Rhode Island

A "practitioner" authorized to issue written certifications are physicians (MD or DO), physician assistants (PA), and advanced practice registered nurses (APRN) licensed in Rhode Island, or physicians (MD or DO) licensed in Massachusetts or Connecticut. The certification must be completed on the RIDOH Practitioner Written Certification Form.

Certifying practitioners must also hold:

• A current, active medical license in Rhode Island, Massachusetts, or Connecticut
• A current DEA registration
• Appropriate state-controlled substance registration

Important note for Massachusetts and Connecticut physicians: Physicians licensed in Massachusetts or Connecticut who do not hold a Rhode Island medical license are eligible to certify Rhode Island patients, provided they satisfy all other requirements, including the bona fide practitioner-patient relationship standard and completion of required CME. Verify compliance with the interstate practice requirements of your home state's licensing board before certifying Rhode Island patients.

Rhode Island does not require practitioners to register with the Medical Marijuana Program before certifying patients. Eligibility to certify is based on holding an active medical license with prescribing authority in Rhode Island, Massachusetts, or Connecticut, along with a current DEA registration and appropriate state-controlled substance registration.

Practitioners may certify patients who have been diagnosed with a "debilitating medical condition". Approved qualifying conditions are:

• Cancer, or the treatment of cancer
• Glaucoma, or the treatment of glaucoma
• Positive status for Human Immunodeficiency Virus (HIV), or the treatment of HIV
• Acquired Immune Deficiency Syndrome (AIDS), or the treatment of AIDS
• Hepatitis C, or the treatment of Hepatitis C
• Autism Spectrum Disorder (requires use of the separate ASD Practitioner Written Certification Form)
• Post-Traumatic Stress Disorder (PTSD) — patients must be 18 years of age or older
• A chronic or debilitating disease or medical condition, or its treatment, that produces one or more of the following: cachexia or wasting syndrome; severe, debilitating, chronic pain; severe nausea; seizures, including but not limited to those characteristic of epilepsy; severe and persistent muscle spasms, including but not limited to those characteristic of multiple sclerosis or Crohn's disease; or agitation related to Alzheimer's disease

Per 216-RICR-20-10-3 § 3.4.4, any person may petition RIDOH to add a condition to the qualifying list by submitting a written petition with supporting scientific literature and letters of support from licensed health care professionals.

Before certifying a patient whose primary qualifying condition involves pain, practitioners must review the Rhode Island Prescription Drug Monitoring Program (PDMP) and evaluate the patient's prescription history for potential drug interactions, adverse events, or untoward clinical outcomes. 

Step 1: Establish a bona fide practitioner-patient relationship.

A written certification may only be issued in the course of a bona fide practitioner-patient relationship after the practitioner has completed a full assessment of the qualifying patient's medical history.

Step 2: Conduct an in-person physical examination.

The written certification must be based on an in-person physical examination. A "full assessment" requires at minimum: documentation of history of present illness, social history, past medical and surgical history, alcohol and substance use history, physical exam, and documentation of therapies with inadequate response. Telehealth evaluations are not permitted for initial certifications.

Step 3: Review the Rhode Island PDMP.

Before issuing a written certification, review the Rhode Island Prescription Drug Monitoring Program and assess the patient's prescription history for potential drug interactions, adverse events, or untoward clinical outcomes from adding medical cannabis.

Step 4: Complete the written certification form.

Complete the RIDOH Practitioner Written Certification Form. For patients being certified on the basis of an Autism Spectrum Disorder diagnosis, use the Practitioner Written Certification Form for Use With Autism Spectrum Disorder Diagnosis. Provide the original signed form to the patient; the patient uploads it with their application to the RI Cannabis Licensing Portal. For applications requiring expedited processing (chemotherapy patients or patients eligible for hospice care), indicate the need for expedited review on the form.

Step 5: Provide patient education.

Document in the medical record and provide in written or verbal format that the patient was educated regarding: maximum daily dose of active ingredient; minimum interval between doses; possible drug interactions, including the risk of co-ingesting alcohol.

Step 6: Maintain complete medical records.

Document in the medical record the basis for issuing the certification, the debilitating condition(s) being certified, the patient's response to conventional medical therapies, your explanation of the risks and benefits of medical cannabis, and all patient education provided.

Step 7: Update the primary care provider.

If you are not the patient's primary care provider, send updates documenting the patient's progress or experience using medical cannabis to the primary care provider at intervals not exceeding 12 months.

Patient registry identification cards expire one year from the date of issuance.

Recertification requires a new written certification using the Practitioner Written Certification Form. Follow-up recertification appointments may be conducted via telehealth, consistent with Rhode Island law and the Regulations for the Licensure and Discipline of Physicians (216-RICR-40-05-1). The initial certification, however, requires an in-person physical examination.

Certifying practitioners must maintain a commitment to the continual assessment of each patient and conduct follow-up appointments at a minimum semi-annual frequency before any card renewal.

Medical professionals have a legal right to recommend cannabis as a treatment in any state, as protected by the Medical Marijuana and Cannabidiol Research Expansion Act (Title III section 301) which became law on December 2, 2022, and the First Amendment (established by a 2004 United States Supreme Court decision to uphold earlier federal court rulings that doctors, and their patients have a fundamental Constitutional right to freely discuss treatment options).

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