Becoming a Patient in Massachusetts

Massachusetts voters in November 2012 established legal protection for medical cannabis patients, caregivers, physicians and medical professionals, cultivators, and providers, which have been codified in 105 CMR 725. Physicians are always covered by the First Amendment’s free speech protections for discussing the benefits and risks of medical cannabis with patients and recommending its use to them. Patients and caregivers with the appropriate paperwork have state law protection from arrest for possession of up to a sixty-day supply of medicine, defined by rulemaking as up to ten (10) ounces of usable cannabis. “Registered marijuana dispensaries” are licensed to both grow and sell medical cannabis. Most patients obtain cannabis from one of the state’s registered marijuana dispensaries, but under limited hardship circumstances, patients and caregivers may cultivate up to a 60-day supply of cannabis. Dispensaries are required to provide medicine at discounted rates for low-income residents. Homebound patients are allowed secure home delivery, and personal caregivers can pick up medicine at dispensaries on behalf of patients under their care. Personal cultivation may still be permitted in rare hardship cases. For the latest information and requirements, consult the DPH program website at: www.mass.gov/medicalmarijuana.

Who is Protected?

Massachusetts’ “Question 3: An Initiative Petition for a Law for the Humanitarian Medical Use of Marijuana” provides patients and caregivers protection from arrest when using or handling medical marijuana in accordance with the law.  Protections only apply to registered patients and caregivers.  Patients and caregivers may purchase medical cannabis from dispensaries that are licensed by the state.

What's Legal

105 CMR 725.035

Patients and caregivers with the appropriate paperwork have state law protection from arrest for possession of up to a sixty-day supply of medicine, defined by rulemaking as up to ten (10) ounces of usable cannabis. Most patients will obtain cannabis from one of the state’s registered marijuana dispensaries, but under limited hardship circumstances and until dispensaries are operational, patients and caregivers may cultivate up to a 60-day supply of cannabis.  Homebound patients are allowed secure home delivery, and personal caregivers can pick up medicine at dispensaries on behalf of patients under their care. Personal cultivation may still be permitted in rare hardship cases.

Eligible Conditions

105 CMR 725.004

To become a qualifying patient under Massachusetts law, a patient must have written certification from a licensed physician as having a debilitating medical condition. A “debilitating medical condition” means any of the following:

  • Cancer
  • Glaucoma
  • Positive status for human immunodeficiency virus
  • Acquired immune deficiency syndrome (AIDS)
  • Hepatitis C
  • Amyotrophic lateral sclerosis (ALS)
  • Crohn’s disease
  • Parkinson’s disease
  • Multiple sclerosis
  • And other conditions as determined in writing by a qualifying patient’s physician

A valid written certification means a written document signed by your doctor, obtained in a bona fide physician-patient relationship that includes a full examination and discussion of the benefits and potential risks of medical cannabis therapy.

While the law requires patients to possess a valid registration card in order to be protected from arrest, until the cards are made available, written certification by a physician serves as a legal equivalent to a registration card for a qualifying patient. In order to prevent wrongful arrest, patients may wish to carry a valid government issued ID card with a picture as well as their written certification.

Minors

If you are less than 18 years of age, DPH rules require your parent or guardian to approve of your medical cannabis use. You must also have certification by two physicians, one of whom must be a pediatrician or pediatric specialist. DPH regulation specifically allows medical cannabis access for a life-limiting illness, defined as one likely to result in death within two years, but two physicians may override the life-limiting restriction if they determine the benefits of medical use of cannabis outweigh the risks for a minor patient.

Application Process

105 CMR 725.015

Your physician begins the process of registering you in the Massachusetts Medical Use of Marijuana Online System (MMJ Online System) by certifying that you have a debilitating medical condition listed above.  That certification takes place online with the Department of Public Health (“The Department”) and includes providing your name, e-mail address, mailing address, and phone number.  Patients must then register with the Medical Use of Marijuana Program (the “Program”).  After being certified, patients will receive an e-mail from the Massachusetts Department of Health (DPH) with (1) a patient PIN number and (2) instructions on how to register with the Program.  Patients may either register online or by paper.  If registering by paper, patients must call the Program at (617) 660-5370 to request a paper registration form.

