Iowa's medical marijuana program is 10 years old. How does it compare with other states? (2024)

Ten years ago this month, Iowa policymakers made it legal to use cannabis for certain medical treatment, marking the start of what would eventually become Iowa's existing medical cannabidiol program.

In April 2014, state lawmakers approved legislation to allow certain patients to use cannabis oil for their health condition. It was the first time a state law allowed Iowans to use marijuana products for their medical care.

Iowa policymakers have since opened the door further and established Iowa's medical cannabidiol program to oversee the cultivation, manufacturing and sale of cannabis products to a greater number of patients with qualifying medical conditions.

But a decade later, Iowa's program remains one of the most restrictive in the nation — even as more than 50,000 Iowans have participated since it launched in 2018.

Regulatory officials overseeing the state cannabidiol program say a tight framework is necessary to ensure the safety and well-being of Iowans.

Advocates, on the other hand, say the program's restrictions means patients in Iowa can't access the full benefits of cannabis products.

Here's a look back on Iowa's history with cannabis, and how the state program compares with others nationwide.

How does Iowa's medical marijuana policies compare to other states?

Iowa's medical program is "incredibly limited" and is not considered by advocates as effective policies, said Morgan Fox, political director for the advocacy group National Organization for the Reform of Marijuana Laws (NORML).

In total, 48 states allow for cannabis use in some form, according to NORML. Of those, 37 states and Washington, D.C., also has what the group describes as a comprehensive medical program.

One of the reasons Fox said Iowa falls behind because of its limitations on THC.

Under current law, Iowans can purchase up 4.5 grams of THC every 90 days, with exceptions for those who obtain a waiver.

As a result, some patients who could benefit from higher THC formulations — such as cancer patients or those who need help with pain management — struggle to access those products.

“Seriously ill patients in Iowa are incredibly limited in the amount they can attain through the cannabidiol program," Fox said.

What's the history of medical marijuana in Iowa?

In April 2014, the Iowa Legislature approved a measure that allowed Iowans to use cannabis oil without facing criminal prosecution to treat epilepsy. But the bill signed into law by then-Gov. Terry Branstad prohibited any manufacturing or distribution of that oil within the state.

The program saw a significant expansion in May 2017 with the passage of the Iowa Medical Cannabidiol Act, which made cannabis products available to thousands more Iowans by expanding the list of qualifying medical conditions.

The law also allowed marijuana plants to be grown within the state, and for manufacturers to develop and distribute cannabis oil that contained up to 3% tetrahydrocannabinol, or THC, the main psychoactive component of cannabis that gives users a high.

The first dispensaries licensed under the Iowa Medical Cannabidiol program began selling medical cannabidiol products to patients on Dec. 1, 2018.

The program has continued to expand in the years since, adding more qualifying medical conditions and additional products available for sale.

However, that growth has been limited by policymakers. In one instance, Gov. Kim Reynolds vetoed legislation that would have removed the then-3% cap on THC within products, citing a belief that expansion of the program should be done cautiously.

What does Iowa's Medical Cannabidiol program look like today?

Currently, the medical cannabidiol program allows for two licensed manufacturers and five dispensaries in the state. Those dispensaries are located in Windsor Heights, Sioux City, Council Bluffs, Waterloo and Iowa City.

In 2020, one of the state's cannabidiol manufacturers shut down permanently, leaving just one manufacturer — Bud and Mary's — to distribute products for the state program.

Iowa awarded a licensed to Iowa Cannabis Co., which currently operates three of the state's dispensaries, to also serve as one of the two cannabidiol manufacturers in Iowa. The production facility is scheduled to come online later in 2024.

Participation in the program is limited to Iowans with certain qualifying medical condition, which include:

• Cancer, if the treatment or the disease has side effects that include severe or chronic pain, nausea or severe vomiting, cachexia or severe wasting.
• Seizures.
• Crohn’s disease.
• Chronic pain.
• Multiple sclerosis with severe and persistent muscle spasms.
• AIDS or HIV .
• Amyotrophic lateral sclerosis (ALS).
• Parkinson’s disease.
• Post-Traumatic Stress Disorder (PTSD).
• Any terminal illness with a probable life expectancy of less than one year.
• Ulcerative colitis.
• Severe, intractableautism with self-injurious or aggressive behaviors in both children and adults.
• Corticobasal degeneration.

How many people use the Iowa Medical Cannabidiol program?

The program reported a total of 18,000 active patient cardholders and 3,700 active caregiver cardholders, as of November 2023, the latest state data available.

That compares with December 2022, when state data reported about 14,500 active patients and about 3,100 active caregivers in the program.

The state program saw $13.6 million in cumulative sales last year, a 24% increase from the $10.2 million in 2022. Sales surpassed $1 million every month in 2023.

What's next for Iowa's medical cannabidiol program?

As it has in the past, the Iowa Legislature continues to consider changes to the state's medical cannabidiol program. That includes a bill that passed the Iowa Senate earlier this month, Senate File 2335, that would increase the number of licensed medical dispensaries in the state from five to 10. The bill is before the Iowa House for debate.

But so far, state policymakers have not made any major adjustments to the existing framework to the Iowa Medical Cannabidiol program. As a result, some advocates say they are not hopeful Iowa will soon have a more inclusive medical marijuana program.

“I think that the political realities within the state are going to make positive cannabis policy reform fairly difficult for the foreseeable future," Fox said.

What factors may be impacting Iowa's medical program?

Even as medical cannabis use is strictly regulated and recreational use remains illegal in the state, many have pointed out Iowans can still access these products through other means.

In recent years, Iowans have been flocking to nearby states that have legalized recreational marijuana, such as Illinois.

And within the state, businesses selling consumable hemp products have become extremely popular. These products are legal under the 2018 Farm Bill, and contain formulations of CBD and THC that some say can benefit individuals with certain health problems.

State officials that oversee Iowa's medical cannabidiol program have said the strict nature of the program has likely driven some Iowans to seek relief from hemp products.

"In general, especially in states like Iowa where cannabis forms are limited, these products are more popular. There is more demand, considering they are legal," Owen Parker, bureau chief of Iowa's Bureau of Cannabis Regulation, previously said.

Both state officials and advocates note the lack of regulation over these products poses a concern to users' safety, particularly those who may be relying on consumable hemp to treat their symptoms.

More: Iowa bill creating age threshold, potency limit on hemp products goes to governor's desk

In addition, Fox said obtaining marijuana from a legal state and traveling back to Iowa, where recreational use is illegal, could open the door for Iowans to face criminal charges.

Michaela Ramm covers health care for the Des Moines Register. She can be reached atmramm@registermedia.com, at (319) 339-7354 or on Twitter at@Michaela_Ramm.