How do medical marijuana laws differ from state to state? And what is the federal law regarding medical marijuana? Get help navigating the complex web of laws around medical marijuana use in the U.S. Medical marijuana is derived from the cannabis plant and can help treat conditions such as anxiety, arthritis, epilepsy, and cancer-related nausea. Its many forms include CBD (cannabidiol) oils and edibles and products containing both THC and CBD.
Medical Marijuana Laws: What You Need to Know
If you have ever thought about trying medical marijuana to treat nagging pain or ease the symptoms of a chronic condition, you may have stopped short due to a few critical questions: Is medical marijuana legal where I live? Can I get in trouble for using it?
If you live in the United States, the answers are: It depends on where you live, and it’s possible, though not very likely.
Making sense of medical marijuana laws can be hard, since many state regulations are in direct conflict with federal laws. What’s more, there has been a sea change in attitudes about marijuana, or cannabis, in this country over the years, which has led an ever-growing number of states to overturn laws banning it. Even legal experts have trouble keeping up with which states now allow the sale and use of medical marijuana.
As a consumer, the first thing to do before considering marijuana as medicine is talk to your doctor about whether it’s safe for you to use and likely to provide any benefit. If you get the go ahead, here’s what you need to know about medical marijuana laws in the United States.
State Laws Prevail
Laws passed in the United States in the 1930s made it illegal to buy, sell, or grow marijuana. The U.S. government’s position on pot has not changed much since then. “It is illegal to purchase, possess, consume, or sell marijuana as far as federal law is concerned,” says Jonathan H. Adler, JD, a professor at the Case Western Reserve University School of Law and author of Marijuana Federalism: Uncle Sam and Mary Jane, a book about pot laws in the United States.
However, Adler says, the risk of the federal government prosecuting any individual for possessing cannabis is extremely low. Instead, federal agents are more focused on large producers of marijuana who sell it on the black market or anyone who sells pot to kids, he says.
What’s more, states are allowed to establish their own laws regarding the sale and use of cannabis. At this writing, medical marijuana is legal in 36 states, plus the District of Columbia and four U.S. territories (Guam, the Mariana Islands, Puerto Rico, and the Virgin Islands). “Congress has repeatedly limited the ability of the federal government to interfere with state medical marijuana programs,” Adler says. “So if you’re acting in compliance with your state law, you are still violating federal law, but you’re not at significant legal risk.”
A Patchwork of Laws
If you are interested in medical marijuana, the first step is to find out whether it’s legal in your state. For residents of two states, Nebraska and Idaho, as well as the territory of American Samoa, the answer is simple: No. The remaining states and jurisdictions have a patchwork of laws that differ dramatically from one to the next. However, states that permit use of cannabis in some form all fall into one of three categories:
Only products containing CBD are legal. Some states only permit the sale of products containing CBD, or cannabidiol, which is one of two major components of marijuana. The other major component of pot is delta-9-tetrahydrocannabinol, better known as THC, which is what causes you to feel “high.” While CBD extracted from cannabis is used in a prescription medicine to treat epilepsy, less is known about its benefits for other health conditions.
Medical marijuana is legal. More than two-thirds of states have legalized marijuana for use as medicine, due in large part to growing evidence that cannabis provides relief of conditions such as chronic pain and chemotherapy-related nausea and vomiting. To obtain cannabis in a state that permits only the use of medical marijuana, you must first receive a recommendation from a doctor or other health care professional who is registered to do so in your state. In some states, such as Oklahoma, a doctor can recommend medical marijuana for any condition. Other states, such as Montana, only allow patients with specific medical conditions (such as glaucoma and cancer) to qualify for a recommendation. The next step is to present a doctor’s recommendation to your state’s cannabis commission, which will issue a cannabis card for a fee. A cannabis card allows you to purchase medical marijuana from a retailer, known as a dispensary.
Any adult can purchase cannabis. A growing number of states allow any adult to buy marijuana with no medical cannabis card. However, if your goal is to treat a medical condition, it still makes sense to speak with your doctor before using cannabis and to obtain a medical cannabis card, says Debbie Churgai, executive director of Americans for Safe Access (ASA).
