The initiatives became law on December 10, 2024, when Gov. Jim Pillen (R) signed a proclamation that certified those election results.

Initiative 437 — the Nebraska Medical Cannabis Patient Protection Act — removes penalties from patients who possess and use allowable amounts of cannabis with a healthcare practitioner's written recommendation. It is “self-executing,” meaning it does not require any further action from the Legislature. 

Initiative 438 — the Nebraska Medical Cannabis Regulation Act — creates a Nebraska Medical Cannabis Commission to license and regulate private businesses that provide medical cannabis to qualified patients. Regulations are due on  July 1, 2025.  The commission is required to begin granting applications for medical cannabis businesses by October 1, 2025.

Thee is no list of qualifying conditions. Healthcare practitioners can certify any patient for whom “in the healthcare practitioner’s professional judgment, the potential benefits of cannabis outweigh the potential harms for the alleviation of a patient’s medical condition, its symptoms, or side effects of the condition’s treatment.”

An adult patient must have a written recommendation from a healthcare practitioner stating that, in the practitioner’s professional judgment, “the potential benefits of cannabis outweigh the potential harms for the alleviation of a patient’s medical condition, its symptoms, or side effects of the condition’s treatment.” The declaration must be signed and dated by the practitioner.

Minor patients must also have a signed and dated written recommendation from a healthcare practitioner, with the same requirements as adult patients. They also must have written permission from a parent or legal guardian who has authority to make their healthcare decisions.

For two years after its issuance, unless the healthcare practitioner specifies a different period of time in the recommendation.

Any physician (MD), osteopathic physician (DO), physician assistant, or nurse practitioner who is licensed under Nebraska's Uniform Credentialing Act or who is licensed in any state and practicing in compliance with the Uniform Credentialing Act.

Yes, caregivers may assist patients "by possessing and acquiring an allowable amount of cannabis and cannabis accessories on behalf of the qualified patient and delivering an allowable amount of cannabis and cannabis accessories to the qualified patient."

Caregivers for adults who are 18 or older must be at least 21 years of age and must have been designated by the qualified patient in a signed affidavit.

In the case of minors and patients under the protection of a legal guardian, a caregiver is either the person's guardian or parent with authority to make healthcare decisions for them or is a person designated in a sworn affidavit by the legal guardian or parent.

Healthcare facilities and home health agencies may also be designated by sworn affidavit if they agree in writing to serve as a caregiver.

No.

Up to five ounces of cannabis not counting "the weight of any other ingredient combined with cannabis as part of topical or oral administrations, food, drink, or other preparations."

Penalties are removed for patients who possess, use, and acquire medical cannabis and for caregivers who assist them by possessing and acquiring cannabis on their behalf. The law does not specify that the cannabis must be acquired from any specific source. Medical cannabis businesses will likely not open in Nebraska until 2026. However, cannabis is legal for all adults 21 and older in two of Nebraska's border states — Colorado and Missouri.

A new Nebraska Medical Cannabis Commission will license private businesses to possess, manufacture, distribute, deliver, and dispense medical cannabis. It can issue different types of licenses for different activities.

The first three members of the Nebraska Medical Cannabis Commission will be the three members of the Nebraska Liquor Control Commission. The governor can appoint two more members, which would need confirmation from the legislature. The commission will also have staff.

It will promulgate and enforce reasonable rules for those businesses and conduct inspections.

The law is silent on this point. It is advisable to be discreet, however. Even if public smoking of cannabis was found to be allowed, doing so may spur backlash that could increase support for hostile revisions to the law. Public smoking of cannabis was part of what spurred backlash in Montana that resulted in that state's voter-enacted medical cannabis law being gutted by lawmakers in 2011.

No. Every cannabis consumer, medical or otherwise, and every person who sells cannabis is currently in violation of federal law. While the federal government has generally not been prosecuting those who comply with state cannabis laws for over a decade, federal law can still create many issues for medical cannabis patients.

Unfortunately, probably not. Nebraska's medical cannabis initiatives had to be very simple and narrow due to a 2020 single-subject ruling. They do not include any explicit non-discrimination protections such as those included in MPP's model bill to make sure people can't lose their jobs, custody of their children, or their access to medical care based on medical cannabis. While at least two states' courts have ruled those states' generally applicable disabilities laws protect disabled patients from being fired for medical cannabis, other states' courts have ruled otherwise. The federal Americans with Disabilities Act (ADA) does not apply to medical cannabis because it is federally illegal — though that could possibly change if cannabis is rescheduled to Schedule III.

Yes, but the Legislature can only "amend, repeal, modify, or impair" a voter-approved ballot initiative if two-thirds of its members or more vote to do so.

Patients and their allies need to make their voices heard. Reach out to your state senator and Gov. Pillen and let them know you want them to stand with patients, their loved ones, and a supermajority of voters.