Hawaii first legalized cannabis for medical use in 2000, making it the first state in the U.S. to adopt a medical cannabis legalization measure via legislative action. Before Hawaii’s 2000 measure, all approved medical cannabis measures in the U.S. were the result of citizen initiatives.
According to the most recent data from Hawaii’s Department of Health, there were 29,399 active in-state patients registered with the state as of June 2025. By comparison, 32,693 patients were registered with the State of Hawaii in September 2023.
While Hawaii’s registered medical cannabis patient base has fallen slightly in recent years, it is very likely to rise again after the recent approval of a medical cannabis measure that significantly expands the number of health conditions that qualify a patient for registration.
“Democratic Gov. Josh Green has signed legislation (HB 302) into law expanding the pool of patients eligible for medical cannabis. Governor Green’s signature came weeks after he signaled his intention to veto the bill due to concerns that separate provisions might put patients’ privacy at risk.” stated NORML in a recent news release.
“The new law, which took immediate effect, permits medical providers to issue cannabis authorizations to any patient for whom they believe “the benefit of the medical use of cannabis would likely outweigh the health risks.” It also allows patients to receive authorizations via telehealth appointments.” NORML also stated.
It is worth noting that since 2018, in addition to registering in-state medical cannabis patients, Hawaii has also permitted legal sales to registered out-of-state patients through its licensed dispensaries, a public policy concept known as ‘reciprocity.’
“There were 25 dispensaries throughout the islands as of April, with 11 of them on Oahu, the most populous island.” reports MJBizDaily about Hawaii’s legal sales market. “MMJ sales in Hawaii could reach $73 million in 2025, according to an MJBiz Factbook projection.”