Cannabis
in Missouri

Under Article XIV, Section 1 of the Missouri Constitution, as amended by voters in 2022, adults 21 and older may possess up to three ounces of dried marijuana or its equivalent, and may buy up to three ounces in a single transaction. Medical patients are allowed more. The Division of Cannabis Regulation sets the standard patient allowance at six ounces a month, and a physician can certify a need for a larger amount. People who grow at home may keep more than three ounces inside their locked cultivation space, but no more than three ounces outside it. Holding more than three ounces but less than six is a civil infraction with a fine of up to $250 for a first violation. Larger amounts can be charged as possession with intent to distribute.

Adults must be 21 or older to buy, possess or use adult-use marijuana in Missouri under the constitutional amendment voters approved in 2022, and retailers must check valid government photo ID. The medical programme sets no minimum age. Patients under 18 can be certified by a physician or nurse practitioner, but the application must include the Division of Cannabis Regulation's Parent/Legal Guardian Consent Form. Once the minor is approved, the parent or guardian must apply to be their caregiver, and only the caregiver may purchase on the minor's behalf. Patients aged 18 to 20 can hold a medical card in their own right, which gives them lawful access to medical dispensaries even though they are too young for adult-use stores.

Missouri allows home cultivation for both adults 21 and older and medical patients, but only with a cultivation registration from the Department of Health and Senior Services. A registered grower may keep six flowering plants, six nonflowering plants and six clones under 14 inches, and all of them must be in an enclosed, locked facility at a private residence. Two registered growers may share one residence and double those counts, provided the department is notified in advance. Caregivers with several patients can grow more. Secondary sources describe the adult-use registration fee as about $100 a year, with a lower cost for patient cultivators. Growing without a registration, or above the plant counts, is penalized, and harvested cannabis kept outside the locked space still counts against the three-ounce limit.

Missouri's cannabis programmes are run by the Division of Cannabis Regulation within the Department of Health and Senior Services. The Division oversees both the medical programme created by Amendment 2 in 2018 and the adult-use market created by Amendment 3 in 2022. It issues patient, caregiver and facility agent ID cards and licenses cultivation, manufacturing, dispensary, testing and microbusiness facilities. It also handles product testing and recalls and sets rules such as those on curbside pickup. Its regulations are in Title 19, Division 100 of the Code of State Regulations. Licensees must report through the state's Metrc seed-to-sale tracking system. Cities and counties do not license cannabis businesses, but they can regulate public consumption. Springfield, for example, applies its smoke-free air ordinance to cannabis smoke.

Missouri taxes adult-use and medical cannabis at different state rates. Adult-use purchases carry a 6 percent state tax, and cities and counties may add a local tax of up to 3 percent. Medical purchases by registered patients carry a 4 percent state tax, and the revenue is directed to veterans' services through the Missouri Veterans Commission. Sources differ on how general sales taxes stack on top of these cannabis-specific rates, and the official pages in this brief do not break it down, so the total at the register can vary by location. The lower medical rate is one of the main practical reasons adults who qualify keep a patient card, together with the higher purchase allowance. If a card lapses, the patient pays the adult-use rate.

Missouri's constitution does not create licensed consumption lounges, and the sources in this brief describe no licence category for on-site use at dispensaries. Consumption is effectively limited to private residences, and landlords may prohibit smoking on their property. Public use is banned in places such as streets, sidewalks, parks, parking lots and the common areas of buildings. It is also banned in vehicles: drivers may not consume, and passengers may not smoke in a moving car. The same restrictions apply to medical patients under Article XIV, Section 1. Local ordinances can go further. Springfield, for instance, bans consumption in parked vehicles in public places and treats cannabis smoke the same as tobacco smoke under its Smokefree Air Act.

Getting a Missouri medical card starts with a certification from a physician (MD or DO) or nurse practitioner who is in good standing in Missouri. Verified practitioners can file the certification form electronically. The patient then applies through the Division of Cannabis Regulation's online registry portal, which is the only way to submit. Secondary sources say this must happen within 30 days of the practitioner signing. The Division has 30 days to approve or reject the application, and approved patients download or print their ID card, which carries a number beginning with PAT. Applications can be rejected for errors such as typos or an unsuitable photo, and applicants can correct and resubmit them. Minors apply with a parent or guardian consent form, and that adult then applies as their caregiver.

Missouri's constitutional amendment names a set of qualifying conditions, including cancer, epilepsy, intractable migraines, PTSD, HIV/AIDS, ALS, Alzheimer's disease, multiple sclerosis, Parkinson's disease, Huntington's disease, Tourette's syndrome, inflammatory bowel disease and Crohn's disease, hepatitis C, chronic pain, wasting syndrome and terminal illness. The list is not closed. A certifying physician or nurse practitioner may also recommend cannabis for any chronic, debilitating or other condition they judge serious enough, which gives Missouri one of the more flexible programmes. Because practitioners have that discretion, the state has no formal petition process for adding conditions. The Division of Cannabis Regulation does not reject applications on medical grounds. It reviews them for completeness and accuracy.

An applicant needs a current certification from a Missouri-licensed MD, DO or nurse practitioner. Secondary sources say the certification is usable for 30 days, so the application should be filed promptly. Missouri no longer requires patients to be state residents. Applications go through the Division of Cannabis Regulation's online portal with a photo, identification and the state fee. Sources give that fee as about $25 to $28. Patients under 18 must also submit the Parent/Legal Guardian Consent Form. Caregivers file their own application with a Patient Authorization Form and the patient's ID number, must be 21 or older, and may serve up to six patients. Patients who want to grow add a separate cultivation registration, which carries its own fee.

Missouri medical ID cards must be renewed through the online registry portal before they expire. The Division of Cannabis Regulation sends reminders 60, 45, 30 and 15 days before the expiration date. A renewal may be submitted as early as 60 days before expiry and no later than 30 days before it. Like a first application, a renewal needs a current certification from a physician or nurse practitioner, and the Division has 30 days to process it. Sources disagree on how long a card lasts, with some describing an annual cycle and others three years, so patients should rely on the expiration date printed on their own card. If a card lapses, the patient loses the medical tax rate and the higher purchase allowance until a new card is issued.

The Division of Cannabis Regulation's patient pages in this brief require certification from a physician or nurse practitioner in good standing in Missouri. They do not say whether the evaluation must be in person, and they do not address telehealth directly. Secondary sources describe certifying evaluations as available either in person or by telemedicine, and commercial clinics routinely offer remote appointments. Nothing in the brief indicates that a certification issued after a proper telehealth visit is treated differently. Whatever the format, the practitioner must be licensed in Missouri and must submit a valid certification form, which verified practitioners can do electronically. A patient using a remote service should confirm that the certifying clinician holds an active Missouri licence before paying for a visit.

The sources in this brief do not establish that Missouri dispensaries accept medical cards issued by other states. One source says the state does not offer full reciprocity. Missouri has removed its residency requirement, however, so a visitor with a qualifying condition can apply for a Missouri card after a certification from a Missouri-licensed physician or nurse practitioner. Any adult 21 or older with valid government photo ID can also buy from adult-use dispensaries without a medical card, within the three-ounce limit. The medical tax rate and higher purchase allowance are available only to Missouri cardholders. Cannabis bought in Missouri may not lawfully be carried into states where it is illegal, and federal law prohibits interstate transport.