South Dakota became the first state to simultaneously vote in favor of creating a medical cannabis program and for the legalization of recreational cannabis in November 2020. Cannabis advocates were dealt a blow on February 8, 2021, when Circuit Court Judge Christina Klinger sided with a suit filed on behalf of Governor Kristi Noem's administration, and ruled that the adult-use amendment was unconstitutional because it violated Amendment Z of the South Dakota constitution, which prohibits proposed constitutional amendments from embracing more than one subject at a time. On November 24, 2021, the Supreme Court also sided with the governor in a 4-1 decision. Voters decided to then mulligan the decision to legalize cannabis in 2022.
Patients from other states should note that there are major penalties for possession of cannabis. Possession of 2 oz or less is a misdemeanor. Offenders could be incarcerated for up to 1 year and may be fined $2,000. Possession of more than 2 oz is a felony. If under 0.5 lb, the punishment can be incarceration of up to 1 year and a fine of up to $4,000. If between 0.5-1.0 lb, violators may be incarcerated up to 5 years and fined $10,000. If between 1-10 lbs, violators may be incarcerated up to 10 years and fined $20,000. If over 10 lbs, the term of imprisonment may be up to 15 years and the maximum fine could be $30,000. The punishment for cultivation is based on the total weight of the plants. Possession of concentrated cannabis is a felony punishable by up to 10 years in prison and a fine of $20,000.
South Dakota's medical marijuana program is operational as of 2022. Patients can obtain medical cannabis provided they have a "debilitating medical condition," which is defined by SDCL 34-20G-1 as "a chronic or debilitating disease or medical condition or its treatment that produces one or more of the following: cachexia or wasting syndrome; severe, debilitating pain; severe nausea; seizures; or severe and persistent muscle spasms, including those characteristic of multiple sclerosis." Patients can possess up to 3 oz of cannabis.