Southern

Legislative
Conference
of

The Council of
State Governments

A SPECIAL
CONDITION:

MEDICAL MARIJUANA
IN SLC STATES

A REGIONAL RESOURCE FROM THE SLC

Lauren Greer

Policy Analyst
Southern Legislative Conference
March 2014

Photo courtesy of flickr user Brian Stalter via Creative Commons License

Copyright March 2014

Introduction

Current Legislation

Gaining traction in a number of state legislatures of The

Council of State Governments (CSG), Southern Legislative Conference (SLC) member states, is the legalization of
marijuana for medical use. Many SLC lawmakers cite stories of families with children suffering from severe seizure
disorders that failed to respond to the more conventional
treatments as the impetus for the push toward its legalization; some of these families have even considered moving
to a state that does allow for the medicinal or recreational
use of marijuana. Prior to the start of the 2014 legislative
session, 21 states and the District of Columbia had legalized
marijuana for medical purposes.1,2 Additionally, in 2012,
voters in Colorado and Washington approved the recreational use of marijuana within their states. Mirroring the
rise in states legalizing or decriminalizing marijuana, public
support for legalization also is on the rise. A 2010 national
survey conducted by the Pew Research Center found that
only 41 percent of Americans supported legalizing marijuana.3 Only three years later, the same Pew survey found
that 52 percent of Americans favor legalization.4

As of February 2014, 10 of the 15 SLC member states have

introduced legislation for the 2014 session that would allow for the medical use of marijuana to some extent.
Although North Carolina does not reconvene until May,
legislation filed in 2013 technically is still available, despite an unfavorable committee vote. Oklahoma also
introduced medical marijuana legislation in 2013. No legislation has been introduced to allow medical marijuana in
Arkansas, Texas, or Virginia in the last two years. However, it should be noted that Arkansas only has a short
budget session in 2014, and Texas will not reconvene for
their next biennial legislative session until 2015. In addition to medical marijuana legislation, some states also
have seen legislation that would allow for the recreational use of marijuana.

Previously Enacted Legislation

Georgia, Louisiana, South Carolina, and Virginia already
have laws from the 1970s and 1980s that allow for some use
of cannabis or cannabis derivatives for medical purposes.
However, all of these programs have remained mostly dormant since their enactment, mainly due to lack of funding
or regulations for implementation. In previous and current legislation, the terms marijuana and cannabis often
are used interchangeably.

SERVING THE SOUTH

Despite the prevalence of marijuana-related legislation

being filed across the Southern states, only a few bills are
expected to make their way through the legislative process
to achieve enactment. However, as the topic moves further
from theoretical and closer to reality, there are some common trends emerging in legislation across the SLC region.
This Regional Resource reviews the similarities among these
12 legislative proposals and two ballot proposals.* The analysis was conducted on the February 28, 2014, version of the
proposals in SLC member states listed on Table 1.
One Arkansas ballot proposal and the Florida ballot proposal have
been included in the comparisons. The Missouri proposals were not
included in the analysis because they propose constitutional amendments to legalize marijuana for recreational uses.
*

THE SOUTHERN OFFICE OF THE COUNCIL OF STATE GOVERNMENTS

PO Box 98129 | Atlanta, Georgia 30359
ph: 404/633-1866 | fx: 404/633-4896 | www.slcatlanta.org

Table 1 Analyzed Medical Marijuana Proposals

Alabama
Arkansas
Florida
Georgia
Kentucky
Louisiana
Mississippi
Missouri
North Carolina
Oklahoma
South Carolina
Tennessee
Texas
Virginia
West Virginia

