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

Alabama has established some of the most rigorous medical cannabis standards in the country, placing the state in a league of its own regarding patient oversight. For women between the ages of 11 and 50, maintaining an active medical cannabis registration requires a recurring hurdle: a pregnancy test performed in a doctor’s office every 30 days. The only exception to this strict rule is for patients who can provide medical documentation of surgery preventing future pregnancy.

A Unique Surveillance Mechanism

This mandate stands out on a national level. Dana Sussman, senior vice president of the advocacy nonprofit Pregnancy Justice, notes that Alabama’s approach appears to be the first of its kind. While many states offer medical cannabis programs, Alabama is unique in requiring this level of regular surveillance just to access legal treatment. As Sussman puts it, this mechanism forces patients to repeatedly prove their pregnancy status, a requirement not imposed on any other patient group.

Dispensaries and Doctor Access

The policy arrives as Alabama’s medical cannabis program officially moves forward. The state’s first dispensary opened this month, following years of legislative and regulatory delays. Currently, dozens of physicians across regions like Huntsville, Mobile, Muscle Shoals, and Foley have received the green light to recommend cannabis for 15 qualifying conditions.

The State Board’s Stance

According to the Alabama Board of Medical Examiners, the 30-day testing cycle is about protecting the developing fetus. Kimie Buley, the board’s director of education, explained to 205focus.com that the board views recommending cannabis to a pregnant patient as a potential violation of a physician's duty. Because pregnancy status can change rapidly, the board mandates frequent testing to ensure continuous legal compliance and avoid potential prenatal exposure.

While 42 states and the District of Columbia currently allow medical cannabis, 205focus.com found that Alabama’s pregnancy testing requirement is an outlier. Most states do not ban access entirely or enforce mandatory testing, preferring instead to provide warnings or counseling. For example, Kentucky state law directs providers to suggest testing for female patients of childbearing age, but patients have the option to decline while still receiving a recommendation.

Prohibitions and Legal Risks

In Alabama, the path is narrower. Physicians are strictly prohibited from certifying medical cannabis for anyone pregnant, breastfeeding, or “attempting to conceive,” according to the Alabama Board of Medical Examiners’ code. Furthermore, Alabama is one of only three states—along with Oklahoma and South Carolina—where the state Supreme Court allows child endangerment laws to be applied to pregnancy.

The consequences for testing positive in the state can be severe, ranging from losing child custody to significant prison time and fines. Since the 2006 chemical endangerment law passed, Alabama has frequently led the nation in prosecuting pregnant women for drug use, with Etowah County often cited for its aggressive enforcement.

Patient Responsibility

H. Marty Schelper, head of the Alabama Cannabis Coalition, urges potential patients to research these requirements thoroughly before starting the certification process. Patients should be prepared for the reality that they must pay for these tests through their healthcare providers, as home tests are not accepted. The cost of these evaluations varies by clinic, adding an extra layer of financial responsibility for those navigating the system.

Though medical groups like the CDC and the American College of Obstetricians & Gynecologists (ACOG) advise against cannabis use during pregnancy, critics like Sussman argue that Alabama’s approach is excessively punitive. By categorically excluding pregnant individuals, she suggests the state denies patients the ability to have a nuanced risk-benefit conversation with their doctors, treating them differently than patients with other medical conditions.