North Carolina remains one of the few states without a regulated cannabis program—but that could soon change. Lawmakers are once again setting the stage for reform, with the North Carolina House of Representatives recently introducing House Bill 1011, titled the North Carolina Compassionate Care Act. Spanning 28 pages, the bill outlines the framework for a proposed medical cannabis program. While this isn’t the state’s first—or even third—attempt at legalization, it marks a significant shift: for the first time, the House is leading the charge. Historically, efforts have been driven by the Senate, particularly by longtime advocate Senator Bill Rabon (R), whose proposals have repeatedly stalled due to lack of House support. Now, with pressure from Senate President Phil Berger (R), the House is finally stepping up to the plate.
Compassionate Care Act
House Bill 1011 closely mirrors its predecessor from the 2023–2024 legislative session, Senate Bill 3, previously introduced by Senator Bill Rabon. Under HB 1011, the North Carolina Department of Health and Human Services (“DHHS”) would oversee the state’s newly proposed medical cannabis program. A “qualified patient” is defined as an individual diagnosed with a debilitating medical condition, including—but not limited to—cancer, epilepsy, PTSD, and Parkinson’s disease. Unlike many early-stage programs in other states, HB 1011 allows patients to smoke or vape cannabis, provided their physician explicitly recommends that method of delivery. Importantly, all medical cannabis purchases by patients would be exempt from state sales tax under the proposed legislation.
To regulate the program, the bill calls for the establishment of the Medical Cannabis Production Commission within DHHS. Like Senate Bill 3, HB 1011 proposes issuing up to ten (10) “Medical Cannabis Supplier” licenses statewide. These suppliers would be vertically integrated, responsible for cultivating, manufacturing, and dispensing medical cannabis to qualified patients. Each supplier may operate up to eight (8) dispensaries, with at least one required in a Tier 1 county—areas designated as economically distressed.
To be eligible for a supplier license, applicants must demonstrate at least two (2) years of residency in North Carolina and maintain majority ownership in the proposed business. Licensure comes with a $50,000 application fee, plus an additional $5,000 for each dispensary or production facility the applicant intends to operate.
HB 1011 is not the only cannabis-related bill introduced this session. House Bill 984, sponsored by House Democrats, offers a much narrower path to medical cannabis access. It would legalize use only for individuals enrolled in a “registered research study” conducted by a state-approved hospital, university, pharmaceutical manufacturer, or private research entity. Meanwhile, House Bill 413 aims to legalize recreational cannabis outright, and Senate Bill 350 proposes establishing both medical and adult-use cannabis programs—making it the only comprehensive cannabis initiative introduced in the Senate this session.
Conclusion
As the national landscape around cannabis continues to evolve, North Carolina finds itself at a pivotal moment. With HB 1011 signaling the House’s first real effort to lead on medical cannabis reform—and a range of other bills surfacing across both chambers—the pressure is on for lawmakers to deliver meaningful change. Whether the state finally establishes a regulated program will depend on bipartisan cooperation and a willingness to prioritize the needs of patients across the Tar Heel State. While past efforts have stalled, the momentum this session suggests that medical cannabis legalization may finally be within reach.