SB 174 (2014) Carlys Law

Statutory (2014) - The Arkansas Medical Cannabis Act
Constitutional (2014) - 2014 Ballot Amendment 2
HB 859 (2014) Cathy Jordan Medical Cannabis Act
HB 885 (2014) Haleighs Hope Act
SB 43 (2014) Cannabis Compassion Act
SB 541 (2014) Louisiana Therapeutic Use of Marijuana Act
SB 2763 (2014) No title
HB 1324 (2014) Compassionate Use of Medical Cannabis Pilot Program Act
HB 84 (2013) North Carolina Medical Cannabis Act
SB 710 (2013) Compassionate Use Act of 2013
SB 1035 (2014) South Carolina Medical Cannabis Therapeutic Treatment Research Act
HB 1385 (2014) Koozer-Kuhn Medical Cannabis Act
None
None
HB 4264 (2014) The Compassionate Use Act for Medical Cannabis

Note: This is not an exhaustive list of medical marijuana proposals in each state.

Nationally, 10 of the 21 states that already have legalized

medical marijuana in some form have done so through traditional legislative means. In 2000, Hawaii became the first
state to enact legislation legalizing marijuana for medical
use. Between Hawaii in 2000, and most recently Illinois and
New Hampshire in 2013, Connecticut, Delaware, New Jersey, New Mexico, Rhode Island, and Vermont have enacted
similar legislation. In 2013, Maryland enacted legislation
that legalized marijuana only for medical research by academic medical centers; however, no regulations have been
established to implement the program.

Public Vote
Some states offer another means of deciding whether marijuana will be allowed public vote. Ballot language has been
approved in Arkansas, Florida, and Missouri that will appear
on the respective 2014 ballot if petitioners can collect the requisite number of signatures before the deadline in each state.
Despite voters rejecting a proposal to legalize medical marijuana in 2012, the Arkansas attorney general has approved
two statutory proposals for the ballot in 2014. The largest
distinction between The Arkansas Medical Cannabis Act
and The Arkansas Medical Marijuana Act is that the latter would not allow for home cultivation. Petitioners have
until July 2014 to collect signatures.
In Florida, the required number of signatures has been
obtained to put the constitutional question of medical mar-

2 A SPECIAL CONDITION: MEDICAL MARIJUANA IN SLC STATES

ijuana legalization before voters in 2014. Although the

language was challenged for being too vague and misleading, it was narrowly approved by the Florida Supreme
Court in January of this year.
In Missouri, the secretary of state has approved 13 separate
petitions for amending the states constitution to allow for
the use of marijuana. Petitioners have until May to collect the requisite number of signatures to have the petitions
placed on the 2014 ballot. The petitions propose a range of
amendments from allowing the recreational use of marijuana for anyone 21 years of age or older, to allowing for
the medical use of marijuana, to allowing the state to tax
and regulate marijuana. Some petitions also call for changing the criminal provisions for marijuana-related offenses
and the expunction of these offenses from existing criminal records. Legislation has also been filed in 2014 to enact
statutory provisions similar to those in the constitutional
ballot proposals.
More than half of the states that currently allow for the
medical use of marijuana have legalized it through public vote. California became the first state in the nation to
approve a ballot measure to allow medical marijuana in
1996. Between 1996 in California and most recently Arizona in 2010, Alaska, Colorado, Maine, Massachusetts,
Michigan, Montana, Nevada, Oregon, and Washington
approved medical marijuana ballot measures. The District of Colombia approved a ballot measure in 1998, but it

Figure 1 Legalization of Marijuana by State and Method

Legislation
Public Vote
Illegal

was not implemented until District Council members approved legislation in 2010, which the U.S. Congress then
allowed to become law.

Drugs Approved for Medical Use

Proposals in SLC member states vary on the form of
marijuana being approved for medical use. Most of the
proposals would allow all forms of cannabis or marijuana,
while three proposals only would allow limited cannabis
derivatives or extracts.
The Alabama proposal is limited to nonpsychoactive cannabidiol (CBD) with a tetrahydrocannabinol (THC) level
of no more than 3 percent.
The Georgia and South Carolina proposals are limited to
medical cannabis, which is cannabis extracts and compounds of cannabis, including, but not limited to, CBD
a nonpsychoactive cannabinoid, that is delivered to patients in a nonsmoking delivery system.

