Nebraska Initiatives 437 + 438 (2024) — The Voter-Passed Medical Mandate

Last verified: May 2026

The Two Initiatives

Initiative 437 — Nebraska Medical Cannabis Patient Protection Act

• Vote: 70.74% YES (Marijuana Policy Project final count; AP and Nebraska Examiner reported ~71.2% on election night).
• Geography: majority in all 49 legislative districts.
• Function: removes state and local penalties for patients possessing up to 5 ounces with a written practitioner recommendation, and for caregivers assisting them.
• Self-executing: did not require legislative implementation to take effect on patient-protection portion.

Initiative 438 — Nebraska Medical Cannabis Regulation Act

• Vote: 66.95% YES (~67% on election night).
• Geography: majority in 46 of 49 legislative districts.
• Function: creates a Nebraska Medical Cannabis Commission with "exclusive" power to license and regulate cannabis manufacturers, cultivators, transporters, and dispensaries.
• Deadlines: emergency rules by July 1, 2025; first licenses issued by October 1, 2025.

The Campaign

Nebraskans for Medical Marijuana — the campaign committee — was organized in 2019 by:

• Crista Eggers (executive director), mother of Colton Eggers, a child with severe epilepsy. The public face of the campaign through three ballot cycles (2020, 2022, 2024).
• Then-State Sen. Anna Wishart (D-Lincoln), legislative co-sponsor of LB 110 (2019), LB 474 (2021), LB 588 (2023). Left office January 8, 2025 due to term limits.
• Former State Sen. Adam Morfeld (D-Lincoln), executive director of Civic Nebraska, ballot-petition co-sponsor.

The Signature Gathering

The campaign turned in roughly 114,000 signatures across both petitions on July 3, 2024, against a constitutional minimum of 86,499 valid signatures per measure. Secretary of State Bob Evnen ultimately certified 89,962 valid signatures for the legalization measure and 89,856 for the regulatory measure — narrow margins that became the focus of subsequent litigation.

The campaign reported approximately $1.6 million in contributions through January 14, 2025. Cost-per-required-signature was $11.76, reflecting roughly $1,016,728 spent on signature collection alone.

Three Ballot Attempts

2020 — Wagner v. Evnen Single-Subject Strike

In 2020, the Nebraska Supreme Court (5-2, Justice Jonathan Papik dissenting) struck the proposed constitutional amendment in Wagner v. Evnen for violating the state’s "single-subject rule." The Court held that combining patient-protection, regulatory, and other features violated the constitutional requirement that initiatives address only one subject.

2022 — Signature Shortfall

In 2022, the campaign came up just short on signatures after the death of major donor Dr. Bruce Lavine and a logistical collapse in volunteer canvassing. The campaign collected enough raw signatures to qualify but could not generate the verified-signature margin needed.

2024 — The Two-Initiative Strategy

To navigate the single-subject rule, in 2024 advocates split the proposal into two narrow statutory initiatives:

• I-437 — simply removes state and local penalties for patients possessing up to 5 ounces with a written recommendation. Self-executing.
• I-438 — creates the Nebraska Medical Cannabis Commission with exclusive licensing/regulatory power. Set July 1, 2025 emergency-rules and October 1, 2025 license-issuance deadlines.

The December 12, 2024 Proclamation

Both initiatives were approved by Gov. Pillen via constitutional proclamation on December 12, 2024, and took legal effect that day. The same day, Pillen and AG Hilgers issued a joint statement "cautioning the public to the limited nature of these proclamations" and stating they "believe that serious issues remain regarding the validity of these petitions under federal law and the Nebraska Constitution." Within months, Hilgers, Pillen, Evnen, and former Sen. John Kuehn launched two parallel lawsuits to invalidate the petitions. See Kuehn v. Evnen page.

Polling vs. Ballot Outcome

An Emerson College Polling / Midwest Newsroom poll of n = 1,000 registered Nebraska voters, fielded September 24-27, 2024 and published October 7, 2024, found 59% in favor of medical legalization, 33% opposed, 8% unsure (credibility interval ±3 percentage points). The actual ballot results — 70.74% on I-437 and 66.95% on I-438 — exceeded the pre-election poll and reflect the strongest cross-cutting support of any policy issue on the 2024 Nebraska ballot.

I-437 carried a majority in all 49 legislative districts, including districts whose state senators voted against LB 677 (2025) implementation legislation.

The Cross-Cutting Coalition

The 70.74% I-437 result reflects an unusual cross-cutting coalition that broke through Nebraska’s otherwise rural-conservative voting pattern:

• Sandhills counties — libertarian-conservative ranching country — broke for I-437 at margins matching Lancaster County.
• German Catholic and Lutheran rural communities — typically socially conservative — supported I-437 at 65%+ rates.
• Czech-American communities in Saunders / Wilber / Schuyler — supported I-437 strongly.
• Native American tribal communities — supported I-437 (Omaha Tribe Title 51 followed in July 2025).
• Veterans, parents of children with severe epilepsy, cancer patients, and other affected demographic groups provided the public face.

Implementation Status as of May 2026

• Patient-protection portion in force (qualifying patients can possess up to 5 oz with recommendation without state-law prosecution).
• 4 cultivator licenses approved; 0 dispensaries operational.
• No NE physician has publicly registered to issue recommendations.
• Two NE Supreme Court appeals pending without ruling dates.
• LB 1235 (2026) was the first medical-cannabis-related law passed in NE history (46-2 April 1, 2026).
• Realistic patient access to a state-licensed Nebraska dispensary is unlikely before late 2026 and could slip into 2027.

Related on this site: Nebraska 5 oz / 30-Day Supply Rule, Nebraska Medical Cannabis Commission, Nebraska Medical Cannabis Cultivator....