In 2012, 63 percent of Massachusetts voters approved Question 3, a state-wide medical cannabis initiative which authorized patients with qualifying medical conditions to access medical cannabis and cannabis products.  The initiative also provided for a licensing regime for registered cultivators, manufacturers, testing laboratories, distribution and retail to supply patients with medical cannabis.  The voter-approved measure eliminated state criminal and civil penalties for registered patients using medical cannabis, permitted home cultivation for patients of up to six plants, and authorized registered patients and their designated caregivers to possess up to a 60-day supply of usable cannabis, defined as 10 ounces.  

Some protections for patients began January 1, 2013, including limited rights to cultivate their own medicine, and the Department of Health (DOH) began issuing ID cards for patients and granting licenses for medical dispensaries in 2014.  The first medical cannabis dispensary opened in Salem, Massachusetts in the summer of 2015.  Under the law registered medical cannabis dispensaries must cultivate and process medical cannabis in addition to retailing what they have produced for eligible patients, and provide medicine at discounted rates for eligible low-income residents. The Commonwealth’s Department of Public Health issues hardship cultivation licenses to patients who qualify.

In 2016, Bay State voters approved Question 4, an adult-use initiative which added parental and organ transplant legal protections for patients. The initiative set January 1, 2018 as the date for state licensing of adult-use cannabis dispensaries, however state legislators pushed that date back to July of that year.  The first adult-use licenses were not issued until October of 2018.  In 2017, Massachusetts enacted H 3818, which established the tax regime for the Commonwealth’s adult-use model and organized specific local control features related to dispensary licensing.  Specifically, the measure required municipalities in which the majority of voters approved Question 4 to hold a referendum proposing to ban cannabis retail sales as a precursor to prohibiting such activity.  Conversely jurisdictions with a majority of voters opposing Question 4 are under no such obligation and can ban legal retail access without seeking voter approval.  In 2018, the state Attorney General said that municipalities cannot ban medical dispensaries.   

Regulations for the initiative were released in 2018, which extended authorization to recommend medical cannabis to certified nurse practitioners, and allowed employees of nursing homes, hospice centers, and other medical facilities to administer medical cannabis. And while the law did not provide for patient protections related to employment or housing, a 2017 Massachusetts Supreme Judicial Court decision ruled that employees may pursue disability discrimination claims against employers in the Commonwealth for employment-related discrimination related to the patient’s legal use of medical cannabis.  Massachusetts still does not provide patient protections in the area of housing.  

In 2019, patients and caregivers were authorized to secure same day access to medical cannabis after seeing a clinician, allowing them to obtain up to 2.5 ounces per 14-day period. Patients still must complete the remaining registration process to obtain their official state medical program card, and patients presenting their cards to medical cannabis retailers are exempt from taxes levied on medical cannabis. 

In 2020, Massachusetts maintained patient access to medical retail facilities as part of the Commonwealth’s COVID emergency response, and authorized curbside pickup, certification of new patients via telehealth, and delivery.