West Virginia legalized medical cannabis in 2017 when former Gov. Jim Justice signed the Medical Cannabis Act. The goal of medical legalization was to provide alternative treatment for symptoms of severe medical issues.

“How could you turn your back on a loved one who is suffering? This is a vehicle for our doctors to help the people,” Justice said at the signing ceremony on April 19, 2017.

Today there are 35,553 active cardholders in West Virginia, according to the state’s Office of Medical Cannabis (OMC).

West Virginia is one of 26 states where recreational marijuana use is illegal. Pushes to legalize recreational use have fallen short. At the federal level, marijuana is still considered a Schedule I drug from the Controlled Substances Act — a drug with no currently accepted medical use and a high potential for abuse.

Patients and cannabis industry workers have welcomed the medical cannabis program, but they see room to grow and believe West Virginia can benefit from access to edibles, secure gun rights and broader cannabis education.

Patients seeking a medical card should first see a registered physician. There are over a hundred registered physicians in the state and a couple of dozen telemedicine companies. 

Jennifer Kirby, a patient and employee at Elevate Holistics, a company dedicated to assisting patients with their medical cards, said a majority of patients meet with a provider online, and the appointments can range from $45 to $99. Health insurance typically does not cover appointments because of marijuana’s federal status.

“All these people want to get off of all their meds, and they just want to be able to be happy,” Kirby said. “I think it’s great.”

Kirby has assisted patients from 15 to 80 years old. For minors to become patients, the state requires they have a registered caregiver. Patients under 17 years old made up 0.1% of the program in 2023, according to a state report. Patients can also designate a caregiver to facilitate delivery of medical cannabis.

Patients need a diagnosis from a registered physician of one of 15 medical conditions that were approved by the state to receive medical cannabis. Those include:

• cancer 
• positive status for HIV or AIDS
• amyotrophic lateral sclerosis 
• Parkinson’s disease 
• multiple sclerosis 
• damage to the nervous tissue of the spinal cord with objective neurological indication of intractable spasticity
• epilepsy 
• neuropathies 
• Huntington’s disease 
• Crohn’s disease 
• post-traumatic stress disorder 
• intractable seizures 
• sickle cell anemia 
• severe chronic or intractable pain of neuropathic origin or severe chronic or intractable pain 
• terminal illness

The physician will then send certification to the OMC. A state application found on the OMC’s website should be completed by patients for a $50 fee, which may be waived for residents experiencing financial hardship. 

Patients can expect to receive a digital card within 24 to 48 hours of submitting the application, barring any complications with the OMC. The cards require renewal once a year, following the same process as a new applicant. 

With a valid medical card and state ID, patients can purchase up to 6 ounces of medical cannabis per month. The amount of product purchased is tracked to an individual’s medical card identification.

The Medical Cannabis Act approved pills; oils; tinctures; liquids; dermal patches; topical forms, including gels, creams and ointments; and a form medically appropriate for vaporization or nebulization, like dry leaf or plant form. Approved accessories and devices, like dry herb vaporizers and batteries, are available at most dispensaries, said Stoney Helmick, senior vice president of NewLeaf, a medical cannabis dispensary.

Bud/flower is the most popular product statewide, comprising 65% of all sales according to data collected by the OMC. Vape cartridges make up about 20%, and concentrates about 10%. Pills and liquid tinctures make up less than 3% of sales. 

Per state law, smoking cannabis is prohibited. Edibles are not permitted for sale, but patients can mix ingestible products with food or drinks themselves.

Most other states with medical programs allow edibles. Kelly Beacham, a medical cannabis patient and former smoker in Berkeley County, said she would support the addition of edibles. 

“I prefer them over flower as it’s protecting my lungs,” she said. “There is an option to produce my own edibles, but it’s extremely time consuming.”

Medical marijuana is sold at dispensaries across the state, but Delta-8 products that can appear similar are sold at stores to anyone. 

Both marijuana and hemp, which is used to make Delta-8, come from the cannabis sativa family, but hemp has a much weaker concentration of THC, the chemical compound that causes a “high.”

The state recognized industrial hemp as an agricultural crop in 2002, which can be used to manufacture textiles and biofuels and also be extracted for CBD oil. 

Congress passed the Hemp Farming Act of 2018, which removed hemp with less than 0.3% THC as a Schedule I drug. West Virginia hemp industries are regulated by the state’s Department of Agriculture.

Delta-8 derived from hemp plants containing less than 0.3% THC is federally legal and has minimal psychoactive effects, according to the Marijuana Policy Project.

It is a felony for Americans to possess firearms while consuming marijuana because of its federal status. It is unclear whether there are federal or state protections for possessing both at the same time, even in states where it is recreationally or medically legal. 

Identification is required for both entering the medical program and purchasing a firearm. Rusty Williams, patient advocate on the state’s Medical Cannabis Advisory Board, said some West Virginians fear they may lose their Second Amendment rights if they join the medical program.

“They look at it like by participating in the program, they’re ultimately volunteering to put themselves on a list, and that alone is enough to scare people away from participating,” he said.

State law holds that employers cannot discriminate against employees solely for being a medical card holder. However, West Virginia is an at-will state, meaning employers can terminate employment at any time, with or without cause. 

“I’ve heard from multiple patients who have lost their jobs because someone found out that they have a medical card, and some nonsense excuse was used to justify their termination,” Williams said. “The patients ultimately believe that they were discriminated against.”

He said that until the federal government provides clarification, it’s difficult to navigate.

Medical card holders who are on probation are under the discretion of a judge whether they can continue using medical cannabis. There is no specific policy, and it is typically decided on a case-by-case basis.

West Virginia medical cards do not apply in other states with medical programs, nor do out-of-state medical cards work here.

When Justice signed Senate Bill 386 in 2017, the initial program only called for 10 growers and processors and 30 dispensaries, not allowing for vertical integration, which means a grower and processor couldn’t also hold a permit for a dispensary. 

Senate Bill 1037, signed in 2019, expanded dispensary permits to 100 in the state and allowed for vertical integration. A majority of operational grower and processor facilities have at least one affiliated dispensary. Vertical integration allows for a streamlined supply chain, which cuts intermediate costs. 

During the initial application and awarding process for grower, processor and dispensary permits in early 2020, all openings were filled. Now, according to the OMC’s website, only nine grower, nine processor and 74 dispensary permits are active. 64 dispensaries are operational. 

The OMC has estimated 2,000 jobs have been created through direct employment — employees at grower, processor and dispensary facilities — and indirect employment —contract workers including construction, plumbing, electricians, security, etc. — with the state’s medical cannabis industry.