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intractable seizure disorders — and, in some cases, other medical conditions — to use certain strains
of medical cannabis preparations. In some cases, those laws were later replaced by or supplemented
with effective medical cannabis laws.
Unlike the 33 states that have effective medical marijuana laws,1 these 16 laws only allow strains that
are low in THC (which has medical value, including by relieving nausea) and rich in another
beneficial compound of marijuana, cannabidiol (CBD). In at least one case, Kansas, the law simply
exempts CBD from the state’s definition of “marijuana,” rendering CBD products legal — but only
if they contain no THC at all. In some cases, the laws only allow for clinical trials with a CBD-based
medicine, Epidiolex.2 One law — South Dakota’s — merely allows cannabidiol after federal law
changes.
While it is commendable that legislators are trying to protect patients with seizures, these laws
unfortunately leave behind the vast majority of patients who could benefit from medical cannabis.
Most of the CBD-focused laws exclude patients with intractable pain, cancer, or AIDS-related
nausea or wasting, muscle spasms, or any condition other than seizure disorders. These limited laws
also leave behind patients whose seizures respond only to strains of cannabis with greater quantities
of THC.
Even patients with intractable epilepsy who could benefit from high-CBD oils cannot expect much
relief from most of these laws. All but three of the laws — Georgia, Iowa, and Virginia’s — fail to
allow for realistic, in-state access, apart from clinical trials for pharmaceutical drugs. (A fourth state,
Texas, also allows in-state production, but it requires doctors to “prescribe” the cannabis extracts,
which puts physicians at risk under federal law.)
However, with the 2018 federal Farm Bill’s legalization of hemp sales and production, the
availability of very low-THC products labeled as containing CBD is increasing nationwide.3
Unfortunately, though, many of the “CBD” products available are untested and largely unregulated.4
Some “CBD” products do not actually contain the amount of CBD that is listed on the label — or
any at all — or they may also contain dangerous compounds such as heavy metals.
1
For a list of those states and key provisions of the laws, see: https://www.mpp.org/issues/medical-marijuana/state-
by-state-medical-marijuana-laws/key-aspects-of-state-and-d-c-medical-marijuana-laws/
2
See: Saundra Young, “Medical marijuana refugees: 'This was our only hope',” CNN, March 10, 2014.
3
For more details, see the Brookings Institute’s “The Farm Bill, hemp legalization and the status of CBD: An
explainer.” Available at: https://www.brookings.edu/blog/fixgov/2018/12/14/the-farm-bill-hemp-and-cbd-explainer/
4
The possible exception would be if the products were made pursuant to a state-regulated hemp industrial program that
includes lab testing and other regulations.
State Condition(s) Type of Means of Access Workability Issues
Cannabis
Alabama For the clinical Extracts that are The law established The law calls for
trial: Epilepsy or “essentially free a study on an federally approved
another from plant experimental studies of Epidiolex, a
neurological material” with no cannabis-based cannabidiol-based
disorder that more than 3% drug — Epidiolex medicine, at the
produces serious, THC — through the University of Alabama
debilitating, or University of at Birmingham.
life-threatening Alabama at
seizures Birmingham, but For other seizure
For the defense: does not include a patients, a 2016 law
A chronic or way for other created an affirmative
debilitating patients to access defense for possession
disease or cannabis. Other of low-THC cannabis
medical patients would have extracts.
condition that to attempt to obtain
produces cannabis oils out-of-
seizures state.
Iowa Cancer (in some Oil extracts Up to five None (apart from the
cases), multiple composed of dispensaries will be possible financial
sclerosis, 0.3% THC or less licensed and must difficulties the centers
seizures, AIDS and at least 5% be open by may have due to a small
or HIV, Crohn’s CBD December 2018. In patient pool), as long as
disease, the meantime, the regulations are
amyotrophic law allows patients workable. However, the
lateral sclerosis, to enroll in program leaves behind
Parkinson’s Minnesota’s patients who could
disease, program; benefit from more
untreatable pain, unfortunately, THC.
or any terminal Minnesota does not
illness. currently permit
this.
Kentucky Not specified “Cannabidiol” None. The law fails “Cannabidiol” must be
to include a source transferred pursuant to a
for CBD. It does written order of a
not make it legal for physician practicing at a
anyone to produce hospital or clinic
the marijuana that affiliated with a public
CBD would be Kentucky university
extracted from in with a medical school.
the state. However, issuing such
an order would break
federal law. Those
participating in an FDA
trial would also be
protected.
State Condition(s) Type of Means of Access Workability Issues
Cannabis
Mississippi Debilitating “CBD oil” with CBD oil must be The law would only
epileptic more than 15% dispensed by the work if universities were
conditions CBD and no University of willing to openly break
more than 0.5% Mississippi’s federal law, or if federal
THC Department of law changes.
Pharmacy Service.
Only three entities, It is also not clear that
all affiliated with patients would be
universities, could protected from arrest, or
possess or produce if they would merely
cannabis oil. have an affirmative
defense that prevents a
conviction.
Nebraska Intractable Liquid or solid Access via the Either the university and
seizures and extracts or oils University of associated physicians
treatment of with more than Nebraska Medical would need to be willing
resistant seizures 10% CBD and no Center, conducting to openly break federal
more than 0.3% a pilot study on law, or they would have
THC CBD. to have federal
permission for the
study.
North Intractable Hemp extracts None. Cannabis This program lacks in-
Carolina epilepsy with at least 5% must be obtained state access to cannabis
CBD and less from another oils.
than 0.9% THC jurisdiction.
South Lennox Gastaut Cannabidiol or Access via licensed None, due to the hemp
Carolina Syndrome, any “manufacture, industrial hemp law.
Dravet salt, derivative, production, which is
Syndrome, or mixture, or defined as less than
“any other severe preparation” of 0.3% THC. The law
form of epilepsy marijuana that also allows for
that is not contains 0.9% or cannabis via
adequately less THC and federally approved
treated by over 15% CBD; sources for clinical
traditional extracts provided trials.
medical at trials must have
therapies” at least 98% CBD
and no more than
0.9% THC
State Condition(s) Type of Means of Access Workability Issues
Cannabis
South Not specifically Cannabidiol, after Until the FDA This will not help
Dakota listed. it is approved by approves a CBD- patients until and unless
the federal Food based product, the FDA approves a
and Drug patients in South CBD-based product.
Administration Dakotans will not
(FDA) have access.
Virginia Any diagnosed Cannabis oils with Per a 2017 law, the None (apart from the
condition or at least 15% CBD state is licensing five possible financial issues
disease or THC-A and no “pharmaceutical due to such a limited
more than 5% processors” to program), if regulations
THC manufacture and are workable. However
dispense CBD and unlike effective medical
THC-A oils. programs, Virginia law
provides patients an
“affirmative defense” in
court, not full
protection from arrest.
Wyoming Intractable “Hemp extracts” There is no in-state The law does not
epilepsy that with less than means of accessing provide for any in-state
does not respond 0.3% THC and at cannabis. It would source of cannabis.
to other least 5% CBD have to be brought
treatments and in from another
other seizure jurisdiction.
disorders