Six Years of Hemp in North Carolina: What the Evidence Actually Shows

Six Years of Hemp in North Carolina: What the Evidence Actually Shows

 

Since the 2018 Farm Bill opened the door to hemp-derived cannabinoids, North Carolina has been quietly running one of the most significant public health experiments in the country — without anyone officially calling it that. No medical program. No recreational law. Just broad, largely unregulated access to the full spectrum of cannabis products, consumed by hundreds of thousands of residents going about their lives.

Now, with a federal deadline approaching that could change everything, it's worth asking what that experiment has actually shown.

The people using these products

Before getting into policy and research, it's worth being clear about who is actually using hemp products in North Carolina — because the public debate rarely reflects the reality on the ground.

A significant and growing share of cannabis consumers are older adults. Seniors managing chronic pain, arthritis, sleep disorders, anxiety, and a range of conditions for which conventional medications either don't work well or carry serious side effects. Many discuss it with their doctors. Many tried cannabis decades ago, set it aside when legal access disappeared, and returned when hemp made it available again. For this population, these products have provided something the pharmaceutical industry and the state's healthcare system have not adequately addressed: relief that works, without a prescription, without stigma, and without the dependency risks associated with opioids and other long-term pain medications.

This isn't anecdotal. A 2025 study published in JAMA Internal Medicine found that cannabis use among adults 65 and older surged 46% in just two years, with the sharpest increases among people managing chronic conditions — heart disease, diabetes, hypertension, cancer. Their primary motivations are pain, sleep, and anxiety. The line between "medical" and "recreational" use has always been somewhat artificial. A retired teacher who sleeps through the night for the first time in years because of a CBD gummy isn't making a lifestyle choice so much as a healthcare decision.

Cannabis and opioids: a relationship worth understanding

One of the most important and underreported findings in cannabis research involves what happens to opioid use when cannabis becomes accessible.

A 2026 study from Boston University, published in the journal Drug and Alcohol Dependence, found that states legalizing cannabis for both medical and recreational use saw a 9-to-11-percentage-point decline in daily opioid use among people who inject drugs — one of the highest-risk populations for overdose. Researchers called the magnitude of the decline "striking" and noted it was consistent across racial, ethnic, and gender groups.

A separate 2025 study published in JAMA Health Forum found that cancer patients significantly reduced their reliance on prescription opioids following the opening of cannabis dispensaries in their states. The rate of patients receiving opioid prescriptions fell by an average of 16% in states that had legalized medical cannabis — across all sexes, age groups, and racial and ethnic demographics.

Research from the University of Pittsburgh found that states legalizing recreational cannabis experienced a short-term decline in opioid-related emergency department visits. And importantly, even after that temporary decline, recreational cannabis laws were not associated with any increase in opioid-related emergencies. Cannabis is not a gateway to opioids. If anything, for many people, the relationship runs the other direction.

None of this research is definitive, and scientists are careful to note that cannabis is not a treatment for opioid use disorder. But the accumulated evidence points clearly toward one conclusion: for many people managing pain, cannabis access reduces reliance on more dangerous alternatives.

What the research says about communities

Beyond individual health outcomes, researchers have been asking a broader question: what does legal cannabis access do to communities as a whole?

A peer-reviewed study published this month in the journal Economic Modelling examined crime data across all 50 states and found that medical cannabis legalization is associated with reductions in property crime, while recreational legalization is associated with reductions in violent crime. The researchers used a rigorous analytical method — constructing statistical stand-ins for each state from non-legalizing states — that corrected for flaws in earlier studies that had sometimes suggested the opposite. Once that more careful analysis was applied, any suggestion that legalization increases crime disappeared.

The study points to what economists call the Becker hypothesis: legal, regulated markets tend to displace the illegal ones, along with the black-market activity associated with them. This finding is consistent with a growing body of research. A 2025 Atlanta study found that decriminalizing marijuana led to a decrease in violent crime as police redirected their attention. A 2024 analysis found adult-use legalization was associated with a substantial decrease in rates of intimate partner violence.

