In 2013, Guam passed Public Law 33-220, known as the “Joaquin Concepcion, II Compassionate Use of Cannabis Act,” which allowed for the medical use of cannabis. The Joaquin Concepcion Act has been amended twice since its enactment, once in 2016 and once again in 2017. The 2017 amendments related to the fees and taxation of medical cannabis cultivation, manufacturing, and laboratory facilities and created ownership restrictions for non-residents of Guam. Guam requires each of its dispensaries to be certified by Patient Focused Certification, a standards project of Americans for Safe Access. Patients or caregivers may possess up to 2.5 ounces of dried or prepared cannabis from a dispensary. However, administrative barriers and procedural delays have prevented the program from effectively serving patients. In 2018, rules defining qualified patients in Guam were expanded to include reciprocity for registered patients visiting Guam from other authorizing jurisdictions, such as a U.S. state. 

Delays in the implementation of the medical program in Guam have frustrated patients. Due to a slow rollout, former Governor Calvo signed a bill that allows home cultivation for patients, though this will only apply until dispensaries on the island are operational. Calvo also signed a bill that provided for independent laboratory testing and allowed non-residents to participate in the territory’s medical cannabis program. In 2019, Governor Lou Leon Guerrero signed a bill that legalized cannabis on the island for non-medical use. When signing the bill, the Governor indicated that she was establishing a Medical Cannabis Regulation Commission to ensure patients were protected.