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“ For now, ederal law is blind to the wisdom o a uture day when theright to use medical marijuana to alleviate excruciating pain may bedeemed undamental. Although that day has not yet dawned, considering

that during the last ten years eleven states have legalized the use o

medical marijuana, that day may be upon us sooner than expected.

”— Ninth Circuit Court o Appeals, Raich v. Gonzales , March 2007

Since the March 2007 decision, 16 additional states have passed effective medical marijuanalaws, bringing the total number to 28, plus Washington, D.C.

How to Remove the Treat o Arrest

2015

P.O. Box 77492Capitol HillWashington, D.C. 20013

Issued by the Marijuana Policy Project

Phone: (202) 462-5747Fax: (202) 232-0442

[email protected]

State-By-State

Medical MarijuanaLaws

with a December 2016 supplement


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CONTENT

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ContentsDecember 2016 Supplement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xii

Executive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

Marijuana’s Medical Uses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Criminalizing Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Changing Federal Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Changing State Laws: From 1978-1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Changing State Laws: Since 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7

What Eective Medical Marijuana Laws Do . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

23 States, Guam, and D.C. Have Eective Medical Marijuana Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Is here Conlict Between Modern State Laws and Federal Law? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12

Federal Law Enorcement and State Medical Marijuana Programs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Federal Court Rulings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .14

Overview o Kinds o State Laws. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Eective Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

herapeutic Research Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Symbolic Measures/Pseudo-Prescriptive Access . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .16

Establishing Provisions or the State Government to Distribute Coniscated Marijuana. . . . . . . . . . . .17

Programs Intended to Allow Low-HC Cannabis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Rescheduling Marijuana. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17

Non-Binding Resolutions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Laws hat Have Expired or Been Repealed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

Where hings Are Going From Here. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .18

ABLES

able 1: Eective Medical Marijuana Laws in 23 States and Washington, D.C.. . . . . . . . . . . . . . . . . . . .20

able 2: ally o State Medical Marijuana Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .27

able 3: Medical Conditions Approved or reatment with Marijuana. . . . . . . . . . . . . . . . . . . . . . . . . . .29

in the 23 States and One District with Medical Marijuana Laws

able 4: An Overview o State Medical Marijuana Dispensary Programs . . . . . . . . . . . . . . . . . . . . . . . .31

able 5: Numbers o Patients, Caregivers, and Dispensaries in . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .35

Each Medical Marijuana State

MAPS

States with Eective Medical Marijuana Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

States with Medical Marijuana Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11

APPENDICES

Appendix A: State Medical Marijuana Laws. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

States with eective medical marijuana laws (removal o criminal penalties) . . . . . . . . . . . . . . . . . A-1States with workable low-HC laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-11

States with lawed low-HC laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-11

States with medical marijuana research laws (therapeutic research programs) . . . . . . . . . . . . . . . A-15

States with symbolic medical marijuana laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-16

States in which medical marijuana laws have expired or been repealed . . . . . . . . . . . . . . . . . . . . . A-17

States that have never had medical marijuana laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-18

Appendix B: Medical Marijuana Brieing Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .B-1Appendix C: Excerpts rom the Institute o Medicine 1999 Report . . . . . . . . . . . . . . . . . . . . . . . . . . . C-1

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CONTENTS

Appendix D: Surveys o Public Support or Medical Marijuana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-1Nationwide medical marijuana public opinion polling results. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-1

State-speciic medical marijuana public opinion polling results . . . . . . . . . . . . . . . . . . . . . . . . . . . . D-3

Appendix E: he Federal Controlled Substances Act (and Drug Schedules) . . . . . . . . . . . . . . . . . . . .E-1Appendix F: How the 24 Eective State and District Laws Are Working . . . . . . . . . . . . . . . . . . . . . . .F-1

New York . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-1

Minnesota. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-2

Maryland. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-3

Illinois . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-4New Hampshire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-6

Massachusetts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-7

Connecticut . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-8

Delaware . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-9

Arizona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-10

New Jersey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-11

Michigan. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-12

New Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-13

Rhode Island . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-14

Montana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-15

Vermont . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-17

Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-18

Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-19

Nevada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-20

Maine. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-21

Oregon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-22

Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-24

District o Columbia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-24

Washington. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-25

Caliornia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .F-25

Appendix G: Low-HC Medical Cannabis Laws. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G-1Appendix H: ypes o Legal Deenses Aorded by Eective State Medical Marijuana Laws . . . . . . H-1Appendix I: Physicians’ Roles Under State Medical Marijuana Laws. . . . . . . . . . . . . . . . . . . . . . . . . . . I-1Appendix J: Federal Litigation Related to Eective State Medical Marijuana Laws . . . . . . . . . . . . . . . J-1

Dr. Marcus Conant v. John L. Walters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-2

United States o America v. Oakland Cannabis Buyers’ Cooperative . . . . . . . . . . . . . . . . . . . . . . . . . . . J-3

Gonzales v. Raich . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-5

County o Santa Cruz, et al. v. Ashcrot, et al .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-7

Arizona v. United States. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-9

Appendix K: herapeutic Research Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . K-1Appendix L: M e d i c a l N e c e s s i t y D e e n s e . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . L - 1Appendix M: Model Resolution o Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . M-1

Appendix N: States hat Have the Initiative Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N-1Appendix O: Eective Arguments or Medical Marijuana Advocates . . . . . . . . . . . . . . . . . . . . . . . . . O-1Appendix P: Partial List o Organizations with Favorable Positions on Medical Marijuana. . . . . . . .P-1Appendix Q: MPP’s Model State Medical Marijuana Bill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Q-1Appendix R: Overview and Explanation o MPP’s Model Bill . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .R-1Appendix S: Federal Law Enorcement and State Medical Marijuana Laws . . . . . . . . . . . . . . . . . . . . .S-1Appendix : Do Medical Marijuana Laws Increase eens’ Marijuana Use? . . . . . . . . . . . . . . . . . . . . .-1Appendix U: State Medical Marijuana Program Finances . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . U-1Appendix V: Medical Marijuana Program Implementation imelines . . . . . . . . . . . . . . . . . . . . . . . . V-1Appendix W: Medical Marijuana Laws and Anti-Discrimination Provisions. . . . . . . . . . . . . . . . . . . W-1



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December 2016 SupplementTe last comprehensive update to MPP’s State-By-State Medical Marijuana Laws

was in late 2015. Tis supplement highlights key developments in state medi-cal marijuana policies since then. It is divided into three sections — states thatenacted new medical marijuana laws, updates rom states with existing medicalmarijuana laws, and updates rom states with unworkable medical marijuana lawsor low-HC laws. States without significant developments since late 2015 are not

included.Te biggest development is that five additional states have enacted effective med-

ical marijuana laws — Arkansas, Florida, North Dakota, Ohio, and Pennsylvania— bringing the total number to 28 plus D.C., Guam, and Puerto Rico. In addition,Louisiana improved its flawed medical marijuana law, but urther revisions to bothits law and rules are likely needed beore the program is truly workable. Tereore,MPP still does not count Louisiana as having an effective medical marijuana law.

Additionally, programs in New York and New Hampshire are now operational,and several states have made improvements to existing medical marijuana orlow-HC medical cannabis laws. Most importantly, two states — Montana and

Michigan — added regulated medical marijuana dispensing systems to theirmedical marijuana programs.

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States hat Enacted New Medical Marijuana Laws In 2016Arkansas — Aer narrowly rejecting medical marijuana at the ballot box in

2012, 53% o Arkansas voters approved Issue 6 — the Arkansas Medical MarijuanaAmendment — in November 2016. wo competing initiatives had ought orplacement on the ballot, Issue 6 and Issue 7. In a ruling issued aer early votingbegan, the Arkansas Supreme Court struck Issue 7 rom the ballot aer findingerrors in signature collection procedures.