Required Medical Condition

All of the proposals require an individual to have an existing medical condition before being considered as a potential
patient who qualifies for the use of medical marijuana as a
THC is the chemical in marijuana that is responsible for most
of its psychological effects. Comparatively, some of the most potent products derived from cannabis can have THC levels as high
as 30 percent.

form of treatment. In order to receive a registry identification card, most of the proposals would require a patient to
have some type of written certification recommending the
use of marijuana for medical purposes from a doctor in their
state with whom they have a bona fide physician-patient
relationship. However, the proposals vary widely on what
classifies as a qualifying or debilitating medical condition.
South Carolina provides the narrowest qualification by only
allowing patients who suffer from seizures to participate in
the research-only program. Similarly, Georgia only would
allow patients who suffer from severe side effects of cancer
treatment, nonresponsive glaucoma, or seizure disorders to
participate in its research-only program.
The most common conditions found among the medical
condition proposals are seizures, cancer, glaucoma, HIV/
AIDS, and Crohns Disease. Table 2 provides a more comprehensive list of some of the more common and unique
conditions included in the proposals as a qualifying or
debilitating medical condition; however, it is not an exhaustive list of the proposed conditions:
The proposals in Florida (ballot and legislation), Alabama,
North Carolina, Oklahoma, and Tennessee would allow
doctors some discretion in recommending the use of medical marijuana for additional qualifying conditions not
listed in law. Likewise, the proposals in Arkansas, Kentucky, Mississippi, Missouri, and West Virginia would

A SPECIAL CONDITION: MEDICAL MARIJUANA IN SLC STATES 3

Most Common and Unique Qualifying Medical Conditions

Proposed for Medical Marijuana Treatment
Alabama
SB 174
Arkansas
Ballot
Florida
Ballot
Florida
HB 859
Gerogia
HB 885
Kentucky
SB 43
Louisiana
SB 541
Mississippi
SB 2763
Missouri
HB 1324
North Carolina
HB 84
Oklahoma
SB 710
South Caorlina
SB 1035
Tennessee
HB 1385
West Virginia
HB 4264

Table 2

Alzheimers

Amyotrophic Lateral Sclerosis

Anorexia

Cancer

Crohns Disease

Depression or Anxiety

Diabetes
Fibromyalgia

Glaucoma

Hepatitis C

HIV/AIDS

Hypertension

Incontinence

Lupus

Multiple Sclerosis
Muscle Spasms

Celiac Disease
Chronic Pain

Autism
Cachexia or Wasting Syndrome

Narcolepsy

Opiate Addiction

Organ Transplantation

Osteoporosis

Post-Traumatic Stress Disorder

Rheumatoid Arthritis
Seizures, including Epilepsy

Severe Migraines
Severe Nausea

Sleep Apnea

4 A SPECIAL CONDITION: MEDICAL MARIJUANA IN SLC STATES

allow the regulating department to add additional qualifying conditions after public petition and comment. The
Louisiana proposal would allow the Therapeutic Marijuana Utilization Review Board, a new entity created by
the proposal within the states Department of Health and
Hospitals, to review and recommend additional qualifying
medical conditions.

Research
Beyond staying apprised of research on the medical uses of
marijuana, seven states specifically have included research
provisions in their legislation.
Georgia and South Carolina only would allow for the
medical use of cannabis by patients enrolled in a research
program conducted by academic medical centers and approved pediatric neurologists.
North Carolina would direct the University of North
Carolina System to undertake research regarding the
efficacy and safety of administering cannabis as part of
medical treatment.
Kentucky and West Virginia would allow registered safety
compliance centers to conduct research related to medical marijuana, but patients are not required to participate.
However, the application for qualifying patients shall ask
whether the patient would like to be notified of any clinical studies conducted in the Unites States needing human
subjects for research on the medical use of marijuana.
Florida legislation would direct the Department of Business and Professional Regulation (DBPR) to specify
persons who will be exempt from possession laws for the
purposes of teaching, research, or testing, but it does not
set any specifications for the research to be conducted.
Oklahoma would direct the State Board of Health to
promulgate rules to authorize and license medical cannabis laboratories to analyze dried, extracted, cured,
food-based, or any other forms of cannabis.Testing
would be voluntary and may include the analysis of contaminants and chemical composition and other methods
of investigation intended to advance the understanding
of the therapeutic benefits of cannabis.

