South Dakota voters pass both recreational Amendment A and medical Measure 26, while Mississippi approves medical Initiative 65

On Election Day, November 3, 2020, cannabis ballot measures swept every state where they appeared—including two deep-red states where voters approved historic reforms that soon faced state constitutional challenges in court.

South Dakota approves both Measure 26 (69.92%) and Amendment A (54.18%)

Before 2020, no state had ever approved medical and recreational cannabis simultaneously on the same ballot. South Dakota voters passed both:

• Initiated Measure 26 (Medical): Approved by 69.92% Yes (291,754 votes) to 30.08% No (125,488 votes), establishing a statutory medical cannabis program that took effect on July 1, 2021.
• Constitutional Amendment A (Recreational): Approved by 54.18% Yes (225,260 votes) to 45.82% No (190,477 votes) to legalize adult possession of up to 1 ounce and establish a regulated market—before Governor Kristi Noem backed a lawsuit that led the South Dakota Supreme Court to strike down Amendment A in November 2021.

Mississippi voters pass Initiative 65 for medical cannabis

In Mississippi, voters overwhelmingly backed Initiative 65 (winning by nearly 74% on the second ballot question) to create a constitutional medical cannabis program. Although the Mississippi Supreme Court struck down Initiative 65 in May 2021 on a technicality involving the state’s obsolete five-district signature requirement, the overwhelming ballot margin pushed the Mississippi Legislature and Governor Tate Reeves to enact the Mississippi Medical Cannabis Act (SB 2095) on February 2, 2022.