Since early 2014, at least 20 states have enacted laws that were intended to allow patients with

intractable seizure disorders — and, in some cases, other medical conditions — to use certain strains
of medical cannabis preparations. In some cases, those laws were later replaced by or supplemented
with effective medical cannabis laws.

Unlike the 33 states that have effective medical marijuana laws,1 these 16 laws only allow strains that
are low in THC (which has medical value, including by relieving nausea) and rich in another
beneficial compound of marijuana, cannabidiol (CBD). In at least one case, Kansas, the law simply
exempts CBD from the state’s definition of “marijuana,” rendering CBD products legal — but only
if they contain no THC at all. In some cases, the laws only allow for clinical trials with a CBD-based
medicine, Epidiolex.2 One law — South Dakota’s — merely allows cannabidiol after federal law
changes.

While it is commendable that legislators are trying to protect patients with seizures, these laws
unfortunately leave behind the vast majority of patients who could benefit from medical cannabis.
Most of the CBD-focused laws exclude patients with intractable pain, cancer, or AIDS-related
nausea or wasting, muscle spasms, or any condition other than seizure disorders. These limited laws
also leave behind patients whose seizures respond only to strains of cannabis with greater quantities
of THC.

Even patients with intractable epilepsy who could benefit from high-CBD oils cannot expect much
relief from most of these laws. All but three of the laws — Georgia, Iowa, and Virginia’s — fail to
allow for realistic, in-state access, apart from clinical trials for pharmaceutical drugs. (A fourth state,
Texas, also allows in-state production, but it requires doctors to “prescribe” the cannabis extracts,
which puts physicians at risk under federal law.)

However, with the 2018 federal Farm Bill’s legalization of hemp sales and production, the
availability of very low-THC products labeled as containing CBD is increasing nationwide.3
Unfortunately, though, many of the “CBD” products available are untested and largely unregulated.4
Some “CBD” products do not actually contain the amount of CBD that is listed on the label — or
any at all — or they may also contain dangerous compounds such as heavy metals.

1
For a list of those states and key provisions of the laws, see: https://www.mpp.org/issues/medical-marijuana/state-
by-state-medical-marijuana-laws/key-aspects-of-state-and-d-c-medical-marijuana-laws/
2
See: Saundra Young, “Medical marijuana refugees: 'This was our only hope',” CNN, March 10, 2014.
3
For more details, see the Brookings Institute’s “The Farm Bill, hemp legalization and the status of CBD: An
explainer.” Available at: https://www.brookings.edu/blog/fixgov/2018/12/14/the-farm-bill-hemp-and-cbd-explainer/
4
The possible exception would be if the products were made pursuant to a state-regulated hemp industrial program that
includes lab testing and other regulations.
 State Condition(s) Type of Means of Access Workability Issues
Cannabis

Alabama For the clinical Extracts that are The law established The law calls for
trial: Epilepsy or “essentially free a study on an federally approved
another from plant experimental studies of Epidiolex, a
neurological material” with no cannabis-based cannabidiol-based
disorder that more than 3% drug — Epidiolex medicine, at the
produces serious, THC — through the University of Alabama
debilitating, or University of at Birmingham.
life-threatening Alabama at
seizures Birmingham, but For other seizure
For the defense: does not include a patients, a 2016 law
A chronic or way for other created an affirmative
debilitating patients to access defense for possession
disease or cannabis. Other of low-THC cannabis
medical patients would have extracts.
condition that to attempt to obtain
produces cannabis oils out-of-
seizures state.

Georgia Seizure Cannabis oil with Cannabis None. However, the

disorders, ALS, no more than 5% preparations will be program leaves behind
intractable pain, THC and with at made by up to six patients who could
PTSD (for least an equal private producers, benefit from more
adults), cancer, amount of CBD along with two THC.
MS, Crohn’s, designated
mitochondrial universities (if they
disease, participate). Patients
Parkinson’s, will be allowed to
autism (for obtain the low-THC
minors), oil from licensed
Tourette’s, dispensaries or
epidermolysis specially licensed
bullosa, pharmacies (if the
Alzheimer's, latter participate).
AIDS, peripheral
neuropathy, and
sickle cell disease

Indiana Treatment- Extracts are to be None. There is no No in-state access.

resistant epilepsy composed of means of gaining in-
only; this means 0.3% THC or less state access.
patients must and at least 5%
have failed to CBD
respond to at
least two other
treatment
options
 State Condition(s) Type of Means of Access Workability Issues
Cannabis

Iowa Cancer (in some Oil extracts Up to five None (apart from the
cases), multiple composed of dispensaries will be possible financial
sclerosis, 0.3% THC or less licensed and must difficulties the centers
seizures, AIDS and at least 5% be open by may have due to a small
or HIV, Crohn’s CBD December 2018. In patient pool), as long as
disease, the meantime, the regulations are
amyotrophic law allows patients workable. However, the
lateral sclerosis, to enroll in program leaves behind
Parkinson’s Minnesota’s patients who could
disease, program; benefit from more
untreatable pain, unfortunately, THC.
or any terminal Minnesota does not
illness. currently permit
this.

