What S.53 Would Do — "The Most Conservative Medical Cannabis Program in the Country"

Last verified: May 2026

Qualifying Conditions

The bill enumerates a set of specific debilitating medical conditions plus catch-alls for terminal illness and conditions added later by an advisory board. The list as currently drafted:

1. Cancer
2. Multiple sclerosis (MS)
3. Severe or persistent nausea (in a person not pregnant) related to specified treatments
4. Epilepsy or seizure disorders
5. Glaucoma
6. Post-traumatic stress disorder (PTSD), subject to evidentiary requirements
7. Autism
8. Crohn’s disease
9. Ulcerative colitis
10. Sickle-cell anemia
11. Amyotrophic lateral sclerosis (ALS)
12. Alzheimer’s disease
13. Terminal illness with life expectancy of less than one year
14. Any condition for which a physician believes opioids are the standard of care and medical cannabis is a less harmful alternative

No Flower, No Smoking, No Home Grow

Unlike most state medical-cannabis programs, the bill does not allow smokable flower, raw plant material, or home cultivation. Permitted product forms are:

• Oils
• Tinctures
• Edibles (≤10 mg THC per serving)
• Topicals
• Transdermal patches
• Suppositories
• Vaporizable concentrates

"Smoking" — the combustion of raw cannabis — is expressly prohibited even by registered patients. This makes the proposed program structurally more restrictive than the medical programs in Florida, Alabama, Mississippi, Louisiana, and even the famously narrow Utah program.

Pharmacist Consultation Requirement

The dispensing model is built around "therapeutic cannabis pharmacies," each of which must hold a separate Board of Pharmacy specialty pharmacy license and employ a licensed pharmacist who provides a consultation at dispensing. The model is loosely modeled on Utah’s. Brian Clark of the South Carolina Pharmacy Association has spoken in favor of this design: "That pharmacist is going to take an oath. I mean, we’re not just going to dispense this when it’s not warranted, you know, so there’s checks and balances in place when you have medical providers involved."

Dispensary Licensing Math

The bill caps the number of therapeutic cannabis pharmacies at one for every 20 traditional pharmacies in the state — roughly 65 to 75 statewide depending on the calculation — and limits each county to no more than three. Additional license categories:

• 15 cultivation centers (capped at 2 acres or 87,120 sq ft each)
• 30 processing facilities
• 5 testing laboratories
• 4 transporters

Vertical-Integration Limits

The bill requires the SC Department of Public Health to set caps on how many businesses any one owner or principal can hold a 5%-or-greater interest in, both statewide and regionally, in order to "avoid excessive market concentration." DPH must report annually on whether independent operators are competing fairly with vertically integrated operators on price and product variety.

Patient and Physician Requirements

• Physician certification only by a SC-licensed MD, DO, or podiatrist (within scope), after a thorough in-person evaluation including a substance-use history.
• Annual 3-hour cannabis-specific CME required of certifying physicians.
• Annually renewable registry ID card issued by the department.
• Patients aged 18–23 require certifications from two physicians.
• Patients under 18 require a parent/guardian application and route-of-administration agreement.
• Categorical ineligibility: patients employed in public safety, commercial transportation, or roles operating heavy machinery.
• Possession cap: 14-day allowable amount as defined by the department.

Administering Agency

⚠️ Earlier versions of the bill named DHEC as the administering agency. With DHEC’s 2025 restructuring into the Department of Public Health (DPH) and the Department of Environmental Services (DES), administration would fall to DPH. The Hemp Farming Program had already migrated to the South Carolina Department of Agriculture in 2024.

Comparison With Other Southern Medical-Only States

Even by Southern standards, the proposed program is on the restrictive end.

Reform-Side Critiques

Some advocacy groups (including elements of the SC Cannabis Coalition and ACLU SC) have critiqued S.53 for being so restrictive that it would underserve patients while consuming the political capital available for cannabis reform. The counter-argument from Sen. Davis and the Compassionate Care Alliance is that a working program — even narrow — opens the legislative door for incremental expansion in subsequent sessions, much as Florida’s 2016 Amendment 2 led to smokable flower in 2019.

Federal-Employer Conflict

The S.53 categorical exclusion of public-safety, commercial-transportation, and heavy-machinery patients is partly a recognition of the SC federal-employer reality. Total active-duty, reserve, and civilian Department of Defense employment in South Carolina exceeds 60,000, plus the ~125,000+ workers at federal contractors and federally regulated employers. Even with S.53 enacted, federal law preempts any patient protection for those employees. See federal installations page.

Related on this site: The 2022 Origination-Clause Kill, The 2024 House 3M Committee Death, South Carolina Compassionate Care Act....