In 2016, 64 percent of North Dakotans voted in favor of the North Dakota Compassionate Care Act (Measure 5), creating a comprehensive cannabis program for patients of the state. The program allowed access for patients at retail dispensaries, but also allowed patients to grow up to eight plants if they live 40 or more miles away from the nearest dispensary. The program is one of the strictest in the nation, as it allows the state’s Department of Health to conduct in person interviews in order to determine eligibility. Implementation legislation for this program became effective in April of 2017, and the state began accepting patient applications to the program in October of 2018. It should be noted that the state made modifications to the underlying ballot initiative in 2017 via SB 2344, which removed provisions allowing for patients to cultivate their own medical cannabis at home and required that authorized medical professionals specifically must recommend that a patient should smoke cannabis as a treatment option in order for the patient to obtain legal access to cannabis flower.  


Medical cannabis sales did not begin in the Flickertail State until March of 2019, almost three years after voters approved Question 5.  In April of 2019, the state made significant changes to the state’s medical program through a series of bills (HB 1119, HB 1283, HB 1417, HB 1519, SB 2200, SB 2210), which collectively eased the burden on minor patient registrations, allowed caregivers to live out-of-state, furthered privacy protections for patients, and added physician assistants to the list of eligible health care professionals authorized to recommend medical cannabis. 


These bills also allowed a process for veterans to submit medical records and discharge documentation instead of a certification, removed the requirement for patients to indicate whether or not they possessed a firearm by including a disclosure about further violations of federal law, and removed the requirement that healthcare providers had to state on patient certifications that the patient was likely to receive a benefit form medical cannabis. Finally, this package of legislation allowed for an increased possession limit of up to 7.5 ounces in a 30-day period (up from 2.5 ounces) for patients with certain qualifying conditions, increased the maximum amount of THC that may be included in a medical cannabis product from 2,000 to 4,000 mg, and removed the requirement that a healthcare provider must authorize use of dried flower.  However, minors (under 19) are not eligible to obtain dried flower.  Twelve new qualifying conditions were also added to the list of eligible conditions required to obtain safe and legal access.  


North Dakota enacted HB 1050 in 2019, replacing imprisonment and criminal penalties for adults possessing up to one half ounce of cannabis with a maximum fine of $1,000.  Other reforms included simplifying the patient application process by no longer requiring patients to pay associated fees with a cashier’s check or having to provide their social security numbers when applying.


In 2020, North Dakota included medical cannabis in the state’s emergency response to COVID, enabling licensed businesses to remain open to serve patients, and allowing patients to use telehealth visits for program enrollment.