Advocates call it compassion. Prohibitionists fear it’s a gateway to recreational use.
But the year is 2024, and an undisputed lion’s share of Americans stands unified behind medical cannabis legalization despite lawmakers in some of our nation’s least progressive legislatures still hanging on to old policies by their fingertips.
Will their stubborn grips prevail for yet another legislative cycle? Another election cycle? Another blue moon?
While 38 states have enacted compassionate medical cannabis laws in the U.S., with another three states—Texas, Georgia and Iowa—taking more restrictive approaches to reform, nine states have continued their prohibition policies as our nation’s last holdouts: Idaho, Indiana, Kansas, Nebraska, North Carolina, South Carolina, Tennessee, Wisconsin and Wyoming.
Yet poll after poll in each and every one of these nine states show time and time again that supermajorities support allowing those with debilitating medical conditions such as cancer, chronic nausea and multiple sclerosis to have legal access to medical cannabis rather than the possibility of jail time for finding relief.
And despite most states recognizing tens of qualifying conditions for patients to access medical cannabis, nearly 44 million Americans live in one the nine prohibition states that recognize none.
Why is that?
Here, Cannabis Business Times takes a deep dive into the political, punitive and electoral landscapes of our nation’s nine medical cannabis prohibition states, what’s likely holding them back, and what the possibilities are for future reform.
Editor’s note: The “Prohibition Penalties” sections in this report come directly from advocacy group NORML’s “laws and penalties” pages for each state.
Idaho
Will Idaho Legalize in 2024? There’s a Chance!
Poll(s): More than two-thirds (68%) of Idaho adults believe medical cannabis should be legal in their state, according to an October 2022 SurveyUSA poll.
Prohibition Penalties:
- Personal Possession: Up to 3 ounces of cannabis is a misdemeanor punishable by up to one year imprisonment and a $1,000 maximum fine.
- Intent to Sell: Up to 1 pound or up to 24 cannabis plants is a felony punishable by up to five years imprisonment and a $15,000 maximum fine. The state includes mandatory minimum sentences for intent to sell more than 1 pound of cannabis.
Ballot Initiative(s): A citizen-led state statute to legalize medical cannabis could appear on the November 2024 ballot in Idaho. The petition, titled the Idaho Medical Marijuana Act, is sponsored by nonprofit Kind Idaho and was cleared in April 2023 to begin signature gathering. The campaign has until May 1, 2024, to collect roughly 63,000 valid signatures (roughly 6% of registered voters in the most recent general election).
Previous Ballot Attempt(s): Kind Idaho attempted a similar campaign for the 2022 ballot but ended up falling short of the needed signatures. Previously, the Idaho Cannabis Coalition attempted to land a medical cannabis question on the 2020 ballot but also came up short amid signature-gathering difficulties during the COVID-19 pandemic.
Recent Legislative Attempt(s):
- In 2021, House Minority Leader Ilana Rubel, D-Boise, and Rep. Mike Kingsley, R-Lewiston, co-sponsored House Bill 108, the Sgt. Kitzhaber Medical Cannabis Act, which was named after a U.S. Air Force veteran with terminal cancer, the Idaho Capital Sun reported. The House Health and Welfare Committee, where it was introduced, never gave it a full hearing.
- In 2023, Rep. John Vander Woude, R-Nampa, introduced the Idaho Medical Cannabis Act (House Bill 370), but, because it was introduced as a personal bill outside the traditional committee process, it was doomed from the get-go and did not advance, Boise Weekly reported.
Current Legislative Attempt(s): While Woude’s late-session introduction of medical cannabis legislation in 2023 didn’t have a meaningful chance for advancing, advocates took it as a sign to spark conversation for Idaho’s 2024 legislative session. So far, nothing has materialized.
Current Legislative Session: Idaho’s session is scheduled to run from Jan. 8 through March 29, although there is no limit on its length.
Legislature Make-Up: Republicans control majorities in both the House (59-11) and the Senate (28-7).
Governor: Brad Little (Republican Party)
Governor’s Stance: The governor’s Office of Drug Policy (ODP) opposes the legalization of cannabis in any form other than specific cannabis-based medications that have received FDA approval. Regarding the medical use of cannabis, ODP’s position is that components of the plant should be evaluated by the same rigorous, scientific FDA process through which every legal medication in the United States is tested.