Before registering as a patient, you must provide:

            (1) Your patient PIN number,

            (2) a current valid form of identification (ID),

            (3) a current photograph of yourself, and

            (4) a $50 registration fee, or a proof of verified financial hardship.

For more registration information, please see the Massachusetts Department of Public Health “Patient Guidance” form: http://www.mass.gov/eohhs/docs/dph/quality/medical-marijuana/patient-guidance-for-registration.pdf

For more information regarding the Medical Use of Marijuana Program’s Fee Structure: http://www.mass.gov/eohhs/docs/dph/quality/medical-marijuana/fee-structure.pdf

Qualifying Patients

105 CMR 725.004

A qualifying patient is a Massachusetts resident 18 years of age or older who has been diagnosed by a Massachusetts licensed certifying physician as having a debilitating medical condition, or a Massachusetts resident under 18 years of age who has been diagnosed by two Massachusetts licensed certifying physicians, at least one of whom is a board-certified pediatrician or board-certified pediatric subspecialist, as having a debilitating medical condition that is also a life-limiting illness, subject to 105 CMR 725.010(J).

Finding a Doctor for a Recommendation

First and foremost, be forthright with your current doctor.  Massachusetts law specifies that your certifying doctor must be a Massachusetts licensed physician (Medical Doctor or Doctor of Osteopathy) who certifies that in his or her professional opinion, the potential benefits of the medical use of marijuana would likely outweigh the health risks for a qualifying patient.

Specifically ask your doctor to help you obtain a medical marijuana recommendation. If you are already medicating with marijuana on your own, tell your doctor specifically what on the Massachusetts list of qualifying conditions you treat with marijuana and how it helps you. Honestly describe the amount of marijuana you use, how often, and by what delivery method.

There is nothing wrong with using medical marijuana or discussing it with your doctor. A federal court has ruled that, under the First Amendment, doctors may not be punished for recommending medical marijuana.  But if you have a qualifying condition and your doctor does not issue medical marijuana recommendations, you may need to visit a medical marijuana specialist.

Obtaining a Registry Identification Card

105 CMR 725.004

The process of registering as a qualified patient in Massachusetts begins with your physician.  Once your doctor has provided certification to the Department that you have a qualifying debilitating medical condition that may benefit from medical marijuana, you will be able to complete your registration with the state.

You will be asked to submit the following to the Department:

(1) Your Massachusetts Department of Health Patient PIN number,

(2) a current valid form of Massachusetts ID (or U.S. Passport/Military ID with proof of Massachusetts Residency),

(3) a current passport-size photograph of yourself, and

(4) a $50 registration fee (checks/money orders should be made payable to “The Commonwealth of Massachusetts”) or proof of financial hardship.  For financial hardship, you must provide one of the following as proof:

(a) Official MassHealth acceptance letter for the current year, or official MassHealth redetermination letter for the current year,

(b) Supplemental Nutrition Assistance Program (SNAP) statement for the current year,

(c) Supplemental Security Income (SSI) benefit verification for the current year, or

(d) State or Federal Tax return for this or last year, including all of the attachments.

Your physician can also indicate if you need a caregiver to assist you with administering or obtaining your medicine.  If so, you must register a qualified caregiver for the Department to issue you a registration certificate.

Qualifying caregivers must be at least 21 years of age.  Caregivers cannot have been convicted of a drug crime.  The primary caregiver may not be the registered qualifying patient’s certifying physician.

Certifying Physician

105 CMR 725.005

Your physician can only recommend medical marijuana after completing a full assessment of your medical history and current condition as part of a bona-fide physician-patient relationship.  Your physician must be licensed to practice in Massachusetts.  Other licensed health professionals such as chiropractors, physician assistance, and nurse practitioners cannot sign the documentation.

Quantity

105 CMR 725.005

A qualifying patient or personal caregiver shall not be subject to arrest or prosecution, or civil penalty, for the medical use of marijuana provided he or she possesses no more marijuana than is necessary for the patient’s personal, medical use, not exceeding the amount necessary for a sixty-day supply.

A sixty-day supply means that amount of marijuana, or equivalent amount of marijuana in marijuana-infused products (MIPs) that a registered qualifying patient would reasonably be expected to need over a period of 60 calendar days for his or her personal medical use, which is ten ounces, subject to 105 CMR 725.010 (I).

