What critical regulatory issues face a state’s new medical cannabis program?

There are many issues that exist when a state considers legalizing medical cannabis.  The regulatory challenges are immense, and the state government must start from the ground up for the unique cannabis industry.  Three major regulatory challenges that lawmakers face include: 1) defining which medical conditions qualify a patient for medical cannabis, 2) what quantity of cannabis products can patient have in their home, and 3) whether there is state reciprocity.

The first issue, defining what medical conditions qualify a patient for cannabis, provides the basis of the entire medical cannabis program. Because there are already 36 states with medical cannabis programs, A state can look at those qualifying conditions that have already been established as standard.1  Most states include such conditions epilepsy, chronic pain, and post-traumatic stress syndrome (PTSD) to qualify for a medical cannabis card.  There are, however, states that have significantly limited the qualifying conditions, such as North Carolina, where the only qualifying condition is intractable epilepsy.1 The legislatures of states must decide whether to be more liberal with their condition list or provide severer restrictions.

The next issue is the quantity of cannabis products that a patient may keep in their private residence.  The states with medical cannabis programs tend to have different quantities of cannabis flower that patients can buy and keep over a certain amount of time.  For instance, in Hawaii, a dispensary can sell no more than 4 ounces to a patient or caregiver over a 15 day period.2 On the other hand, in California, a retailer can sell up to 8 ounces to a patient with exceptions for more based on a recommendation from a doctor.2 The state must not only decide how much flower a patient can have, but also if it will allow the purchase and use of concentrates to their medical patients. Quantities of cannabis flower and concentrates that are allowed are vital to the program because it defines how much a patient can have to manage symptoms.

The third issue is state reciprocity.  This means that a patient who is a member of one state’s medical program can purchase cannabis products in another state under its own medical program.  For instance, Delaware has reciprocity.  A patient from Colorado with a medical cannabis card can obtain medical cannabis in Delaware, as long as they meet one of the qualifying conditions outlined in Delaware’s medical cannabis program.1  Patients are not allowed to cross state lines with medical cannabis, but reciprocity laws help patients obtain the necessary relief provided by cannabis even when they are traveling. For example, it is illegal to drive from Maryland to Delaware with medical cannabis, but if a Maryland patient was to visit Delaware, they could still obtain the cannabis they needed.  Nebraska should consider their own medical cannabis population as well as surrounding states reciprocity laws when deciding whether to honor other states’ medical cannabis cards.


  1. State Medical Marijuana Laws. National Conference of State Legislatures. https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx. Accessed on February 4, 2020.
  2. Purchase Limits for Medical and Recreational Cannabis by State. Blaze. https://support.blaze.me/hc/en-us/articles/360047501473-Retail-Purchase-Limits-for-Medical-and-Recreational-Cannabis-by-State. Accessed on February 4, 2020.

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