The researchers are honest about the limits of their findings: effects vary by state, by type of legalization, and they take years to fully materialize. But the weight of the evidence no longer supports the argument that legal cannabis access makes communities worse off.

North Carolina: an accidental case study

Here is where national research connects directly to life in this state.

The Economic Modelling study analyzed states that formally legalized cannabis. North Carolina doesn't appear in that category. And yet — since the 2018 Farm Bill defined hemp as any cannabis plant with less than 0.3% Delta-9 THC — North Carolina has quietly become one of the most cannabis-accessible states in the country. The state's hemp industry generates between $759 million and $1.1 billion in annual sales annually and supports roughly 9,000 jobs, with over 850 licensed growers and more than 1,700 registered processors. Dedicated hemp dispensaries number in the hundreds — Raleigh alone has 28, Wilmington has dozens more — and that count doesn't include the smoke shops, vape stores, and convenience stores carrying hemp products alongside everything else on their shelves. Even Salisbury, a city of roughly 35,000 in the Piedmont, has at least eight dedicated hemp dispensaries.

For six years, North Carolina has been running its own cannabis experiment — without the licensing framework, the age verification requirements, the lab testing mandates, or the regulatory infrastructure that legalized states have built.

What happened during that time? Overall reported crime is down 23.2% since 2013, including a 56% drop in burglaries and a 37% drop in robberies. The overall crime rate dropped 4.9% between 2023 and 2024 alone. Violent crime did spike in 2020 and 2021 — homicide rates surged during the pandemic years — but those increases tracked national patterns driven by pandemic-related disruption, economic stress, and civil unrest, not by hemp commerce.

The honest summary: North Carolina has had broad cannabis access for six years, and the state has not become a cautionary tale. That is consistent with everything the national research shows.

The case for getting regulation right

Here is an argument that deserves more serious attention in Raleigh: the hemp route is better.

Cannabis products derived from federally legal hemp have operated, until recently, within a functioning commercial ecosystem — interstate commerce, legitimate banking, accessible e-commerce, the ability to build sustainable small businesses. The same products available in licensed marijuana dispensaries in other states have been available in North Carolina without the multi-year licensing gauntlets and massive capital requirements that have effectively locked independent operators out of legalized markets elsewhere.

That model worked. The problem was never the products themselves. The problem was the absence of the basic guardrails that any responsible consumer market requires: age verification, mandatory third-party lab testing, clear labeling, and staff equipped to answer questions. North Carolina failed to enact even basic age restrictions despite broad agreement that they were needed. That failure — not hemp itself — is what allowed candy-branded THC gummies to end up in convenience stores next to the actual candy bars.

The legislative picture has been frustrating. The House focused on a targeted, workable framework: age limits, lab testing requirements, a licensing structure that would let the industry operate responsibly. The Senate repeatedly pushed toward something much closer to an outright ban on intoxicating cannabinoids. Negotiations stalled. Nothing passed. No child protections were enacted.

The result is that North Carolina now faces a federal deadline in November 2026 that would effectively ban most hemp-derived products — not because regulation failed, but because the state never got around to regulating at all. If the federal ban holds without a legislative fix, products that hundreds of thousands of North Carolinians use legally today would become controlled substances overnight. People who currently walk into a licensed business and make a legal purchase would find themselves in a legal gray zone — not because the products changed, but because Congress moved faster than Raleigh did.

The irony is that North Carolina was demonstrating something valuable before any of this happened. Broad, accessible hemp commerce, available to adults across the state, did not produce the disasters its opponents predicted. Property crime fell. Seniors found relief. Small businesses created jobs. The sky did not fall.

What this state actually needs — and still has time to pursue — is the straightforward framework that sensible regulation provides: licensed dispensaries with trained staff, mandatory lab testing and transparent labeling, verified ages, and products out of gas stations. Adults making informed decisions about legal products is not a public health crisis. What creates a public health crisis is an unregulated market with no standards, no accountability, and no one checking IDs.

Polling shows 95% of North Carolinians support changing the state's cannabis laws. The research, the public health data, and six years of lived experience are pointing in the same direction. The path forward is clear. It just requires the political will to take it.

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