“That’s especially important if you have a chronic condition or you’re taking other medications, since cannabis could interact with other drugs,” Churgai says. What’s more, the ASA is lobbying to provide certain advantages for people who use cannabis for medical purposes, such as tax breaks, priority access to preferred products, and compassionate-use programs for people who can’t afford medical marijuana, Churgai says.
Other State-by-State Differences
State laws regarding cannabis vary in a number of other ways. If you’re considering medical marijuana, be sure you first find out:
- What form of cannabis is legal. Minnesota allows the use of medical marijuana, but it’s illegal to smoke a joint or take a bong hit; cannabis is only permitted in liquid, pill, or vaporized form.
- How much cannabis you can possess. In Arizona, a medical cannabis patient can have up to 2.5 ounces at any given time, but in Florida the limit is 4 ounces.
- Whether you can grow pot at home, and how much. You can’t grow your own in Ohio, for example, but in Maine a household of two adults can cultivate up to a dozen plants.
- Whether your medical cannabis card is valid in a state you’re visiting. For example, medical cannabis is legal in Missouri, but dispensaries in that state do not recognize out-of-state medical cannabis cards.
Following some other rules can keep you out of legal jeopardy if you choose to use medical marijuana.
- Don’t drive while using medical marijuana. Driving under the influence of marijuana is illegal in every state, regardless of whether you have a medical cannabis card. ASA recommends medicating after you arrive at your destination.
- Don’t cross state lines with cannabis. That’s illegal, too, which means if you’re flying from one state to another, don’t pack your pot. If the state you’re traveling to recognizes your medical cannabis card, you can purchase medical marijuana while visiting, Churgai says, but buy only what you need, since you can’t bring the leftovers home.
- Be leery of buying pot on the black market. Let’s say your son’s friend Jason grows and sells pot. If you buy from him, it is an illegal transaction. “Just because marijuana may be legal for medicinal or recreational purposes in a state does not mean anyone can sell marijuana to anybody,” says Adler, who explains that legal sellers must be licensed by the state. What’s more, cannabis sold in dispensaries is tested for quality and purity, capabilities Jason likely lacks.
When Federal Law Matters
Regardless of what state you live in, federal laws against marijuana use can still affect you. For example, if you live in federally subsidized housing, it’s off-limits, Churgai says. If you plan to purchase a gun, prior use of cannabis is a problem: The background check required by the Bureau of Alcohol, Tobacco, Firearms and Explosives asks if you have used illegal drugs, stating clearly that the list includes marijuana, Adler says. If your job requires a federal security clearance, you may be turned down if you have a medical cannabis card. Finally, since banks have to follow federal regulations, most won’t process credit card transactions for medical marijuana dispensaries, so if you shop for cannabis, be sure to bring cash.
Jonathan H. Adler, JD, the Johan Verheij Memorial Professor of Law; director, Coleman P. Burke Center for Environmental Law, Case Western Reserve University School of Law.
Debbie Churgai, executive director, Americans for Safe Access.
U.S. Customs and Border Protection: “Did You Know. Marijuana Was Once a Legal Cross-Border Import?”
Americans for Safe Access.
FDA: “What You Need to Know (And What We’re Working to Find Out) About Products Containing Cannabis or Cannabis-derived Compounds, Including CBD.”
Nature: “The reality behind cannabidiol’s medical hype.”
The Health Effects of Cannabis and Cannabinoids: “The Current State of Evidence and Recommendations for Research. Chapter 4: Therapeutic Effects of Cannabis and Cannabinoids.”
What Are Medical Marijuana and Cannabidiol (CBD)? Everything You Need to Know
The cannabis plant, from which marijuana is derived, is often smoked for recreational purposes. But people are increasingly using marijuana to treat medical conditions — and this medical marijuana is not always smoked. It comes in many forms:
- Marijuana cigarettes containing the cannabinoids (chemical compounds) tetrahydrocannabinol (THC) or cannabidiol (CBD), or both THC and CBD
- CBD oils, edibles, tinctures, creams, and capsules
- Cannabis-derived pharmaceutical products approved by the Food and Drug Administration (FDA)
Studies suggest that the medical use of marijuana may help treat the following conditions or help alleviate the following symptoms: (1)
- Anxiety, particularly social anxiety disorder
- Chronic pain
Some research has suggested that the cannabinoids in marijuana could also be useful in managing these conditions: (2,3,4,5,6,7)
- HIV/AIDS like Crohn’s disease and irritable bowel syndrome (IBS)
According to a 2017 report from the National Academies of the Sciences, Medicine, and Engineering (NASME), the strongest scientific evidence so far has been found in support of using marijuana for chronic pain, cancer-related nausea and vomiting, and MS-related spasticity. (1)
This NASME report, one of the largest of its kind, looked at more than 10,000 studies published since 1999.
