Cannabis Policy Across the Country: A Look at Regional Trends

The United States is witnessing a patchwork of cannabis policies. While a majority of states have embraced some form of legalization, whether for adult-use or medical programs, a few states still cling to outdated prohibition laws. This stark divide highlights the fragmented nature of cannabis regulation across the nation, where a substance that's legal in one state can lead to severe penalties in another state.

Northeast 

The Northeast has become more progressive on cannabis policy reform. The successful 2016 legalization effort in Massachusetts led to Maine, Vermont, Connecticut, and Rhode Island passing adult-use cannabis laws. The only holdout is New Hampshire, which remains an island of prohibition, despite repeated efforts to pass adult-use legislation. 

Mid-Atlantic 

The Mid-Atlantic region has undergone a rapid transformation regarding cannabis legalization in recent years. New Jersey legalized adult-use cannabis in 2020 through a ballot measure, while New York passed a law to legalize cannabis for adult use in 2021. Maryland voters overwhelmingly approved a ballot measure legalizing cannabis for those 21 and older in 2022, and Delaware joined the ranks of legal states in April 2023. Meanwhile, Pennsylvania, an outlier on cannabis policy reform in the region, is one of only 19 states where adults can be incarcerated simply for possessing cannabis. 

Midwest 

The Midwest presents a diverse landscape regarding cannabis reform. In 2018, Michigan became the first state in the Midwest to legalize cannabis for adults 21 and older. Illinois followed suit in 2019, becoming the first state in the country to legalize adult-use cannabis through a state legislature. In 2022, Missouri voters passed a constitutional ballot measure to legalize and regulate cannabis for adults, and in 2023, both Ohio and Minnesota joined the list of adult-use legalization states in the Midwest. While efforts to legalize adult-use cannabis through ballot initiatives have fallen short in South Dakota and North Dakota, voters in both states approved medical cannabis, and Nebraska voters overwhelmingly approved two companion medical cannabis initiatives in 2024. Wisconsin, Iowa, Indiana, and Kansas still remain stubbornly behind the times and are some of the few states left with no effective medical cannabis law and that still imposes jail time for simple possession of cannabis.

Pacific Coastal 

The Pacific Coastal region has been at the forefront of cannabis policy reform in the United States. Oregon was the first state to decriminalize possession of small amounts of cannabis in 1973, and in 1996, California became the first state to legalize medical cannabis. Washington joined the national conversation in 2012, being one of the first two states to legalize adult-use cannabis. Further, Alaska became the third state (tied with Oregon) to legalize cannabis for adults’ use in 2014. While Hawai’i remains the only state in the Pacific Coastal region to lack an adult-use cannabis legalization law, in 2000, the state became the first state in the nation to pass a medical cannabis law through the legislature rather than the citizen initiative process. 

Rocky Mountains 

The Rocky Mountains region is another mixed bag on cannabis policy reform. In 2012, Colorado voters ushered in a new era, making their state the first in the nation (tied with Washington state) to legalize cannabis. In Nevada, voters legalized cannabis for adult use in 2016, and Montana followed suit in 2020. Meanwhile, Utah voters approved a medical cannabis ballot initiative in 2018. However, the other two states in the region, Idaho and Wyoming, are still holding the line on prohibition and continue to impose jail time for simple cannabis possession.

Southwest 

Arizona and New Mexico have embraced legalization, joining the growing number of adult-use cannabis states across the country. Oklahoma voters approved medical cannabis in 2018, but then defeated a ballot initiative that would have legalized the adult use of cannabis in 2023. Most recently, Texas became the 40th medical cannabis state after Gov. Greg Abbott signed a medical cannabis expansion bill into law earlier this year.

Southeast

Southeastern states have been more hesitant to embrace cannabis reform, but there has been some steady, incremental progress to roll back prohibition across the region. Virginia became the first state in the South to legalize cannabis for adults, and cannabis is also legal in Washington, D.C., although sales are not yet legal in either jurisdiction. Arkansas and Florida voters approved medical marijuana initiatives in 2016. Then, in 2021, Alabama became the 36th state to pass medical cannabis legislation. In 2023, Kentucky legalized medical cannabis and Mississippi implemented a comprehensive medical cannabis program. West Virginia has also legalized medical cannabis, although it remains one of the 19 states that have yet to even decriminalize cannabis possession. Louisiana has also made steady progress by passing and expanding medical cannabis laws and stopping incarceration for possessing up to 14 grams of cannabis. Meanwhile, Georgia, South Carolina, and Tennessee lack a viable medical cannabis program and continue to imprison individuals for possessing small amounts of cannabis. And while North Carolina has removed jail time as a penalty for possession of small amounts of cannabis, the state still lacks a medical cannabis program.