Recommending Cannabis in Washington

Health care professionals recommending medical cannabis must be licensed to practice medicine in the State of Washington. Physicians, physician’s assistants, naturopaths and advanced registered nurse practitioners have the authority to recommend medical cannabis for the treatment of a wide variety of terminal and debilitating conditions. A physical condition must be conducted as appropriate and recommendations must be issued on tamper-resistant paper.  There are no state registration requirements for health care professionals or their patients.

Qualifying Conditions

  • Cancer
  • Multiple Sclerosis
  • Human Immunodeficiency Virus (HIV)
  • Epilepsy or other seizure disorder
  • Spasticity disorders
  • Intractable pain, unrelieved by standard treatments and medications
  • Glaucoma (acute or chronic), unrelieved by standard treatments and medications
  • Crohn’s disease with debilitating symptoms, unrelieved by standard treatments and medications
  • Hepatitis C with debilitating nausea or intractable pain, unrelieved by standard treatments and medications
  • Diseases, including anorexia, which cause nausea, vomiting, wasting, appetite loss, cramping, seizures, muscle spasms or spasticity, unrelieved by standard treatments or medications
  • Posttraumatic stress disorder (PTSD)
  • Traumatic brain injury

Health Care Professional Requirements

  • Must be one of the following and licensed to practice in the State of Washington:
    • Medical doctor (MD)
    • Physician assistant (PA)
    • Osteopathic physician (DO)
    • Osteopathic physician assistant (DOA)
    • Naturopathic physician
    • Advanced registered nurse practitioner (ARNP)
  • Must issue authorization on a form approved by the Department of Health that is printed on tamper-resistant paper
  • Must have newly initiated or documented relationship with patient
  • Must complete physical exam as appropriate, based on patient’s condition and medical history
  • Must document in the patient’s record the terminal or debilitating condition, and that the patient may benefit from treatment of the condition or its symptoms with the medical use of cannabis
  • Must advise patient about risks and benefits of medical marijuana, and document such discussion in the patient’s record
  • Must inform the patient of other options to treat the medical condition and document attempts to treat the condition without cannabis
  • Must not have a practice that consists solely to authorize medical cannabis
  • Must not examine patients where cannabis is produced, processed or dispensed
  • Must not solicit or accept payment to or from any dispensary, producer or processor
  • Must not offer a discount or other financial reward to patients for their patronage of a dispensary, producer or processor
  • Must not hold an economic interest in an enterprise that produces, processes, or sells marijuana, if the health care professional is authorizing medical use of marijuana
  • The board of naturopathy, board of osteopathic medicine and surgery, medical quality assurance commission, and nursing care quality assurance commission must develop continuing education programs related to medical use of marijuana for the health care professionals that they regulate
  • Authorizations expire in one year for adult patients and six months for minor patients (under 18 years of age).
  • Additional requirements for minor patients:
    • Must ensure the minor patient’s parent or legal guardian participates in the treatment and consents to medical use of marijuana
    • Must consult with other healthcare providers involved in the minor patient’s treatment, as medically indicated, before authorization or reauthorization of medical use of marijuana
    • Must re-examine the minor patient at least once every six months, or as medically indicated:
      • Must determine that the minor patient continues to have a qualifying medical condition and that the condition benefits from medical use of marijuana
      • Must include a follow-up discussion with the minor patient’s parent or legal guardian to ensure the parent or legal guardian continues to participate in treatment