Cannabis Was on the Ballot in Five States - But What Do these Results Really Mean for Patients?

Prior to the election, there were 19 states that allowed both recreational adult use and medical cannabis, 29 allowing medical cannabis only, and 2 states with a total prohibition on cannabis. Electors in five states, Arkansas, Maryland, Missouri, North Dakota, and South Dakota, had cannabis-related ballot measures to consider yesterday. Each of the states already have an established medical cannabis law so the ballot questions were largely focused on recreational use.

While these ballot measures did not focus on medical cannabis patients, there are still ways in which patients may be impacted. Whether a ballot measure passed or not, it is still critical for patient advocates to continue fighting for improved access in their state. And for advocates in states with newly approved cannabis ballot measures, it is more important than ever to stay involved and ensure that the recreational market is regulated separately from the medical market, preserving patient access and protections that are already enjoyed in the state.

Yesterday, votes were cast across the nation not only for state ballot measures and local policymakers, but for federal representatives and senators, and in turn control of Congress. This blog post focuses on the state ballot measure results only.

While Election Day is only one day of the year, often vote tabulations take longer. Because of this, at the time of publication of the blog, we still do not know the winners for a number of key federal seats. What we do know so far is that a number of winning candidates, including Senator-elect John Fetterman, Senator Brian Schatz, Representative Brian Mast, and Representative David Joyce, have been outspoken advocates for medical cannabis access, and that medical cannabis remains a bipartisan issue, with supporters on both sides of the aisle.

We don’t yet know the final makeup of the 118th Congress, or whether there will be a change in chamber leadership. The final results and chamber party alignment will determine the shape of policy making for the next two years. ASA is keeping a close eye on federal election results and will be publishing a separate blog addressing what the federal results mean for medical patients once we know more. Keep an eye out for that blog!

The State Results

Arkansas: FAILED Issue 4 was a citizen-proposed amendment that would have changed the Arkansas Constitution to allow and regulate cannabis for adult use. This amendment would have opened up the pathway for a new adult use market in the state, in addition to the already existing medical cannabis market. While this measure failed, the state’s medical cannabis program is not affected and ASA urges lawmakers to continue to make improvements to the medical cannabis market in the state.

Maryland: APPROVED Question 4 allowed Marylanders to decide whether to amend the state constitution to allow for cannabis possession and use and direct the 2023 Maryland Congress to pass laws and regulations for an adult-use market in the state. The measure passed, and will go into effect by July 2023. ASA is encouraged by the support of cannabis in the state, and expects legislators to regulate it separately from the existing medical market to ensure that patients in the state are not left behind or without protections they’ve come to rely on.

Missouri: APPROVED Amendment 3 was a citizen-backed petition that removed prohibitions on possessing, consuming, using, delivering, manufacturing, and selling cannabis for adults over 21 years or age from the state Constitution. Amendment 3 also improves the medical cannabis program by extending patient registrations to 3 years instead of 1, allowing physicians to recommend cannabis to more patients, and removing the prohibition on out-of-state residents from accessing medical dispensaries. This amendment, particularly the improvements to the medical cannabis program, will help more individuals gain access to medical cannabis in the state. This amendment goes into effect December 9, 2022.

North Dakota: FAILED Measure 2 would have legalized the adult use of cannabis, allowing those 21 years or older to possess up to an ounce of cannabis and permit home cultivation of up to 3 cannabis plants. The measure also directed the government to regulate the industry. While this ballot measure failed to reach the passage threshold, medical cannabis still remains law in the state and ASA hopes policymakers continue to improve the program.

South Dakota: FAILED Voters in South Dakota had a second chance at legalizing adult use cannabis after first passing a ballot measure in 2020 that was later struck down by the state’s Supreme Court. Measure 27 was a citizen-backed initiative that again proposed to legalize the adult use and possession of cannabis, and would allow the state to regulate the industry. Despite passing two years ago, this measure failed to garner the same support this cycle.

What’s next? 

Our seasoned advocates know that our job is never truly done until every person has access to safe and legal medical cannabis. This remains true today. While Maryland and Missouri have become the 20th and 21st states to pass recreational adult-use cannabis, they are still a long way from regulations issued and retail doors opening.

According to polling, less than 10% of adults in the country totally oppose medical and recreational cannabis legalization efforts. However, of the five states with ballot measures, only two states passed, Maryland and Missouri, which shows that we still have a lot of work cut out for us to really end the stigma associated with cannabis. Coincidentally, Maryland and Missouri also received higher than 50% in ASA’s State of the States Report for their medical cannabis programs, while the other states with measures scored below 50%. The vast majority of improvements to these medical programs would not have been achieved through ballot measures, and this is why ASA continues to advocate for improved medical access.

In the coming months, Maryland and Missouri lawmakers will begin considering policies and regulations for the adult-use market. It is important that patients stay involved and have their voices heard during this process. Unfortunately, ASA has seen a pattern among some states of combining the adult-use program with medical, often rolling back medical protections or access in favor of having one system of cannabis control. This is not acceptable for patients. By staying involved and voicing your concerns about patient protections and access, you can help ensure that the medical cannabis market in those states remain intact and separate from recreational use.

Arkansas, North Dakota, and South Dakota all had failed ballot measures, but this doesn’t mean patients are in the clear and can relax their advocacy efforts! Medical cannabis programs still exist in these states, and while voters declined to legalize cannabis for recreational use, it was not a widespread rejection of cannabis as a whole. Legislators in those states may not be considering recreational cannabis policies as directed by ballot measures, but patient advocates must make sure to keep the pressure on elected officials to continue to improve the medical programs in their states.

What can I do? 

ASA remains concerned about the state and federal conflict of law that prevents state lawmakers from fully protecting patients and regulating the industry as it should be. Until there is a change in federal law, patients will remain in legal limbo because of this conflict between the states and federal government. This is a top priority for ASA, and one we are hopeful to see movement in in the coming months and years.

Our work never stops, and you have the opportunity to have your voice heard in DC this December! Americans for Safe Access invites you to join us for our 10th annual National Medical Cannabis Unity Conference happening December 11-14, 2022 in Washington, DC.

As part of our conference, ASA is also hosting a Hill Day in Congress to give attendees the opportunity to meet with their federal representatives on the Hill and advocate for medical cannabis advancement. This is a great opportunity for patients, caregivers, physicians, researchers, and more! We hope to see you there!