Where Are Medical Marijuana and CBD Legal in the U.S.?

The use of marijuana is illegal in the United States under federal law, but individual states are passing laws decriminalizing the adult use or medicinal use of the drug if the state has a regulatory system in place.

Using marijuana to treat health problems is currently the subject of fierce debate, but despite the medical controversies and legal challenges, scientists have continued their efforts to study how marijuana affects the brain and other parts of the body.

And while the Food and Drug Administration (FDA) has not yet approved marijuana plants as a safe and effective drug, in June 2018, the agency approved the first cannabinoid-derived prescription drug in the United States. (1,2)

This drug, available under the brand name Epidiolex, uses a purified form of cannabidiol (CBD) — a chemical compound in marijuana that appears to produce a calming effect — to treat two types of childhood epilepsy.

Previously, the FDA had approved three drugs that contain synthetic cannabinoids to treat anorexia in those with HIV/AIDS, as well as for patients experiencing chemotherapy-induced nausea and vomiting.

Although marijuana is available in many locations around the United States, that doesn’t mean it’s legal in all those locations. The drug is still considered illegal by the federal government.

Your ability to legally purchase and use marijuana, whether medically or recreationally, depends on the state in which you live.

The National Conference of State Legislatures (NCSL) and the National Organization for the Reform of Marijuana Laws (an organization that tracks marijuana law developments) maintain up-to-date lists of which states have made what forms of the drug legal. (3,4)

You can also check your state’s department of health website.

As of February 2022, 37 states, four territories, and the District of Columbia have made marijuana legal for medical use. As of November 2021, 18 states, two territories, and the District of Columbia have enacted measures to regulate marijuana for adult nonmedical use.

Ten states and the District of Columbia, according to the NCSL, have made it legal for adults to possess and use it recreationally but not publicly. (5) They are:

• Alaska
• California
• Colorado
• Hawaii
• Maine
• Massachusetts
• Michigan
• Nevada
• Oregon
• Washington

The laws that states pass to legalize marijuana often allow cities or counties within those states to pass their own laws restricting or forbidding the growing or selling of marijuana at their discretion. This means that in California, for example, you may be able to open a dispensary in your town but not grow marijuana there.

Check your municipal and state government websites for up-to-date information on what’s legal or not in individual cities and counties.

In What Countries Is Marijuana Legal?

As of now, Uruguay and Canada are the only two countries in which it’s legal to consume pot recreationally.

There are 16 states in which it’s legal to use CBD products medicinally but not any other kind of marijuana. (3)

These states are:

• Alabama
• Georgia
• Indiana
• Iowa
• Kentucky
• Mississippi
• Missouri
• North Carolina
• Oklahoma
• South Carolina
• Tennessee
• Texas
• Utah
• Virginia
• Wisconsin
• Wyoming

According to a Brookings Institution report, many states consider a product to be CBD if it contains less than 0.3 or 0.5 percent tetrahydrocannabinol (THC). (6)

But just because a product contains more CBD than THC doesn’t make this form of marijuana any more legal to the federal government.

Nope. Sorry.

If it’s against the law to buy, possess, or sell pot in your state, buying it online from an individual or company in a state where it is legal doesn’t make your transaction any less illegal. That means you shouldn’t buy marijuana from California and have it shipped to you if you live in, say, Kansas.

But no matter what state you live in, you should not buy or send pot through the mail because the drug is still illegal on the federal level. The U.S. Post Office, which is a federal government agency, may confiscate your product, and you may be arrested. (7)

To purchase and use medical marijuana in states where it’s legal, you’ll have to apply for a card that gives you that privilege. You’ll need a doctor to certify that marijuana will help treat your condition or its symptoms. Your state may maintain a list of physicians who can serve in that capacity.

Each state has its own list of what are called qualifying conditions. These are the medical reasons that your state will allow you to use medical marijuana to treat.

Medical marijuana may be indicated for a number of conditions, though it varies greatly by state, as does the evidence on its efficacy, depending on the condition:

• Cancer
• HIV/AIDS
• Inflammatory bowel disease
• Glaucoma
• Anxiety
• Tourette’s syndrome
• Multiple sclerosis
• Cachexia (wasting syndrome)
• Hepatitis C
• Alzheimer’s disease
• Chronic pain

States, and sometimes counties within states, charge fees for card applications. Many, like California, will waive or reduce the fee for those who are eligible.

These fees are usually around $100 to $150 for a card that’s valid for one year. Some states, like Vermont, charge $50. (8) The fees increase if you want a card that will be valid longer. Certifying clinicians might also charge a fee for their services.

Each state places a different limit on the amount of medical marijuana you are allowed to purchase.

In New Jersey, for example, a medical marijuana ID card entitles you — or limits you, depending on how you see it — to 2 ounces (oz) a month. (New Jersey lawmakers are considering increasing it to 4 oz a month.) (9)

In Oregon, with a valid medical marijuana ID, you’re allowed to purchase 24 oz of marijuana or 5 grams of cannabinoid extract at a time (or over the course of one day). (10)

According to reporting done by Wikileaf, the average cost of ¹⁄₈ oz of marijuana in the United States is $40. In Canada, marijuana has been legal longer, so there’s less incentive to charge high rates, and it’s usually around 30 percent cheaper. (11)

Edibles can cost anywhere from $5 for a brownie to $45 for gumdrops.

Even if marijuana is legal in your state, what you’re consuming might not be safe.

Because there are currently no federal standards in place to ensure the quality and safety of medical marijuana, no company or grower is required by law to make sure they’re selling a safe, pure, and effective product.

While there are state regulations that attempt to ensure consumer safety, these vary and may not be strongly enforced. Pennsylvania, for example, requires all products be tested — for things like microbial contamination, heavy metals, and pesticides — at centralized third-party locations. But depending on which state you live in, it’s hard to ensure that all forms of marijuana are pure and effective. So that burden, unfortunately for now, falls mostly on the consumer.

In a study published in Clinical Microbiology and Infection, researchers from the University of California in Davis found lethal mold and fungi on 20 medical marijuana samples taken from Northern California pot growers and dispensaries. (12)

The authors of the UC Davis study cautioned people with compromised immune systems, such as people with cancer, to avoid smoking or vaping marijuana. (12) The bacteria they found on the plants can cause fatal lung infections. Because of this, the researchers recommended that those with weakened immune systems consume edibles (13)

Illegal growing, which is a major problem, particularly in California, means toxic crops. Black market growers use fertilizers and poisons, as well as pesticides banned in the United States. Extracts from cannabis treated with mycobutinol, a fungicide, can end up with really high concentrations of the chemical, which can produce high levels of cyanide if smoked.