South Dakota Medical Cannabis Qualifying Conditions — SDCL § 34-20G-1(8)

Last verified: May 2026

The Qualifying-Condition Schedule

The Symptom-Based Eligibility Framework

Unlike many state medical-cannabis programs that enumerate specific diagnoses only, SD’s framework includes a symptom-first eligibility category. The statute provides that a "debilitating medical condition" is "a chronic or debilitating disease or its treatment that produces one or more of" the listed symptoms (cachexia, severe pain, severe nausea, seizures, severe persistent muscle spasms). This means a patient with a chronic condition not specifically enumerated may still qualify if the condition or its treatment produces any of the listed symptoms.

Specifically Enumerated Conditions

• Cancer or its treatment (with associated severe pain, nausea/vomiting, or wasting).
• Acquired Immune Deficiency Syndrome (AIDS) / HIV-positive status.
• Amyotrophic Lateral Sclerosis (ALS).
• Multiple Sclerosis.
• Crohn’s disease.
• Epilepsy and seizures.
• Glaucoma.
• Post-Traumatic Stress Disorder (PTSD).

Conditions Notably Absent

Several conditions common in other state programs are not covered:

• Chronic pain absent another listed condition. Patients with chronic pain that doesn’t fit the "severe pain" symptom-based threshold or the cancer / MS / ALS specific conditions may not qualify.
• Severe anxiety, generalized anxiety disorder, depression. Mental-health conditions other than PTSD are not covered.
• Autism spectrum disorder. Not specifically enumerated.
• Sickle cell anemia, Tourette’s syndrome. Not specifically enumerated.
• Inflammatory bowel disease other than Crohn’s (ulcerative colitis is not specifically listed).
• Migraine, fibromyalgia, peripheral neuropathy. Not specifically enumerated.
• Insomnia or sleep disorders. Not covered.

Patients with these conditions may be eligible if their condition produces qualifying symptoms (e.g., severe pain or severe muscle spasms) but the certifying practitioner must make that case under the symptom-based rubric.

The 2023 SB 1 Freeze on the Qualifying-Condition List

The original IM 26 statute included a public petition process through which residents could ask SDDOH to add qualifying conditions. The process produced documented advocacy efforts in 2021–2022 (notably by patient-advocacy groups seeking chronic pain not requiring a separately listed underlying condition).

The 2023 SB 1 froze the qualifying-condition list at the statutory enumeration and revoked the public-petition process. Reform efforts to broaden the list remain a recurring legislative subject. As of May 2026, the list has not been expanded since 2021.

Practitioner Discretion Within the Framework

Within the eligible-condition framework, the certifying practitioner has clinical discretion to determine whether a particular patient’s condition qualifies. The practitioner must:

• Have a bona fide practitioner-patient relationship with the patient.
• Have responsibility for the qualifying condition or have received a referral from a treating practitioner.
• Conduct an in-person physical examination (telehealth not permitted).
• Document the qualifying condition (or qualifying symptom from a chronic disease) in the medical record.
• Submit the certification through the SDDOH portal.

Practical Notes

• The symptom-based framework provides flexibility. Patients whose specific condition isn’t listed may still qualify if it produces severe pain, severe nausea, seizures, severe spasms, or wasting.
• The 2023 SB 1 freeze means new conditions cannot be added by petition. Legislative action is required.
• Document conventional-treatment failure where applicable. Particularly for chronic-pain qualification.
• Find an experienced certifying practitioner. Practitioners with cannabis-medicine experience can often interpret the symptom-based framework more flexibly than primary-care providers without cannabis expertise.

Related on this site: Becoming a South Dakota Medical Canna..., SD Medical Cannabis Dose & Supply, Initiated Measure 26 (2020).