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Why did the state of Ohio adopt a medical marijuana policy? And why did it do so in 2016? This article examines the diffusion of medical cannabis policy across the U.S. and to Ohio by describing the evolution of images related to the policy and by exploring the content of the law. Using evidence from legislators’ remarks on the floor of the Ohio General Assembly and interviews with activists and analysts, I show that the direct initiative helped push members of the Ohio General Assembly to write and adopt a medical marijuana law (MML) when they were unlikely to do so. I analyze trends in media coverage of medical marijuana to demonstrate that the spread of the policy has also been aided by shifting images related to the beneficiaries of medical cannabis programs. Turning to the content of the law, I find that Ohio’s MML is written in a similar way to later adopters in the Midwest – where laws are more restrictive and medicalized. Finally, I assess how the characteristics of the law have affected the implementation of Ohio’s Medical Marijuana Control Program.

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