Te Alcoholic Beverage Control Division (ABCD) will operate the ArkansasMedical Marijuana Amendment, and patients will enroll through the Departmento Health (DOH). Te ABCD has 120 days to issue guidelines or the approvalo between our and eight cultivation acility licenses and up to 40 dispensaries.DOH also has 120 days to issue guidelines or the issuance o ID cards or patientenrollment in the program. It should be noted that legislators are considering de-laying these timelines by up to 60 days so that the program will be fixed to thestate’s fiscal year. MPP estimates that it could be a year beore patients can startconsuming medical cannabis under the program.

Once guidelines or implementation are finalized, patients will be able to apply

or enrollment with the DOH. In order to qualiy, they must submit a writtencertification rom an Arkansas-licensed physician certiying that they suffer roman applicable disease, and pay a yet-to-be-established “reasonable” application ee.Designated caregivers can enroll in the program to assist the physically disabledand minors under 18. Qualiying conditions include cancer, glaucoma, HIV/AIDS, hepatitis C, ALS, ourette’s syndrome, Crohn’s disease, ulcerative colitis,PSD, severe arthritis, fibromyalgia, Alzheimer’s disease, or the treatment o anyo these conditions. In addition, patients with doctors’ certifications qualiy i theyhave a chronic or debilitating medical condition (or its treatment) that producescachexia or wasting syndrome, peripheral neuropathy, intractable pain that hasnot responded to other treatment or at least six months, severe nausea, seizures,and severe or persistent muscle spasms. DOH has the power to approve new quali-ying conditions.

Patients visiting Arkansas rom out-o-state can qualiy or the program i theArkansas law covers their condition and they have their medical marijuana IDcard with them.

Registered patients and caregivers who have their registry ID cards on hand arenot subject to arrest, prosecution, or penalty or the use and possession o up totwo and one-hal ounces o marijuana. Such penalties include “disciplinary actionby a business, occupational, or proessional licensing board or bureau.” Further,employers cannot discriminate or penalize patients or caregivers based on theirpast or present status o enrollment with the program. Te law allows landlords toprohibit on-site cannabis smoking.

Te amendment permits local control and cities, towns, and counties may passreasonable zoning restrictions on dispensaries and cultivation acilities. Localitiescan only outright prohibit the operation o any acilities through a popular elec-tion pursuant to Arkansas’ initiative process.

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Florida — On November 8, 2016, 71% o voters approved constitutionalAmendment 2, which mandates the creation o an effective medical marijuanaprogram. Florida already had a program that was both a low-HC law and anunworkable medical marijuana program or terminally ill patients; the latterwas passed by the Legislature earlier in 2016. Unlike most other low-HC laws,Florida’s provided or in-state access, although there are currently only seven busi-nesses permitted to cultivate and dispense medical cannabis in the entire state.

Amendment 2, which takes effect January 3, 2017, requires the Department oHealth to promulgate regulations within six months. Many o the specifics o howthe law will be implemented are le up to the agency, and the Legislature may alsopass laws to implement the program as long as they are not inconsistent with theamendment. Te health department is also required to begin issuing ID cards topatients and licensing dispensaries, called “medical marijuana treatment centers,”within nine months. I the department ails to meet these deadlines, Amendment2 explicitly creates a private right o action, allowing any Florida citizen to sue tocompel it to act.

o qualiy or the program, a patient must have a debilitating medical condition,a certification rom a physician licensed to practice medicine in Florida, and anID card rom the Department o Health. Te physician must conduct a physi-cal exam and assess the patient’s medical history, in addition to certiying thatthe patient suffers rom a debilitating medical condition, that the medical use omarijuana would likely outweigh the potential health risks or the patient, andor how long the physician recommends the medical use o marijuana. Writtenparental consent is required or minors. Debilitating medical conditions are: can-cer, epilepsy, glaucoma, HIV/AIDS, post-traumatic stress disorder, amyotrophiclateral sclerosis, Crohn’s disease, Parkinson’s disease, multiple sclerosis, or “otherdebilitating medical conditions o the same kind or class as or comparable to thoseenumerated.”

Amendment 2 contemplates a variety o medical marijuana products, includingood, tinctures, aerosols, oils, and ointments. Te health department will deter-mine how much medical cannabis will be “presumed to be an adequate supply,”but this presumption can be overcome i a patient can show that they need more.Patients may designate caregivers, who must be at least 21 years old and have anID card. Te number o caregivers per patient, and patients per caregiver, as wellas background checks and any other requirements, will be set by regulation.

Once the program is operating, registered patients and their designated caregiv-ers will be protected rom arrest, prosecution, and civil sanctions or actions incompliance with the program. Educational institutions and employers need not

accommodate medical marijuana use. Te number and location o dispensaries,the rules governing their licensing and operation, and applicable taxes and eeswill all be determined by regulation.

North Dakota — On November 8, 2016, 64% o voters approved Measure 5,a compassionate medical marijuana initiative spearheaded by an all-volunteerNorth Dakota-based group. Te Department o Health is charged with draingregulations or the implementation o the program, which went into effect onDecember 8, 2016.

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o qualiy or the program and access medical cannabis, a patient must havea written certification rom a physician with whom the patient has a bona fiderelationship.

Te qualiying conditions are cancer, HIV/AIDS, hepatitis C, ALS, PSD undercertain circumstances, agitation o Alzheimer’s disease, dementia, Crohn’s disease,fibromyalgia, spinal stenosis, chronic back pain (including neuropathy or damageto the nervous tissues o the spinal cord with objective neurological indication

o intractable spasticity), glaucoma, epilepsy, a medical condition that producescachexia or wasting syndrome, severe and debilitating pain that has not respondedto previously prescribed medication or surgical measures or more than threemonths or or which other treatment options produced serious side effects, intrac-table nausea, seizures, or severe and persistent muscle spasms.

Patients are prohibited rom using marijuana in a public place or a workplace.

Patients may designate a caregiver to assist with their medical use o marijuana,such as by picking it up rom a dispensary or them. o serve as a caregiver, anindividual must be 21 years o age or older, have no elony convictions, and mustregister with the state. Tey may assist no more than five patients.

Patients and caregivers are allowed to possess no more than three ounces o us-able marijuana per 14-day period. Registered patients and caregivers will be ableto obtain medical cannabis rom a licensed nonprofit compassion center.

Te department will license an undetermined number o nonprofit compas-sionate care centers that are required to maintain appropriate security, includingwell-lit entrances, an alarm system that contacts law enorcement, and video sur- veillance. Tey may not be located within 1,000 eet o a school, and they will besubject to inspections and other rules.

I a qualified patient lives more than 40 miles rom the nearest compassionatecare center, the patient or caregiver can cultivate up to eight marijuana plants inan enclosed, locked acility as long as it is not within 1,000 eet o a public school.

Ohio — While Ohio decriminalized marijuana possession in 1973, it took until2016 or state lawmakers to adopt a workable medical marijuana law. Tat year, theMarijuana Policy Project and Ohioans or Medical Marijuana led a voter initiativecampaign to adopt a medical marijuana constitutional amendment. However, thestate Legislature intervened and passed its own measure, HB 523, beore voterscould weigh in. As a result, the initiative campaign did not complete its signaturedrive. Gov. John Kasich signed the bill on June 8, 2016.

Te result was a more limited medical marijuana law, which technically wentinto effect on September 8, 2016. However, it will be at least a year beore patientsreceive the ull benefit o the law as the program is established and rolled out. Alsobeginning on September 8, patients were to receive a limited affirmative deense,which was intended to allow them to avoid a criminal conviction or possessiono marijuana under certain circumstances. Unortunately, language contained inthe law was not clear on the requirements or physicians who might want to helppatients obtain the affirmative deense, and it is uncertain i the affirmative deenseis possible without additional regulatory assistance rom the state medical board,or an amendment to the law by lawmakers.

