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

Alabama has established some of the most rigorous medical marijuana regulations in the country, placing a unique burden on female patients. To maintain their medical cannabis registration, women between the ages of 11 and 50 are now required to undergo monthly pregnancy tests at a doctor’s office, unless they can provide documentation of a surgical procedure that prevents conception.

A Unique Surveillance Mechanism

This mandate distinguishes Alabama from the rest of the nation. Dana Sussman, senior vice president of the legal and advocacy nonprofit Pregnancy Justice, notes that this is the only state with such a framework. According to Sussman, this represents a system of ongoing surveillance that requires patients to repeatedly prove their pregnancy status to access a medical product that should be broadly available.

Implementation and Medical Oversight

As Alabama’s medical cannabis program finally gains momentum, with the state’s first dispensary opening this month, the reality of these requirements is hitting home. Dozens of physicians across the state are now authorized to recommend cannabis, but they must operate under strict guidelines set by the Alabama Board of Medical Examiners.

Kimie Buley, director of education for the board, emphasized in an email to 205focus.com that the policy aims to prevent potential harm to a developing baby. Buley noted that since pregnancy status can change rapidly and may not be immediately obvious, the 30-day testing cycle is deemed necessary for compliance and safety. Under current state administrative code, physicians are strictly prohibited from certifying medical cannabis for patients who are pregnant, breastfeeding, or attempting to conceive.

National Context

While 42 states and the District of Columbia have legalized medical cannabis, an analysis of these state programs reveals that Alabama is an outlier. Most jurisdictions do not mandate pregnancy testing for patients. Even in states where physicians are cautioned against certifying cannabis for pregnant patients—such as Arizona or Mississippi—the approach typically relies on warnings rather than required monthly clinical screenings.

In Kentucky, for instance, while doctors are encouraged to suggest a pregnancy test for patients of childbearing age, the patient retains the right to decline. Meanwhile, Oklahoma previously debated similar exclusions but, following a 2024 appellate court ruling, it was established that using medical cannabis while pregnant does not constitute a crime.

Legal Risks and Ethical Concerns

The environment in Alabama is particularly severe. Because the state allows criminal statutes related to child endangerment to be applied to pregnancy, a positive drug test can lead to dire consequences, including the potential for lost custody and significant prison time. Alabama has consistently led the nation in the incarceration of pregnant women for drug use, with Etowah County serving as a notable center for such enforcement.

Advocates argue that this policy is both invasive and discriminatory. H. Marty Schelper of the Alabama Cannabis Coalition advises patients to be fully aware of the extra costs and clinical requirements before entering the program. Ultimately, as the CDC and the American College of Obstetricians & Gynecologists advise against use during pregnancy, Alabama’s blanket exclusion and surveillance policy remain a sharp point of contention for those seeking to manage chronic health issues through the state's authorized medical providers.