With the signature of Gov. Tate Reeves (R) on a compromise medical marijuana bill on Wednesday, Mississippi becomes the 37th state to legalize the use of marijuana for medicinal purposes.

Mississippi voters had overwhelmingly approved medical marijuana at the polls in November 2020, passing a broad medical marijuana measure, Initiative 65, with 74% of the vote (and rejecting a more restrictive legislative alternative, Initiative 65A.) But that victory was nullified by the state Supreme Court, which ruled that the state's signature gathering requirements for initiatives could not be complied with, invalidating not only Initiative 65 but also the whole initiative process in the state.

Heedful of the will of the people, both the legislature and the governor vowed to get a medical marijuana bill passed. The Supreme Court ruling was in May 2021; it took until now for the executive branch and the legislative branch to come to agreement on how to replace what the judicial branch threw out. Meanwhile, patients waited increasingly impatiently.

They got medical marijuana, but in a more restrictive form that what the voted for back in 2020. The Mississippi Medical Cannabis Act (Senate Bill 2095) allows patients to purchase smokeable marijuana, but only ¾ of an ounce per week, and there is no provision for home cultivation. Marijuana flower must be no more than 30 percent THC, while concentrates must be no more than 60 percent.

People with a specified list of conditions -- cancer, Parkinson's, Huntington's, muscular dystrophy, glaucoma, spastic quadriplegia, HIV, AIDS, hepatitis, amyotrophic lateral sclerosis (ALS), Crohn's, ulcerative colitis, sickle cell anemia, Alzheimer's, agitation of dementia, PTSD, autism, pain refractory to opioid management, diabetic/peripheral neuropathy, spinal cord disease, or severe injury -- qualify for medical marijuana.

People with chronic medical conditions that produce wasting, severe nausea, seizures, severe muscle spasms, and chronic pain also qualify, but chronic pain is narrowly defined as "a pain state in which the cause of the pain cannot be removed or otherwise treated, and which in the generally accepted course of medical practice, no relief or cure of the cause of the pain is possible, or none has been found after reasonable efforts by a practitioner."

Doctors, certified nurse practitioners, physician assistants, and optometrists can all sign recommendations for patients if they believe the patient "would likely receive medical or palliative benefit" from medical marijuana. But before they can do that, they have to have completed eight hours of continuing medical education courses on medical marijuana (and five hours each year after that) and have performed an in-person examination of the patient.

People who want to get in the medical marijuana business can obtain licenses if they pay nonrefundable application fees ranging from $1,500 for a 1,000-square foot canopy micro-cultivator license to $100,000 for the largest operators. There is no cap on the number of medical marijuana businesses. There will be a wholesale tax of 5 percent in addition to the state sales tax of 7 percent.

Marijuana reform advocates generally praised the passage of the bill, though with some reservations.

"With this victory, tens of thousands of Mississippians with debilitating health conditions will finally be able to safely and legally access something that can alleviate their pain and improve their quality of life. Mississippi now serves as the latest example that medical cannabis legalization is possible in any state in the country. We are hopeful that this move will add to the growing momentum towards cannabis policy reform in the South," said Toi Hutchinson, president and CEO of the Marijuana Policy Project (MPP) in a press release.

"Marijuana access is long overdue for Mississippi's patients," NORML's State Policies Manager Jax James said in a blog post. "The overwhelming majority of voters decided in favor of this policy change over a year ago, and for the past 14 months the will of the people has been denied."

But James also expressed disappointment in some of both what the bill does contain and what it does not.

"We remain concerned that lawmakers saw fit to add unnecessary taxes on cannabis products, that patients are prohibited from home-cultivating limited amounts of cannabis for their own personal use, and that those with chronic pain are restricted from accessing cannabis products until first using more dangerous and addictive substances like opioids," she said.

For MPP, though, the bottom line was that another state now allows patients access to medical marijuana.

"Despite tremendous support, Mississipians faced an uphill battle for a medical cannabis program. With this new law, justice has finally prevailed. Patients in Mississippi who are seriously ill will no longer be subject to arrest and criminal penalties for using medical cannabis and instead will be met with compassion. We applaud the legislature for working to restore the will of the voters in one of the most conservative states in the nation and Gov. Reeves for signing it into law," said Kevin Caldwell, MPP Southeast legislative manager.

The state Department of Health will begin issuing patient registry cards in 60 days, begin accepting applications from practitioners and begin licensing marijuana businesses other than dispensaries within 120 days, and licensing dispensaries within 150 days. The clock is ticking.