Indiana
Will Indiana Legalize in 2024? Don’t Hold Your Breath!
Poll(s): More than 86% of adults in Indiana believe cannabis should be legal in one form or another, including 54.2% who support adult-use legalization and 32.2% who support medical-only cannabis legalization, according to a 2023 Hoosier Survey conducted by Ball State University.
Prohibition Penalties:
- Personal Possession: Up to 30 grams of cannabis is a misdemeanor punishable by up to 180 days imprisonment and a $1,000 maximum fine.
- Intent to Sell: Up to 30 grams of cannabis is a misdemeanor punishable by up to one year imprisonment and a $5,000 maximum fine.
Ballot Initiative (s): Indiana is one of 24 states in the nation that does not provide for citizen-initiated ballot measures.
Recent Legislative Attempt(s): Indiana lawmakers introduced a dozen bills related to cannabis in 2023, including two designed specifically to legalize the plant solely for medical use—Senate Bill 237 and House Bill 1263. The former bill was sponsored by Senate Minority Leader Greg Taylor, a Democrat, and the latter by GOP Rep. Jim Lucas. While Lucas picked up two Republican co-sponsors for his legislation, neither bill received a vote in committee.
Current Legislative Attempt(s):
- Taylor reintroduced his medical cannabis bill Jan. 8 in the Senate, where it was referred to the Commerce and Technology Committee.
- GOP Sen. Eric Bassler introduced legislation Jan. 16 that aims to legalize a medical cannabis program only after the plant is removed as a federal Schedule I controlled substance. The proposal, Senate Bill 294, was referred to the Commerce and Technology Committee.
Current Legislative Session: Indiana’s session is scheduled to run from Jan. 8 through March 14 with a limit of 30 legislative days during even-numbered years.
Legislature Make-Up: Republicans control majorities in both the House (70-30) and the Senate (38-10, with two seats vacant).
Governor: Eric Holcomb (Republican Party)
Governor’s Stance: Gov. Eric Holcomb opposes legalizing cannabis because of its designation as a federal Schedule I substance, saying in a December 2021 interview that “I took an oath” to “uphold the law—state and federal.”
Kansas
Will Kansas Legalize in 2024? It’s Anyone’s Guess!
Poll(s): More than 67% of Kansas adults believe cannabis should be legal for anyone 21 and older, according to an October 2023 Kansas Speaks survey conducted by the Docking Institute of Public Affairs at Fort Hays State University. In addition, 63.6% of respondents said they were either “highly likely” or “somewhat likely” to vote for a state Legislature candidate who supported medical cannabis legalization.
Prohibition Penalties:
- Personal Possession: Any amount of cannabis is a misdemeanor punishable by up to six months imprisonment and a $1,000 maximum fine.
- Intent to Sell: Up to 25 grams of cannabis is a felony punishable by 14 months of probation and up to 51 months imprisonment and a $300,000 maximum fine.
Ballot Initiative(s): Kansas is one of 24 states in the nation that does not provide for citizen-initiated ballot measures.
Recent Legislative Attempt(s):
- In May 2021, the Kansas House passed a medical cannabis bill via a 79-42 vote. The legislation carried over to 2022’s legislative session, when the Senate left it on the table at the time of adjournment in May.
- In October 2022, Kansas lawmakers held two hearings on the merits of medical cannabis legalization in an effort to develop a comprehensive bill for the 2023 session, which resulted in Senate Bill 135 being introduced.
- S.B. 135 failed to advance out of the Kansas Senate Federal and State Affairs Committee, which tabled debate on the legislation in late March 2023.
Current Legislative Attempt(s): Kansas has a two-year legislative session, so S.B. 135 has carried over for consideration in 2024. But in a pre-session interview, Senate President Ty Masterson, R-Andover, said that the bill “that’s in our committees right now is a nonstarter,” KSNT reported. Masterson said he’s willing to entertain medical cannabis legalization, but “it has to protect our children,” adding that what he’s open to is “some type of pilot program or something that is controlled to the point you can test it.”
Current Legislative Session: Kansas’ session is scheduled to run from Jan. 8 through May 3, including an original adjournment on April 5 before a veto session begins on April 29.
Legislature Make-Up: Republicans control majorities in both the House (85-40) and the Senate (29-11-1, with one vacant seat).
