Cannabis Across the Country: A Look at Regional Legalization Trends

Jul 10, 2024

Gallup Poll, legalization, medical cannabis, United States

Cannabis Across the Country: A Look at Regional Legalization Trends

There are several factors propelling cannabis reform across the United States. Public opinion has steadily become more favorable towards legalization, and according to Gallup polls, more than two-thirds of Americans now support legalizing cannabis for adults’ use, a dramatic increase from decades prior. The potential for tax revenue and economic benefits is also a strong motivator for many states. Additionally, the racial disparities in cannabis arrests are prompting calls for criminal justice reform. 

While some states have fully embraced legalization for both medical and recreational use, others have yet to budge on prohibition. This regional breakdown highlights the fragmented nature of cannabis policy in the United States. 


(Connecticut, Maine, Massachusetts, New Hampshire, Rhode Island, Vermont)

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, although the N.H. House of Representatives has been passing legalization for years and 2024 marked the first time the Senate passed a legalization bill. 


(Delaware, Maryland, New Jersey, New York, Pennsylvania)

The Mid-Atlantic region is undergoing a rapid transformation regarding cannabis legalization for adults. New Jersey legalized recreational cannabis in November 2020 through a ballot measure, followed by legislators passing three companion bills in 2021 to establish a regulated adult-use market, while New York passed a law to legalize cannabis for adult use in the same year. Maryland voters overwhelmingly approved a ballot measure (Question 4) legalizing cannabis for those 21 and older in 2022. Question 4 secured the highest winning margin of any cannabis legalization ballot measure to date, with MPP playing a pivotal role in the campaign to end Maryland's cannabis prohibition. Delaware also joined the ranks of legal states in April 2023, and MPP played a leading role in the advocacy coalition that guided the passage of legalization.

Meanwhile, Pennsylvania is increasingly an outlier on cannabis policy reform, with nearly all the neighboring states having legalized cannabis for adults. Because Pennsylvania does not have a ballot initiative process, legislative action is the sole path for reform in Pennsylvania. MPP remains actively engaged with allies in the state to push for the passage of adult-use cannabis legislation.


(Illinois, Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, Wisconsin)

The Midwest presents a diverse landscape regarding cannabis reform. In 2018, Michigan voters approved a cannabis legalization initiative, making Michigan the first state in the Midwest to legalize cannabis for adults 21 and older. Illinois followed suit shortly after, becoming the first state in the country to adopt a regulatory system for cannabis cultivation, testing, and sales through a state legislature. The MPP-backed bill in Illinois was a trailblazer in equity, both in licensing and expungements. With the passage of Amendment 3 in 2022, Missouri voters ended the failed policy of cannabis prohibition through 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.

Several Midwest states have made efforts to reform cannabis laws by voter initiative in recent years. Voters in North Dakota and South Dakota approved medical cannabis, and efforts to place the question of adult-use legalization on the November 2024 ballot in both states are underway. Meanwhile, advocates in Nebraska are working tirelessly to qualify a constitutional medical cannabis initiative for the ballot in 2024 after facing a series of setbacks.

While some neighboring states in the Midwest have made progress on cannabis policy reform, Wisconsin, Iowa, Indiana, and Kansas still remain stubbornly behind the times compared to other states and the nation as a whole. These Midwest states are some of the few states left with no effective medical cannabis law and that still imposes jail time for simple possession of cannabis.

However, as more and more states move forward, it’s only a matter of time before the remaining Midwest states improve their cannabis laws. Neighboring states with successful adult-use and medical cannabis programs will put pressure on holdouts to re-evaluate their policies, and the future of cannabis policy in the Midwest is likely to involve continued progress toward legalization. 

Pacific Coastal 

(Alaska, California, Hawaii, Oregon, Washington)

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, a pioneering move at the time. California followed suit in 1996, becoming 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. Alaska has also been a groundbreaker in cannabis policy reform, with voters legalizing medical cannabis in 1998, and in 2014, Alaska became the third state (tied with Oregon) to legalize cannabis for adults' use.

Meanwhile, in 2000, Hawai’i became the first state in the nation to pass a medical cannabis law through the legislature — rather than the citizen initiative process. Although Hawai’i remains the only state in the Pacific Coastal region to lack an adult-use cannabis legalization law, a 2024 legalization bill came closer to the finish line than ever before, demonstrating growing momentum for legalization in the state.

Rocky Mountains 

(Colorado, Idaho, Montana, Nevada, Utah, Wyoming)

The Rocky Mountains Region is another mixed bag on cannabis policy reform. On November 6, 2012, Colorado voters ushered in a new era, making their state the first in the nation (tied with Washington state) to legalize cannabis, with MPP playing a leading role. A little over a year later, retail stores opened their doors, making history. In the following years, voters legalized cannabis for adult use in Nevada in 2016, and Montana followed suit in 2020. Meanwhile, Utah voters approved Proposal 2 — the Medical Cannabis Act — 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.


(Arizona, New Mexico, Oklahoma, Texas)

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, and the state now boasts one of the most expansive medical cannabis programs in the nation. However, Oklahoma voters defeated a ballot initiative to legalize, regulate, and tax cannabis for adults during a 2023 special election.

Texas remains an outlier. Despite lacking a comprehensive medical program and continuing to criminalize possession, decriminalization measures have gained traction on local ballots in recent years, hinting at a potential shift in policy.


(Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia, Washington, D.C., West Virginia)

Southeastern states have been more hesitant to embrace cannabis reform. 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. 

However, there has been steady, incremental progress to roll back prohibition in the Southeast, with several states implementing medical cannabis programs. In 2016, Arkansas voters approved a medical marijuana initiative. Then, in 2021, Alabama became the 36th state to pass medical cannabis legislation, although patients are continuing to wait for relief as the licensing process has been delayed and no one can legally use or access medical cannabis yet. In 2023, Kentucky legalized medical cannabis. In the same year, Mississippi implemented a comprehensive medical cannabis program, and upwards of 35,000 patients are now participating after a little over a year of operations. West Virginia is another Southeastern state that has legalized medical cannabis, although it remains one of the 19 states that have yet to even decriminalize cannabis possession. 

While the Southeast has been slower to evolve on cannabis policy reform, there are signs of change. Over the past several years, Louisiana has made steady progress to roll back what were among the most draconian cannabis laws in the country. The Louisiana legislature has passed and expanded medical cannabis laws, stopped incarceration for possessing up to 14 grams of cannabis, and allowed expungements for low-level cannabis offenses. As public support grows, MPP is actively engaging with lawmakers and voters to make Louisiana the first state in the “Deep South” to legalize adult-use cannabis. 

Meanwhile, in 2021, 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. In Florida, where medical cannabis is already legal, voters will decide whether to legalize cannabis for adult use this November. 

Final Thoughts

The United States is witnessing a patchwork of cannabis policies across regions. Over half the U.S. population lives in a legal cannabis state, and states that have legalized cannabis are blue, red, and purple. While some states are embracing comprehensive legalization, others are taking a more cautious approach with medical programs or decriminalization. Public opinion and the success of existing programs are likely to continue driving reform efforts nationwide.

MPP has played a significant role in much of the progress our movement has achieved across the country in the past 20 years, and the cannabis policy landscape continues to evolve at a swift pace. You can support our efforts to continue changing laws and changing lives by donating to MPP, or by becoming a monthly sustaining member.