Voters Decide on Health-Related Ballot Proposals

November 12, 2020 | Andy Baker-White

In last week’s election, voters in several states cast their ballots on proposals related to the use of legal and illicit drugs. These ballot proposals influence key public health issues such as tobacco control, substance use prevention and treatment, and mental health—with many of them implemented by state health agencies.

Below is a brief summary of the proposals to increase tobacco prices, reallocate the use of tobacco settlement funds, allow the medical and non-medical use of marijuana, decriminalize and re-prioritize certain drugs offenses, increase addiction recovery services, and establish the use of psilocybin (i.e., a hallucinogenic chemical obtained from certain plants and fungi) for mental health conditions.

Tobacco Price Increases and Tobacco Settlement Fund Allocation


In Oregon, voters approved Measure 108 which would increase taxes on distributors of tobacco products and e-cigarettes. Cigarettes would increase from $1.33 to $3.33 per 20-pack, with e-cigarettes and other nicotine inhalants taxed at a rate of 65% of the wholesale sales price. The cigar tax would increase to 65% of wholesale prices, not to exceed $1.00 per cigar.

Revenues will be applied to the administration and enforcement of the tax and any remaining funds are to go to the Oregon Health Authority for medical and healthcare-assistance programs, including mental health services, tribal health providers, and other tobacco and nicotine prevention and treatment programs.


Voters in Colorado approved Proposition EE to incrementally increase cigarettes per pack and incrementally raise the tax rate on other tobacco products to 62% by 2027. The rate on authorized modified risk tobacco products will increase to 31% by 2027. A new tax on nicotine products such as e-cigarettes would be created and begin at 30% and increasing to 62% by 2027.


Question 814 in Oklahoma was defeated by voters. Currently, 75% of the funds the state receives from the 1998 Master Settlement Agreement (MSA) amount is deposited in the state’s Tobacco Settlement Endowment Trust Fund for tobacco use prevention and smoking cessation programs. The measure would have reduced the amount deposited to the fund to 25% of the annual MSA payment and the remainder would be directed to the state’s Medicaid match funding.

Medical Use of Marijuana

Before the election, the medical use of marijuana was authorized in 33 states, D.C., Guam, Puerto Rico, U.S. Virgin Islands, and the Northern Mariana Islands. After last week’s results two more states, Mississippi and South Dakota, will allow the medical use of marijuana.


In Mississippi, the establishment of a medical marijuana program overseen by the Mississippi State Department of Health was approved. Voters chose Initiative 65, a measure that sets out a list of debilitating medical conditions for which qualifying patients can receive a medical marijuana identification card issued by the department of health.

The department of health is authorized to regulate the entities that cultivate, process, and sell medical marijuana, as well as establish rules for tracking and labeling medical marijuana, advertising and marketing, uses in nursing homes, hospices, and assisted living facilities, and reciprocity for out-of-state cardholders. The measure also limits local zoning restrictions that can be imposed on medical marijuana establishments.

South Dakota

In South Dakota, voters approved Measure 26 to establish a medical marijuana program overseen by the South Dakota Department of Health (DOH). The measure allows the medical use of marijuana by qualifying patients, including minors, and authorizes the South Dakota DOH to register and regulate marijuana cultivators, manufacturers, testing facilities, and dispensaries.

Qualifying patients with a debilitating medical condition as certified by a physician may obtain a registration card from the DOH. The department will also establish a verification system for resident cardholders and reciprocity is given to non-resident out-of-state medical marijuana cardholders.

Additions to the list of debilitating medical conditions may be made via a petition and review process with the South Dakota DOH. Local governments may establish certain limits on medical marijuana establishments within their jurisdictions and may require a local license and fee, however, they are not allowed to prohibit a dispensary.

Non-Medical Use of Marijuana

The non-medical use of marijuana was approved in four states, Arizona, Montana, New Jersey, and South Dakota.


In Arizona, voters approved proposition 207 that will allow the possession and use of non-medical marijuana by anyone 21 years or older. The Arizona Department of Health and Human Services (Arizona DHHS) is directed to develop rules to regulate and license marijuana retail stores, cultivators, and production facilities. The new law does not allow the smoking of marijuana in open spaces (e.g., public parks and sidewalks) or public places as defined by the state’s smoke-free law.