Governor: Laura Kelly (Democratic Party)
Governor’s Stance: Gov. Laura Kelly has long supported legalizing medical cannabis and has vowed to work with the Kansas Legislature to pass “thoughtful” legislation.
Nebraska
Will Nebraska Legalize in 2024? There’s a Chance!
Poll(s): Roughly 83% of Nebraskans support legalizing medical cannabis, according to the 2021 Nebraska Annual Social Indicators Survey conducted by the University of Nebraska-Lincoln.
Prohibition Penalties:
- Personal Possession: Up to 1 ounce is an infraction on the first offense; the second offense is a misdemeanor punishable by five days imprisonment (seven days for third offense) and a $500 maximum fine. Possession of 1 ounce to 1 pound is a misdemeanor punishable by up to three months imprisonment and a $500 maximum fine.
- Intent to Sell: Any amount is a felony punishable by up to 20 years imprisonment and a $25,000 maximum fine. Subsequent offenses include a three-year mandatory minimum to a life sentence in prison.
Ballot Initiative(s): Nebraskans for Medical Marijuana is attempting to put a pair of statutory measures relating to legalization before voters in the November 2024 election. One petition the group is circulating aims to establish a doctor-patient system, and the other would create the framework for a regulated industry. The campaign has until July 3 to collect roughly 87,000 valid signatures per petition to land each on the ballot.
Previous Ballot Attempt(s): Nebraskans for Medical Marijuana ran similar legalization campaigns for the 2020 and 2022 ballots. In 2020, the group met the signature-gathering requirements only to have its petition struck down by the Nebraska Supreme Court, which ruled it violated the state’s single-subject rule and could not appear on the ballot. And in 2022, the group faced a major setback when the campaign’s main donor died in a plane crash; it ultimately fell short of meeting county qualifications for its signature drive.
Recent Legislative Attempt(s):
- In January 2021, Democratic Sen. Anna Wishart—who has helped spearhead Nebraskans for Medical Marijuana—introduced the Medicinal Cannabis Act (Legislature Bill 474). The bill was amended in committee and carried over to the 2022 legislative session.
- In January 2022, Republican state Sen Mike Groene introduced L.B. 1275, which aimed to adopt a restrictive medical cannabis program limited to oil in pill form with only four qualifications for patients. After Groene resigned, Wishart ended up keeping the legislation alive, but both L.B. 474 and her own L.B. 1275 died when the Legislature adjourned that April.
Current Legislative Attempt(s): In 2023, Wishart picked up where she left off by reintroducing the Medicinal Cannabis Act with a new bill number: L.B. 588. Once again, the legislation was referred to the Judiciary Committee, which held yet another hearing to take testimonials but did not act on advancing the bill. The legislation carried over to the 2024 legislative session.
Current Legislative Session: Nebraska’s session is scheduled to run from Jan. 3 through April 18 with a limit of 60 legislative days during even-numbered years.
Legislature Make-Up: Nebraska is the only state in the country with a unicameral Legislature—one chamber—which is controlled by a Republican majority (32-17).
Governor: Jim Pillen (Republican Party)
Governor’s Stance: The month before his November 2022 election, Gov. Jim Pillen told KETV that he would support medical cannabis only through the U.S. Food and Drug Administration. “I am a supporter of FDA-approved process prescriptions—so approved medical marijuana through the FDA process. Then, we have safe product that all of us can agree on,” he said.
North Carolina
Will North Carolina Legalize in 2024? It’s Anyone’s Guess!
Poll(s): Seventy-eight percent of likely voters in North Carolina favor legalizing medical cannabis, while only 18% are opposed to such reform, according to a February 2024 poll conducted by Meredith College.
Prohibition Penalties:
- Personal Possession: Up to 0.5 ounce of cannabis is a misdemeanor punishable by a $200 maximum fine; possessing between 0.5 ounce and 1.5 ounces is a misdemeanor punishable by up to 120 days imprisonment; possessing greater amounts is a felony.
- Intent to Sell: Up to 10 pounds of cannabis is a felony punishable by up to eight months imprisonment and a discretionary fine on the first offense; greater amounts carry mandatory minimum sentences.
Ballot Initiative(s): North Carolina is one of 24 states in the nation that does not provide for citizen-initiated ballot measures.