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Also starting on September 8, three different agencies — each charged with over-seeing different parts o the program — were to begin the process o developingand adopting rules or the state program. Te Department o Commerce, whichwill oversee cultivators, processors, and testing labs, will have nine months toadopt rules. Te Board o Pharmacy will have 12 months to establish rules relatedto patients and dispensaries, and the state’s previously mentioned medical boardwill likewise have 12 months to consider and adopt rules related to recommendingphysicians. Much o the 2016 law leaves the specifics up to the agencies overseeing

the program, so the rule-making process will be particularly important to ensurethe program is air and workable or patients.

Te costs and exact qualifications or patients to participate have not yet been o-ficially adopted, nor the specific amount patients will be allowed to possess, whichthe current law defines as a “90-day supply.” Te state’s sales tax would apply tothe sale o medical marijuana. Currently, the state’s sales tax rate is 5.75%, anddepending on additional rates set by local municipalities, the total sales tax couldbe as high as 8% at the register.

Once the program is ully in effect, registered patients and their designatedcaregivers will be protected rom arrest, prosecution, and discrimination in childcustody matters. Registration status alone cannot be used as the basis or a DUIinvestigation, nor can patients be discriminated against when seeking organ trans-plants or housing. Employers do not have to accommodate employees’ on-site use,but prospective employers cannot reuse to hire due to a person’s registry status.Importantly, ull legal protections under the law do not take effect until the patienthas been issued a medical cannabis registration card.

Ohio’s law does include a airly broad list o qualiying medical conditions. Teseinclude AIDS, Alzheimer’s disease, amyotrophic lateral sclerosis, cancer, chronictraumatic encephalopathy, Crohn’s disease, epilepsy or another seizure disorder,fibromyalgia, glaucoma, hepatitis C, inflammatory bowel disease, multiple scle-

rosis, chronic or intractable pain, Parkinson’s disease, positive status or HIV,post-traumatic stress disorder, sickle cell anemia, spinal cord disease or injury,ourette’s syndrome, traumatic brain injury, and ulcerative colitis. Te state medi-cal board may add other diseases or medical conditions.

It is possible that out-o-state patients will be allowed to access medical marijua-na in Ohio-licensed dispensaries. Te law allows the state to enter into agreementswith particular states i regulators wish to do so, although reciprocity is not auto-matic under the law.

Whole plant cannabis is allowed or vaporization, but smoking is not permitted.

Te burden on recommending physicians is significant, which may seriouslylimit patients’ ability to enroll in the program. Doctors who plan to recommendmedical use o marijuana to patients must be preapproved by the state in order todo so, and he or she will be required to take a class. o certiy a patient, physiciansmust expect to provide ongoing care or the patient, apply on behal o each pa-tient seeking to be included in the state registry, and provide urther inormationto the state on how effective the treatment is.

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Te number o dispensaries, cultivation centers, and testing labs that will be al-lowed to operate is le to regulatory authorities to determine, along with the eesthe various agencies expect to charge or licenses. In act, the vast majority o theregulatory system or businesses will be up to the regulatory authorities to adopt.By the end o 2016, some regulations had been proposed, but are not likely to beadopted until early 2017.

Pennsylvania — Te Pennsylvania Senate first approved SB 3, a comprehensive

medical marijuana bill, on May 12, 2015. Aer a sustained campaign by patientsand amilies with Campaign or Compassion, with significant help rom MPP’slobbying and communications team, the House ollowed suit and approved anamended bill on March 16, 2016. Te Senate made final tweaks, and on April17, Gov. om Wol signed Pennsylvania’s medical marijuana legislation into law,making it Act 16. Pennsylvania’s medical marijuana law went into effect on May17, 2016.

o qualiy or the program and access medical cannabis, patients must have aqualiying condition and must submit a doctor’s recommendation to the healthdepartment. Physicians wishing to recommend medical cannabis must first reg-ister with the department and take a our-hour course. Tey must also have anongoing relationship with the patient and complete an in-person exam prior toissuing the recommendation.

Te qualiying conditions are terminal illness, cancer, HIV/AIDS, amyotrophiclateral sclerosis, Parkinson’s disease, multiple sclerosis, epilepsy, inflammatorybowel disease, neuropathies, Huntington’s disease, Crohn’s disease, post-traumaticstress disorder, intractable seizures, glaucoma, autism, sickle cell anemia, damageto the nervous tissue o the spinal cord with objective neurological indication ointractable spasticity, and severe chronic or intractable pain o neuropathic origin,or i conventional therapeutic intervention and opiate therapy is contraindicatedor ineffective. Pennsylvania is the first state to specifically list autism as a quali-

ying condition without limiting the condition to autism with sel-injurious oraggressive behavior.

Te program allows patients to use pills, oils, gels, creams, ointments, tinctures,liquid, and non-whole plant orms that may be administered through vaporiza-tion, but not smoking. Dispensaries will not be allowed to sell edibles, but medicalmarijuana products can be mixed into ood or drinks or patients in a acility orresidence.

Registered patients and caregivers will be protected rom arrest, prosecution, anddiscrimination in child custody and employment. However, out-o-state patientswill not have legal protections or use or possession in Pennsylvania, nor access

to Pennsylvania dispensaries. Parents and guardians o minors with qualiyingconditions can apply or a sae harbor letter that provides legal protections or theadministration o medical marijuana.

Te Department o Health has released many o the temporary regulations thatwill guide the implementation process, including the rules or grower/processor,dispensary, and laboratory permits. Te applications or medical marijuana busi-nesses will be released on January 17 and are due on March 20. Te department

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announced that they will be distributing permits in at least two phases. For thefirst phase, there will be a maximum o 12 grower/processor licenses and 27 dis-pensary licenses issued. Te department plans to announce the recipients 90 daysaer the deadline. Grower/processor applicants will pay $10,000 or applicationsand $20,000 or registration. Tey will also pay a 5% tax on the sale o medicalmarijuana to the dispensary. Dispensary applicants will pay $5,000 per applica-tion and $30,000 or each location.

Te department has divided the state into six regions with a maximum o twogrower/processor permits issued per region. Meanwhile, up to 27 dispensary per-mits will be issued in specific counties. Each dispensary permit is allowed threelocations. Te first location must be in the assigned county, but additional loca-tions must be located elsewhere in the region.

Portions o the law related to dispensaries will expire three years aer the ederalgovernment completes rescheduling o marijuana.

Patient and doctor regulations are expected to be released prior to April 2017.

Updates From States With Existing MedicalMarijuana LawsColorado — Colorado passed several bills in 2016 related to medical marijuana.

SB 40 allows out-o-state ownership o state marijuana businesses, while HB 1371establishes important protections or medical marijuana patients in school. Underthe new law, students who are patients may not be punished or possessing andconsuming medical marijuana products while on campus — subject to schoolrules — and patients cannot be denied admission simply due to their patientstatus.

Connecticut — In February, several new conditions were added to Connecticut’s

medical marijuana program through the administrative process — sickle cell dis-ease, post-laminectomy syndrome with chronic radiculopathy, severe psoriasisand psoriatic arthritis, amyotrophic lateral sclerosis, ulcerative colitis, and com-plex regional pain syndrome. However, Connecticut remains one o a handul ostates that does not have a general qualiying condition or severe or intractablepain.