Renewals

Massachusetts registry cards are good for one year. If your certification has expired, you will need to obtain a recertification from your physician.  You may check your certification status by using your account at https://sso.hhs.state.ma.us/ (for online applicants) or calling the Program at (617) 660-5370 (for paper applicants).

Before renewing your registration, you will need:

(1) A current valid form of identification (ID) (only required if there is a change in information from your previous registration or if you have an updated ID.  This includes a change in your ID’s expiration date),

(2) the same username used during your initial registration

(3) a form of payment (or proof of verified financial hardship)

For more renewal information, please see the Massachusetts Department of Public Health “Patient Guidance” form: http://www.mass.gov/eohhs/docs/dph/quality/medical-marijuana/patient-guidance-for-registration-renewal.pdf

You may re-apply for registration on an annual basis, up to 60 days before the date that your registration expires.  It is highly recommended that applicants apply for a registration renewal at least 60 days prior to the expiration of their current Program card.  This will ensure that there is no gap in the applicant’s active status.

For more information, please refer to the following step-by-step renewal instructions: http://www.mass.gov/eohhs/docs/dph/quality/medical-marijuana/mmj-system-registration-renewal-step-by-step.pdf

Registry Card Changes or Loss

If there are any changes to the information you provided the Program, you must update this information with the Program within 5 business days. Log in to VG (https://sso.hhs.state.ma.us ) and update your information.

Notify the program within 5 business days if your card is lost. Request a new card through your online account. For paper applicants, send a check payable to “The Commonwealth of Massachusetts” with a letter.  There is a $10 fee to replace Program IDs cards.

Indigent Patients and Patients with Mobility Issues

105 CMR 725.005

Dispensaries will be required to provide medicine at discounted rates for low-income residents. Patients who earn less than 300% of the federal poverty level, or who are enrolled as recipients of MassHealth or Social Security Income are eligible for the discount.

As an alternative to the discount program as well as patients with mobility issues and a lack of access to a nearby dispensary may also apply for a hardship cultivation license (see section below).

Hardship Cultivation Registration

105 CMR 725.035

Eligibility

In certain circumstances, a patient may be granted a “hardship cultivation registration.”  These registrations allow patients to cultivate their own personal supply of marijuana. Such registrations are generally granted to patients with financial hardships, physical incapacities to access reasonable transportation, or those who lack a RMD within a reasonable distance to their residence.

A qualifying patient registered with the Department pursuant 105 CMR 725.015 may apply for a hardship cultivation registration if such patient can demonstrate that his or her access to a RMD is limited by

(1) Verified financial hardship; or

(2) Physical incapacity to access reasonable transportation, as demonstrated by an inability to use public transportation or drive oneself, lack of a personal caregiver with a reliable source of transportation, and lack of a RMD that will deliver marijuana to the patient’s or personal caregiver’s primary address; or

(3) Lack of a RMD within a reasonable distance of the patient’s residence and lack of a RMD that will deliver marijuana to the patient’s or personal caregiver’s primary address.

Process to Obtain Registration

105 CMR 725.035 (B); 105 CMR 725.035 (C)

To obtain a hardship cultivation registration, a registered qualifying patient shall, in a form and manner determined by the Department, submit the following:

(1) A non-refundable registration fee, unless waived pursuant to 105 CMR 725.015(A)(7);

(2) Information supporting a claim that access is limited due to one or more of the circumstances listed in 105 CMR 725.035(A);

(3) An explanation including lack of feasible alternatives to mitigate the limitation claimed under 105 CMR 725.035(A);

(4) A description and address of the single location that shall be used for the cultivation of marijuana, which shall be either the registered qualifying patient’s or one personal caregiver’s primary residence;

(5) A written explanation of how the qualifying patient will cultivate marijuana in accordance with the requirements of 105 CMR 725.035;

(6) A description of the device or system that will be used to ensure security and prevent diversion of the marijuana plants being cultivated;

(7) Written acknowledgement of the limitations on his or her authorization to cultivate, possess, and use marijuana for medical purposes in the Commonwealth; and

(8) Any other information required by the Department.

Cultivation Guidelines

105 CMR 725.035 (D)-(O)

A registered qualifying patient with a hardship cultivation registration, or his or her personal caregiver(s), may cultivate only at the location specified in the application approved by the Department.