How Does Marijuana Affect the Body?
It depends on whether THC or CBD is the cannabinoid at work. They produce similar effects, but there are differences in intensity because they each affect a different neural pathway.
THC is thought to engage with the body’s endocannabinoid system, which helps regulate physiological functioning. THC is similar to a chemical that’s present in this system, and when these two chemicals meet, the similarity allows THC to exert an influence on the body and brain in ways that alter coordination, memory, decision-making, appetite, and mood.
The endocannabinoid system also helps regulate gastrointestinal functions, and this may explain why medical marijuana seems to help digestive disorders like IBS.
CBD, scientists think, affects the brain because of the way it interacts with the neurological pathways that regulate serotonin, the hormone that regulates anxiety, pain, nausea, and appetite.
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How Can Marijuana Help Opioid Use Disorder?
Some individuals use marijuana instead of addictive opioids to treat pain. In these cases, marijuana may actually be responsible for a decrease in the use of — and deaths from — these prescription drugs.
A study published in May 2018 in JAMA Internal Medicine reported that prescriptions for opioids decreased in states that have medical marijuana laws. Researchers looked at Medicare data from 2010 to 2015 and found that states with active dispensaries saw 3.742 million fewer daily doses of opioids filled by pharmacies. (8)
4 Doctors Comment on Legal Marijuana and Prescribing Fewer Opioids
Another study, published in October 2014 in JAMA Internal Medicine, found that states with medical cannabis laws had a 24.8 percent lower annual overdose rate than states without such laws. (9)
Some states, like Pennsylvania and New York, now consider opioid use disorder as a qualifying condition for medical marijuana use. New York, for example, allows people who qualify to use medical marijuana instead of opioids to treat pain.
What Is Cannabidiol and How Will It Affect Me?
Cannabidiol is the cannabinoid in marijuana that, along with interacting with the brain’s serotonin system, may also help relax and calm you, but it doesn’t alter your perception or affect physical reactions too much. CBD may be particularly effective for: (10)
- Anxiety disorders
- Nausea and vomiting
- Psychotic disorders
- Non-cancer-related pain
- Sleep problems (Dravet syndrome and Lennox-Gastaut syndrome)
Staci Gruber, MD , is an associate professor of psychiatry at Harvard Medical School in Boston and the director of the Marijuana Investigations for Neuroscientific Discovery program at McLean Hospital in Belmont, Massachusetts, which is researching the neurological effects of medical marijuana use.
In a large study that she’s conducting on the use of medical marijuana, Dr. Gruber says the second most commonly reported use of medical marijuana among subjects is for anxiety. She’s also about to begin an FDA-approved clinical trial of a CBD sublingual (administered under the tongue) tincture, consisting of CBD in a coconut oil base, for the treatment of anxiety. (Tinctures are medicines — in this case CBD — dissolved in a liquid like alcohol or glycerine.)
Indeed, anecdotal evidence points to the effectiveness of CBD as an anxiety and stress reducer, as well as a sleep aid. Eric*, a busy sales executive in San Francisco, has been sleeping more soundly since he started using a high-CBD, low-THC product via a vaporizer three months ago for work-related stress and anxiety.
“The quality of my sleep is better, I’m sleeping longer and deeper, and I now have no problem falling and staying asleep,” he says. “It has changed my life.”
In addition to being a potentially powerful treatment for anxiety disorders, a growing body of research is suggesting that CBD may help treat symptoms of neurological disorders such as Parkinson’s disease and Alzheimer’s disease . (11,12)
Scientists think that CBD acts in yet to be determined ways that protect the brain against inflammation and oxidative stress. (13)
Research also points to CBD as a potential treatment for psychosis and schizophrenia . (14,15)
Medical marijuana may also be effective in palliative care. In one Canadian case study, published in 2013 in Case Reports in Oncology, physicians reported that CBD oil, administered orally, was a successful treatment for a 14-year-old patient in palliative care with an aggressive form of leukemia. (16)