Later in 2016, the Connecticut Legislature passed legislation to expand its ex-isting program to allow minor patients to qualiy or the program. Connecticuthad been the last remaining state to completely exclude minors rom its medicalcannabis program. Minors’ registrations require certification rom two doctors,

and minor patients are prohibited rom smoking, inhaling, or vaporizing medicalmarijuana.

Delaware — Te Legislature adjourned aer adding terminal illness as a qualiy-ing condition under the state’s medical marijuana program, as well as allowingCBD oil use by minors in schools and on school buses. Both measures were signedby Gov. Jack Markell. Meanwhile, a second compassion center was approved in2016, and a third is expected to be licensed shortly, which will bring the totalnumber to three.

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Hawaii — Te Hawaii Legislature passed legislation to clariy and strengthenthe state’s medical marijuana dispensary law, which was enacted in 2015. HB2707 creates a legislative oversight commission to recommend legislation to im-prove the dispensary program. In addition, the law decriminalizes possessionand use o paraphernalia or authorized individuals and allows, in some cases,or the interisland transport o marijuana to certified laboratories. It also allowsadvance practice-registered nurses to issue recommendations to qualiying pa-tients and adds patches, inhalers, and nebulizers to the approved list o modes o

administration.

Illinois — Lawmakers in Illinois passed and Gov. Bruce Rauner signed SB 10, amuch-needed bill that made significant changes to the state’s medical marijuanaprogram. First, it changed the recommendation process or physicians, makingit easier or patients to get through the registration process. Te bill also addedpost-traumatic stress disorder to the state’s list o qualiying medical conditions,and extended the program — which was set to sunset on January 1, 2018 — to July1, 2020.

Massachusetts — Under Gov. Charlie Baker’s administration, the Departmento Public Health began accepting dispensary applications on a rolling basis. As oDecember 2016, six dispensaries were open and serving patients.

Maryland — Maryland announced another delay in the implementation o itsmedical marijuana program. Te Maryland Medical Cannabis Commission an-nounced which cultivators and processors received preliminary license approvalin the summer and which dispensaries received approval in December 2016.Medical marijuana is now expected to be available to patients in mid to late 2017.Maryland has been one o the slowest states to implement its program, and its se-lection process or growers was subject to a controversy. During the 2016 session,the Legislature enacted HB 104, which will also allow nurse practitioners, dentists,podiatrists, and nurse midwives to recommend medical marijuana beginning

June 1, 2017.

Michigan — On September 20, 2016, Gov. Rick Snyder signed into law signifi-cant improvements to the state’s medical marijuana program. Te state will nowallow licensed provisioning centers to dispense marijuana. Also, medical marijuana extracts and products made rom them are now allowed.

Minnesota — In 2016, the Legislature approved Rep. Nick Zerwas’s HF 3142,which permits a single dispensary employee to transport medical cannabis to alaboratory or testing or to a acility or disposal. I the medical cannabis is beingtransported or any other purpose, two employees must staff the transport vehicle.Te bill also allows pharmacists to videoconerence with patients, allowing them

to provide expertise to many more seriously ill patients. Also in 2016, the statehealth commissioner approved adding PSD as a qualiying condition. UnderMinnesota law, patients with PSD will be allowed to register beginning in August2017.

Montana — 2016 was a year o significant change or the state medical marijuanaprogram. Montana’s original medical marijuana law, passed through a 2004 voterinitiative backed by MPP, was overturned by lawmakers in 2011 and replaced witha program that was largely unworkable.

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Among many burdensome requirements, cultivators could not assist more thanthree patients, and the state medical board was required to audit any doctor whorecommended medical marijuana or more than 25 patients a year. esting medi-cal marijuana or saety and potency was illegal, and law enorcement officerscould enter any provider’s location — even private homes — to conduct a war-rantless search. Most troubling, the law contained many serious deects, leavingmedical marijuana providers vulnerable to criminal prosecution under even thebest o circumstances.

Te law was challenged in state court and some o the worst provisions weretemporarily blocked, which enabled the program to continue while the matter wasunder consideration by the courts. Te proceeding lasted nearly five years, and inApril 2016, the Montana Supreme Court issued its final order, upholding most othe bad 2011 law. Te result was that by August, over 11,000 patients — 94% o thestate program — were without access to medical marijuana except through illicitsources.

A voter initiative designed to change or remove many o the harmul provi-sions that were upheld by the Montana Supreme Court, I-182, appeared on theNovember 2016 ballot, and it passed with 54% o the vote. Te election resultwas a welcome relie to the thousands o patients waiting to restore access, butan error in the initiative language meant possible delay beore access was to beully restored in July 2017. Local patients, activists, and medical marijuana busi-nesses again took the matter to court, and on December 7, 2016, the state courtordered the state health department to allow patients to reunite with their provid-ers immediately.

New Hampshire — In November 2015, the Department o Health and HumanServices began allowing patients to preregister or medical marijuana ID cards.Despite the act that patients were still being arrested in the state, the AttorneyGeneral’s office argued that patients should not be able to obtain ID cards (which

would protect them rom arrest) until the first dispensary was ready to open. Aterminally ill lung cancer patient, Linda Horan, became the first patient to receivean ID card in December aer she sued the state and won, and she was able to visita dispensary in Maine to obtain cannabis legally.

Te first dispensary began serving patients on April 30, 2016, and the other threeall opened by late 2016.

New York — Te first medical marijuana dispensary opened January 7, 2016,and all but one o the 20 dispensaries were operational as o December 2016.Registered organizations were also permitted to implement home delivery pro-grams beginning in August 2016. Access to the program has been difficult due to

ew doctors participating, high costs, and a restrictive list o qualiying conditions,which does not include severe or chronic pain. Aer extensive criticism o theprogram as being unduly restrictive, the Department o Health issued a report inAugust 2016 announcing numerous planned expansions o the program, some owhich are in the process o being implemented. For example, nurse practitionerscan now recommend medical marijuana to their patients.

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wards rectiying this issue during the 2016 session, but the law still remains justshy o workable. Specifically, Sen. Fred Mills introduced two bills, both o whichhave been signed by Gov. John Bel Edwards. Te first, SB 271, replaces the word“prescribe” in existing law with “recommend.” Doctors cannot prescribe medicalmarijuana, as it is a violation o their ederal DEA license. However, physicians dohave the First Amendment right to recommend the treatment option to patients.

SB 180 amended criminal statutes to offer protections specifically to patients and

their caregivers or possession and consumption o medical marijuana. However,the law does not explicitly exempt growers, pharmacies, and their staff rom stateelonies or growing and distributing marijuana. While it is possible the law willeventually prove workable, it should be improved to explicitly offer protections tothe entire supply chain.

o qualiy or the medical marijuana program, a patient will need a doctor’s rec-ommendation and must have cancer, HIV/AIDS, cachexia or wasting disorder,seizure disorders, spasticity, Crohn’s disease, muscular dystrophy, or multiple scle-rosis. Inhaled or “raw or crude” marijuana is not allowed.

Te law provides or 10 specially licensed pharmacies that may dispense mari-

juana and one or two production acilities — two are only allowed i LouisianaState and Southern University agricultural centers decide to exercise a right ofirst reusal. Medical cannabis is unlikely to be available beore late 2017 or 2018.Unless the law is re-enacted by the Legislature, the act will expire on January 1,2020. Also, upon ederal rescheduling to Schedule II, each reerence to a “recom-mendation” would change to “prescription.”

In June 2016, both Louisiana State and Southern University announced thattheir boards approved plans to operate medical marijuana cultivation acilities. Ithey ollow through, they would be the first universities to cultivate marijuana incontravention o ederal law. Some universities and hospitals in other states haveexpressed interest in similar involvement, but have ultimately not participated dueto concerns about ederal law and unding.

