South Dakota

South Dakota voters approved Initiated Measure 26 in November 2020 with 70% support, legalizing medical cannabis. The program launched in 2021 and has seen rapid growth, with approved medical cannabis cards up 62% year over year as of April 2026. The Department of Health administers the program, which as of March 2026 serves approximately 18,759 approved patients with 540 caregivers and 219 approved practitioners. The state has roughly 81 licensed dispensaries along with 35 cultivators, 19 manufacturers, and six testing labs. Qualifying conditions include chronic pain, PTSD, cancer, epilepsy, Crohn's disease, and ALS. A 2020 adult-use amendment (Amendment A) was struck down by the state Supreme Court in 2021, and a 2024 recreational ballot measure was defeated with 55% voting against. Patients may possess up to 3 ounces of cannabis.

Ask the Expert about South Dakota

Regulator

Medical Cannabis Program, South Dakota Department of Health

Key Legislation

S.D.C.L. §34-20G

Year Legalized

2020

Program Size

~18,759 approved patients

Key Facts

Approved by 70% of voters in 2020 via Initiated Measure 26
Patient count grew 62% year over year as of April 2026
Approximately 81 licensed dispensaries, 35 cultivators, and 19 manufacturers
Adult-use Amendment A was struck down by the state Supreme Court in 2021
A 2024 recreational legalization ballot measure was defeated with 55% voting against

Key Legislation

S.D.C.L. §34-20G (South Dakota Medical Cannabis Act)

Regulatory Body

Medical Cannabis Program, South Dakota Department of Health

Country Info

ISO Code

Region

North America

Tier

Tier 2 — Emerging

Status

Medical — Legal

Sources

South Dakota Department of Health — Medical Cannabis Program South Dakota Medical Cannabis Act (S.D.C.L. §34-20G)

Disclaimer: This information is for general reference only and does not constitute legal advice. Cannabis regulations change frequently. Always verify with official sources and local legal counsel before making compliance decisions.