transportation to a dispensary, a caregiver with access to

reasonable transportation, or a dispensary that will deliver to the patients residence.
Oklahoma would require a patient or caregiver to either obtain a patient growers license, which is separate
from the identification card, or require membership in
a licensed collective, which may have no more than 75
members.
The legislation in Florida, Kentucky, Mississippi, and
West Virginia explicitly would allow patients or caregivers to cultivate their own cannabis.
Ten of the proposals would require an entity to register
or be licensed for the purpose of growing medical cannabis; however, only the legislation in West Virginia and the
ballot proposals in Arkansas and Florida would allow the
cultivator to sell directly to the patient or caregiver. The
other proposals that would require a license for cultivation
include the legislation in Florida, Kentucky, Louisiana,
Missouri, North Carolina, Oklahoma, Tennessee, and
West Virginia. In most cases, being registered or licensed
as a cultivation center only allows for selling, processing,
or delivering the cultivated cannabis to a separate licensed
entity for dispensing.
One of the more unique cultivator-related provisions is in
the Florida legislation, which would allow medical cannabis farms permitted by the DBPR to cultivate, manufacture,
sell, deliver, and possess with the intent to sell, cannabis,
cannabis-based products, and cannabis plants for wholesale
to a licensed dispensary. Before applying for the permit,
all of the necessary agricultural classifications must be obtained to indicate that the land on which the farm is located
is primarily for bona fide agricultural purposes.
Some states, like North Carolina and Oklahoma, would
require a separate license to produce marijuana-related
products or paraphernalia.

Dispensing

Language in six of the proposed laws would allow a qualifying

patient or his or her designated caregiver to cultivate cannabis.

Most of the proposals would require a separate license or

registration for dispensaries, which serve as the intermediary between the cultivator and qualifying patient. Some
proposals require a chain of three or four licensed entities
before the product would reach the patient.

Arkansas would require the patient or caregiver to obtain a Hardship Cultivation Certificate, but only if it is
determined that the patient lacks access to a nonprofit dispensary. The certificate only would be issued if the
patient, based on physical incapacity, lacks reasonable

In Louisiana, a license to dispense therapeutic marijuana only would be issued to pharmacists who are either
employed by or the owner of a therapeutic marijuana treatment center. A license to operate a therapeutic
marijuana treatment facility only will be granted to phar-

Cultivation

A SPECIAL CONDITION: MEDICAL MARIJUANA IN SLC STATES 5

macies that employ a pharmacist who holds a therapeutic

marijuana dispensing license.
In Oklahoma, medical cannabis dispensing centers would
have to be licensed to dispense cannabis and cannabis
products through a storefront for medical use to member patients and caregivers. A separate license is required
for a medical cannabis delivery service for cannabis and
cannabis products to patients, designated caregivers,
cannabis laboratories, manufacturers, cultivators, and
dispensing centers.
In Tennessee, a licensed producer would be able to possess,
cultivate, harvest, and deliver cannabis or related products to a licensed processor. A licensed processor would
be able to possess, process, package, and deliver cannabis and related products to participating pharmacies and
regulated dispensaries, which then would distribute the
cannabis or products to program participants.
The proposals in Georgia and South Carolina only would
allow the academic medical centers conducting the research to act as dispensaries. The Alabama legislation is
silent regarding the source of the drug.

Limitations on Amount in Possession

Nine of the proposals would limit the amount of medical
cannabis a patient or caregiver could possess at one time.
The caregiver possession limitations generally are collective or in lieu of patient possession. Table 3 provides the
patient and caregiver possession limits for each proposal.