Recent Legislative Attempt(s):
- In April 2021, Republican Sen. Bill Rabon filed the North Carolina Compassionate Care Act after his personal experience as a cancer survivor. The bill advanced through three committees that year but was ultimately postponed from advancing further.
- In June 2022, the state’s Compassionate Care Act passed the Senate in a 36-7 vote before facing opposition in the House. During a closed-door meeting in late June, House lawmakers internally voted to kill the bill with Speaker Tim Moore acting as a main opponent of advancing the reform effort.
Current Legislative Attempt(s):
- In January 2023, Sen. Rabon along with Republican Sen. Michael Lee and Democratic Sen. Paul Lowe refiled the N.C. Compassionate Care Act as Senate Bill 3. The North Carolina Senate, once again, passed the legislation in 36-10 vote last February. And, once again, the bill stalled in the House, where Speaker Tim Moore said not enough members backed the proposal to bring it to the floor.
- In 2024, this Senate-passed bill remains in the House’s court.
Current Legislative Session: North Carolina’s session is scheduled to run from April 24 through July 31, although there is no limit on its length.
Legislature Make-Up: Republicans control majorities in both the House (72-48) and Senate (30-20).
Governor: Roy Cooper (Democratic Party)
Governor’s Stance: Gov. Roy Cooper said in October 2022 that he believes small amounts of cannabis should be decriminalized and that “North Carolina should take steps to end this stigma.”
South Carolina
Will South Carolina Legalize in 2024? It’s Anyone’s Guess!
Poll(s): More than three-fourths (76%) of South Carolina adults support legalizing medical cannabis, while only 14% are opposed to the reform, according to an April 2023 poll conducted by Winthrop University.
Prohibition Penalties:
- Personal Possession: Up to 1 ounce of cannabis is a misdemeanor punishable by up to 30 days imprisonment and a $200 maximum fine on the first offense; subsequent offenses are punishable by up to one year imprisonment and a $2,000 maximum fine. Greater amounts carry felony charges.
- Intent to Sell: Up to 10 pounds of cannabis is a felony punishable by up to five years imprisonment with a maximum $5,000 fine; greater amounts carry mandatory minimum sentences.
Ballot Initiative(s): South Carolina is one of 24 states in the nation that does not provide for citizen-initiated ballot measures.
Recent Legislative Attempt(s):
- In February 2022, after seven floor sessions and more than 65 changes were considered, the South Carolina Compassionate Care Act, a medical cannabis bill sponsored by Sen. Tom Davis, R-Beaufort, passed the state’s Senate in a 28-15 vote.
- In May 2022, the legislation advanced to the House floor, but Rep. John McCravy, R-Greenwood, challenged the bill’s constitutionality—arguing that it would create a new tax and that revenue-raising bills must originate in the lower chamber. On this technicality, the House voted, 59-55, to table the bill, dealing it a blunt defeat.
Current Legislative Attempt(s):
- In January 2023, Davis reintroduced the South Carolina Compassionate Care Act (S. 423), which the Senate Medical Affairs Committee voted, 9-8, the next month to skip the committee process and send the bill straight to the Senate calendar for consideration. But it failed to reach the floor for debate before last year’s legislative session ended.
- On Feb. 6, 2024, the Senate voted, 26-13, in favor of a special order to expedite Davis’ legislation to the top of the calendar for consideration this year. Floor debate began Feb. 7 and continued Feb. 8, but the Senate adjourned without a vote. The third round of floor debate on the bill was scheduled to pick up at noon Feb. 13. If passed by the Senate, the legislation would face a less clear path toward enactment in the House.
Current Legislative Session: South Carolina’s session is scheduled to run from Jan. 9 to May 9, with the length limited to the first Thursday in June.
Legislature Make-Up: Republicans control majorities in both the House (88-36) and Senate (30-15-1)
Governor: Henry McMaster (Republican Party)
Governor’s Stance: While Gov. Henry McMaster said during a 2018 gubernatorial debate that legalizing medical cannabis would put the state in “very dangerous territory,” he offered a different perspective in 2021, when he said he would be open to considering reform for medicinal purposes and that “there is a lot of suffering that is treatable … with medical marijuana.”
Tennessee
Will Tennessee Legalize in 2024? Don’t Hold Your Breath!
