Medical HIGH

North Dakota

North Dakota remains a strictly medical-use state, having rejected comprehensive adult-use cannabis ballot initiatives in 2018, 2022, and November 2024.
The state's medical cannabis program is one of the smallest and most tightly controlled in the nation, capping the market at two manufacturing facilities and eight dispensaries statewide.
North Dakota is functionally surrounded by adult-use jurisdictions (Montana and Minnesota), creating significant cross-border economic and enforcement dynamics.
Despite partial decriminalization of simple possession in 2019, Black residents face arrest rates for cannabis possession that are 5.5 times higher than those of white residents.
The 2025 legislative session authorized low-dose edibles (lozenges) and two-year medical identification cards, representing incremental expansion of the medical program.

North Dakota represents a unique paradigm within the broader midwestern United States concerning cannabis policy. While the state authorized the medical use of cannabis through a citizen-initiated ballot measure in 2016, subsequent legislative interventions significantly curtailed the program's scope, notably by eliminating home cultivation provisions. The state operates under a conservative political trifecta that has consistently prioritized strict regulatory controls, limited market licensing, and robust law enforcement funding over rapid market expansion or social equity initiatives. The trajectory of adult-use legalization in North Dakota indicates a slow but measurable shift in public opinion. The margin of defeat for adult-use ballot measures has narrowed sequentially: 59% opposed in 2018, 55% opposed in 2022, and 53% opposed in 2024. This narrowing gap, combined with the successful adult-use legalization in neighboring Minnesota and Montana, suggests that while North Dakota remains a medical-only state, the pressure to conform to regional market norms continues to build. The state's regulatory body, the Department of Health and Human Services (DHHS), maintains rigorous oversight of the active medical patient registry, which hovered near 10,500 individuals by early 2026.

Medical

Medical Program

Medical Status: Legal — registered patients only, for specific debilitating conditions. Authorized via Initiated Statutory Measure 5 (2016), heavily restricted by SB 2344 (2017). No home cultivation permitted.^[9]

The North Dakota medical cannabis market has grown steadily since retail operations launched in 2019, climbing from $6.36 million in FY 2020 to $21.6 million in FY 2023, with estimates projecting stabilization around $25 million in 2024. Dried flower accounts for approximately 66% of market volume. Revenue collected by the state from program fees (patient registrations, dispensary certifications, manufacturing licenses) totaled $2,114,824 across the 2021–2023 biennium. The market is defined by severe structural constraints: two licensed manufacturers supply all eight retail dispensaries. There is no specialized state excise tax on medical cannabis — gross receipts are taxed at the standard 5% state sales tax rate plus local levies, yielding an effective rate near 7%. This restricted supply chain drives pricing notably higher than neighboring adult-use states, with flower commanding $40–$60 per eighth and $280–$400 per ounce. The 2025 edibles authorization introduced lozenge products ranging from $25–$50 per package.

Penalties (Outside Medical Program)

Offense	Amount	Classification	Penalty
Possession	Under 0.5 ounces (14 grams)	Civil Infraction	Civil infraction; maximum $1,000 fine. No jail time. ^[8]
Possession	0.5 ounces to 500 grams	Class B Misdemeanor	Up to 30 days incarceration, maximum $1,500 fine. ^[8]
Possession	Over 500 grams	Class A Misdemeanor	Up to 360 days incarceration, maximum $3,000 fine. ^[8]

Criminal Justice

Despite partial decriminalization in 2019, cannabis enforcement remains a significant burden on North Dakota's judicial and law enforcement resources. In 2023, more than 2,300 criminal cases filed involved solely cannabis-related charges. Through the first half of 2024, approximately 1,350 such cases were generated. Enforcement disproportionately impacts communities of color. According to the ACLU North Dakota, Black individuals in North Dakota are 5.5 times more likely to be arrested for cannabis possession than white individuals — placing the state 7th nationally for racial disparity in cannabis possession arrests. The starkest disparities were documented in Morton, Cass, Burleigh, Grand Forks, and Ward counties. Academic research confirms that the 2019 decriminalization did not ameliorate these underlying racial biases. North Dakota has no cannabis-specific expungement mechanism. The only available pathway is a Summary Pardon Application, a discretionary process revised in 2019 to allow those convicted of simple possession or paraphernalia offenses to apply, provided no new criminal convictions occurred in the preceding five years. Approval requires a recommendation from the Pardon Advisory Board followed by a final unilateral decision by the Governor.

What North Dakota Is Leaving on the Table

If North Dakota had adult-use cannabis sales at the level of operational states:

Benchmark	Per Capita	Rank	Estimated ND Market
Connecticut (#20)	$60.73	Lowest	$46M
New Jersey (#15)	$126.23	Mid-pack	$96M
Colorado (#9)	$196.26	Mature	$149M

Based on total state population and per capita sales from operational markets. Actual results vary by market design, tax structure, licensing speed, and border dynamics. See how all 20 legal states compare →

Borders

Border Dynamics

Neighbor	Legal Status	Notes
Montana	Adult-Use Legal, Medical Legal	—
Minnesota	Adult-Use Legal, Medical Legal	—
South Dakota	Medical Legal; adult-use has been repeatedly rejected or overturned by courts	—

North Dakota's geographic position between two functional adult-use markets — Montana to the west and Minnesota to the east — creates sustained cross-border pressure on its prohibition regime. Law enforcement and judicial officials widely acknowledge that residents regularly cross state lines to access recreational cannabis, returning with product that is technically illicit within North Dakota. This dynamic is particularly pronounced in the southwestern corridor near Montana. Prosecutors in this region have noted that local juries and attorneys have grown weary of aggressively pursuing simple possession cases, reflecting a de facto decriminalization effect driven by regional legal norms. South Dakota to the south maintains a medical-only framework, providing no comparable pull factor. Neither the North Dakota Highway Patrol nor the Midwest HIDTA publishes granular corridor-specific interdiction data for cannabis trafficking originating from legal adjacent markets.

Economic

Economic Opportunity

Operating strictly as a medical market with approximately 10,500 patients, North Dakota's current medical cannabis market is valued between $21.5 million and $25 million annually. The failed 2024 adult-use Measure 5 was deliberately engineered to be highly restrictive — capped at 7 manufacturing licenses and 18 retail licenses — to appeal to conservative voters. The North Dakota Legislative Council's fiscal note for that measure projected $10,227,600 in new state revenues during the 2025–2027 biennium against $8,324,275 in administrative and enforcement costs, yielding a modest net positive fiscal impact. These revenues would have derived largely from standard sales tax streams, as the measure controversially avoided imposing a specialized excise tax. No granular job creation estimates have been published.

Political