In 2000, Hawaii passed SB 862/HD 1, making it the first state to legalize medical cannabis via the legislative (rather than the voter-initiated) process. The legislature amended the law in 2013 with two bills. HB 668 moved the medical cannabis program from the Department of Public Safety to the Department of Health and established a medical marijuana registry fund. SB 642 defined “adequate supply,” “medical use,” “primary caregiver,” “usable marijuana,” and “written certification,” amended registration requirements, and created a mechanism for law enforcement to immediately verify registration status 24 hours a day, seven days a week. Prior to the effective date of SB 642, “adequate supply” was defined as up to seven plants (no more than three of which could be mature) and one ounce of usable cannabis per each mature plant. After the legislation took effect in January of 2015, registered medical cannabis patients and their registered caregivers could possess up to four ounces of usable cannabis and cultivate up to seven plants, whether mature or immature.

In 2015, the legislature passed two more bills that improved the medical cannabis program. HB 321 created a program allowing eight medical marijuana dispensaries with two cultivation licenses each and allowing more dispensaries to be licensed after October 1, 2017. SB 1291 clarified anti-discrimination protections for patients. In 2016, the legislature passed HB 2707, which created a legislative oversight group to monitor the state medical program and report back to the legislature before the 2018 session. The bill also expanded the allowed delivery methods and protections for medical cannabis paraphernalia. 

2017 brought significant improvements for Hawaii’s medical cannabis program, including legislation that expanded the number of plants an individual can grow (from seven to 10 at any stage of growth), amended laboratory certification standards, and added four new qualifying conditions. Hawaii also improved its petition process for adding qualifying conditions, provided clarifications about patient privacy, and developed a state-sanctioned cashless purchasing system for medical cannabis. The state also deserves credit for making technical changes to its program by replacing the word “marijuana” with “cannabis” in their statutes.  In 2018, Hawaii passed legislation permitting registered out-of-state cannabis patients to legally purchase cannabis while visiting the state. In 2019, Hawaii announced that registrations could be valid for up to three years and that out-of-state patients could now obtain medicine in Hawaii.

Despite these advancements, safe and legal patient access in Hawaii remains extremely challenging with only eight licensed dispensaries operating, with the first of them opening a full 17 years after the state’s medical program was enacted, and two years after Hawaii approved medical storefront access.  Although Hawaii’s program has been law for nearly 20 years, the state did not approve its first medical cannabis production and dispensary facilities until 2018. Hawaii’s slow rollout has also experienced product and consumer safety challenges, as noted above. 

In 2019, state lawmakers worked but failed to reach agreement on a broad adult-use measure, though a bill did make it through the legislature that replaces jail time with a $130 fine for possession of three grams of cannabis or less. In 2020, the state organized COVID measures that included only declaring cannabis businesses essential and allowing telemedicine for patient renewals.