Massachusetts voters approved a ballot initiative Tuesday that legalizes marijuana for medical use for qualifying patients. Massachusetts becomes the eighteenth state, plus the District of Columbia, to allow medical use of the federally illegal drug.

Initiatives pushing for the legalization of medical marijuana appeared on three state ballots this year: in Massachusetts, Arkansas and Montana. Jennie Drage Bowser, an analyst with the National Conference of State Legislatures, says The Baystate was the only one of the three to approve a new legalization measure. 

“Massachusetts of course approved it, Arkansas voters rejected medical marijuana, which was not a big surprise. The polls were indicating going in that was going to happen, and had Arkansas voters approved it, that would have been the first Southern state to adopt medical marijuana.”

Bowser says voters in Montana, where medical marijuana has been legal since 2004, chose in this year’s measure to accept the state legislature’s stricter limitations on the drug which it agreed to last year. Two other states, Colorado and Washington, voted to fully legalize on Tuesday. Massachusetts becomes the fifth New England state to legalize medical marijuana, after Maine, Vermont, Connecticut, and Rhode Island.

The Baystate’s ballot measure limits the availability of the drug to patients with a “debilitating medical condition” including cancer, HIV/AIDS, glaucoma, Hepatitis C, and Parkinson’s disease, among others. 

The measure allows for so-called marijuana treatment centers in the state which would grow and provide marijuana to patients and caregivers. A total of thirty-five treatment centers can be established throughout the state with at least one, but no more than five, centers in each county. The law does not require health insurers to cover the cost of marijuana. The law goes into effect January 1st.