Caregivers and Assistance Limits

With one exception, all of the proposals would extend the
protections provided to a qualifying patient to his or her
designated caregiver. Like patients, caregivers also would
be required to have a registry identification card provided by the regulating agency. Seven of the proposals limit
the number of patients a caregiver may assist at one time.
The numbers range from one patient in Missouri, two patients in North Carolina, three patients under the Florida
legislation, and five patients in Arkansas, Kentucky, and
West Virginia. The largest number of patients allowed is
in Oklahoma, in which a single caregiver could assist up to
25 qualifying patients simultaneously; however, the limit
is reduced to 10 patients if operating within 1,000 feet of a

Table 3 Maximum Possession Amounts

Patient Possession Limit
Usable Cannabis

Plants

Caregiver Possession Limit

Usable Cannabis

Plants

Arkansas

2.5 ounces

6 marijuana plants only 3 may be more than

12 inches in height or
diameter

Florida
Legislation

250 grams

8 mature plants and 8

immature plants

Kentucky

12 ounces at the site where 12 mature plants and 12

cultivated or 3 ounces
seedlings at the site where
elsewhere
cultivated

Mississippi

30 grams per mature plant

3 mature plants and 4

immature plants

3 mature plants and

30 grams per mature plant
4 immature plants
collectively with patient
collectively with patient

Missouri

2.5 ounces during a 14-day

period

None

2.5 ounces

North Carolina

Varies by recommended
delivery method

Oklahoma

8 ounces

12 plants

8 ounces, per patient

12 plants, per patient

Tennessee

1 month supply

None

1 month supply

None

West Virginia

6 ounces

12 mature plants and 12

seedlings, if no caregiver
designated for cultivation

6 ounces, per patient

12 mature plants and 12

seedlings, per patient

2.5 ounces, per patient

6 marijuana plants per

patient, not to exceed 30
plants total

250 grams, per patient

8 mature plants and 8

immature plants, per
patient

12 ounces at site where

cultivated or 3 ounces
elsewhere, per patient

12 mature plants and 12

seedlings at the site where
cultivated, per patient

None

Varies by recommended
delivery method

6 A SPECIAL CONDITION: MEDICAL MARIJUANA IN SLC STATES

jail, correctional facility, public or private primary school,

church, or daycare facility. Louisiana has the only proposal that does not mention patient caregivers.

Other Notable Provisions

Some of the proposals include a breakdown of how the
funds collected from the sale of medical cannabis should be
distributed.
Under the Arkansas proposal, any sales tax revenue remaining after covering the state Department
of Healths cost of administering the program would
be distributed as follows: 50 percent for the Newborn
Umbilical Cord Blood Initiative Fund and 50 percent
for drug education programs administered by the Department of Human Services.
Under the Oklahoma proposal, sales tax would be remitted to the states general fund and license fees would
be distributed as follows: 30 percent for the department
where operational expenses were incurred; 30 percent
for general state, county, and city tax funds; 20 percent
for drug rehabilitation and prevention programs sponsored or organized by the Oklahoma Department of
Mental Health and Substance Abuse; 10 percent for the
Oklahoma Department of Agriculture, Food, and Forestry; and 10 percent for law enforcement entities.

Table 4

Maximum Number of Patients

Assisted by a Caregiver

State

Maximum Number of
Patients

Arkansas

Florida

Kentucky

Missouri

North Carolina

Oklahoma
West Virginia

10 or 25
5

Under the Louisiana proposal, a physician would be required to have a separate license to prescribe therapeutic
marijuana. However, only certified neurologists, oncologists, and ophthalmologists would be eligible for the license.
Tennessee has one of only two proposals that would include existing pharmacies in any context (Louisiana has
the other). Under the proposed Tennessee Safe Access program, patients and caregivers would have to enroll in a Safe
Access program at a participating pharmacy or regulated
dispensary to receive their identification card in order to
obtain cannabis for medical use from these sources.

