UPDATE: The South Carolina Senate voted, 24-19, on Feb. 14 to approve a third and final reading of the Compassionate Care Act, officially passing the legislation and sending it to the House for consideration.
South Carolina is one step closer to ending its prohibition of medical cannabis after Senate lawmakers voted, 26-17, in favor of advancing a legalization bill Feb. 13 on the chamber floor.
The legislation, the South Carolina Compassionate Care Act, must pass one final reading in the Senate before facing a less clear path toward enactment in the House, where a previous version of the bill died on a procedural anomaly in 2022—when a representative challenged its constitutionality because it included a tax provision, and revenue-raising bills must originate in the lower chamber.
If the legislation, sponsored by Sen. Tom Davis, R-Beaufort, survives the gamut this legislative session and is signed into law by Republican Gov. Henry McMaster, South Carolina would become the 39th state in the nation to legalize the plant for medicinal use. Twenty-four states have gone on to legalize adult-use cannabis.
Although McMaster has a mixed record on his cannabis stance since taking the governor’s office in 2017, he offered an openness to reform in 2021, when he said “there is a lot of suffering that is treatable … with medical marijuana.”
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During Senate debate, which began Feb. 7 and resumed Feb. 8 and 13, Davis offered anecdotes of cannabis’s positive effects on various individuals, including the story of former South Carolina Sen. Scott Richardson’s wife, Margaret Richardson, who suffers from trigeminal neuralgia, an agonizing condition that involves a nerve that originates near the top of the ear and splits into three toward the eye, cheek and jaw, according to Johns Hopkins Medicine.
People with trigeminal neuralgia experience episodes and/or jolts of chronic pain that can be triggered by even the lightest touch, from brushing one’s teeth to putting on makeup. In Richardson’s case, she found relief for her condition in medical cannabis when pharmaceuticals did not work.
Still, South Carolina state senators who oppose medical cannabis legalization pushed back against Davis’ bill, some saying they had concerns it’d do more harm than good via abuse, while others offered concerns about roadside safety, youth use, and it being a potential gateway toward recreational use.
Davis indicated that some of the concerns overstate reality.
“We’re not introducing evil into the Garden of Eden here,” Davis said during debate. “This isn’t the serpent temping Eve with an apple. We have kids smoking marijuana now, recreationally, and all too often we have them smoking marijuana that’s laced with fentanyl and they’re dying. So, this idea that we’re opening a Pandora’s box and somehow are going to introduce recreational marijuana use in South Carolina, to me, it’s naïve.”
While Davis has never been so close, the road to landing a legalization bill on the governor’s desk has been a bumpy one in South Carolina. The senator from Beaufort has been working on crafting legislation and advocating for a medical cannabis program for the past decade.
Notably, Davis extended his reform olive branch throughout the chamber in recent years in an attempt to please the masses with ongoing revisions to his legislation. He entertained 65-some amendments during seven floor debates in 2022.
In 2024, friends and foes of the legislation—which garners 11 co-sponsors in the Senate—recognized Davis for his openness to make changes. The senator even included a sunset provision for the entire bill so that lawmakers are forced to come back to the table in eight years to address any unintended consequences.
Sen. Kevin Johnson, D-Clarendon, said during floor debate that he opposes the bill because he believes it will grant access to too many people who either won’t benefit from medical cannabis or will exaggerate their ailments to gain access. But Johnson said that he can now “live” with the bill because of the work Davis put into it.
“I just want to commend the senator from Beaufort, because, in my opinion, this was a terrible, terrible bill that I was just hoping it would not pass,” Johnson said during floor debate. “But you have listened to everybody that wanted to have some input on the bill, and the bill is a much better bill. Now, I’m not going to vote for it, but it’s a much better bill to the point that if it does pass, I can live with it, whereas when we first started, I couldn’t even live with it if it passed.”
Davis continued to embrace his bill’s adversaries throughout the multisession debate: “Legislation is only as good as the opposition it has,” he said Feb. 8 on the floor.
While the Senate didn’t quite take up seven floor sessions to advance the legislation this year, the debate did endure three rounds before this Tuesday’s vote for an initial approval of the bill.
“Those of you who were here a couple years ago will remember that this was the bill that would allow doctors under certain limited circumstances to authorize patient use of marijuana or cannabis … for medicinal purposes provided that the patient was diagnosed with a certain underlying condition,” Davis said.
