Recommending Cannabis in Hawai'i

Physicians recommending medical cannabis must be licensed under Haw. Rev. Stat. § 453, and licensed with authority to prescribe drugs and is registered under Haw. Rev. Stat. § 329-32.[1]  Advanced practice registered nurses with prescriptive authority under Haw. Rev. Stat. § 457-8.6 and registered under Haw. Rev. Stat. § 329-32 may certify patients for medical marijuana use.[2]  Physician Assistants are not allowed to write recommendations. Physicians and advanced practice registered nurses must demonstrate a bone fide relationship with patients[3]. To establish this relationship, the treating physician, at a minimum shall:

  1. Complete a full assessment of the qualifying patient’s medical history and current medical condition, including conducting a review of the qualifying patient’s medical records related to the medical condition as medically appropriate and conducting an in-person physical examination;
  2. Provide follow-up care and treatment as medically appropriate to the qualifying patient and assess the qualifying patient’s medical condition during the course of the qualifying patient’s medical use of marijuana; and
  3. Maintain records of the qualifying patient’s treatment and medical condition in accordance with medically accepted standards. [4]

To certify a patient for medical marijuana use, a physician or advanced practice registered nurse must do the following:

  1. Diagnose the patient as having a debilitating medical condition covered under current medical marijuana law (i.e. Haw. Rev. Stat. § 329-121);
  2. Explain the potential risks and benefits of medical marijuana use to the patient or his/her guardian; and
  3. Certify, in writing, that in his/her professional opinion, after having completed a full assessment of the patient’s medical history and current medical condition made in the course of a bona fide physician-patient relationship or bona fide advanced practice registered nurse-patient relationship, as applicable, that the potential benefits of the medical use of marijuana would likely outweigh the health risks for the particular qualifying patient. [5]

Qualifying Conditions 

  • Cancer
  • Glaucoma
  • Positive status for human immunodeficiency virus (HIV) or acquired immune deficiency syndrome (AIDS), or the treatment of these conditions

A chronic or debilitating disease or medical condition or its treatment that produces one or more of the following:

  • Cachexia or wasting syndrome
  • Severe pain
  • Severe nausea
  • Seizures, including those characteristic of epilepsy
  • Severe and persistent muscle spasms, including those characteristic of multiple sclerosis or Crohn’s disease
  • PTSD
  • Any other medical condition approved by the Department of Health pursuant to administrative rules in response to a request from a physician or advanced registered nurse or potentially qualifying patient.[6] 

[1] Haw. Rev. Stat. § 329-121.

[2] Haw. Rev. Stat. § 329-121.

[3] Haw. Rev. Stat. § 329-126; HAR § 11-160-11.

[4] HAR § 11-160-2; the regulations have not been updated to provide the corresponding requirements to establish a bona fide advanced practice registered nurse-patient relationship.

[5] Haw. Rev. Stat. §§ 329-122, 126; HAR §§ 11-160-11, 12.

[6] Haw. Rev. Stat. § 329-121.