Conclusion
While the legalization or decriminalization of marijuana
use for medicinal or recreational purposes has been on the
legislative agenda in many states outside the SLC region for
a number of years, it is only within the past few years that
Southern state legislatures have begun to grapple with the
complexities of this issue.
For a number of Southern states, crafting legislation that
addresses the use of medical marijuana has been the focal
point in this mostly uncharted area. To that end, as the
possibility of legalizing medical marijuana becomes more
plausible, there are many issues policymakers will need to
address, including, but not limited to: determining which
department will regulate its cultivation, distribution, and
use; issuing licenses to cultivators and distributors; registering qualifying patients; determining whether a patient
must designate caregivers; establishing a tax structure to
determine which products will be taxed and at what rate
they will be taxed; determining the cost of medical marijuana and its related products; setting limitations on where
medical marijuana can be consumed (i.e. work or school);
and determining whether insurance will cover the cost of
medical marijuana.
Although it is not an exhaustive analysis of medical marijuana-related proposals in the SLC states, as of February 28,
2014, this SLC Regional Resource demonstrates that the idea
of legalization is spreading in the Southern region.

References

1) Medical marijuana gains traction in the Deep South, The Atlanta Journal-Constitution, February 9, 2014.
http://www.ajc.com/ap/ap/legislative/medical-marijuana-gains-traction-in-the-deep-south/ndJGG/.
2) Medical marijuana still beyond reach in Maryland, The Baltimore Sun, January 28, 2014.
http://articles.baltimoresun.com/2014-01-28/health/bs-md-medical-marijuana-20140118_1_medical-marijuana-morhaim-biker-bar.
3) Majority Now Supports Legalizing Marijuana, Pew Research Center, April 4, 2013.
http://www.people-press.org/2013/04/04/majority-now-supports-legalizing-marijuana/.
4) Ibid.

A SPECIAL CONDITION: MEDICAL MARIJUANA IN SLC STATES 7

THE SOUTHERN OFFICE OF THE COUNCIL OF STATE GOVERNMENTS

REGIONAL VIEW NATIONAL REACH

his report was prepared by Policy Analyst

Lauren Greer for the Human Services & Public
Safety Committee of the Southern Legislative
Conference (SLC) of The Council of State Governments (CSG), under the chairmanship of state Senator
Emmett W. Hanger, Jr. of Virginia
The mission of The Council of State Governments
Southern Legislative Conference is to foster and encourage intergovernmental cooperation among its
15-member states. In large measure, this is achieved
through the ongoing work of the Conferences six
standing committees and supporting groups. Through
member outreach in state capitols, policy research,
member delegations to points of interest, meetings and
fly-ins, staff support state policymakers in their work to
build a stronger region.
Founded in 1947, the Southern Legislative Conference is a
member-driven organization and the largest of four regional legislative groups operating under The Council of State
Governments and comprises the states of Alabama, Ar-

SERVING THE SOUTH

kansas, Florida, Georgia, Kentucky, Louisiana, Mississippi,

Missouri, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia and West Virginia.
The SLCs six standing committees provide a forum which
allows policymakers to share knowledge in their area of expertise with colleagues from across the South. By working
together within the SLC and participating on its committees, Southern state legislative leaders are able to speak in a
distinctive, unified voice while addressing issues that affect
their states and the entire region.
The Southern Office was opened in Atlanta in 1959. Initially charged with serving all three branches of state
government, the duties of the Office have evolved to providing services primarily to the more than 2,400 legislative
members and staff of its 15-state region. SLC members are
appointed by the leadership of the 30 legislative chambers
in the South. The SLC Annual Meeting has grown to become the largest regional gathering of state legislators in
the country and attracts the largest audience of any of the
CSG regional conferences.

THE SOUTHERN OFFICE OF THE COUNCIL OF STATE GOVERNMENTS

PO Box 98129 | Atlanta, Georgia 30359
ph: 404/633-1866 | fx: 404/633-4896 | www.slcatlanta.org