It used to be a very simple question to answer: How many medical marijuana states are there?

Before the election of President Barack Obama, you either lived in a state where patients with certain conditions could legally grow and use cannabis as medicine with a doctor’s recommendation, or you lived in a state where growing cannabis got you thrown in prison—no matter what your condition.

Since then, however, there have been more-restrictive medical marijuana laws passed in some states. Some states don’t let patients (or their caregivers) cultivate their own cannabis, forcing them to the dispensary to purchase medicine. Some states don’t allow cannabis flower at all, relegating patients to only non-smoked forms of medicine.

Then there is the recent advent of states, mostly in the South and Midwest, that allow low-THC / high-CBD cannabis oils, primarily for epileptic children. Are these so-called “CBD-only states” to be considered “medical marijuana states,” when nobody is using any actual marijuana? What about the states lacking smokable cannabis flower, a.k.a. marijuana? Are those “medical marijuana states?”

The major national marijuana reform organizations take different views on the question. Americans for Safe Access (ASA), the non-profit focused exclusively on medical cannabis reforms, takes the broad view. “46 U.S. states and three territories now have medical cannabis laws,” begins a review of the group’s annual report card on medical marijuana policy in the United States.

However, ASA itself recognizes the schism between medical marijuana and CBD. “In addition to DC, Guam and Puerto Rico, and the thirty states that are commonly recognized as having viable medical cannabis laws,” ASA writes, “another sixteen states have adopted laws that only allow the possession of certain cannabis oil extracts rich in cannabidiol.”

CBD and THC in the USA

So, it’s thirty medical marijuana states and sixteen CBD states? Maybe. In a demonstration of just how quickly the political landscape is shifting on the issue of marijuana, since ASA’s report card was published in March, Kansas passed a law in May excluding CBD from the definition of marijuana, making it essentially legal.

But Kansas law still bans THC and most CBD oil contains some trace amounts of THC. Functionally, this makes Kansas different than the sixteen CBD states that recognize some level of THC (usually below 0.3 percent) within CBD oil as legal.

If a law technically allows medical marijuana (or CBD) but is functionally inoperable, it’s hard to consider that a “medical marijuana state.” For instance, South Dakota declared CBD a Schedule IV (legal) drug back in 2017, but ASA did not include it in the March report on medical marijuana states, because the law depends on approval of CBD by the Food & Drug Administration (FDA).

In June, the FDA did give that approval to Epidiolex, a CBD drug manufactured by GW Pharmaceuticals that lacks THC. So, now, are there eighteen CBD states? If so, only Idaho and Nebraska remain without any sort of medical marijuana law.

Thirty Green States

At least we can agree that there are thirty “medical marijuana states,” right? Marijuana Policy Project (MPP), the largest marijuana advocacy non-profit, agrees with ASA on that count of thirty. The National Organization for the Reform of Marijuana Laws (NORML), the oldest marijuana consumers’ lobby, says thirty-one – the difference being NORML’s inclusion of a medical marijuana law in Louisiana that MPP rejects as inoperable.

But you only get to thirty using the broadest definition of medical marijuana. If we consider only the states that allow any patient (or their caregiver) to cultivate their own cannabis as medicine, then there are only fourteen “medical marijuana states.” The nine states with legal marijuana for all adults – Alaska, California, Colorado, Maine, Massachusetts, Nevada, Oregon, Vermont, and Washington – allow all patients to grow cannabis at home, as do Hawaii, Michigan, Montana, Oklahoma, and Rhode Island.

If you include states where some patients under certain circumstances may cultivate their own cannabis, the “medical marijuana states” increase to seventeen. New Mexico requires patients to demonstrate a hardship preventing them from buying marijuana at dispensaries. Arizona bans any patient living within 25 miles of a dispensary from home-cultivation. North Dakota has a similar ban within 40 miles of a dispensary.

If, however, a “medical marijuana state” is merely one where patients can smoke cannabis, there are another nine states we can add – Arkansas, Connecticut, Delaware, Florida, Illinois, Maryland, New Hampshire, New Jersey, and Ohio – that ban home grow but have dispensaries, for a total of twenty-six.

The remaining four states – Minnesota, New York, Pennsylvania, and West Virginia – do not allow for the smoking of marijuana. You’d have to believe legal access to non-smoked cannabis products (i.e.: edibles, tinctures, topicals, etc.), but not smoked marijuana, counts as a “medical marijuana state” to get to the total of thirty.

The Importance of Voting

This year’s election features four states voting on changes in their marijuana laws. Michigan, already a “medical marijuana state” by all definitions, is voting to become a legalization state. But votes in three other states could change these numbers.

North Dakota is voting on legalization, which would effectively nullify the 40-mile patient-grow exclusionary zone around medical cannabis dispensaries.

Utah and Missouri are voting on medical marijuana initiatives to move them beyond their current “CBD-only” status. Utah would become one of the no-home-grow states if its initiative passes. Missouri has three initiatives to choose from, one that would add them to the shortlist of fourteen states that allow all patients to grow versus two that only move the state into the no-home-grow column.

So, how many medical marijuana states are there? Whether it’s 14, 30, 46, one thing is for sure: it’s a whole lot more states than there were twenty-five years ago.