Despite being approved by voters, South Dakota has not legalized cannabis. South Dakota made history in the 2020 election by becoming the first state to vote to simultaneously legalize both medical and recreational marijuana. Recreational legalization was set to go into effect on July 1, 2021. However, the voter-approved amendment to the state constitution has been overturned by Circuit Judge Christina Klinger, in line with Governor Kristi Noem's objection to the amendment. Measure 26, which will establish a medical marijuana system, remains unaffected.

Voters approved both Initiated Measure 26, or the Medical Marijuana Initiative, which legalized medical marijuana on its own, as well as South Dakota Constitutional Amendment A, the Marijuana Legalization Initiative, that not only legalized recreational cannabis, but also would have created a medical market if Measure 26 had failed. Despite the overturning of South Dakota Constitutional Amendment A to legalize, Measure 26 is still in effect, and the state will proceed with establishing a medical marijuana market. Proponents of the cannabis legalization in the state are currently preparing an appeal to the judge's ruling.