Voters' Will vs. New Rules: The Battle for Medical Cannabis in Nebraska

On September 2, 2025, the Nebraska Medical Cannabis Commission members announced that they had approved more regulations that would limit a patients’ access to obtaining medical cannabis products (1). These new regulations will need to be approved by Nebraska Governor Jim Pillen. In 2024, voters had approved to legalize medical cannabis through two ballot initiatives (1,2). It was supported by Nebraskan voters by two to one. The Marijuana Policy Project detailed these legal measures (2):

1. Initiative 437 — the Nebraska Medical Cannabis Patient Protection Act:
   1. This initiative works to decriminalize the use and possession of medical cannabis for patients with a healthcare practitioner's written recommendation. It is "self-executing," so it doesn't need legislative approval to take effect.
2. Initiative 438 — the Nebraska Medical Cannabis Regulation Act:
   1. This measure establishes a Nebraska Medical Cannabis Commission that will be able to license and regulate private businesses that provide medical cannabis to patients that qualify. The commission is required to begin granting applications for medical cannabis businesses by October 1, 2025.

In July 2025, the Medical Cannabis Commission approved new regulations that took away a patient’s access to “botanical cannabis” and additionally, limited the number of licensed dispensaries in the state to have no more than twelve establishments. Lastly, the organization mandated physicians to have to “specify which cannabis formulation, potency, and dose is appropriate for each individual patient,” (1). These new legislative measures will limit the “total number of state-licensed cultivators to no more than four and requiring doctors to undergo ten hours of medical education training prior to discussing medical cannabis therapy with their patients, among other changes,” (1).

“By approving rules that pile on new barriers and unlawfully restrict forms of cannabis, they are dismantling what the people demanded at the ballot box,” Crista Eggers, executive director of Nebraskans for Medical Marijuana, said in a statement (1,3). “This is a direct assault on patients, families and the democratic process itself. Nebraskans voted for access to medicine. Instead, the commission delivered defiance, obstruction and betrayal.”

The Nebraskan advocacy group helped lead the effort for the 2024 ballot initiatives (1,3).

Despite the legislation, licensing for medical cannabis businesses planned is mandated to begin by October 1, 2025 (1). Attorney General Mike Hilgers has “threatened to sue” regulators who work toward granting these licenses. “The sale of marijuana — medicinal or otherwise — is not lawful, and therefore, is unconstitutional,” Hilgers said (1). “So, as the attorney general, my job is to enforce the Constitution.”

“This doesn’t have to be a knock-down, drag-out process, but there is a clear law that was passed,” Eggers told the Medical Cannabis Commission (3). “I would appreciate, and the patients here and the patients in this state would appreciate you adhering to what the voters passed.”

“In a healthy democracy, those with competing visions on public policy vie for voters’ support and abide by their voting decisions. However, it is becoming clear that those who oppose marijuana policy reform would rather take voters out of the equation altogether,” said NORML’s Deputy Director Paul Armentano. “Whether or not one personally supports or opposes cannabis legalization, these undemocratic tactics ought to cause of deep concern.”

In July 2025, the Omaha Tribe of Nebraska legalized both recreational and medical cannabis. With the legislation adopted, the tribe became the first fully regulated, as well as legal, adult-use and medical cannabis system within Nebraska (4).

References

1. Norml. NE Medical Cannabis Commission approves new rules restricting patient access https://norml.org/blog/2025/09/03/nebraska-state-appointed-commission-approves-new-rules-undermining-medical-cannabis-access/ (accessed Sep 5, 2025).
2. Marijuana Policy Project. Nebraska Medical Cannabis Laws Faqs https://www.mpp.org/states/nebraska/nebraska-medical-cannabis-laws-faqs/ (accessed Sep 5, 2025).
3. Wendling, Z. Swapped out: New Nebraska Medical Cannabis Regs advance to final approval, draw public ire • Nebraska Examiner https://nebraskaexaminer.com/2025/09/02/swapped-out-new-nebraska-medical-cannabis-regs-advance-to-final-approval-draw-public-ire/ (accessed Sep 5, 2025).
4. Colli, M. Adult-use and medical cannabis legalized by Omaha tribe of Nebraska https://www.cannabissciencetech.com/view/adult-use-and-medical-cannabis-legalized-by-omaha-tribe-of-nebraska (accessed Sep 5, 2025).