As Americans across the country observe 4/20, a day that recognizes cannabis, North Carolina remains one of just 13 states that have not legalized medical marijuana.

That may not be the case for long. 

A bill in the North Carolina Senate, the NC Compassionate Care Act, would make medical marijuana legal for a narrowly crafted group of people diagnosed with certain medical conditions.

That bill stalled in the Senate in summer 2021, and it has not yet come up for a vote again. It is backed by two powerful state Republicans, Sens. Bill Rabon (R-Southport) and Michael Lee (R-Wilmington), the primary sponsors of the bill.

The Senate is expected to take up the bill in 2022, during a short session set to begin May 18, after the statewide primary on May 17.

One of the bill’s sponsors, Sen. Wiley Nickel (D-Cary), said not to expect much news until the session starts, but he is optimistic that the bill will be passed, he told NC Health News.

“This is a bill that is moving in the right direction, with lots of good, important support in a bipartisan manner,” Nickel said. “And I’m very hopeful that we will pass that bill when we return.”

Liz Sharpe, a spokesperson for one of the bill’s primary sponsors, Sen. Paul Lowe (D-Winston Salem), said in an email that no action has been taken on the bill since August due to redistricting and the state budget, but “we are hoping to get the bill moving!”

The bill has support from the majority of North Carolinians, according to one poll by WRAL NewsThe SurveyUSA poll found that 72 percent of North Carolinians supported medical marijuana legalization.

Support for medical marijuana is high across the political spectrum. The poll found that 64 percent of registered Republicans, 75 percent of registered Democrats and 78 percent of unaffiliated voters supported legalization.

What’s in the bill?

The Compassionate Care Act would make North Carolina “the most conservative state” of states with laws legalizing medical marijuana” with “a very, very narrowly tailored focus just on folks with chronic conditions, end of life care,” Nickel said at a judiciary committee hearing on the bill last summer.

Rabon called the bill “the most tightly regulated and controlled bill of its type,” at a committee hearing. 

Only people diagnosed by a doctor with a “debilitating medical condition” including cancer, epilepsy, positive HIV or AIDS status, or post traumatic stress disorder would qualify for a medical marijuana card, according to the bill.

If passed, the bill would also set up an advisory committee that would report on the effectiveness of the program annually and keep track of medical marijuana cards and physicians who issue the cards.

It would also establish a program in the University of North Carolina system to research cannabis as a medical product.

Marijuana as medicine

There are benefits and risks to medical marijuana as there are for most drugs, said Keith Humphreys, professor of psychiatry and behavioral sciences at Stanford University, in a March webinar hosted by Attorney General Josh Stein’s office.

The U.S. Food and Drug Administration (FDA) has not yet approved cannabis for specific medical conditions, as it is still completing medical research studying the impact of cannabis for medical use.

However, one cannabis-derived product, Epidiolex, has been approved by the FDA, for some seizure disorders. Three synthetic cannabis-related products — Marinol, Syndros and Cesamet — have also been approved.

Humphreys predicted more medications made using cannabis will be made.

“There’s no reason to be afraid of cannabis-based medications,” Humphreys said.

Does this mean recreational marijuana is going to be legalized?

Some people may be opposed to medical marijuana legalization because they don’t want it to lead to recreational marijuana legalization.

Legalizing recreational use of marijuana received less support than medical marijuana from North Carolinians in the WRAL/Survey USA poll. Nonetheless, over half of North Carolinians surveyed — 57 percent — agreed that recreational marijuana should be made legal.

Key legislators behind the bill have been clear they are not in favor of recreational marijuana legalization.

“Recreational marijuana is not what we want in our state,” Lee said at the judicial committee hearing.

As of November 2021, 18 states have taken measures to legalize recreational marijuana, less than half of the 37 states that have legalized medical marijuana.

Accessing THC in NC

At the same time as state legislators craft a narrowly tailored medical marijuana bill, North Carolinians can go to a store right now and buy products containing THC, the substance mostly responsible for marijuana’s impact on a person’s mental state.

Delta-8 THC, a hemp-derived product with a similar chemical structure to Delta-9 THC, the compound found in marijuana, is widely available across North Carolina, NC Health News previously reported.

Image of various Prime Sunshine CBD and Delta-8 products on display as well as a picture of the hemp plant to the left. Photo Credit: Mona Dougani

The 2018 Farm Bill, passed by the U.S. Congress makes this possible by creating a loophole companies use to sell CBD-derived products containing less than 0.3 percent THC.

Delta-8 THC has psychoactive effects similar to Delta-9 THC, and it can have intoxicating effects, or make users “high.”

The FDA has not approved or evaluated Delta-8 THC products and cautions against using those products for medical use, especially because their production is unregulated and they could be manufactured in “uncontrolled or unsanitary settings,” according to the FDA.

Medical marijuana is also already legal on some tribal land in North Carolina.

The Eastern Band of Cherokee Indians, located in the westernmost part of North Carolina, legalized medical marijuana in August, 2021, as well as possession of up to an ounce of marijuana on tribal lands.


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