On June 26, 2018, 57% of Oklahoma voters approved State Question 788, which legalized marijuana for any medical use on a doctor's recommendation. 

The way it was written, SQ788 became effective July 26, with the state mandated to start accepting patient applications just a month later. With the Legislature out of session, state leaders opted not to meet in a special session to address gaps in the medical marijuana measure. That decision meant Oklahoma's medical marijuana industry would be built on the foundation created by the authors of SQ788, which did not seek to be comprehensive but instead establish as a priority the needs of patients to get immediate access to cannabis treatments.

More than a year later, 200,000 patients have been licensed by the Oklahoma Medical Marijuana Authority, and more than 6,000 business licenses granted. Dispensaries began selling THC-rich products in November 2018, about the same time many patients were able to harvest their first legally home-cultivated cannabis.