Poll(s): Seventy-nine percent of Tennessee adults support legalizing the “doctor authorized use” of medical cannabis, while only 13% oppose reform, according to a November 2023 poll conducted by the Siena College Research Institute.
Prohibition Penalties:
- Personal Possession: Up to 0.5 ounce of cannabis is a misdemeanor punishable by up to one year imprisonment and a $2,500 maximum fine, including minimum fines of $250 for first-time convictions and $500 for subsequent convictions.
- Intent to Sell: Between 0.5 ounce and 10 pounds is a felony punishable by one to six years imprisonment and a $5,000 maximum fine.
Ballot Initiative(s): Tennessee is one of 24 states in the nation that does not provide for citizen-initiated ballot measures. (But see “current legislative attempts” below for a nonbinding legislative referendum that could appear before voters.)
Recent Legislative Attempt(s):
- In 2014, Tennessee adopted a CBD-focused law (Senate Bill 2531), which was modified by the Legislature in following years to become the state’s low-THC program, which allows qualifying patients to possess CBD oils with no more than 0.9% THC.
- In 2021, the Tennessee Legislature approved Senate Bill 118, which created the “Tennessee Medical Cannabis Commission” to study and consider medical cannabis legalization but only for when the federal government reschedules the plant from its Schedule I status under the Controlled Substances Act.
- In January 2022, Democratic Rep. Jason Powell introduced a constitutional amendment to legalize medical cannabis, but his resolution failed to advance out of subcommittee.
- In 2023, several bills related to cannabis policy reform were introduced in the Tennessee Legislature; none managed to pass the Senate Judiciary Committee, a required stop for cannabis legislation where Republican body members have blocked any and all advancement in recent years.
Current Legislative Attempt(s): Although medical cannabis legislation doesn’t appear favorable for passage in 2024, Rep. Jesse Chism, D-Memphis, filed House Bill 2657 on Jan. 31, which aims to put forward three nonbinding questions pertaining to legalization for Tennessee voters to answer as an “advisory referendum” on the November 2024 ballot:
- Should Tennessee legalize medical cannabis?
- Should Tennessee decriminalize less than 1 ounce of cannabis?
- Should Tennessee legalize and regulate commercial sales of adult-use cannabis?
Current Legislative Session: Tennessee’s session is scheduled to run from Jan. 9 to April 25 with a 90-day limit.
Legislature Make-Up: Republicans control majorities in both the House (75-24) and Senate (27-6).
Governor: Bill Lee (Republican Party)
Governor’s Stance: Gov. Bill Lee is a firm opponent of cannabis reform, stating in 2019 that he doesn’t believe in decriminalizing cannabis. In 2018, he offered skepticism about the plant having medicinal value; however, Lee did say that same year that he’d “consider” signing medical cannabis legislation should it reach his desk.
Wisconsin
Will Wisconsin Legalize in 2024? There’s a chance!
Poll(s): Eighty-three percent of likely Wisconsin voters support legalizing medical cannabis, while only 12% oppose the reform, according to an April 2019 poll conducted by Marquette University Law School.
Prohibition Penalties:
- Personal Possession: Any amount of cannabis is a misdemeanor for first-time offenders that’s punishable by up to six months imprisonment and a $1,000 maximum fine; subsequent offenses are considered felonies punishable by up to 3 1/2 years imprisonment and a $10,000 maximum fine.
- Intent to Sell: Up to 200 grams (roughly 7 ounces) of cannabis is a felony punishable by up to 3 1/2 years imprisonment and a maximum $10,000 fine.
Ballot Initiative(s): Wisconsin is one of 24 states in the nation that does not provide for citizen-initiated ballot measures.
Recent Legislative Attempt(s):
- Wisconsin Democrats have tried to pass cannabis policy reform in every legislative session for more than a decade now but to no avail. Senate Democratic Leader Melissa Agard, D-Madison, has taken the lead on myriad bills, including legislation she introduced in April 2019 that would have legalized both medical and adult-use cannabis.
- More recently, in September 2023, Agard unveiled similar legislation with Rep. Darrin Madison, D-Milwaukee, to legalize medical and adult-use cannabis. The bill attracted 36 co-sponsors across both chambers—all Democrats.