A social equity ownership program will also be created to promote the ownership and operation of marijuana businesses “by individuals from communities disproportionately impacted by the enforcement of previous marijuana laws.” Expungement of certain marijuana-related convictions will also be allowed.

Revenue from the taxes levied on marijuana will be used to first cover the costs incurred by the Arizona DHHS and other state agencies to implement and administer the new law. Any remaining funds will go to community colleges, local law enforcement agencies, fire departments, state highway needs, and others.


Voters in Montana also approved Initiative No. 190, which authorizes the Montana Department of Revenue to license and regulate the cultivation, processing, and sale of marijuana to anyone 21 years or older. The Montana Department of Public Health and Human Services (DPHHS) laboratory is responsible for licensing laboratories to test the content and quality of the marijuana.

Initially, only entities that are licensed under the state’s medical marijuana laws and in good standing with the Montana DPHHS can apply for and receive licenses to cultivate, process, or sale non-medical marijuana. Tax revenue from the sale of non-medical marijuana is to be divided among the state’s general fund and various state agencies, including a portion to be administered by the Montana DPHHS for increasing drug addiction treatment, overdose prevention and treatment, and supporting job placement, housing, and counseling for persons with substance use disorders.

New Jersey

In New Jersey, non-medical marijuana is on track for legalization. If approved, Public Question No. 1 will amend the state’s constitution to allow the “growth, cultivation, processing, manufacturing, preparing, packaging, transferring, and retail purchasing and consumption of cannabis, or products created from or which include cannabis, by persons 21 years of age or older.” The New Jersey Cannabis Regulatory Commission will oversee and regulate these activities.

South Dakota

South Dakota voters also approved the legalization of non-medical marijuana. With Amendment A the state’s constitution is amended to allow the cultivation, processing, transportation, and sale of marijuana to anyone 21 years of age or older. The South Dakota Department of Revenue is authorized regulate these activities.

Local governments may limit or ban marijuana businesses within their jurisdiction. Any tax revenue that remains after going to the revenue departments administrative costs is to be split evenly between supporting public schools and the state’s general fund.

Drug Decriminalization, Addiction Recovery, and Lowering the Priority of Drug Offenses

Oregon voters approved Measure 110 to reclassify the unlawful possession of controlled substances, including cocaine, heroin, ecstasy, LSD, methamphetamines, and psilocybin, as a civil, rather than criminal, offense. Possession of small amounts of these drugs will result in a $100 fine or the completion of a health assessment at an Addiction Recovery Center.

The unlawful manufacture or distribution of controlled substances or possession of larger amounts of the drugs will remain a criminal offense. The Oregon Health Authority is directed to create and support an Oversight and Accountability Council to fund and oversee the establishment of the Addiction Recovery Centers.

The purpose of the centers is to immediately triage the acute needs of people who use drugs and assess and address their on-going needs with intensive case management and linkage to care and services. The expanded access to drug treatment and services is to be funded with the state’s marijuana tax revenue.

Voters in D.C. approved Initiative 81 to make the investigation and arrest of anyone 18 years of age or older for the non-commercial cultivation, distribution, possession, and use of entheogenic plants and fungi as the lowest law enforcement priority. Entheogenic plants and fungi is defined as the species of plants and fungi that contain ibogaine, dimethyltryptamine, mescaline, psilocybin, or psilocyn (e.g., magic mushrooms or shrooms, peyote, and iboga).

The measure asserts that the “use of entheogenic plants and fungi have been demonstrated, through scientific studies, to be beneficial in addressing a variety of afflictions including substance abuse, addiction, trauma, post-traumatic stress syndrome, chronic depression, anxiety, diabetes, cluster headaches and other conditions.”

Psilocybin Services

Oregon voters also approved Measure 109 directing the Oregon Health Authority to create a program to administer psilocybin services (services provided to a person before, during, and after the consumption of a psilocybin product, commonly referred to as ‘magic mushrooms.’) to pre-screened individuals 21 years or older by licensed service providers.

The measure requires a two-year development for the Oregon Health Authority to adopt regulations for the program and establishes an advisory board to make recommendations to and advise the Oregon Health Authority. The Oregon Health Authority may not require the diagnosis of any medical condition as a condition for receiving psilocybin services.