65 from 2020 included in table above.) |
HB 1231 "Harper Grace's Law" 2014 |
"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) |
| Missouri (NEW comprehensive program approved in 2018, included in table above)
|
HB 2238 (2014) |
"Hemp extracts" equal or less than .3% THC and at least 5% CBD by weight. |
| North Carolina |
HB 1220 (2014) Epilepsy Alternative Treatment Act- Pilot Study HB 766 (2015) Removes Pilot Study designation |
"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. |
| Oklahoma (NEW comprehensive medical program approved in 2018 and listed above) |
HB 2154 (2015) |
A preparation of cannabis with no more than .3% THC in liquid form. |
| South Carolina |
SB 1035 (2014) Medical Cannabis Therapeutic Treatment Act- Julian's Law |
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 |
| Tennessee |
SB 2531 (2014)
Creates a four-year study of high CBD/low THC cannabis at Tenn. Tech Univ.
|
"Cannabis oil" with less than .9% THC as part of a clinical research study.
|
| HB 197 (2015) |
Same as above. |
| Texas |
SB 339 (2015)
Texas Compassionate Use Act
HB 3703 (2019)
|
"Low-THC Cannabis" with not more than 0.5 percent by weight of tetrahydrocannabinols. |
| Utah (NEW comprehensive program approved in 2018, included in table above) |
HB 105 (2014) Hemp Extract Registration Act |
"Hemp extracts" with less than .3% THC by weight and at least 15% CBD by weight and contains no other psychoactive substances |
|
Virginia
(NEW comprehensive medical program approved in 2020 and listed above)
|
HB 1445- no longer in effect |
Cannabis oils with at least 15% CBD or THC-A and no more than 5% THC. |
| Wisconsin |
AB 726 (2013 Act 267) |
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. |
Wyoming
|
HB 32 (2015)
Supervised medical use of hemp extracts. Effective 7/1/2015 |
"Hemp extracts" with less than 0.3% THC and at least 5% CBD by weight. |
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