On that note, the South Carolina Compassionate Care Act intends to create one of the more restrictive medical cannabis programs in the nation in that it would require doctors to have in-person relationships with patients, run background checks for a history of substance abuse, and create written treatment plans for each individual.
Before the Senate’s debate ignited on Feb. 7, Davis said Sen. Greg Hembree, R-Horry, had circulated a Wall Street Journal column about the “dangers” of cannabis. But Davis used the opinion piece as leverage to defend provisions in his bill around physicians doing their due diligence before certifying patients.
“And it can be dangerous,” Davis said. “You’re not going to hear me say that it can’t be abused. You’re not going to hear me say that it can’t cause, as this says, ‘complications in pregnancy.’ You’re not going to hear me say that it can’t take an underlying anxiety or mental condition and exacerbate it and make it dangerous. … This [column] actually makes my point: This is why you have to have such thorough diligence on the front end with a physician sitting down with a patient, because this is not something to be taken lightly.”
The legislation aims to limit patient access to 12 “debilitating medical conditions,” including cancer, multiple sclerosis, epilepsy, glaucoma, post-traumatic stress disorder, Crohn’s disease, sickle cell anemia, ulcerative colitis, cachexia or wasting syndrome, autism, severe nausea, chronic medical conditions causing severe muscle spasms or pain, and terminal illness.
During a 14-day period, qualifying patients would be allowed to purchase no more than 4,000 milligrams of THC in topical form (patches, lotions, creams, ointments), 1,600 milligrams of THC in oral form (oils, tinctures, capsules, edibles), or 8,200 milligrams of THC in oil form for vaporization. Physicians could prescribe various allowable amounts to individual patients. Smokeable cannabis and home grows would be banned under the legislation.
In addition, medical cannabis would be dispensed through “therapeutic cannabis pharmacies,” rather than traditional dispensaries, and the legislation would require those retail facilities to always have a state-approved pharmacist on-site.
This was a provision Davis expanded on following border state Georgia rolling out a restrictive, low-THC oil program this past year. In an effort to make access widely available, Georgia regulators paved way for independent pharmacies throughout the state to dispense the cannabis oil only to have to walk back on their regulations after the U.S. Drug Enforcement Administration (DEA) issued a warning that federally registered pharmacies cannot dispense Scheduled I controlled substances like cannabis.
But Davis wanted to clarify that his bill differs from Georgia’s approach in that the therapeutic cannabis pharmacies in South Carolina would not be federally regulated retail facilities.
“What Georgia attempted to do was to say to pharmacies, like a Publix or a Walgreens that dispense controlled medications [Schedule II-V], that they could also dispense cannabis,” Davis said. “[In South Carolina] it has to be a separate facility that solely dispenses cannabis. So, it's not subject to DEA supervision and regulation. It doesn’t fall within that jurisdiction. I want to be very clear about that. … the pharmacist dispensing that we have in this bill is in line with the states that have programs that have not been interfered with.”
The state’s Department of Health and Environmental Control (DHEC) along with the Board of Pharmacy would be responsible for establishing rules and regulations as well as licensing industry participants under Davis’ bill, while a Medical Cannabis Advisory Board would be tasked with overseeing the marketplace.
Under the bill, the DHEC would be responsible for issuing licenses for the following establishments:
- 15 cultivation centers;
- 30 processing facilities;
- four transporters;
- one therapeutic cannabis pharmacy for every 20 state-permitted pharmacies; and
- five independent testing laboratories.
Also, local governments would be able to prohibit medical cannabis establishments from operating within their jurisdictions or enact ordinances to regulate the time, place, manner and number of medical cannabis establishments in their locality.
Among the 38 states that have legalized medical cannabis without severe limitation—such as Georgia’s low-THC oil program or Texas law that caps THC content at 1%—Davis said the South Carolina Compassionate Care Act would “by far” be the most restrictive in the nation.
Despite the restrictions on accessing smokeable forms such as flower and prerolls, qualified patients would still be able to access the plant in products like tinctures, vaporizers and edibles under his legislation.
Regardless of form, Davis said his aim all along has been to allow doctors in consultation with their patients to decide what is the best course of medical treatment, especially when that patient is in pain and pharmaceuticals have not provided relief.
“I believe doctors should be empowered. I believe doctors ought to be able to do what they believe is in their patient's best interest,” he said. “The question then becomes how specifically should we act?”
Without acting, many South Carolinians with debilitating medical conditions will continue to seek out cannabis from their “dealer” and be criminalized for doing so, Davis said.
“And that can’t be the compassionate response,” he said. “It just can’t be."