Missouri — Te Department o Agriculture has issued two grower licenses, themaximum allowed by law. wo dispensaries are open and serving patients in theSt. Louis area, making it the first state to provide access pursuant to a low HCmedical cannabis program. However, the patient base is extremely small, whichcould jeopardize the viability o the program.

Oklahoma — HB 2835, which allows adults to possess low-HC oil, was enactedon November 1, 2016. (Minors were already allowed to do so.) Te law also addsseveral qualiying conditions: Spasticity due to multiple sclerosis or paraplegia, in-

tractable nausea and vomiting, and chronic wasting diseases, in addition to severeepilepsy. However, the law still ails to provide or an in-state source o medicalmarijuana. In addition, the U.S. Supreme Court declined to hear Oklahoma’s chal-lenge to Colorado’s marijuana laws.

ennessee — ennessee tweaked its ineffective low-HC law by enacting HB2144 on May 20, 2016. Te law now provides that patients may possess CBD oilswith no more than 0.9% HC i they have “a legal order or recommendation”or the oil and they or an immediate amily member have been diagnosed with

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epilepsy by a ennessee doctor. In addition, universities could cultivate marijuanawith no more than 0.6% HC, process it into oil, and dispense it to qualified pa-tients as part o a research study, but they are unlikely to do so, as it would violateederal law.

Utah — Te Legislature and governor approved Rep. Gage Froerer’s HB 58,which builds on an existing low-HC program by requiring the Department oHealth to establish a procedure or neurologists to transmit records o their evalu-

ation o a patient’s use o low-HC oil. Te law also required the department toaccept requests or proposals to conduct a study o the oil, which were to be com-pleted by November 2016. Also passed was SCR 11, a resolution urging Congressto reschedule marijuana to Schedule II. Utah law still does not provide or includein-state production o low-HC oils.



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Executive Summary • Favorable medical marijuana laws have been enacted in 43 states and the

District o Columbia since 1978. (Tree o those states’ laws have since expiredor been repealed.) However, many o the laws that remain on the books areineffectual, due to their reliance on the ederal government to directly provideor authorize a legal supply o medical marijuana.

• Currently, 40 states, the District o Columbia, and Guam have laws on thebooks that recognize marijuana’s medical value — or the value o certainstrains:

- Since 1996, 23 states, the District o Columbia, and Guam have enactedlaws that effectively allow patients to use and access medical marijuanadespite ederal law. o be effective, a state law must remove criminal penal-ties or patients who use and possess medical marijuana with their doctors’approval or certification. Effective laws must also have a realistic means orpatients to access marijuana, such as by growing it at home or buying it at adispensary. Finally, the laws must allow patients to either smoke or vapor-ize marijuana or marijuana oils and must allow or a variety o strains o

marijuana, including both strains with higher and lower amounts o HC.

- One state, Louisiana, has an ineffective law that recognizes marijuana’smedical value but relies on doctors and pharmacies breaking ederal law.

- An additional 16 states allow only low-HC marijuana or cannabis oils.Most o those laws — much like dozens o ineffective medical marijuanalaws enacted beore 1996 — are unlikely to provide patients with relie untilederal law changes. Several depend on risk-averse individuals and insti-tutions, such as universities, to break ederal law by distributing cannabis.Others have no means o in-state access to cannabis preparations at all.

• Eleven o the 23 effective state medical marijuana laws were enacted throughthe ballot initiative process — in Alaska, Arizona, Caliornia, Colorado,Maine, Massachusetts, Michigan, Montana, Nevada, Oregon, and Washingtonstate. Te other 12 effective state laws were passed by the state legislatureso Connecticut, Delaware, Hawaii, Illinois, Maryland, Minnesota, NewHampshire, New Jersey, New Mexico, New York, Rhode Island, and Vermont.Washington, D.C.’s law was approved by voter initiative but was substantiallyrevised beore the D.C. Council prior to taking effect. Several o the states’laws that were enacted by voters were later revised or added to by the state’slegislature.

• Te ederal government cannot orce states to criminalize conduct that is il-legal under ederal law, nor can the ederal government orce state and localpolice to enorce ederal laws.

• Because 99% o all marijuana arrests in the nation are made by state and local(not ederal) officials, properly worded state laws effectively protect at least 99out o every 100 medical marijuana users who would otherwise be prosecuted.Indeed, there aren’t any known cases in which the ederal government hasprosecuted patients or small amounts o marijuana in the 23 states that haveenacted medical marijuana laws since 1996.


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• Since 2001, ederal courts have handed down decisions on three signifi-cant medical marijuana cases: U.S. v. Oakland Cannabis Buyers’ Cooperative(OCBC), Gonzales v. Raich, and Conant v. Walters. Te U.S. Supreme Courtissued opinions on the first two o these cases and declined to hear the third.

- In OCBC , the court determined that the medical necessity deense cannotbe used to avoid a ederal conviction or marijuana distribution; in Raich,the court held that the ederal government can arrest and prosecute pa-

tients in states where medical marijuana is legal under state law. Despiteissuing unavorable decisions in both cases, the U.S. Supreme Court did notin any way nulliy effective state medical marijuana laws, nor did it preventadditional states rom enacting similar laws.

- Te U.S. Supreme Court also sent the Raich case back to the Ninth U.S.Circuit Court o Appeals to consider additional legal issues. Te NinthCircuit ruled that there is not yet a constitutional right to use marijuana topreserve one’s lie. It also held that the “medical necessity” criminal deensecannot be used in a civil suit to prevent a ederal prosecution.

- In deciding Conant , the Ninth U.S. Circuit Court o Appeals held that doc-

tors cannot be prosecuted or recommending that their patients use medicalmarijuana. By choosing not to hear Conant , the U.S. Supreme Court let thisprotection stand.

• A handul o courts have considered whether specific medical marijuana laws— or specific provisions o those laws — are preempted (or nullified) by ed-eral law. In 2008 and 2009, the U.S. Supreme Court reused to hear appealso two Caliornia court decisions finding that ederal law does not preemptthe challenged parts or applications o Caliornia’s medical marijuana laws. InMay 2011, Arizona Gov. Jan Brewer asked a ederal court to rule whether ed-eral law preempts the state’s medical marijuana law. Her case was thrown out.Subsequently, a state-level trial court in Arizona ruled against another claimthat the state’s law was preempted.

• Ultimately, the ederal government should reschedule or de-schedulemarijuana so it can be sold as other medicines are sold. Because the ederalgovernment has only taken the very limited step o directing the Departmento Justice not to interere with well-regulated state marijuana programs, theonly way to provide patients with legal protections and sae access to medicalcannabis is through legislation in the states.

• Tis report describes all avorable medical marijuana laws ever enacted in theUnited States, details the differences between effective and ineffective state

laws, and explains what must be done to give patients immediate legal accessto medical marijuana. Accordingly, a model bill and a compilation o resourc-es or effective advocacy are provided.