Current Legislative Attempt(s):
- Although Wisconsin Republicans—who have held majorities in the Assembly and Senate since 2011—have failed to entertain a vote on numerous legalization proposals, the GOP appears to have its own plan to legalize medical cannabis in 2024 (well, maybe).
- On Jan. 8, Rep. Jon Plumer, R-Lodi, took the lead in unveiling the Assembly Republicans’ plan for a restrictive, state-run medical cannabis program that’s backed by Speaker Robin Vos, R-Rochester.
- While this plan hit early bumps via Senate Majority Leader Devin LeMahieu, R-Oostburg, saying that creating state-run dispensaries is a “nonstarter” for several caucus members in his chamber, the GOP leaders have all year to come up with a compromise if they’re truly serious about reform.
Current Legislative Session: Wisconsin’s session is scheduled to run from Jan. 16 through March 14, but the state has full-time legislators who can meet throughout the year after adjourning from their regularly scheduled sessions.
Legislature Make-Up: Republicans control majorities in both the House (64-35) and Senate (22-10, with one vacant seat).
Governor: Tony Evers (Democratic Party)
Governor’s Stance: While Gov. Tony Evers, who has held office since 2019, has pushed for adult-use cannabis legalization via his state budget proposals in past years, he said in early January 2024 that he’s willing to get on board with the more limited medical cannabis program being proposed by Republican lawmakers.
Wyoming
Will Wyoming Legalize in 2024? Don’t Hold Your Breath!
Poll(s): Eighty-five percent of Wyoming residents support legalizing medical cannabis, while 54% support legalizing adult-use cannabis, according to a December 2020 poll conducted by the Wyoming Survey and Analysis Center at the University of Wyoming.
Prohibition Penalties:
- Under the Influence: Any person using or under the influence of cannabis is subject to a misdemeanor punishable by up to six months imprisonment and a $750 maximum fine.
- Personal Possession: Up to 3 ounces of cannabis is a misdemeanor punishable by up to 12 months imprisonment and a $1,000 maximum fine.
- Intent to Sell: Any amount is a felony punishable by up to 10 years imprisonment and a $10,000 maximum penalty.
Ballot Initiative(s): Wyoming provides for citizen-initiated statutes and veto referendums, but, due to a controversy between state officials and advocates, a push to land a medical cannabis legalization question on the 2024 ballot failed.
Previous Ballot Attempt(s): From late 2021 to early 2023, Compassionate Options Wyoming—sponsored in part by Wyoming NORML and the Wyoming Libertarian Party—organized a signature-gathering effort to qualify a pair of initiatives for the November 2024 election: one to legalize medical cannabis and another to reduce cannabis use and possession penalties. Despite collecting roughly 36,000 signatures ahead of a March 2023 deadline, the advocates never submitted their petition due to confusion over the minimum number of signatures required, the Casper Star-Tribune reported. The advocates thought they needed roughly 42,000 valid signatures based on 15% of total ballots cast in the previous general election, but the Secretary of State’s office clarified after the March deadline that that number was based on the 2020 election turnout and that the actual threshold based on the 2022 election turnout was 29,700 signatures.
Recent Legislative Attempt(s):
- In March 2021, the Wyoming House Judiciary Committee entertained a pair of legalization bills: one for medical cannabis and another for adult-use cannabis. The body voted, 6-3, to endorse the latter bill, which was sponsored by the GOP House majority whip. The legislation was placed on general file for full-chamber consideration, which it never received.
- In February 2022, Libertarian Rep. Marshall Burt introduced the Wyoming Patient Cannabis Act with nine co-sponsors signed on in the House and one in the Senate in an effort to legalize medical cannabis. The House did not act on advancing the bill.
Current Legislative Attempt(s): As of early February, a medical cannabis-related bill has yet to be introduced for the 2024 legislative session.
Current Legislative Session: Wyoming’s session is scheduled to run from Feb. 12 to March 8 with a limit of approximately 20 legislative days during even-numbered years.
Legislature Make-Up: Republicans control majorities in both the House (57-5) and Senate (31-2).
Governor: Mark Gordon (Republican Party)
Governor’s Stance: Gov. Mark Gordon suggested during a Republican primary debate in August 2022 that he’d be willing to consider medical cannabis legislation: “I think I would be willing to look at the research,” he said. But he stopped short of taking any official stance on the matter, saying that it wasn’t much of a priority for him.