In 2021, the Kansas House passed House Substitute (H. Sub.) for Senate Bill (SB) 158, which would create the Kansas Medical Marijuana Regulation Act and the Kansas Medical Marijuana Regulation Program. While the Senate did not work the bill in 2021, it remains alive for consideration during the 2022 session, along with a similar bill, SB 315. This edition of A Kansas Twist discusses elements of the Kansas bills in the context of medical marijuana laws in other states.
A total of 36 states and the District of Columbia have approved comprehensive, publicly available medical marijuana/cannabis programs; see Table 1 below. Approved measures in 11 states allow the use of “low THC, high cannabidiol (CBD)” products for medical reasons in limited situations or as a legal defense; see Table 2 below.
This edition of A Kansas Twist digs into these tables to summarize and analyze some of the key features of comprehensive medical marijuana laws in other states, including registration requirements, medical conditions, possession limits and cultivation regulations. These provisions were selected over several others, including dispensary operation and recreational use, because they have been at the center of the medical marijuana policy debate in Kansas and other states and were included in both H. Sub. for SB 158 and SB 315.
Registration refers to a program requiring “established ID cards or a registry” to participate in the jurisdiction’s medical marijuana program. All 36 states and Washington, D.C., that have legalized medical marijuana require registration, aside from Washington state where registration is voluntary for adults age 21 and older but is required for minors, caregivers of minors, or adults age 18‒20. A registration fee is required in 33 states, ranging from $1 to $200 with $50 as the most common fee. In addition, three states do not charge a fee and two states have unclear fee structures. Nine states offer fee reductions for patients who meet eligibility criteria including senior citizens, military veterans or patients currently utilizing government assistance such as the Supplemental Nutrition Assistance Program, Medicaid/Medicare or Temporary Disability Benefits. Nine states also recognize visiting patients enrolled in their home state’s medical marijuana program, although some require additional temporary registration or proof of registration from the home state. The proposed Kansas legislation — H. Sub. for SB 158 and SB 315 — would require patients to register with the state medical marijuana program and obtain an ID card. The suggested fee is $50 with a reduced fee of $25 available for patients who are “indigent or a veteran” or for caregiver registration.
Medical conditions specify diseases or disorders determined by each jurisdiction “that would allow an individual to receive access to medical marijuana.” Two states — Oklahoma and Virginia — do not specify a list of qualifying conditions. The conditions listed are largely similar across the other states and broadly include conditions such as chronic pain, cancer treatment, psychiatric conditions such as anxiety, neurologic conditions such as multiple sclerosis, and nausea and vomiting. The list of qualifying conditions also is used for deciding interstate registration reciprocity. For example, Arizona, Delaware and Nevada recognize medical marijuana registration from other states for conditions approved in their states. In Kansas, H. Sub. for SB 158 and SB 315 include specific conditions that are similar to those listed above and include reciprocal registration for patients enrolled in their home state’s medical marijuana program who have a Kansas qualifying condition.
Possession “specifies the amount of marijuana a patient can possess with protection from criminal penalties.” Jurisdictions quantify their possession limits through mass limits, time-based supply limits, or a mixture of the two. Of note, California has no limits on possession when recommended by a physician. In the 16 states that use only a mass limit, the most commonly allowed maximum is 2.5 ounces. The seven states that utilize a time-based supply limit most commonly allow a 30-day supply with some allowing up to a 90-day supply. Seventeen states use both mass and time to establish a possession limit, such as 2 ounces in 30 days in Vermont or 3 ounces in 14 days in North Dakota. To compare these values more evenly, KHI converted them to ounces per day. There is a wide range of daily possession limits, with the largest in Alaska and Montana (1 ounce per day), a limit 588 times greater than the smallest limit in Alabama (0.0017 ounce per day). The median limit is 0.14 ounce per day. In Kansas, H. Sub. for SB 158 and SB 315 both specify a 30-day supply possession limit with no mass limit.
The term cultivation “indicates whether a jurisdiction allows qualified patients or designated caregivers to plant, grow or harvest marijuana for medical use.” Eighteen of the states examined prohibit cultivation as part of their medical marijuana programs. Of the remaining states, 15 have restrictions regarding cultivation. The most frequent restriction is on the number of marijuana plants a patient or caregiver is allowed to cultivate — often further divided between mature and immature plants — with 12 total plants as the most common maximum. Another condition seen in three states centers on accessibility of medical marijuana for patients, including geographic exceptions for patients who live more than 25 miles from a dispensary or who more generally have a “verified hardship in accessing a treatment center.” Other conditions for cultivation are used to increase safety, with requirements for plants to be kept in an enclosed, locked location or registration for cultivation to be separate from registration in the state’s medical marijuana program. In H. Sub. for SB 158 and SB 315, the overall language regarding cultivation licensing refers to commercial cultivation regulation. The section on patient privileges in both bills does not explicitly include or exclude permission for personal cultivation.
While individual states have their own specificities in each provision category, there are many similarities. The provisions from other states examined in this edition of A Kansas Twist are comparable to the proposed Kansas Medical Marijuana Regulation Act and the Kansas Medical Marijuana Regulation Program outlined in 2021 H. Sub. for SB 158 and SB 315. Further understanding the effects of these provisions on social, economic and health outcomes experienced in other states that have implemented comprehensive medical marijuana laws could assist Kansas policymakers as they make decisions about medical marijuana legislation.
*The tables rely on two primary sources — the Network for Public Health Law (as of February 14, 2019) and the National Conference of State Legislatures (as of May 18, 2021).
The Kansas Health Institute supports effective policymaking through nonpartisan research, education and engagement. KHI believes evidence-based information, objective analysis and civil dialogue enable policy leaders to be champions for a healthier Kansas. Established in 1995 with a multiyear grant from the Kansas Health Foundation, KHI is a nonprofit, nonpartisan educational organization based in Topeka.