At any given location, cultivation may occur pursuant to only one hardship cultivation registration, absent proof that more than one registered qualifying patient resides at the location

A hardship cultivation registration will be valid for one year from the date of issue, and may be renewed, in a form and manner determined by the Department, on an annual basis by meeting the requirements in 105 CMR 725.035(B).

A hardship cultivation registration shall allow the registered qualifying patient or his or her personal caregiver(s) to cultivate a limited number of plants sufficient to maintain a 60-day supply of marijuana solely for that patient’s use, or as further specified by the Department.

Cultivation and storage of marijuana shall be in an enclosed, locked area accessible only to the registered qualifying patient or his or her personal caregiver(s), subject to 105 CMR 725.650. Marijuana shall not be visible from the street or other public areas.

A registered qualifying patient or his or her personal caregiver(s) cultivating marijuana pursuant to a hardship cultivation registration shall adhere to industry best practices in the cultivation of marijuana plants and storage of finished product, and any standards specified by the Department.

A registered qualifying patient and his or her personal caregiver(s) is prohibited from selling, bartering, giving away or distributing in any manner marijuana or paraphernalia.

The Department may inspect the cultivation site of a registered qualifying patient with a hardship cultivation registration, or the cultivation site of his or her personal caregiver(s), at any time. Acceptance of a hardship cultivation registration by a registered qualifying patient constitutes consent for such inspection of the cultivation site.

 After obtaining a hardship cultivation registration, a registered qualifying patient is responsible for notifying the Department, in a form and manner determined by the Department, within five business days after any change to the information that he or she or his or her personal caregiver(s) was previously required to submit to the Department.

A registered qualifying patient with a hardship cultivation registration, or his or her personal caregiver(s) if applicable, must have the registration available at the site of cultivation. Such registration must be made available upon request of the Department or other government agency acting within their lawful authority.

A registered qualifying patient with a hardship cultivation registration, or his or her personal caregiver(s) if applicable, is prohibited from purchasing marijuana from a RMD, provided however that such individuals may purchase seeds.

Health Insurance

105 CMR 725.650

Nothing in 105 CMR 725.000 Requires any health insurance provider, or any government agency or authority, to reimburse any person for the expenses of the medical use of marijuana.     

Limitations

105 CMR 725.425

Patients are not permitted to operate motor vehicles while under the influence of cannabis. Patients do not have a right to use their medicine in public, at a place of employment, on school grounds or buses, or in correctional facilities. Cities and towns may establish their own laws that also limit use. Health insurance is not required to pay for medical cannabis.

Each of the following, in and of itself, constitutes full and adequate grounds for revocation of a registration card issued to a registered qualifying patient, personal caregiver, or dispensary agent, or a hardship cultivation registration:

(1) Fraudulent use of a registration card

(2) Selling, distributing, or giving marijuana to any unauthorized person;

(3) Tampering, falsifying, altering, modifying, duplicating, or allowing another person to use, tamper, falsify, alter, modify, or duplicate a registration card or hardship cultivation registration;

(4) Failure to notify the Department within five business days after becoming aware that the registration card has been lost, stolen, or destroyed; or

(5) Failure to notify the Department within five business days after a change in the registration information contained in the application or required by the Department to have been submitted in connection therewith.

In addition to the above, each of the following, in and of itself, shall be adequate grounds for the revocation of a registration card issued to a registered qualifying patient:

(1) The qualifying patient is no longer a resident of the Commonwealth;

(2) The qualifying patient, taking into account the amounts of marijuana or MIPs obtained by his or her personal caregiver if applicable, seeks to obtain or obtains more of such amounts than is allowable under 105 CMR 725.105(F)(2); or

(3) The qualifying patient has used marijuana in a manner that puts others at risk of their health, safety, or welfare, or has failed to take reasonable precautions to avoid putting others at such risk

A conviction of a felony drug offense in the Commonwealth, or a like violation of the laws of another state, the United States or a military, territorial, or Indian tribal authority shall also be adequate grounds for the revocation of a dispensary agent’s registration card.

In addition to the grounds in 105 CMR 725.425(A), a conviction of a felony drug offense in the Commonwealth, or a like violation of the laws of another state, the United States or a military, territorial, or Indian tribal authority shall also be adequate grounds for the revocation of a dispensary agent’s registration card.