(Editor’s note: This story is part of a recurring series of commentaries by cannabis experts. Julie Werner-Simon is an associate professor at Drexel University School of Law, a legal analyst for the Cannabis as an Emerging Business course at Drexel College of Business in LeBow, and a former federal prosecutor. This is the first installment of a three-part series).

In America, more than nine out of ten people live in a place where marijuana is more or less legal.

Although marijuana use has been illegal at the federal level for more than 50 years, 328 million of the 335 million U.S. residents (including those in the District of Columbia and the four most populous U.S. territories, the U.S. Virgin Islands, Puerto Rico, the Northern Mariana Islands, and Guam) have embraced at least one of three levels of legalization.

first-degree conditions

The first category includes states (and territories), i.e. states that have cannabis programs for adult use and have set implementation dates or passed legislation legalizing cannabis for adult use.

Under first-degree rules, adults residing in a state or territory can legally purchase marijuana (in accordance with the laws of the state or territory) without having to prove a medical condition.

The list of states and territories that have legalized first degree adults includes 16 states (Alaska, Arizona, California, Colorado, Illinois, Maine, Massachusetts, Michigan, Montana, Nevada, New Jersey, Oregon, South Dakota, Vermont, Virginia, Washington), as well as the District of Columbia, Guam, and the Northern Mariana Islands.

Second-degree conditions

This is followed by second tier municipalities that have legalized, implemented, or set dates for medical marijuana programs, providing patients with broad access to cannabis for a variety of medical conditions.

Almost all states start with medical programs and then, years later, move on to coexisting first-grade adult programs.

Second-degree programs vary widely, but in general, states and territories that have them allow patients to possess and smoke at least medical cannabis.

There are now 36 states, plus the District of Columbia and the U.S. territories of Guam, Puerto Rico and the U.S. Virgin Islands in the second tier.

That’s more than twice as many as those that are also suitable for adults.

There are two exceptions to the American custom of starting with the second degree first and then the first:

  • South Dakota, which became the first and second state to simultaneously legalize medical and recreational marijuana on the November 2020 ballot (an effort the state’s elected officials faced).
  • A U.S. territory in the Northern Mariana Islands that legalized marijuana for medical and adult use in 2018.

Third degree conditions

There are also Tier 3 states that include even fewer locations, these are states (no US territory has this status) with strictly limited access to medical marijuana (ALS) products.

SLO status often precedes approval of an application for a second degree in medicine.

Over the years, third-graders have become accustomed to limited programs (some even call their SLOs medical marijuana programs).

Then SLO drops the third-order cocoon through voter initiative or legislation and turns it into a second-order health care program.

States like Florida, Missouri and Oklahoma, for example, have moved from UAC status to Tier 2 status for medical marijuana.

However, in March 2021, Republican lawmakers in Florida filed a bill to give HHP status that would have significantly reduced the amount of THC allowed in medical marijuana in Florida.

According to the Miami Herald, lawmakers say marijuana abuse by doctors and patients (who use [Florida’s second-degree medical program] to … get rich and high) will lead to a marijuana addiction crisis. Florida remains a second-rate state when it comes to the press.

Iowa is now in its third year, but has yet to graduate with a second degree.

A sign of this movement occurred in June 2020, when the governor of Iowa lifted the low THC limit for ASP patients, but then manually implemented a quantity limit (4.5 grams per 90 days) for Iowans in his program.

Under Iowa’s restrictive law, smoking marijuana is still illegal.

The states of Texas and Georgia, where treatment with low-THC marijuana is allowed, as well as expanding the population of low-THC marijuana patients and preparing for future second-degree patient status.

Other states described in the National Conference of State Legislatures database have a university research component, such as Alabama, which, among several other features, allows research on low-THC substances only on the campus of the University of Alabama.

In contrast, Tennessee allows only one of its public universities to conduct epilepsy research using a low-THC drug, while Kentucky allows medical schools and public universities (which receive research grants) to use low-THC drugs to study epilepsy.

And in 2015, Georgia passed a law allowing the state’s university system to study, on a limited basis, the efficacy of low-THC oil in terminal cancer, seizures and other refractory diseases.

All OAS member countries have defined their status in their legislation, and some have named persons with serious diseases in their bills.

For example, South Carolina’s 2014 ESL program is called Julian’s Law and is named after a child born in the state who developed epilepsy at age two and then moved with his family to Colorado for marijuana treatment.

Although South Carolina designates its ESL participants as medical marijuana patients, the state only allows limited use by people with uncontrolled epilepsy, defined by law as use that does not respond to traditional medication.

Patients in South Carolina, as well as other states with similar SLOs, can only access low-THC cannabis in the form of oil.

North Carolina also allows the use of certain cannabis products to treat all forms of epilepsy.

This is the case in Indiana, where a 2017 law allows the use of low-THC products to treat epilepsy.

Wisconsin allows it for seizures, while Wyoming allows it for both epilepsy and seizure disorders.

Texas also passed a limited access law in 2015 and 2019.

Currently 11 countries are members of SLA: Alabama, Georgia, Iowa, Indiana, Kentucky, North Carolina, South Carolina, Tennessee, Texas, Wisconsin and Wyoming.

In total, more than 120 million people live in a state, territory, or District of Columbia of the first degree, and 117 million people live in places that are only of the second degree forensically. Add to that 89 million people in third-degree states where access to marijuana is severely restricted. In total, more than 328 million people live in a state or territory where marijuana is more or less legal.

(At this point, check out part two of Werner-Simon’s post on the legalization of marijuana in the United States. The next part will describe the places in the U.S. where marijuana is still completely illegal).

Julie A. Werner-Simon is a legal analyst for the Cannabis as an Emerging Business course at the Drexel LeBow School of Business. She can be reached at [email protected].

The previous version of this series can be found here.

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