In Alabama, these patients have to take monthly pregnancy tests for medical cannabis

Alabama has implemented one of the most rigorous medical cannabis programs in the country, placing a unique and heavy burden on patients. For women between the ages of 11 and 50, the state requires medical cannabis patients to undergo a pregnancy test in a doctor’s office every 30 days to maintain their registration, unless they provide documentation of surgery that prevents them from having children.

A Unique Surveillance Mechanism

This mandate is drawing national scrutiny from advocacy groups. Dana Sussman, senior vice president of Pregnancy Justice, noted that Alabama’s approach appears to be the first of its kind. She described it as a mechanism of regular surveillance, noting that it forces patients to prove they are not pregnant to access medicine that should be available to everyone.

The rules are governed by the Alabama Board of Medical Examiners. Kimie Buley, the board's director of education, explained that the requirements are intended to protect against potential exposure to developing babies, as a patient’s pregnancy status can change rapidly. The board has maintained that a 30-day certification window is the most appropriate way to ensure compliance.

How Alabama Compares

A 205focus.com review of state laws confirms that while 42 states and the District of Columbia permit medical cannabis, Alabama is an outlier. Most states do not mandate regular pregnancy testing, nor do they strictly ban access for pregnant or breastfeeding individuals in the same manner. In jurisdictions like Kentucky, providers are encouraged to recommend testing, but patients can decline and still receive certification.

In Alabama, however, the administrative code explicitly prohibits physicians from recommending medical cannabis to anyone who is pregnant, breastfeeding, or actively attempting to conceive. This creates a challenging landscape for patients, as the state already leads the nation in the criminalization of pregnant women regarding drug use, with the state Supreme Court permitting the application of chemical endangerment laws to pregnancy.

Patient Responsibility and Costs

As Alabama’s medical cannabis rollout gains momentum—with the first dispensary opening this month and dozens of doctors authorized to provide recommendations—advocates are urging patients to be prepared. H. Marty Schelper of the Alabama Cannabis Coalition emphasizes that patients must fully understand these requirements, including potential extra costs for frequent office visits and testing, before entering the program.

While medical organizations like the CDC and the American College of Obstetricians & Gynecologists advise against cannabis use during pregnancy, critics argue that Alabama’s blanket exclusion prevents the necessary, nuanced risk-benefit conversations between doctors and their patients. As Sussman pointed out, the policy takes a deeply invasive and punitive approach that is not applied to any other medical condition.