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California voters passed Proposition 215 in 1996, making the Golden State the first in the union to allow for the medical use of marijuana. Since then, 35 more states, the District of Columbia, Guam, Puerto Rico and U.S. Virgin Islands have enacted similar laws.
POST 2020 ELECTION UPDATE: As of Nov. 4 2020, voters in Mississippi and South Dakota approved a measure to regulate cannabis for medical use, bringing the total to 36 states and 4 territories. However, Mississippi's measure is being challenged as of February 2021. Please see Table 1 for more information.
UPDATE: As of March 1, 2021, voters in Arizona, Montana, New Jersey and South Dakota approved measures to regulate cannabis for adult-use. The governor of New Jersey signed the legislation on March 1. The Virginia legislature enacted legislation on February 27 and sent the bill to the governor. If signed, Virginia's law will bring the total to 15 states and 3 territories- NOT counting South Dakota's challenged and overturned measure. Please see Table 1 for more information.
A total of 36 states, District of Columbia, Guam, Puerto Rico and U.S. Virgin Islands have approved comprehensive, publicly available medical marijuana/cannabis programs. (See Table 1 below for more information.)
Approved measures in 11 states allow 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 marijuana programs. NCSL uses criteria similar to other organizations tracking this issue to determine if a program is "comprehensive":
- Protection from criminal penalties for using marijuana for a medical purpose.
- Access to marijuana 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 marijuana products, plant material or extract.
- Is not a limited trial program. (South Dakota and Nebraska have limited, trial programs that are not open to the public.)
MARCH 1, 2021: MAP IS BEING UPDATED TO REFLECT CHANGES IN SOUTH DAKOTA AND VIRGINIA
* = 2020 measures in Mississippi and South Dakota were overturned or are in court as of Feb. 19, 2021. Please see Table 1 below for more information.
Medical Uses of Marijuana
In response to California's Prop 215, the Institute of Medicine issued a report that examined potential therapeutic uses for marijuana. 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 marijuana 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, marijuana 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 marijuana a federal offense. In October of 2009, the Obama Administration sent a memo to federal prosecutors encouraging them not to prosecute people who distribute marijuana 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 marijuana 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 marijuana 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 marijuana. Since marijuana is still a Schedule I substance, federal law prohibits its prescription, making the initiative invalid. Medical marijuana "prescriptions" are more often called "recommendations" or "referrals" because of the federal prescription prohibition.
States with medical marijuana laws generally have some form of patient registry, which may provide some protection against arrest for possession up to a certain amount of marijuana for personal medicinal use.
Some of the most common policy questions regarding medical marijuana include how to regulate its recommendation, dispensing, and registration of approved patients. Some states and localities without dispensary regulation are experiencing a boom in new businesses, in hopes of being approved before presumably stricter regulations are made. Medical marijuana growers or dispensaries are often called "caregivers" and may be limited to a certain number of plants or products 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.
** While Montana's revised medical marijuana law limits caregivers to three patients, caregivers may serve an unlimited number of patients due to an injunction issued on January 16, 2013.
Table 2. Limited Access Marijuana Product Laws (low THC/high CBD- cannabidiol)
| 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 |
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 posession 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, fibroymyalgia, 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 |
| Kentucky |
SB 124 (2014) Clara Madeline Gilliam Act Exempt cannabidiol from the definition of marijuana and allows it to be administerd 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
(NEW comprehensive medical use program approved in 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 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 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 laboratory |
Yes |
Yes |
| Tennessee |
SB 2531 (2014)
Creates a four-year study of high CBD/low THC marijuana at TN Tech Univ. ______ HB 197 (2015) |
Researchers need to track patient information and outcomes
______ No |
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. _____ Allows for legal defense for having the product as long as it was obtained legally in the US or other medical marijuana state. |
Yes, intractable seizure conditions. ______ Yes, intractable seizure conditions. |
No ______ No |
"Cannabis oil" with less than .9% THC as part of a clinical research study ______ Same as above. |
Yes |
Yes |
| Texas |
SB 339 (2015)
Texas Compassionate Use Act
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 institution to grow or cultivate industrial hemp. |
Yes, intractable epilepsy that hasn't responded to three or more treatment options suggested by 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
(NEW comprehensive medical program approved in 2020 and listed above)
|
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 marijuana 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
- 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
- Finances/Tax information
- Law enforcement/crime information
- 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
- Retail/Adult Use information and news
- Public health and youth information
- Interest groups, position statements, opinions, and model regulation examples