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Overview Despite marijuana’s widely recognized therapeutic value, the medical use o

marijuana remains a criminal offense under ederal law. Nevertheless, avorablemedical marijuana laws have been enacted in 43 states since 1978.1 Many o theavorable state laws are ineffectual oen due to their reliance on the ederal gov-ernment to directly provide or authorize a legal supply o medical marijuana.Fortunately, since 1996, 23 states and the District o Columbia have ound ways to

allow seriously ill people to use and saely access medical marijuana with virtualimpunity, despite ederal law.2

Sixteen additional states currently have laws on the books that extend only tocannabis preparations that have low amounts o tetrahydrocannabinol or “HC”(a compound that can cause euphoria, which also has medical benefits). Almostall o those laws are limited to patients with seizure disorders and most — likelaws enacted beore 1996 — are unlikely to actually result in patients receiving in-state access because they ail to take ederal law into account. Te 40th state withsome sort o medical cannabis law currently on its books, Louisiana, has a law thatis not explicitly limited in the HC content, but its law will almost certainly be

ineffective until ederal law changes.While the U.S. Supreme Court ruled in U.S. v. Oakland Cannabis Buyers’

Cooperative (OCBC) (532 U.S. 483) that the medical necessity deense cannot beused to avoid a ederal conviction or marijuana distribution, a state may removeits own criminal penalties rom citizens who possess, grow, or distribute medicalmarijuana. Moreover, both the Obama administration and Congress have signaledthat ederal authorities should not target those complying with well-regulatedstate marijuana laws, although those activities are still prohibited by ederal law.3

Even beore ederal policy relaxed, careully craed state laws provided near

complete protection because the overwhelming majority o marijuana arrests aremade at the state and local levels, not the ederal level. Te relatively ew medi-cal marijuana arrests made at the ederal level almost always involve larger-scaledistribution.

Te recent ederal policy o non-intervention in state laws has allowed or bet-ter medical marijuana programs that include well-regulated distribution systemsand laboratory testing, rather than relying solely on small-scale or undergroundsystems o access that were less vulnerable to ederal law enorcement. However,many complications remain because o outdated ederal laws, including difficul-ties getting banking services.

Tis report analyzes the existing ederal and state laws and describes what can bedone to give patients legal access to medical marijuana. Te most effective way toallow patients to use medical marijuana is or state legislatures to pass bills similarto the laws in Nevada, Rhode Island, and Maine.

A model state medical marijuana law, which is influenced by the aorementionedlaws, can be ound in Appendix Q.

1 See Appendix A.2 See able 1 or details on these laws.3 James M. Cole, Guidance Regarding Marijuana Enorcement, United States Department o Justice, Office o the

Deputy Attorney General, Aug. 29, 2013; Josh Harkinson, “Te Federal War on Medical Marijuana Is Over,“ Mother Jones, Dec. 16, 2014.


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Marijuana’s Medical Uses

Marijuana has a wide range o therapeutic applications, including:

• relieving nausea and increasing appetite;

• reducing muscle spasms and spasticity;

• relieving chronic pain; and

• reducing intraocular (“within the eye”) pressure.

Hundreds o thousands o patients and their doctors have ound marijuana tobe beneficial in treating the symptoms o HIV/AIDS, cancer, multiple sclerosis,glaucoma, seizure disorders, and other serious conditions.4 For many people,marijuana is the only medicine with a suitable degree o saety and efficacy.

Tese patients’ experiences are also backed up by research. In March 1999, theNational Academy o Sciences’ Institute o Medicine (IOM) released its landmarkstudy, “Marijuana and Medicine: Assessing the Science Base.” Te scientists whowrote the report concluded that “there are some limited circumstances in whichwe recommend smoking marijuana or medical uses.”5

Although obstacles created by ederal policy have made it difficult to conductresearch into marijuana’s medical value, studies continue to demonstrate marijuana’s medical benefits. In 2010, the Center or Medicinal Cannabis Research,which was created and unded by the Caliornia State Legislature to “coordinaterigorous scientific studies to assess the saety and efficacy o cannabis,” presentedits findings. Tey included clinical research showing that marijuana is effectiveat relieving muscle spasticity associated with multiple sclerosis and at alleviatingneuropathic pain, which is notoriously unresponsive to traditional medications.6

Marijuana is comprised o over 85 cannabinoids, or components. Tese cannabi-noids act synergistically in whole plant medical cannabis or an “entourage effect.”

Researchers discovered that the body has receptor proteins or HC and other can-nabinoids, and that it makes its own similar substances, called endocannabinoids.7

Te most well known cannabinoid, which is responsible or the “high,” is HC.Although other cannabinoids also have therapeutic value, HC (currently in syn-thetic orm), is the only cannabinoid that can be obtained by prescription in theU.S., under the brand name Marinol. Another cannabinoid, cannabidiol (CBD),is being administered under the brand name Epidiolex to a limited number opatients in the U.S. in trials. While these medications are important options, theyinclude only a single cannabinoid each and are no substitute or medical marijua-na laws. In addition, Marinol is also much slower acting than inhaled marijuana,and nauseated patients are oen unable to keep pills down.

Given the lie experiences o millions o Americans and the large and growingbody o evidence showing marijuana’s relative saety and medical value, it should

4 See Appendix B or a more detailed briefing paper about marijuana’s medical uses.5 See Appendix C or excerpts rom the IOM report.6 Grant, Igor M.D., et al. Report to the Legislature and Governor o the State o Caliornia presenting findings

pursuant to SB847 which created the CMCR and provided state unding. UC San Diego Health Sciences,University o Caliornia, February 11, 2010.

7 Seppa, Nathan. “Not just a high,” Science News, Vol. 177 #13 (p.16), June 19, 2010.http://www.sciencenews.org/view/eature/id/59872/title/Not_just_a_high


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come as no surprise that public opinion polls find that most Americans supportlegal access to medical marijuana.8

Criminalizing Patients

Federal marijuana penalties assign up to a year in prison or as little as onemarijuana cigarette — and up to five years or growing even one plant. Tere is noexception or medical use, and many states mirror ederal law.

Tere were more than 693,000 marijuana arrests in the United States in 2013,87% o which were or possession (not sale or manuacture).9 Even i 1% o thosearrested were using marijuana or medical purposes, then there are more than7,000 medical marijuana arrests every year!

In addition, untold thousands o patients are choosing to suffer by not utilizing atreatment that could very well cause them to be convicted in 27 states.

Changing Federal Law

Te ederal Controlled Substances Act o 1970 established a series o five “sched-ules” (categories) into which all illicit and prescription substances are placed.

Marijuana is currently in Schedule I, defining the substance as having a highpotential or abuse and no currently accepted medical use in treatment in theUnited States.10 Te ederal government does not allow Schedule I substances tobe prescribed by doctors or sold in pharmacies. Schedule II substances, on theother hand, are defined as having accepted medical use “with severe restrictions.”Schedules III, IV, and V are progressively less restrictive.

Te Attorney General has the authority to move marijuana into a less restrictiveschedule, and has delegated that authority to the DEA. Despite multiple petitionsand years o litigation, the DEA has reused to move cannabis into a less restrictiveschedule.11 Te DEA most recently rejected a petition to reschedule marijuana on

July 8, 2011. Its decision was upheld in ederal court, and the U.S. Supreme Courtrejected a request that it review the decision.12

Unortunately, current ederal research guidelines make it nearly impossible todo sufficient research to meet the DEA and FDA’s exceedingly high standard omedical efficacy or marijuana.13 Since 1995, MPP has been helping scientists at-tempt to navigate ederal research obstacles, and there is no clear end in sight.Gaining FDA approval would likely take at least a decade, a major change in ed-eral policy, and assumes that a privately unded company is willing to spend thetens o millions o dollars necessary to do the research.

8 A November 2012 CBS News poll ound 83% o Americans believe doctors should “be allowed to prescribemarijuana or medical use.” (Backus, Fred and Condon, Stephanie. “Poll: Nearly hal support legalization omarijuana,” CBS News, November 29, 2012.)

9 Federal Bureau o Investigation, Uniorm Crime Reports, Crime in the United States 2013.10 See Appendix E or more details on the ederal Controlled Substances Act.11 Appendix B provides more inormation about this litigation.12 Americans or Sae Access v. DEA, 706 F.3d 438 (D.C. Cir., Jan. 2013).13 See Appendices B and K or details on the difficulties involved with marijuana research.


