Medical marijuana program expands as advocates file adult-use legalization ballot initiatives


Last update: January 13, 2020

In 2018, Missourians overwhelmingly approved Amendment 2 to establish constitutional protections for medical marijuana patients, legalizing the use of medical marijuana for serious health conditions. The Missouri Department of Health and Senior Services has facilitated the implementation and expansion of the program, which now serves over 20,000 patients in the state.

The Show Me State might vote on adult-use legalization later this year. Polls indicate there is broad support, and constitutional legalization petitions have been filed. They will require over 160,000 voter signatures to qualify for the 2020 ballot. It remains to be seen whether a well-resourced campaign will emerge as a leader. 
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Missouri approves Amendment 2 to legalize medical marijuana


On Election Day 2018, Missourians voted to pass Amendment 2 with 65.5% support. Many local medical marijuana advocates and national organizations, including MPP, endorsed Amendment 2. With its passage, the right of Missouri patients to safely access medical marijuana was officially enshrined in the state constitution.

With a physician’s approval, a patient may qualify for medical marijuana if they have been diagnosed with any of the following conditions:

  • Cancer
  • Epilepsy
  • Glaucoma
  • Intractable migraines unresponsive to other treatment
  • Conditions that cause persistent pain or muscle spasms, including MS, Parkinson’s disease, and Tourette’s syndrome
  • Debilitating psychiatric disorders such as PTSD
  • HIV or AIDS
  • A chronic medical condition normally treated with prescription medication that can lead to dependence, when a physician determines that medical marijuana could be an effective and safer treatment
  • Any terminal illness
  • Hepatitis C
  • ALS
  • Inflammatory bowel disease
  • Crohn’s disease
  • Huntington’s disease
  • Autism
  • Neuropathies
  • Sickle cell anemia
  • Alzheimer’s disease
  • Cachexia
  • Wasting syndrome

Home cultivation is permitted for caregivers and qualified patients who apply for and receive a cultivation card. Each cardholder may grow up to six plants.

Current marijuana laws in Missouri


Medical marijuana is legal for registered patients. Voters approved Amendment 2 in 2018 to establish a medical marijuana program.

Marijuana possession has been decriminalized. Legislation was approved in 2014 to decriminalize the possession of 10 grams or less of cannabis. Possession of 10 grams or less is punishable by a fine only, but the offense remains a criminal misdemeanor. The possession of greater quantities of cannabis remains punishable by jail time.

Cultivation for non-patients remains illegal. Cultivating 35 grams or less is a Class E felony, which is punishable by up to four years of imprisonment and a maximum fine of $10,000. Cultivating 35 grams or more is a Class C felony, which is punishable by a sentence of three to 10 years imprisonment and a fine of $10,000.

Timeline of marijuana reform in Missouri


2008: In Missouri v. Cox, the state Court of Appeals affirmed a lower court’s rejection of a patient’s medical necessity defense because the legislature had already expressed its intent by placing marijuana in Schedule I, even though statute allowed the dispensing of Schedule I substances by certain professionals.

2014: Gov. Jay Nixon signed into law the Missouri Medical Marijuana Bill, allowing the use of CBD oil to treat persistent seizures.

Lawmakers enacted SB 491, decriminalization legislation that reduced penalties for those possessing up to 10 grams of marijuana. A first offense is punishable as a class D misdemeanor (an infraction) and carries a fine of $250-$1,000 with no jail time.

2015: Missouri issued licenses to two non-profits to grow cannabis for oil to be sold to patients.

2017: Kansas City voted to reduce the penalties for simple possession of marijuana, amending local laws regarding the possession of up to 35 grams of marijuana for adults age 21 and older from a criminal misdemeanor to a civil offense punishable by a $25 fine.

2018: Voters passed Amendment 2, legalizing medical marijuana in Missouri.

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