South Dakota voters approved a law in 2020 legalizing the medical use of marijuana, four years after rejecting the idea. Separately in 2020, voters approved an amendment to the South Dakota Constitution to legalize recreational use, but the state Supreme Court nullified it. Voters rejected another proposal in 2022.

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Recreational legalization ballot questions in Florida, North Dakota and South Dakota all failed. Two medical measures passed in Nebraska but face legal challenges over the validity of the signatures required to get the measures on the ballot. Why two measures? One legalizes the medical use of cannabis, and the second regulates it.