In 2018, Governor Ralph Torress (R) signed HB 20-178, legislation authorizing the creation of both medical and adult-use commercial cannabis production and access systems. Due to the small population size (about 55,000 residents), lawmakers decided to legalize cannabis for medical and non-medical purposes to sustain the program. CNMI’s medical program includes several important tenants for patients, such as a robust qualifying condition list, strong patient civil rights protections, and a tax exemption. As the territory implements regulations the Islands’ grade will no doubt improve.