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Amidst the media storm about the election of Donald Trump to President of the United States it was easy to miss the other big news on 8 November 2016: four US states voted by popular ballot to legalise recreational use of cannabis, and a further four voted to legalise or extend the use of medical cannabis. The only state to vote 'no' to increased legal access to cannabis was Arizona, where 52% of voters preferred not to legalise recreational use (medical use is already legal).

Once the new laws are implemented, a total of 29 states will permit medicinal cannabis, and eight will permit recreational use. That means that the percentage of Americans living in states where marijuana use is legal for adults will rise from 5 percent, to more than 20 percent.

It's not yet clear how the election of Trump as President may or may not impact on the general trend towards legalisation in the States. The key issue is that cannabis remains an illegal drug at the federal level. Under Obama, the Attorney General's office adopted a policy of non-interference with state legalisation laws. At this point, no one is sure whether the new administration will continue that policy of non-interference or not.

Trump has been consistent in supporting the concept of medical marijuana throughout his campaign, but he has flipped back and forth in his views on recreational drug use. At recent campaign rallies he stated that he believes states should decide for themselves on whether to legalise - but he's also said that he sees recreational cannabis legalisation as a bad thing.

Tellingly, Trump has just nominated a passionate anti-cannabis advocate, Senator Jeff Sessions, to be U.S. Attorney General. Sessions views drugs through a strong moral lens, maintaining that 'good people don't smoke marijuana'. According to the New York Times, an African-American prosecutor testified before Congress in 1986 that Mr. Sessions had joked that he thought that the Ku Klux Klan "was O.K. until I found out they smoked pot."

Beau Kilmer, a drug policy expert at the nonprofit Rand Corp., points out that it's unlikely that any sort of changes to cannabis law will be the top priority for incoming Trump administration officials. Any federal crackdown could have significant political fall-out, and the growing cannabis industry will no doubt already be preparing a political lobby to tackle any threat to their profits head-on.

Public policy Professor Mark AR Kleiman is cautions against full commercial legalisation being ushered in. Prior to passage of the four ballots he argued, "If there is a for-profit industry, the kind many legalization schemes create, its interests will be at odds with public health." (See "We're Legalizing Weed Wrong" article, 9 November 2016).

A state by state breakdown of the cannabis ballots follows.

In California, 56.4% of voters agreed that people over 21 should be allowed to possess limited amounts of marijuana for personal use and to cultivate of up to six plants in private residences, provided they are shielded from public view. The sale of recreational marijuana will not be allowed until licenses are issued, a process that may take a couple of years to sort out.

California, which recently overtook the UK to become the fifth largest economy in the world, is expected to have a recreational cannabis market greater than Colorado, Washington, Oregon and Alaska combined. Californian officials expect additional tax revenue of around US $1 billion from sales. The money will be spent on a range of programmes including research into medical cannabis, developing procedures around drug driving impairment and drug education for young people.

Massachusetts also voted to legalise recreational use of cannabis, with 53.6% in favour. The state already allows medicinal use. A commission will be created to regulate cannabis in the state.

In Nevada, 54.5% voted to legalise recreational use. Adults 21 years and over will be able to purchase and consume one ounce or less, or grow up to six plants for personal use. Medical cannabis was legalized in Nevada in 2000.

Maine voted to legalise recreational cannabis with a very narrow margin of 50.2% to 49.8%.

Florida voters passed a constitutional amendment to legalise the use of medical cannabis for individuals with specific debilitating diseases or conditions as determined by a licensed state physician. The Department of Health will be required to register and regulate marijuana production and distribution centers. 71.3% voted in favour of the measure.

In North Dakota, 63.7% voted to legalise cannabis to treat some medical conditions, including cancer, AIDS, epilepsy and hepatitis C. Patients will need identification cards listing specific criteria.

Arkansas also passed a medical cannabis measure that would allow patients with one of 17 specific conditions to buy medicine from dispensaries licensed by the government. Tax revenue from the sales will go to technical institutes, vocational schools, work force training and the state's general fund. 53.2% voted in favour.

Montana residents voted to expand the state's existing medical cannabis system by repealing the three-patient limit for medical cannabis providers. Proponents of the measure argued that the existing restrictions blocked patients from accessing care. Medical marijuana was legalized in the state in 2004.

Arizona was the only state to vote against its proposed cannabis measure, with 52% opposing the legalisation of recreational cannabis use for adults aged 21 and above.

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