Marijuana is considered illegal for all purposes in North Carolina. However, North Carolina does allow the limited use of cannabis products or specifically low-THC CBD oils, as an alternative treatment for intractable forms of epilepsy. Intractable epilepsy is a form of epilepsy that has not responded, or no longer responds, to conventional medications.
The North Carolina legislature passed the Epilepsy Alternative Treatment Act, also known as Hope 4 Hailey and Friends Act, in 2014. This law enabled doctors affiliated with the neurology departments of four state universities to recommend cannabis for patients with intractable seizure disorders. The state universities in this program were Wake Forest University, Duke University, East Carolina University, and the University of North Carolina (UNC).
Neurologists affiliated with these universities could recommend medical marijuana that was predominantly cannabidiol (CBD) with trace amounts of tetrahydrocannabinol (THC). CBD is an active compound in cannabis that possesses no psychotropic properties and is recognized to have therapeutic effects. Patients in the program were given identification cards that enabled them to possess the cannabis products recommended by their neurologists. Neurologists approved to make recommendations had to be part of the program, i.e., registered with the study in any of the universities. The CBD oil used by the patient had to contain less than 0.3% THC and at least 10% CBD, by weight, to meet legal standards. Patients' details were tracked and analyzed to ascertain the need and viability of a statewide program.
The Epilepsy Alternative Treatment Act was amended in 2016 with the passage of HB 766 by the North Carolina legislature. HB 766 changed certain specifications in the law to increase accessibility by local residents. It included provisions stipulating that any board-certified neurologist affiliated with any state-licensed hospital can recommend medical marijuana (low-THC CBD) as treatment. The amendment also modified the standards for legal medical marijuana in the state to:
Less than 0.9% THC
At least 5% CBD by weight
No psychoactive effects or substances
Marijuana possession is partially decriminalized in North Carolina. Possession of 0.5 ounces of cannabis (or less) is a misdemeanor that carries a $200 fine in the state.
North Carolina’s laws do not permit a felon to purchase marijuana, as medical and recreational marijuana purchase or possession remains illegal in the state. A person with a prior conviction faces steeper penalties, including incarceration and fines, upon conviction of marijuana-related offenses.
Recreational and medical marijuana remains illegal in North Carolina. However, studies show that North Carolinians support having a medical marijuana program. Elon University poll surveyed residents' opinions on marijuana in North Carolina in 2021. The results show that 73% support creating a medical marijuana program, while 54% support legalizing recreational marijuana in the state.
Marijuana is illegal in North Carolina and is not available for sale. As such, it is not taxed and does not generate revenue for the economy of the State of North Carolina. Consequently, it can be inferred that marijuana has no direct effect on the economy of the state. Even low-THC CBD, which is legal to possess in the state, can not be obtained in the state. This is because there are no state-regulated procedures for obtaining CBD extracts and caregivers have to purchase them out of state.
Proponents of marijuana legalization assert North Carolina could net tens of millions of dollars in revenue from the taxation of legal marijuana. Michigan, a state with similarities in population size and tax system operations, netted $45 million in marijuana tax revenue in 2020. Legal marijuana in North Carolina could add similar figures to the state's annual tax revenue.
The Tax Foundation proposes that states without an established recreational or medical marijuana program lose millions of dollars in revenue from excise and sales tax. According to the report, North Carolina has the potential to generate over $182 million in revenue from excise tax for the sale of recreational marijuana within three years of its establishment. This estimate does not include potential revenue from sales tax, application fees, and other business taxes. The Tax Foundation obtains this figure using the average excise tax paid in states with similar population sizes.
Marijuana is still completely illegal in North Carolina, but the Epilepsy Alternative Treatment Act enables specific individuals to legally possess low-THC CBD cannabis extracts. The Act does not make provisions for the production, distribution, and sales of CBD extracts in the state, and most residents procure it out-of-state. However, a comparison of arrest figures prior to and following the passage of the legislation indicated a decrease in marijuana-related arrests in North Carolina.
In the year before legalization (2014), there were 22,773 marijuana arrests, with 92% being for possession and only 8% for sales. After low-THC CBD was legalized (2016), arrests for marijuana possession dropped to 14,619, and arrests for sales to 1,270. The 15,899 total arrests represented a 30.2% decrease from the pre-legalization figures of 2014.
