Becoming a Patient in Puerto Rico

The main website of Puerto Rico’s medical cannabis program can be accessed at http://cannabismedicinal.salud.gov.pr. Additional information regarding the program, including repealed regulations, can be found at http://www.salud.gov.pr/Dept-de-Salud/Pages/Cannabis-Medicinal.aspx.

What’s Allowed

Patients may be recommended a maximum of 28 g of cannabis flowers or the equivalent per day. Puerto Rico law defines 28 g of cannabis flower as equivalent to 8 g of THC in the form of a concentrate and as equivalent to 800 mg of THC in edible form. Registered patients or their caregivers in possession of a valid registry ID may acquire and possess up to a 30-day supply of medical cannabis from a licensed dispensary. Once 30 days have elapsed, the patient or caregiver may obtain a new 30-day supply from a dispensary.

Allowable forms of medicine and means of consumption include: oral/sublingual drops; oral inhalers; topicals; suppositories; transdermal patches; edible products, including edible products made with cannabis concentrates; vaporization of floral material (flowers, leaves, and trim); vaporization of concentrates; capsules/tablets; tinctures; concentrates; and any other form/means authorized through the issuance of an administrative order or determination. Vaporizing cannabis floral material is only authorized if the patient’s healthcare provider has determined that vaporization is the ideal method of administration, if the healthcare provider has determined that no other suitable alternatives or adequate treatments exist, or if the patient has been diagnosed with a terminal illness. Dispensaries are prohibited from supplying cannabis flowers to any patient whose medical cannabis recommendation does not explicitly authorize vaporization of cannabis floral material. Smoking medical cannabis is strictly prohibited.

Patients must have their medical cannabis ID card on them to enter dispensaries and at all times when in possession of or using medical cannabis. Similarly, caregivers must have their medical cannabis ID card on them to enter dispensaries and to be in possession of medical cannabis.

Puerto Rico does not impose a residency requirement on medical cannabis registry applicants. Visitors to the island from jurisdictions (including foreign countries) that don’t have a medical cannabis program may apply for a Puerto Rican medical cannabis card. Additionally, Puerto Rico extends reciprocity for 30 days to cardholding medical cannabis patients from other jurisdictions when their patient status can be confirmed by the card-issuing authorities in the patients’ home jurisdictions. In order to obtain, possess, and use medical cannabis for more than 30 days, a patient with a medical cannabis registry card issued by a different jurisdiction must apply for a Puerto Rican medical cannabis card.

Eligible Conditions

Qualifying conditions include: Alzheimer’s disease; anorexia; arthritis; autism; cancer; chemotherapy for cancer; depression; anxiety disorders as defined in DSM V; disorders related to being HIV+; degenerative illnesses, such as amyotrophic lateral sclerosis and multiple sclerosis; inflammatory bowel disease; incurable and advanced illnesses that require palliative care; epilepsy; fibromyalgia; glaucoma; hepatitis C; insomnia; spinal cord lesions, migraines; peripheral neuropathy; Parkinson’s disease; post-traumatic stress disorder; AIDS; bipolar disorder; any condition causing cachexia; chronic pain; severe nausea; persistent muscle spasms; and other conditions recommended by the medical advisory board and approved by the regulatory board in administrative determinations.

Access

Registered patients may visit any medical cannabis dispensary on the island. A list of licensed dispensaries is maintained at http://cannabismedicinal.salud.gov.pr/?page_id=2797.

Consumption

Public consumption of cannabis remains illegal. Medical cannabis may be used in private residences and places. Regulation 9038 defines “private residence” as the place where the patient resides; this includes but is not limited to a hospice, nursing home, or residential care facility where the patient lives or receives daily care, including assistance with the administration of medication. “Private place” is defined as a place or space where there exists an expectation of privacy, where one would not unexpectedly find oneself in the presence of a third party, and for which one has the permission of the legal owner or legally authorized possessor.

Paraphernalia

Paraphernalia (e.g., vaporizers for dry flower) can be purchased at dispensaries.

Caregiver

Adults may have one caregiver, while minor patients may have up to two. A caregiver must be at least 21 years old or legally emancipated, must be a resident of Puerto Rico, and must register with the health department and obtain a caregiver identification card to receive legal protection when handling or transporting cannabis on behalf of a patient. Caregivers may also be qualifying patients. Generally, a caregiver may only assist one patient, but Regulation 9038 does lay out some exceptions (e.g., when more than one qualifying patient resides at the same address as the caregiver). Individuals who have been convicted of the possession, distribution, or sale of a controlled substance cannot serve as caregivers.

Application Process

Applications are handled through the health department’s online Licencia Cannabis platform. Once a patient’s authorized healthcare provider has uploaded the patient’s recommendation to the platform, the patient can open an online account by entering some basic personal information. Once the account has been created, the patient can select the type of request they’d like to submit, find their doctor’s recommendation, complete the required steps (e.g., sign the privacy policy, take a 2”x2” photo, and upload other required documents), and submit their application. The patient and caregiver application and renewal fees are $25, but veterans of the U.S. armed forces are exempt from paying the fees related to becoming and remaining a patient. The patient will be able to follow the application’s progress in real time through their Licencia Cannabis account. Renewals and duplicates can also be obtained through the online platform.

Individuals under the age of 21 who participate in the medical cannabis program are considered minor patients. In these cases, two authorized healthcare providers must diagnose the patient with a debilitating condition and the patient’s parents or legal guardian must consent in writing to the patient’s use of medical cannabis. The parents or legal guardian must register as caregivers and obtain cannabis on the minor patient’s behalf. If both parents have been convicted on a local, state, or federal felony charge, a third person who can comply with the caregiver requirements may be designated as the minor patient’s caregiver.

Healthcare Provider

Authorized healthcare providers may issue medical cannabis recommendations to patients. Authorized healthcare providers are those who are authorized to practice medicine in Puerto Rico, who have a license to prescribe and/or administer drugs in conformance with state and federal laws and regulations, and who, furthermore, comply with the requirements set forth in Law No: 42-2017 and Regulation 9038. A list of authorized healthcare providers is maintained at http://www.salud.gov.pr/Documents/Cannabis/Directorio%20de%20Médicos.pdf.

Confidentiality

The law requires that the confidentiality of patient information be guaranteed consistent with the requirements of the Health Insurance Portability and Accountability Act of 1996 (HIPPA).

Housing

The use of medical cannabis remains illegal in federally subsidized housing.

Employment

Employers may permit their employees to use medical cannabis in the workplace, but are not required to do so.

Insurance

Health insurance providers are not mandated to cover medical cannabis expenses.

Reciprocity

For more information on reciprocity, please refer to The Medical Cannabis Patient's Guide for U.S. Travel.