In 1996, California became the first medical cannabis state when voters approved Prop 215, the Compassionate Use Act. That law allowed doctors to recommend cannabis for any serious or persistent medical condition and allows patients to legally use, possess, and grow cannabis and designate caregivers to assist them. In 2003, the California legislature passed the Medical Marijuana Program Act, establishing a voluntary ID card program, protections for transporting cannabis, and a legal framework to protect not-for-profit dispensing collectives and cooperatives. The voluntary registry issued ID cards that offered protection from arrest for patients and caregivers in possession of no more than eight ounces of cannabis or cultivating no more than six mature or 12 immature plants. Patients and designated caregivers without a state ID card, or those in possession of larger quantities, are afforded an affirmative defense. Qualified patients on probation or parole may legally use medical cannabis with the consent of their probation or parole officer. 

In 2015, the state passed the Medical Cannabis Regulation and Safety Act (MCRSA), a trio of bills that created a state-regulated medical cannabis production and sale system, and protected medical cannabis patients in need of an organ transplant. Voters approved the Adult Use of Marijuana Act (Proposition 64) in 2016, which expanded rights for patients by adding parental rights protections, enhancing patient privacy rules, prohibiting cities from banning personal cultivation, and exempting card-holding patients from sales tax. 

In July of 2017, Governor Brown signed the Medicinal and Adult-Use Cannabis Regulation and Safety Act (MAUCRSA), legislation combining 2015’s MCRSA with 2016’s voter-approved AUMA ballot initiative (Prop 64). In November of 2017, California published emergency rules and regulations that implemented the combined measure. These emergency regulations also impacted the state’s medical program, particularly in regards to how businesses are licensed, purchasing limits for patients, and much-needed regulations for the manufacturing of cannabis products.

Despite the legacy of cannabis policy reform in California, local control responsibility provided for in the state’s constitution remains the primary tool being utilized by two-thirds of California local governments to deny safe, legal patient access to medical cannabis. A lack of leadership and coordination among state and local lawmakers, the Governor’s office, and medical cannabis reform organizations to overcome this issue also remains a key obstacle to addressing the state’s legal access challenges. 

California’s 2018-2019 legislative session saw the state pass legislation designed to alleviate tax burdens on commercial cannabis businesses and introduce a statewide social equity program. AB 1863 allowed for the deduction of business expenses for a cannabis trade or business under the state’s personal income tax law, and SB 1294 created a voluntary statewide social equity program that offers technical assistance and grant funding to local governments interested in organizing programs designed to benefit minority-owned/operated cannabis businesses. To date, only a handful of California local governments have developed social equity programs including San Francisco and Los Angeles, and none of the programs have been successful in extending the intended benefit advertised during program enactment. 

Local Governments did have a hand in blocking patient access though; in 2019, 25 cities filed suit against the state to prevent legal cannabis delivery to patients from neighboring jurisdictions with legal access systems. However, in 2020 during the COVID pandemic, the state declared cannabis businesses as essential, providing for curbside pickup and home delivery subject to state and local authorization during the emergency and permitted telehealth visits with physicians for patient enrollment renewals.