Marijuana arrest figures in North Carolina are high compared to other states with medical and legal marijuana programs. As of December 2022, a report shows North Carolina is the third largest contributor in the United States for marijuana-related arrests. The Federal Bureau of Investigation (FBI) Crime Data Explorer reports that by 2018 marijuana-related arrests stood at 21,251, 19,622 arrests for marijuana possession, and 1,629 arrests for the sale of marijuana. In 2019, the total number of marijuana arrests in North Carolina was 17,040, including 15,827 arrests for marijuana possession and 1,213 for the sale of marijuana. In 2020, law enforcement recorded 13,424 marijuana arrests, including 12,307 arrests for possession and 1,117 for the sale of marijuana. In 2021, the data for North Carolina shows law enforcement officers reported 13,389 marijuana arrests and 12,407 for marijuana possession, and 982 for the sale of marijuana.
There was a 19% decrease in marijuana-related arrests between 2018 and 2019. By 2020, marijuana sale and possession arrests fell further by 21%. Marijuana arrest figures declined in 2021. However, the decrease was less than 1%.
North Carolina does not issue identification cards to registered patients in the medical marijuana program. Instead, patients' caregivers are required to register with the Department of Health and Human Services (DHHS) to be able to legally obtain medical cannabis on behalf of the patients. A qualified designated caregiver in North Carolina must be at least 18 years old and a legal resident of the state. A caregiver must also be the parent, legal guardian, or custodian of the patient if the patient is a minor. The applicant must complete and submit a caregiver's registration form, along with a copy of a valid photo ID, such as an N.C. driver's license. During their application, the caregiver must also provide:
The name and address of their patient
The neurologist's name and address
The neurologist's hospital affiliation
A written attestation from the neurologist affirming the patient's condition
Mail the completed application and all supporting documents to:
N.C. Epilepsy Alternative Treatment Registration
3008 Mail Service Center
Raleigh, NC 27699-3008
The DHHS will process the caregiver application and mail a caregiver letter to the applicant, if it is approved. The DHHS caregiver registration letter will identify the person as a registered caregiver in North Carolina and enable them to legally carry cannabis extracts in the state. The letter should always be in the caregiver's possession and must be provided upon request by law enforcement officers.
Marijuana, or hemp, has been cultivated in North Carolina since the late eighteenth century. The State Assembly passed a bill passed in 1762 that allowed North Carolina hemp to be cultivated and exported. Tolerance for marijuana dropped drastically in the twentieth century, most conspicuously after the influx of Mexican immigrants following the Mexican Revolution of 1910. The Poison Act of 1907 was amended in 1913 to include marijuana and restrict its access. The Poison Act was enacted to regulate the sale of certain substances by requiring a physician's written order, without which the sale was prohibited. Marijuana was made illegal in the United States with the passage of the Marihuana Tax Act in 1937. This federal law made marijuana illegal in the country, except for medicinal and industrial use. The 1970 Controlled Substances Act repealed the Marihuana Tax Act but effectively outlawed marijuana for all uses by labeling it a Schedule 1 drug. Schedule 1 drugs, under the Controlled Substances Act, are considered to have no acceptable medical applications and a high potential for abuse.
The passage of the Controlled Substances Act led to a surge in marijuana-related arrests over the next few years. In an effort to reduce the arrest rates and ease the strain on resources, several states, including North Carolina, chose to decriminalize marijuana possession. In 1977, North Carolina reduced the possession of 0.5 ounces of cannabis or less to a misdemeanor with a maximum fine of $200.
There was an initiative introduced in 2014 in the North Carolina legislature to legalize medical marijuana that was defeated in the House Committee. The Committee further issued an unfavorable report that blocked consideration of any bill concerning MMJ for the next two years.
In 2015 Governor Pat McCrory signed HB766 into law, amending the Epilepsy Alternative Treatment Act passed the previous year. This enabled patients diagnosed with intractable epilepsy to use CBD-based cannabis extracts with low THC as an alternative treatment to conventional medications. The cannabis extract can only contain trace amounts of THC - less than 0.9% by weight - and at least 5% CBD. The patient must be diagnosed by a neurologist affiliated with any state-licensed hospital in North Carolina with a severe seizure disorder, such as intractable epilepsy.
In June 2022, North Carolina’s Senate passed the North Carolina Compassionate Care Act with Senate Bill 711. The bill was introduced in 2021 and initiated by Bill Rabon, Paul Lowe, and Michael Lee. The proposed act permits persons with a debilitating medical condition to register and purchase medical marijuana from licensed and regulated medical cannabis dispensaries. The bill establishes the regulatory authority - The Medical Cannabis Production Commission to regulate medical cannabis centers and provide a framework for the licensing, production, and supply of medical cannabis. Lastly, it set forth the fees and tax payable for a cannabis production facility, cannabis suppliers, and medical cannabis center. Senate Bill 711 passed through four senate committees but failed at North Carolina’s House of Representatives.