Kansas Not limited to “Cannabidiol” None, although Because CBD is simply

patients; anyone limited CBD excluded from the
may possess production might be state’s definition of
CBD allowed under the “marijuana” — but
state’s new hemp THC remains illegal —
research program. any CBD product must
contain no traces of
THC. Without in-state
access to laboratory
tested CBD products,
patients will be unable
to verify THC content.

Kentucky Not specified “Cannabidiol” None. The law fails “Cannabidiol” must be
to include a source transferred pursuant to a
for CBD. It does written order of a
not make it legal for physician practicing at a
anyone to produce hospital or clinic
the marijuana that affiliated with a public
CBD would be Kentucky university
extracted from in with a medical school.
the state. However, issuing such
an order would break
federal law. Those
participating in an FDA
trial would also be
protected.
 State Condition(s) Type of Means of Access Workability Issues
Cannabis

Mississippi Debilitating “CBD oil” with CBD oil must be The law would only
epileptic more than 15% dispensed by the work if universities were
conditions CBD and no University of willing to openly break
more than 0.5% Mississippi’s federal law, or if federal
THC Department of law changes.
Pharmacy Service.
Only three entities, It is also not clear that
all affiliated with patients would be
universities, could protected from arrest, or
possess or produce if they would merely
cannabis oil. have an affirmative
defense that prevents a
conviction.

Nebraska Intractable Liquid or solid Access via the Either the university and
seizures and extracts or oils University of associated physicians
treatment of with more than Nebraska Medical would need to be willing
resistant seizures 10% CBD and no Center, conducting to openly break federal
more than 0.3% a pilot study on law, or they would have
THC CBD. to have federal
permission for the
study.

North Intractable Hemp extracts None. Cannabis This program lacks in-
Carolina epilepsy with at least 5% must be obtained state access to cannabis
CBD and less from another oils.
than 0.9% THC jurisdiction.

South Lennox Gastaut Cannabidiol or Access via licensed None, due to the hemp
Carolina Syndrome, any “manufacture, industrial hemp law.
Dravet salt, derivative, production, which is
Syndrome, or mixture, or defined as less than
“any other severe preparation” of 0.3% THC. The law
form of epilepsy marijuana that also allows for
that is not contains 0.9% or cannabis via
adequately less THC and federally approved
treated by over 15% CBD; sources for clinical
traditional extracts provided trials.
medical at trials must have
therapies” at least 98% CBD
and no more than
0.9% THC
 State Condition(s) Type of Means of Access Workability Issues
Cannabis

South Not specifically Cannabidiol, after Until the FDA This will not help
Dakota listed. it is approved by approves a CBD- patients until and unless
the federal Food based product, the FDA approves a
and Drug patients in South CBD-based product.
Administration Dakotans will not
(FDA) have access.

Tennessee For individuals: For individuals: Tennessee Participating universities

intractable cannabis oil with universities may would have to have
seizures less than 0.9% of cultivate marijuana, approval from the “drug
THC make oils, and enforcement
For clinical trials: dispense it to administration located
any disease For clinical trials: patients, but only as in the state,” which is
cannabis oil with part of an approved unlikely since the only
less than 0.6% of research study. federally authorized
THC grower of marijuana is
Patients may the University of
possess low-THC Mississippi.
oils obtained
pursuant to a “legal Regarding out-of-state
order or access, patients would
recommendation have to travel through
from the issuing states where cannabis is
state,” if they or an illegal.
immediate family
member was
diagnosed with
epilepsy by a
Tennessee doctor.

Texas Intractable “Low THC Dispensaries For a patient to qualify,

epilepsy cannabis” with at regulated by the their neurologist must
least 10% CBD Department of “prescribe” low-THC
and no more than Public Safety may cannabis, yet doing so
0.5% THC cultivate marijuana would break federal law.
plants, process
them, and distribute
low-THC cannabis.
 State Condition(s) Type of Means of Access Workability Issues
Cannabis

Virginia Any diagnosed Cannabis oils with Per a 2017 law, the None (apart from the
condition or at least 15% CBD state is licensing five possible financial issues
disease or THC-A and no “pharmaceutical due to such a limited
more than 5% processors” to program), if regulations
THC manufacture and are workable. However
dispense CBD and unlike effective medical
THC-A oils. programs, Virginia law
provides patients an
“affirmative defense” in
court, not full
protection from arrest.

Wisconsin Not specifically Creates an Physicians and In April 2018, Attorney

listed exception to the pharmacies that General Brad Schimel
definition of THC have been issued an issued a memo saying
(which is illegal investigational drug licensed hemp
under state law) permit by the FDA producers could not
for patients who may dispense extract and sell CBD
possess cannabidiol. oils from the plants.
“cannabidiol in a While he rescinded the
form without a Finally, in late 2017, memo in May 2018,
psychoactive the state enacted a some uncertainty
effect” and a pilot program to remains and sales have
doctor’s license industrial not begun. No state
certification hemp production, that borders Wisconsin
which may provide allows non-resident
a means of access. patients to obtain
cannabis from any of
the states’ dispensaries.

Wyoming Intractable “Hemp extracts” There is no in-state The law does not
epilepsy that with less than means of accessing provide for any in-state
does not respond 0.3% THC and at cannabis. It would source of cannabis.
to other least 5% CBD have to be brought
treatments and in from another
other seizure jurisdiction.
disorders