Medical marijuana is not legal in North Carolina. The state has no functioning medical cannabis program, and possession of marijuana remains a criminal offense under state law. Several bills have been introduced in the General Assembly to change this, but none have passed into law as of 2025.
Where Legalization Efforts Stand
North Carolina lawmakers have introduced multiple cannabis-related bills in the 2025-2026 legislative session, but none have gained significant traction. House Bill 1011, titled the NC Compassionate Care Act, would create a medical cannabis program. House Bill 413, the Marijuana Legalization and Reinvestment Act, goes further by proposing full legalization. H413 passed its first reading in the House on March 18, 2025, then was referred to the Rules, Calendar, and Operations committee, where it has sat without further action.
Previous sessions saw similar efforts stall. Senate Bill 3, also called the Compassionate Care Act, was introduced in an earlier session and outlined a medical-only framework. It attracted bipartisan interest but never reached a full floor vote. The pattern in North Carolina has been one of introduction, committee referral, and inaction.
What the Proposed Program Would Look Like
If the Compassionate Care Act were to pass, it would establish a fairly restrictive medical program. Patients would need a written certification from a physician confirming a qualifying diagnosis. The proposed list of qualifying conditions includes:
- Cancer
- Epilepsy
- HIV/AIDS
- ALS (Lou Gehrig’s disease)
- Crohn’s disease
- Sickle cell anemia
- Parkinson’s disease
- PTSD, with evidence of a traumatic event such as military combat, being the victim of a violent or sexual crime, or service as a first responder (details of the trauma itself would not be required)
- Multiple sclerosis
- Cachexia or wasting syndrome
- Severe or persistent nausea related to end-of-life care, or in patients who are bedridden or homebound (excluding pregnant individuals)
- Terminal illness with a life expectancy under six months
- Hospice care
The bill also proposes a Compassionate Use Advisory Board that could add conditions to this list over time. Patients would register through a state-run system and receive a medical marijuana card. But again, none of this is currently in effect.
The One Place in NC Where Cannabis Is Legal
There is a single exception within North Carolina’s borders. The Eastern Band of Cherokee Indians, a federally recognized sovereign nation based on the Qualla Boundary in western North Carolina, has legalized cannabis on its tribal land. The tribe decriminalized possession in 2021 and opened the Great Smoky Cannabis Company, the state’s first marijuana dispensary, in 2024.
The dispensary initially sold medical marijuana to anyone 21 or older who held a tribal medical card or a valid out-of-state medical marijuana card. After the tribal council passed a recreational use ordinance on July 4, 2024, the dispensary expanded access to adult members of any federally recognized tribe. North Carolina state law does not apply on sovereign tribal land, so this dispensary operates entirely outside the state’s legal framework. Non-tribal members without an out-of-state medical card cannot purchase cannabis there.
Current Penalties for Possession
Outside tribal land, marijuana remains a Schedule I controlled substance in North Carolina. Possessing any amount is illegal, though the consequences vary significantly by quantity.
Simple possession is classified as a Class I felony under state statute, though in practice, small amounts (half an ounce or less) are typically charged as misdemeanors and may result in a fine or probation for first-time offenders. Giving someone less than 5 grams without payment does not count as a “delivery” offense under state law.
The penalties escalate sharply at higher quantities. Possessing more than 10 pounds triggers trafficking charges: 10 to 50 pounds carries a minimum sentence of 25 months in prison and a $5,000 fine. At 50 pounds or more, that jumps to at least 35 months and a $25,000 fine. Amounts over 2,000 pounds carry a minimum of 70 months and $50,000, and 10,000 pounds or more means at least 175 months in prison with a $200,000 fine.
Hemp-Derived THC Products
While marijuana is illegal, hemp-derived products containing THC (like delta-8 and delta-9 edibles made from hemp) are currently legal in North Carolina. These products are widely available in gas stations, vape shops, and specialty stores across the state. Some contain enough THC to produce noticeable psychoactive effects, which is why many people use them as an alternative in the absence of a medical program.
The regulatory environment around these products is remarkably loose. As of now, there are no state or federal age restrictions on purchasing hemp-derived THC products, no limits on how much you can buy, no concentration caps, and no required child-safety packaging or quality testing standards. This lack of oversight has drawn criticism from both legalization advocates and opponents, and it may become a factor in future legislative debates about creating a regulated cannabis program.