Medical cannabis expands across the South: Alabama (2021), Mississippi (2022), Kentucky (2023), and Texas (2025)

Long the region most resistant to cannabis reform, the American South saw a series of bipartisan legislative breakthroughs between 2021 and 2025 as lawmakers in Alabama, Mississippi, Kentucky, Louisiana, and Texas enacted or expanded medical cannabis programs.

Key Southern medical cannabis legislative dates

• Alabama SB 46 (Signed May 17, 2021): Governor Kay Ivey signed the Darren Wesley ‘Ato’ Hall Compassion Act, authorizing medical cannabis tablets, capsules, tinctures, patches, and nebulizers for 15 qualifying conditions (though multi-year administrative lawsuits over licensing delayed dispensary openings).
• Louisiana HB 652 & HB 391 (Signed June 2021): Louisiana—which first modernized its medical cannabis program in 2015—signed legislation in June 2021 adding smokable raw medical cannabis flower (effective January 1, 2022) and decriminalizing possession of up to 14 grams to a $100 fine with no jail time.
• Mississippi SB 2095 (Signed February 2, 2022): Nine months after the Mississippi Supreme Court struck down voter-approved Initiative 65 on a signature-gathering technicality, the Mississippi Legislature passed and Governor Tate Reeves signed the Mississippi Medical Cannabis Act, with the state’s first medical dispensaries opening in January 2023.
• Kentucky SB 47 (Signed March 31, 2023): Following Governor Andy Beshear’s November 2022 executive order protecting medical patients, the Kentucky General Assembly passed Senate Bill 47 (26–11 in the Senate, 66–33 in the House), and Beshear signed it on March 31, 2023 to make Kentucky the 38th medical cannabis state (effective January 1, 2025).
• Texas HB 46 (Signed June 21, 2025): On June 21, 2025, Texas Governor Greg Abbott signed House Bill 46 (effective September 1, 2025), the largest expansion yet of the Texas Compassionate Use Program—adding chronic pain and crooked-spine/terminal conditions, authorizing medical inhalation/vaporization devices, and expanding the number of licensed dispensing organizations across Texas.