In 2014, Missouri passed HB 2238, which created a legal right for eligible patients to obtain, possess, and use hemp extracts in limited circumstances. The law defines a hemp extract as a preparation of cannabis that contains at least 5 percent CBD and no more than 0.3 percent THC, and only allows access to these extracts for patients with severe seizure disorders who have a recommendation from a neurologist and state hemp registration card.  Patients are allowed to purchase hemp extracts from two state-regulated “cannabidiol oil care centers”, which were licensed by the Department of Agriculture in 2015 and began serving patients in 2016.

In 2018, Show-Me State voters did just that, approving Amendment 2 and authorizing the creation of a comprehensive medical cannabis framework.  The measure allows for home cultivation and personal possession limits of up to four ounces for a 30-day period (no more is allowed without demonstrating a medical necessity).  Though the program created by Amendment 2 contains a patient condition list to obtain eligibility, it also allows doctors to use their professional judgment as to whether or not medical cannabis may assist a patient. This flexibility is notable and something for other states with limited condition lists to consider.  Rules governing program operation were released in May of 2019, and state regulators began accepting applications for medical cannabis dispensaries in August of that year.