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] 

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