North Dakota

A health care provider such as a physician, advanced practice registered nurse (APRN) or physician assistant (PA) may recommend medical cannabis under North Dakota’s Medical Marijuana Program following the guidelines below:

• Physicians and physician assistants must be licensed through the North Dakota Board of Medicine and have a license in good standing.
• APRN’s must be licensed through the North Dakota Board of Nursing and have a license and good standing.

Determining a bona fide provider-patient relationship: 
• The health care provider has reviewed the patient's relevant medical records and completed a full assessment of the patient's medical history and current medical condition, including a  relevant, medical evaluation of the patient. 
• The health care provider has created and maintained records of the patient's condition in accordance with medically accepted standards.
• The patient is under the health care provider's continued care for the debilitating medical condition that qualifies the patient for the medical use of marijuana.
• The health care provider has a reasonable expectation that they will continue to provide follow up care to the patient to monitor the medical use of marijuana as a treatment of the patient's debilitating medical condition.
• The relationship is not for the sole purpose of providing written certification for the medical use of marijuana.

 A certification is not a prescription. It reflects the practitioner’s clinical determination that the patient has a qualifying condition. North Dakota has created a guide for medical providers. 

North Dakota does not require practitioners to register with the state before certifying patients. To certify a patient, complete the written certification form and provide it to the patient for submission with their application. There is not a practitioner registration.  Health care providers simply need to create an account in the registration system and complete a Health Care Provider Account Registration. Authorized providers under the law include physicians and PA’s licensed through the ND Board of Medicine and APRN’s licensed through the ND Board of Nursing. Medical Marijuana Program staff verify licenses with each patient application review.

Initial Education Requirement

North Dakota does not require practitioners to complete a cannabis-specific education course before certifying their first patient. 

Continuing Education (CME/CEU)

No cannabis-specific continuing education requirement has been identified for North Dakota practitioners beyond standard professional licensure renewal requirements. 

Qualifying Medical Conditions

• A Terminal Illness
• Acquired Immune Deficiency Syndrome
• Agitation of Alzheimer's Disease or related Dementia
• Amyotrophic Lateral Sclerosis
• Anorexia Nervosa
• Anxiety Disorder
• Autism Spectrum Disorder
• Brain Injury
• Bulimia Nervosa
• Cancer
• Crohn's Disease
• Decompensated Cirrhosis caused by Hepatitis C
• Ehlers-Danlos Syndrome
• Endometriosis
• Epilepsy
• Fibromyalgia
• Glaucoma
• Interstitial Cystitis
• Migraine
• Neuropathy
• Positive Status for Human Immunodeficiency Virus
• Post-traumatic Stress Disorder
• Rheumatoid Arthritis
• Spinal Stenosis or chronic back pain, including neuropathy or damage to the nervous tissue of spinal cord with objective neurological indication of intractable spasticity 
• Tourette  Syndrome
• A chronic or debilitating disease or medical condition or treatment for such disease or medical condition that produces one or more of the following:
  • Cachexia or wasting syndrome
  • Severe debilitating pain that has not responded to previously prescribed medication or surgical measures for more than three months or for which other treatment options produced serious side effects
  • Intractable nausea
  • Seizures
  • Severe and persistent muscle spasms, including those characteristic of multiple sclerosis.  o

For the current official list, visit https://www.hhs.nd.gov/sites/default/files/documents/DOH%20Legacy/MM/Debilitating-Medical-Conditions-exclusion.pdf

Step 1: Evaluate the patient.

Conduct an in-person physical examination of the patient. Telehealth evaluations are  permitted for initial certification.  Confirm the patient has a qualifying condition.

Step 2: Complete the certification document.

The written certification is an online form included in the Medical Marijuana Program’s registration system. State law includes specific information regarding what is required on the form. For example, the form must include the health care provider’s practice location, license number and specialty. 

As part of the patient application, the patient enters the name and email address of the health care provider. The health care provider receives a notification via email that they are requested to complete a written certification for the patient. Via the registration system, the health care provider completes the written certification. The registration system links the written  certification to the patient application. Medical Marijuana Program staff review the application. The patient is issued a registry ID card if approved.

Step 3: Maintain records.

Document the evaluation, qualifying condition determination, and issuance of the certification in the patient’s medical record consistent with your licensing board’s documentation standards.

Health care providers must notify the Medical Marijuana Program if they can no longer provide follow up care or monitor the patients that they have certified. The Medical Marijuana  Program will notify patients that they will have 90 days to renew their application with a different provider who will certify them. After 90 days, patient cards will be moved to a withdrawn 
status unless a renewal has been completed.

There are two alternative application processes allowed in the law –
1) veteran patients who receive care through the VA and

2) patients enrolled in a hospice (end of life) care program. In both cases, other documents are required in lieu of a written certification. Medical Marijuana Program staff will work with applicants to ensure proper documentation is received.

Patients must be recertified every  2 years.

A new evaluation is required at each recertification.

Telehealth is permitted for recertification visits.

 A new written certification must be completed at each recertification.

Medical professionals have a legal right to recommend cannabis as a treatment in any state, as protected by the Medical Marijuana and Cannabidiol Research Expansion Act (Title III section 301) which became law on December 2, 2022, and the First Amendment (established by a 2004 United States Supreme Court decision to uphold earlier federal court rulings that doctors, and their patients have a fundamental Constitutional right to freely discuss treatment options).

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