Medical Marijuana: Planning For Legalization

Across the country, the regulatory environment for medical and recreational marijuana is changing rapidly. In November 2022, a study by Pew Research Center revealed that 88 percent of adults nationwide support the legalization of medical cannabis, and 59 percent support legalization for both medical and recreational uses. State-level regulations have transformed to reflect public favor for both medical and recreational legalization, with 37 states having legalized the use of medical cannabis and 21 states having legalized recreational cannabis as of February 2023. Based on the history of legalization nationwide, once a state legalizes cannabis for medical purposes, the legalization of recreational usage often follows within several years. Both medical and recreational legalization, especially recreational, have implications on land use regulation, permitting processes, law enforcement operations, administrative procedures at the local and state levels, equity considerations and more.

In North Carolina, both medical and recreational marijuana usage remain illegal, although some marijuana-related offenses have been decriminalized. As of April 2022, 72% of North Carolinians supported legalizing marijuana for medical purposes. The North Carolina General Assembly is currently considering the Compassionate Care Act, which would establish the statutory and organizational framework for legally using cannabis products to treat debilitating medical conditions. What would these new laws mean for NC local governments, and how can communities best prepare for the future of medical and recreational cannabis?


A similar version of the North Carolina Compassionate Care Act (SB 711) passed the North Carolina Senate in June 2022, but died in committee within the North Carolina House. This year’s bill (SB 3) was passed by the Senate in early March and is now being considered by the House once more. The current version of the bill would establish a medical marijuana program through the North Carolina Department of Health & Human Services. Under the current bill:

  • Ten medical marijuana supplier licenses would be issued to companies to grow, process and sell medical cannabis.
  • Patients with specific medical conditions, many of which are considered terminal, would be permitted to access and use medical cannabis.  
  • Medical cannabis centers would not be permitted within 1,000 feet of a church, childcare facility, public or private school or institution of higher education.
  • Medical cannabis patients would not be permitted to grow their own cannabis or smoke or vape any products purchased in a public place.

SB 3 has been criticized by some advocates for artificially limiting the number of businesses that would be permitted to supply medical marijuana and not doing enough to support efforts to decriminalize marijuana possession. On the other hand, SB 3 is considered to be the version of the bill most likely to pass the House, although other less restrictive bills have begun to filter their way into the session. One example is the Marijuana Justice and Reinvestment Act (SB 346), which was introduced in late March and would create a medical marijuana program with explicit patient protections, legalize recreational cannabis production and consumption, permit home growing of cannabis and expunge previous cannabis possession felony and misdemeanor charges.


From a regulatory perspective, the legalization of medical cannabis tends to create fewer and simpler considerations for regulation and permitting than the legalization of recreational cannabis. Once states have legalized one form of cannabis or the other, communities and counties tend to leverage one of two strategies for regulation: licensing of individual businesses and regulation through zoning. In states where only medical cannabis is legalized, regulation through zoning is prevalent, and this trend appears to be consistent with the NC Compassionate Care Act’s restrictions on where a medical cannabis center can be located. Additionally, many communities combine zoning regulations with business permitting. Although, for states that have only legalized medical cannabis, it is more common for licensing to occur through the state, while local governments tend to have a bit more jurisdiction over licensing and permitting if recreational use is legalized.

Communities that opt to regulate marijuana-related businesses through a business license process will benefit from being able to track trends related to business ownership and operation. Additionally, they may have an easier time ensuring businesses are in compliance with local and state regulations. That said, this approach requires extensive internal and external coordination and collaboration to ensure a smooth administrative process. Communities looking to regulate through zoning may have an easier time regulating marijuana through existing zoning terminology and land uses, including agriculture, retail, industrial manufacturing, food processing and so on. This approach, however, comes with it’s own considerations and caveats. For example, cannabis is often cultivated in warehouses and greenhouses rather than fields of row crops. Opting to include cannabis cultivation under an existing agricultural land use, as opposed to industrial uses, could have implications on the character of development in those areas.


As the Compassionate Care Act and similar legislation progress through the NC General Assembly, communities must remain attuned to the potential local and statewide implications of medical, and someday recreational, cannabis legalization. Given the public’s widespread support for legalization of medical cannabis, communities should be prepared for legalization to occur sooner rather than later. Most importantly, communities should remain collaborative and proactive in their approaches to planning for and regulating cannabis-related businesses and land uses.

In our upcoming Centralina Learns session, Medical Marijuana: Planning for Legalization, we will hear from communities outside North Carolina about their experiences related to legalization, regulation and permitting. We’ll also hear from North Carolina experts on what the current legislation would mean for North Carolinians and their communities related to administration, land use, public education, law enforcement and equity. Register at the link above to register for the session and engage in dialogue on this “budding” issue!