On April 19, 2017, Governor Justice signed SB 386, the West Virginia Medical Cannabis Act, which called for the creation of a Medical Cannabis Commission to be established to oversee and operate a state medical cannabis program.  Under the program patients would be able to secure legal access to authorized cannabis products after a physician review determines eligibility.  Mountain State patients in hospice, those with chronic and debilitating medical conditions and those experiencing severe chronic pain would be eligible to participate in the new program.  With respect to treatment products, SB 386 only provided for the use of cannabis in the form of oils, pills, topicals, vaporization (but not of dry flower), tinctures, liquids, and dermal patches. 

Following enactment of the law the West Virginia Department of Health issued their report and recommendations to the Governor and Legislature in February of 2018, which advised that dry flower be included in the authorized list of cannabis treatment methods, and modified language related to physician evaluations to expand patient eligibility.  The recommendations also called for a focus on affordable patient access and the removal of caps on medical retail storefront licenses to be issued by the state.  

In March of 2019, Governor Jim Justice signed a medical cannabis banking bill into law, which extends state legal protections to any official prosecuted by the federal government for handling cannabis proceeds.