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Nonetheless, there are several other ways to change ederal law to give patientslegal access to medical marijuana14:

• Te U.S. Secretary o Health and Human Services (HHS) can declare thatmarijuana meets sufficient standards o saety and efficacy to warrant resched-uling. However, rescheduling alone will not provide patients prescriptionaccess to marijuana.

• Because Congress created the Controlled Substances Act (CSA), Congress can

change it. Some possibilities include: passing a bill to move marijuana into aless restrictive schedule, moving marijuana out o the CSA entirely, or evenreplacing the entire CSA with something completely different. In addition,Congress can remove criminal penalties or the medical use o marijuana re-gardless o what schedule it is in.

• HHS can allow patients to apply or special permission to use marijuana on acase-by-case basis. In 1978, the Investigational New Drug (IND) compassion-ate access program was established, enabling dozens o patients to apply orand receive marijuana rom the ederal government. Unortunately, the pro-gram was closed to all new applicants in 1992, and only our are still receiving

medical marijuana through the program.While none o the ederal reorms listed above have happened yet, nearly 20 years

aer the first modern medical marijuana law passed, state medical cannabis lawshave created sufficient pressure that Congress is finally beginning to reconsiderits stance. In 2014, Congress approved an appropriations bill that prevents theDepartment o Justice rom spending any resources interering with the imple-mentation o state medical marijuana laws through the 2015 fiscal year.

Meanwhile, both the House o Representatives and the Senate are consideringthe C.A.R.E.R.S. Act, which would amend the Controlled Substances Act to allowstates to set their own policies in regard to medical marijuana. Te act — S.683/

H.R.1538 — would also reschedule marijuana, acilitate research, and make otherpositive changes. Unortunately, it is currently stalled in committee. Careullycraed state medical marijuana programs remain the only mechanism to providerelie to patients who benefit rom medical cannabis.

Changing State Laws: From 1978 to 199515

States have been trying to give patients legal access to marijuana since 1978. By1991, avorable laws had been passed in 34 states and the District o Columbia.(Te other nine states that have had avorable laws are Hawaii, enacted in 2000;Maryland, initially in 2003; Delaware in 2011; Kentucky, Missouri, Mississippi,and Utah in 2014, and Oklahoma and Wyoming in 2015. Te latter six laws arerestricted to low-HC, CBD-rich cannabis preparations.)

Unortunately, because o numerous ederal restrictions, most o these laws havebeen largely symbolic, with little or no practical effect. For example, Louisiana,exas, and several other states have passed laws stating that doctors may “prescribe”marijuana or certain marijuana preparations. However, ederal law prohibits doc-

14 Appendix B details some o these other routes.15 See “Overview o Kinds o State Laws,” beginning on page 15.


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tors rom writing “prescriptions” or marijuana, so doctors are unwilling to riskederal sanctions or doing so. Other states rely on universities or pharmacies togrow or dispense marijuana, institutions which have been unwilling to openlybreak ederal law.

Changing State Laws: Since 1996

Te tide began to turn in 1996 with the passage o a Caliornia ballot initiative.Caliornia became the first state to effectively remove criminal penalties or quali-ying patients who possess and use medical marijuana.

Caliornia’s law, like the initial wave o effective state laws, provided access byallowing patients to cultivate their own medicine or to designate a caregiver todo so. It also encouraged “ederal and state governments to implement a planto provide or the sae and affordable distribution o marijuana to all patients inmedical need o marijuana.”

Caliornia’s law specifies that qualiying patients need a doctor to “recommend”marijuana. By avoiding issuing a prescription, doctors are not violating ederallaw in order to certiy their patients. (O note, Arizona voters also passed a medi-

cal marijuana initiative in 1996, but it turned out to be only symbolic becauseit required a prescription — an order to dispense a medication — rather than arecommendation — a statement o a doctor’s proessional opinion.)

Over the next our years, seven states and the District o Columbia ollowed inCaliornia’s ootsteps. Alaska, Oregon, Washington, and the District o Columbiapassed similar initiatives in 1998. (Until 2010, Congress prevented the D.C. initia-tive rom taking effect. D.C. is a district, not a state, and is thereore subject to strictederal oversight.) Maine passed an initiative in 1999, and Colorado and Nevadaollowed suit in 2000. Also in 2000, Hawaii broke new ground when it became thefirst state to enact a law to remove criminal penalties or medical marijuana users via a state legislature.

In 2003, Gov. Robert Ehrlich o Maryland became the first Republican gover-nor to sign workable medical marijuana legislation into law. Tis law was a verylimited sentencing mitigation, which was later expanded several times and finallyincluded a realistic means o accessing cannabis in 2014.

Later in 2003, Caliornia’s legislature and Gov. Gray Davis (D) expanded thestate’s existing law to allow patients and caregivers to collectively or cooperativelycultivate marijuana as long as it was not done or “profit.” Te improved law provided a legal basis or dispensaries operating in the state, but did not explicitlyallow them. It also did not include any state regulation or registration.

Vermont, Montana, and Rhode Island joined the ranks o medical marijuanastates next, in 2004 and 2006. All three laws ollowed the pattern o the priorlaws — allowing patients and caregivers to possess and grow a limited amount omarijuana, without providing or any regulated distribution.

Beginning in 2007, some states began to include state-regulated dispensaries intheir laws. In 2007, Gov. Bill Richardson (D) signed SB 523, making New Mexicothe 12th state to protect medical marijuana patients rom arrest. New Mexico’s lawwas the first to allow state-regulated and state-licensed larger-scale providers. Itdid not explicitly include home cultivation, but the health department has issuedpatients personal cultivation licenses.


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In 2008, Michigan voters approved a medical marijuana initiative, makingMichigan the first Midwestern state with an effective medical marijuana law.Michigan’s was the last effective state medical marijuana law enacted that reliedonly on home cultivation and caregivers without providing or state-regulateddispensaries.

In 2009, Rhode Island became the first state to add regulated nonprofit dispensa-ries to its existing law. Maine’s voters ollowed suit in November 2009, approving

an initiative that added nonprofit dispensaries, a patient and caregiver registry,and additional qualiying conditions to the state’s medical marijuana law.

On January 18, 2010, New Jersey became the 14th medical marijuana state andthe first to enact a medical marijuana law that relied solely on dispensaries, with-out providing or home cultivation.

In late 2009, Congress finally allowed an initiative Washington, D.C. voters hadenacted in 1998 to go into effect. Te D.C. Council put the initiative on hold in2010 and then significantly restricted the law. Te council removed home cul-tivation — but included regulated dispensaries and cultivation acilities — andeliminated most o the qualiying conditions. (Te qualiying conditions were

restored in 2014.)Also in spring 2010, Colorado’s legislature expanded the state’s existing medical

marijuana law by explicitly allowing, regulating, and licensing dispensaries (called“medical marijuana centers”), growers, inused product manuacturers, and labs.Unlike most states, Colorado’s dispensaries are allowed to be or-profit, and thereare no caps on the numbers o each type o business.

Arizona voters approved an initiative that made their state the 15th with an e-ective medical marijuana law in November 2010. Unlike the state’s 1996 measure,this law used “certification” instead o “prescription” to ensure it would be effec-tive. Te law allows about 125 nonprofit dispensaries and or patients or their

caregivers to cultivate i they do not live near dispensaries.Since 2011, eight more states — Connecticut, Delaware, Illinois, Maryland, New

Hampshire, Massachusetts, Minnesota, and New York — and the U.S. territoryGuam have enacted effective medical marijuana laws. Massachusetts’ measure wasa ballot initiative; Guam’s law was approved by voters aer being reerred to theballot by the legislature; and the other programs were approved by the states’ legis-latures and governors. O those laws, only Massachusetts allows home cultivation,and the provision is limited to patients who obtain a waiver due to hardship.

