Alabama Medical Cannabis Qualifying Conditions — 17 Conditions Under § 20-2A-3(21)

Last verified: May 2026

The Compassion Act Qualifying-Condition Schedule

How the 17 Conditions Were Selected

The Compassion Act’s 17-condition list was negotiated during the 2021 legislative process. Sen. Tim Melson and Rep. Mike Ball balanced patient-advocacy proposals (which had argued for broader symptom-based eligibility) against conservative legislators’ concerns about "recreational creep." The resulting list focuses on conditions with peer-reviewed evidence of cannabis efficacy, conditions where conventional pharmacotherapy has documented limitations, and conditions of high political-coalition salience (PTSD especially among veterans and first responders).

Conditions Notable for Inclusion

• Autism spectrum disorder. One of the few state programs to expressly include autism. The clinical evidence base is mixed; the political salience among parents was decisive.
• Depression. Most state programs do not include depression as a standalone qualifying condition. Alabama’s inclusion reflects Sen. Melson’s pharmacology-based framing.
• PTSD (military and first-responder). The bill expressly extends PTSD coverage to military and first-responder PTSD — an explicit acknowledgment of veteran-advocacy lobbying.
• Sickle cell anemia. A condition disproportionately affecting Black Americans; its inclusion reflected coalition-building by Rep. Laura Hall and the Alabama Legislative Black Caucus.
• Chronic or intractable pain. Available only when conventional therapeutic and opiate intervention is contraindicated or has proved ineffective. The two-tier requirement is more restrictive than the chronic-pain inclusion in most state programs.

Conditions Notable for Exclusion

Several conditions common in other state programs are not covered by the Compassion Act:

• Glaucoma. Excluded despite glaucoma’s historical status as a flagship medical-cannabis indication.
• Anxiety disorders generally. Only panic disorder is covered; generalized anxiety disorder, social anxiety disorder, and obsessive-compulsive disorder are not.
• Chemotherapy-induced peripheral neuropathy. Not specifically listed; would have to qualify under chronic-pain.
• Migraine. Not covered.
• Inflammatory bowel disease (other than Crohn’s). Ulcerative colitis is not specifically listed.
• Insomnia or sleep disorders. Not covered.

Patients with these conditions may be eligible if their condition produces qualifying symptoms (e.g., a migraine sufferer may qualify for chronic / intractable pain if conventional treatment has failed) but the certifying physician must make that case.

The "Conventional Treatment Has Failed" Requirement

For most of the 17 conditions, the Compassion Act requires documentation that conventional treatment has failed — unless cannabis is considered first-line under current standard of care. The "conventional treatment has failed" requirement varies by condition:

• Chronic / intractable pain: Both conventional therapeutic and opiate intervention must be contraindicated or have proved ineffective. The double requirement is more restrictive than other states.
• Depression: Standard antidepressant therapy must have been tried or be contraindicated.
• PTSD: Conventional psychotherapy and pharmacotherapy must have been tried or be contraindicated.
• Cancer-related cachexia/nausea/pain: Cancer diagnosis itself qualifies; conventional treatment failure is not separately required for the symptom-management aspect.

Adult Daily THC Cap — 50 mg Default, 75 mg With Physician Approval

Adult patients (19+) are capped at 50 mg total THC per day for the first 90 days of registration. After 90 days, the certifying physician may approve up to 75 mg total THC per day with documented justification:

• Inadequate symptom control at 50 mg.
• Established tolerance.
• Terminal illness (where higher doses may be appropriate for end-of-life palliative care).
• Documented medical appropriateness.

The cap is total cannabinoid — not per dose — and is tracked via the state seed-to-sale system. Dispensaries verify the cap at each visit and decline to dispense over the limit.

Minor Patient Cap — 3% THC Dose-Form Maximum

Patients under 19 face a 3% THC dose-form maximum — meaning the formulation administered cannot exceed 3% THC by composition. The cap is designed to limit psychoactive exposure for pediatric patients while permitting high-CBD / low-THC formulations for conditions like pediatric epilepsy. Minor patients require a designated caregiver who handles purchase and administration on the patient’s behalf.

The 70-Day Supply Limit

Patients are limited to a 70-day supply per dispensing visit. The 70-day calculation is the daily THC cap multiplied by 70 (so an adult patient at the 50 mg/day cap can purchase up to 3,500 mg of THC per visit; an adult at the 75 mg/day expanded cap can purchase up to 5,250 mg). The 70-day supply must last at least 70 days from purchase — the next dispensing visit must be at least 70 days later.

Adding Conditions to the List

The Compassion Act creates a procedural mechanism for AMCC to add conditions to the qualifying list under § 20-2A-3(21)(p). The petition process requires medical evidence and AMCC review. As of May 2026, no additional conditions have been added beyond the original 17. Petitions filed by patient-advocacy groups are pending.