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Mixed Medical Messages in the Deep South

Medical marijuana rollouts have been rocky in Alabama, Louisiana and Mississippi.



STATES IN THE Deep South have had bumpy to rocky starts to their medical marijuana regimes. Let’s get the skinny on Alabama, Louisiana and Mississippi.


Medical marijuana legalized: May 17, 2021; Recreational cannabis legalized: Still illegal; Operating licenses available: Disputed; Licenses issued (as of Sept. 2023): 55


Alabama legalized medical marijuana in 2021, but the rollout has faced issues including lawsuits and disagreements, largely due to limited cannabis licenses and disputes over allocation of those licenses. Multiple companies, including Medella, Alabama Always and Verano Holdings, are engaged in ongoing litigation against the Alabama Medical Cannabis Commission due to problems with the license allocation process.

Alabama Always, which was not issued a license, is at the heart of a lawsuit against the commission claiming it illegally deliberated in secret before selecting winners in violation of the state’s Open Meetings Act, which requires deliberations to be done in public. In August, a state judge issued a temporary hold on the issuance of new licenses.

Industry analysts project up to $1 billion in annual sales of recreational cannabis in Alabama but the path to legalization would appear unlikely anytime soon.


Medical marijuana legalized: June 30, 2015; Recreational cannabis legalized: Still illegal but possession of small amounts is decriminalized; Operating licenses available: 30; Licenses issued (as of Sept. 2023): 22


Louisiana’s path to medical cannabis legalization actually started way back 1978 with the passage of Act No. 725, which legalized prescription cannabis for glaucoma and cancer patients. Unfortunately, there was no way for patients to legally and practically obtain cannabis in the state—despite the law, few patients were treated. Fast forward to 2019, when Louisiana fi nally began allowing legal dispensing of tinctures after passing a new medical cannabis law in 2015.

As of 2023, each of the nine Louisiana jurisdictions administered by the state’s Health Department has just a single dispensary. Yet public support for legalization has surged in the state to 70 percent in polling this year, up from 42 percent in 2013. So far, legislation to e ect that has been killed in the Louisiana state house.

By 2025, annual sales of medical cannabis are projected to reach between $330-$400 million, with a potential $922 million in sales and $222 million in tax revenue projected for a fully legalized market.


Medical marijuana legalized: Feb. 2, 2022; Recreational cannabis legalized: Still illegal; Operating licenses available: No statewide cap; Licenses issued (as of Sept. 2023): 192


Signifi cant strides have been made in Mississippi regarding the legalization of cannabis, particularly for medical use. The momentum began with a November 2020 ballot measure, where 69 percent of voters approved the establishment of a comprehensive medical cannabis program. However, the Mississippi Supreme Court nullifi ed this initiative, prompting a push for legislative intervention.

Mississippi legislators passed the Mississippi Medical Cannabis Act in January 2022, with the fi rst sales launching in January 2023. Even though several cities and counties have opted out, the medical cannabis market in the state has fl ourished.

Annual medical marijuana sales in Mississippi are forecast to reach $265 million by the close of 2023 and are projected to nearly triple to $800 million by 2027.



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