All o the medical marijuana laws enacted since 2009 have allowed regulateddispensaries, although the regulatory and licensing process have sometimes taken

two years or longer. In the cases o Connecticut, Maryland, and Illinois, the lawsprovide or separate commercial cultivation licenses as well.

Following the relaxation o ederal enorcement policies, several states withexisting medical marijuana laws have improved their laws to include licensedand regulated dispensaries. Vermont ollowed Rhode Island and Maine’s lead in2011, and Nevada and Oregon did so in 2013. In 2015, Hawaii’s legislature addeda licensed dispensary system and Caliornia’s legislature enacted a licensing andregulatory system or all types o medical marijuana businesses.


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Washington and Alaska voters made marijuana legal or adults who are 21 orolder in 2012 and 2014. Neither state had a licensed dispensary system (numer-ous dispensaries operate in Washington, but are not legal under state law), butthose laws allow or regulated distribution to individuals who are 21 or older.Washington’s legislature also provided or a medical endorsement or adult-usestores in 2015.

In 2014, a new wave o medical marijuana-related laws was enacted aer a grow-

ing number o parents o children with devastating seizure disorders became awareo cannabis’s potential to bring relie to their children. Since then, three statesapproved effective comprehensive medical marijuana laws and 16 states enactedlaws intended to allow patients with seizures — and sometimes other conditions— to use strains o cannabis that are low in HC. As was mentioned, many othose 16 laws do not reflect the lessons learned about how to cra workable laws,and almost all ail to provide in-state access that will work in light o ederal law.

In addition, in 2015, Louisiana amended and expanded an existing ineffectivemedical marijuana law, but it ailed to fix the law’s atal flaws. Te law still requiresa “prescription” and relies on pharmacies to break ederal law by distributingcannabis.

Many o the effective state medical marijuana laws continue to evolve includingby adding anti-discrimination protections, improving options or access, and ex-panding qualiying conditions. In addition, new states — including Nebraska andUtah — are seriously considering comprehensive medical cannabis laws.

Hawaii

Twenty-three states and the District of Columbia have laws thatprotect patients who possess marijuana with their doctors’ approvaland allow patients to cultivate marijuana or acquire it from providers.

23 States and D.C. Have Effective Medical Marijuana Laws

Alaska

In addition to state laws, some state courts — including the Idaho Supreme Court and a Florida Court of Appeals —have found that patients can avoid a conviction for either possession or cultivation by proving a medical necessitydefense. Other states have ruled against a necessity defense. Details are available in Appendix K. Also, Marylandwill allow teaching hospitals to propose medical marijuana programs.


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In all, more than 148 million Americans — about 47% o the U.S. population —now live in the 23 states, or the ederal district, with effective medical marijuanalaws. Eighty-five percent live in a state that has some orm o medical cannabislegislation on the books. See ables 1 to 5 and Appendix F or more details abouteach law.

What Eective Medical Marijuana Laws DoTe 14 laws (including Washington, D.C. and Guam) that were originally en-

acted by initiative and the 12 laws created by state legislatures are similar in whatthey accomplish.16 Each o these jurisdictions allow patients to possess and usemedical marijuana i approved by a medical doctor.17 Depending on the state, pa-tients may cultivate their own marijuana, designate a caregiver to do so, and/orobtain marijuana rom a dispensary.

Fieen o the laws allow at least some patients to cultivate a modest amount omarijuana in their homes. Nineteen states, Guam, and the District o Columbiaallow or regulated dispensing, though in some o the states with newer laws,the dispensaries are not yet up and running. In addition, while Washington andAlaska have no state-licensed dispensaries, voters in both states approved state-

licensed adult-use stores.

23 States, Guam, and D.C. Have Eective Medical Marijuana Laws

wenty-three states, Guam, and the District o Columbia have laws that protectpatients who possess marijuana with their doctors’ approval and allow patients tocultivate marijuana or acquire it rom providers.

In addition to these statutes, some state courts — including the Idaho SupremeCourt and a Florida Court o Appeals — have ound that patients can avoid aconviction or either possession or cultivation by proving a medical necessity de-ense. Other states have ruled against a necessity deense. Details are available in

Appendix L.

In addition, under each o the state laws, physicians are immune rom liabilityor discussing or recommending medical marijuana in accordance with the law.

o qualiy or protection under the law, patients typically must have documenta-tion veriying they have been diagnosed with a serious illness. Most laws includea list o qualiying conditions, but in Caliornia and Washington, D.C., doctorsmay recommend cannabis or any condition they believe it will alleviate.

States typically require a statement o approval signed by a physician. o help lawenorcement veriy that patients qualiy or legal protections, all o the states have

provisions or state registry programs that issue identification cards to registeredpatients and their caregivers, though the ID cards are voluntary in Caliornia,Maine, and Washington.

Patients’ marijuana possession and cultivation limits are generally restricted toa concrete number: One to 24 ounces o usable marijuana and six to 24 plants,sometimes limiting the number that can be mature.

16 See able 1 or specifics on each state law. Also see Appendix F or how these laws are working in the real world.17 Te text o New Mexico’s law does not speciy that patients can cultivate marijuana; it provides or state-

regulated distribution and allows the department to determine how much marijuana patients and theircaregivers can possess. Te New Mexico Department o Health enacted rules allowing the amount o marijuanapatients can possess to include plants.


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In many states, regardless o what the source o the marijuana is — including iit was purchased on the criminal market — a patient in possession o an allow-able quantity o marijuana and otherwise in compliance with the law is protectedrom arrest and/or conviction. However, some states, such as New Jersey andWashington, D.C. only allow patients to possess marijuana that was obtainedrom dispensaries.

o illustrate how the laws work, consider the ollowing prototypical vignette:

“Joe” has AIDS. His doctor advised him that marijuana could boost his appetite,so he has three marijuana plants growing in a locked closet in his apartment, andhe uses a smoke-ree vaporizer to consume our puffs o marijuana every eveningbeore dinner. While he waits or his plants to produce harvestable cannabis andwhenever they ail to produce a sufficient supply, he purchases cannabis rom alicensed dispensary. One day, Joe’s neighbor smells marijuana and calls the police.Te officer knocks on Joe’s door, and when Joe opens it, the officer sees the vapor-izer on the table.

Luckily, Joe lives in one o the 23 states with an effective medical marijuana law.Joe acknowledges using marijuana, but then shows the officer his state-issued ID

card. Te officer calls the state health department to veriy the ID card, gives Joehis best wishes, and goes on his way.

I Joe lived in one o the 27 other states, he would be arrested, prosecuted, andpossibly sent to prison.

Hawaii

Alaska

Washington,DC

Twenty-three states and the District of Columbia have laws that protect patients who possess marijuana

with their doctors’ approval and allow patients to cultivate marijuana or acquire it from providers.

Missouri enacted a law to protect certain patients who possess low-THC marijuana with their doctors’

approval and to allow patients to acquire it from providers.

Louisiana has a law that is intended to protect patients and provide access to medical cannabis,

but which unrealistically relies on doctors “prescribing” cannabis.

40 States With Medical Marijuana Laws, 2015

Sixteen states have laws that are intended to protect certain patients who possess low-THC marijuanawith their doctors’ approval, but which have serious flaws such as failing to provide in-state access.


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Most o the state laws protect patients who are complying with the state’s law andhave an ID card rom being arrested. Te other states have a deense that can beraised in court to prevent a conviction.18

Is here Conlict Between Modern State Laws and Federal Law?

In the 19 years since Caliornia and other states began protecting medical marijuana patients rom arrest, many questions have suraced regarding the status othose laws in relation to ederal law. Some believe that the ederal government cannulliy state laws, or that state laws have no real value in

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State-by-State Laws Report 2015

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