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In 1996, California voters passed Proposition 215, making the Golden State the first in the union to allow for the medical use of marijuana. Since then, 30 more states, the District of Columbia, Guam and Puerto Rico have enacted similar laws. As of Jan. 22, 2018, the Vermont legislature passed adult-use legalization legislation and the governor signed the bill. The measure does NOT set up a regulatory for system for sales or production. See text of measure below.

A total of 31 states, the District of Columbia, Guam and Puerto Rico now allow for comprehensive public medical marijuana and cannabis programs.  (See Table 1 below for more info.) Approved efforts in 15 states allow use of “low THC, high cannabidiol (CBD)” products for medical reasons in limited situations or as a legal defense. Those programs are not counted as comprehensive medical marijuana programs but are listed in Table 2. NCSL uses criteria similar to other organizations to determine if a program is “comprehensive”: See Table 2 below for more information.

  1. Protection from criminal penalties for using marijuana for a medical purpose;
  2. Access to marijuana through home cultivation, dispensaries or some other system that is likely to be implemented;
  3. It allows a variety of strains, including those more than “low THC;” and
  4. It allows either smoking or vaporization of some kind of marijuana products, plant material or extract.

United States map of State Cannabis Programs

Medical Uses of Marijuana

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 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, 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.

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/Adult Use
Alaska
Measure 8(1998) SB 94 (1999) Statute Title 17, Chapter 37
Yes
Yes
Yes
No, but adults over 21 may purchase at retail adult dispensaries.
Ballot Measure 2(2014)
Marijuana Regulations
Arizona
Proposition 203 (2010)
Yes
Yes
Yes
Yes, for AZ-approved conditions, but not for dispensary purchases.
Arkansas
Issue 6 (2016) Details pending
Pending
Pending
Pending
Pending
California
Proposition 215 (1996)  SB 420 (2003)
Yes
Yes (cooperatives and collectives)
No
NoProposition 64 (2016)
Colorado
Medical program info
Adult-use info
Amendment 20 (2000)
Yes
Yes
Yes
No
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)
Yes
Yes
Yes
Delaware
SB 17 (2011)
Yes
Yes
Yes
 Yes, for DE-approved conditions.
District of Columbia
Initiative 59(1998)  L18-0210 (2010)
Yes
Yes
Yes
Initiative 71 (2014)
Florida
Amendment 2(2016) Details pending
Pending
Pending
Pending
Pending
Guam
Proposal 14A
Approved in Nov. 2014, not yet operational.
Draft rules released in July 2015
Yes
Yes
Yes
No
Hawaii
SB 862 (2000)
Yes
Yes
Yes
No
Illinois
HB 1(2013) Eff. 1/1/2014
Rules
Yes
Yes
Yes
No
Louisiana
SB 271 (2017) (not yet in effect)
Pending
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.
Question 1 (2016) page 4
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
Massachusetts
Question 3(2012)
Regulations(2013)
Yes
Yes
Yes
No
Question 4 (2016)
Michigan
Proposal 1 (2008)
Yes
Not in state law, but localities may create ordinances to allow them and regulate them.
Yes
Yes, for legal protection of posession, but not for dispensary purchases.
Minnesota
SF 2471, Chapter 311 (2014)
Yes
Yes, limited, liquid extract products only
Yes
No
Montana
Initiative 148(2004) SB 423 (2011)
Initiative 182(2016)
Yes

New details pending

No**
New details pending
Yes
New details pending
No
New details pending
Nevada
Question 9(2000) NRS 453A NAC 453A
Yes
Yes
Yes
Yes, if the other state’s program are “substantially similar.” Patients must fill out Nevada paperwork. Adults over 21 may also purchase at adult retail dispensaries.
Question 2 (2016) page 25
New Hampshire
HB 573 (2013)
Yes
Yes
Yes
Yes, with a note from their home state, but they cannot purchase through dispensaries.
New Jersey
SB 119(2009)
Program information
Yes
Yes
Yes
No
New Mexico
SB 523 (2007)
Medical Cannabis Program
Yes
Yes
Yes
No
 

New York

 

A6357 (2014) Signed by governor 7/5/14
Yes
Ingested doses may not contain more than 10 mg of THC, product may not be combusted (smoked).
Yes
No
North Dakota
Measure 5(2016) Final details pending
YesYesYesNo
Ohio
HB 523 (2016) Approved by legislature, signed by governor 6/8/16, not yet operational
Yes
Yes
Yes
Details pending, but will require reciprocity.
Oklahoma
SQ 788 Approved by voters on 6/26/18, not yet operational
Details pending
Details pending
Not as voted on
Details pending
Oregon
Oregon Medical Marijuana Act(1998)
SB 161(2007)
Yes
Yes
Yes
No, but adults over 21 may purchase at adult retail dispensaries.
Measure 91 (2014)
Pennysylvania
SB 3 (2016) Signed by governor 4/17/16 Not yet operational
Yes
Yes
Yes
Puerto Rico
Public Health Department Regulation 155 (2016) Not yet operational
Cannot be smoked
Rhode Island
SB 791(2007)  SB 185 (2009)
Yes
Yes
Yes
Yes
Vermont
SB 76(2004) SB 7(2007) SB 17(2011)
H.511 (2018)
Yes
Yes
Yes
No
H.511 approved by legislature, signed by governor 1/22/18.
Effective July 1, 2018.
Does NOT provide for legal production or sales.
Allows adults 21 years or older to possess up to one ounce of marijuana.
Selling marijuana in Vermont remains illegal.
Allows adults to grow two mature plants.
Public consumption of marijuana is also not allowed.
Washington
Initiative 692(1998) SB 5798 (2010)
SB 5073(2011)
No
Yes, approved as of Nov. 2012, stores opened in July, 2014.
Yes
No, but adults over 21 may purchase at an adult retail dispensary.
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 terminally ill to buy in other states.

 

** 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)
StateProgram Name and Statutory Language (year)Patient Registry or ID cardsDispensaries or Source of Product(s)Specifies ConditionsRecognizes Patients from other statesDefinition 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
Iowa

 

SF 2360, Medical Cannabidiol Act of 2014 (Effective 7/1/14)
Yes
Doesn’t define or provide in-state methods of access or production.
Yes, intractable epilepsy
No
“Cannabidiol- a non-psychoactive cannabinoid” that contains below 3% THC, no more than 32 oz, and essentially free from plant material.
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
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
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
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
 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
Yes
Yes, licensed by the Department of Public Safety.
Yes, intractable epilepsy.

 

No
“Low-THC Cannabis” with not more than 0.5 percent by weight of tetrahydrocannabinols; and not less than 10 percent by weight of cannabidiol
Yes
Yes
Utah
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
HB 1445
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

This article was first published on https://www.cannabisimp.com.

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