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CA Healthcare Facility Implementation Guide for the Compassionate Access to Medical Cannabis Act
"Ryan’s Law" SB 311(2021), SB 988 (2022), SB 302 (2023)
Ryan’s law was passed in honor of Ryan Bartell, who was diagnosed with Stage 4 pancreatic cancer at the age of 41. As his condition progressed, he was admitted to the palliative wing of a hospital, where he spent his first four and a half weeks on fentanyl to treat his pain. Unfortunately, the first hospital could not allow Ryan to use cannabis in their facility. He stayed on this medication until his family could locate and move Ryan to a hospital that would allow him to use cannabis. As a result of using medical cannabis, he spent his last two and a half weeks lucid and pain-free with his family and friends. Following this experience, Ryan’s father, Jim Bartell, made it his mission to ensure that no other family would have to navigate this choice for palliative care, losing precious time with their loved one.
The Compassionate Access to Medical Cannabis Act, also known as “Ryan’s Law,” requires California healthcare facilities to permit the use of medical cannabis on their premises for terminally ill patients or patients aged 65 and older with chronic diseases who hold a valid Medical Marijuana Identification Card (MMIC) or a physician’s recommendation.
The Act was passed by the legislature with support from a diverse group of organizations, including Americans for Safe Access (ASA). The law applies to all CA health care facilities, including acute care hospitals, special hospitals, skilled nursing facilities, congregate living health facilities, hospice providers, and (as of 2023) home health agencies. Emergency departments of a health care facility, chemical dependency recovery hospitals, and state hospitals are excluded from the Act's provisions.
In 2022, SB 988 was passed to clarify the chain of command for cannabis in health care facilities, requiring patient or primary caregiver be responsible for acquiring, retrieving, and administering medicinal cannabis; that medicinal cannabis be stored securely at all times in a locked container or with the patient’s primary caregiver; and that the health care facility create a policy and procedure for disposing of cannabis if a patient or caregiver leaves any remaining product after their discharge
In 2023, the legislature passed SB 302, expanding the provisions of the Compassionate Access to Medical Cannabis Act by including any patient over 65 years of age with a chronic disease, adding home health agencies to the definition of “health care facility,” and explicitly prohibiting health care facilities from denying a patient’s admission based on a patient’s use of medicinal cannabis.
Americans for Safe Access (ASA) has created this guide and implementation tools to help California health care facilities remain in compliance with the responsibilities outlined in the Compassionate Access to Medical Cannabis Act.
Founded in 2002, Americans for Safe Access (ASA) is the largest national organization of patients, medical professionals, scientists, providers, and concerned citizens promoting safe and legal access to cannabis for therapeutic use and research. ASA has utilized a variety of tactics, including legislation, education, litigation, research, grassroots empowerment, advocacy, and services for medical cannabis stakeholders to meet the immediate needs of patients and consumers while clearing the way for a national medical cannabis program.
The Compassionate Access to Medical Cannabis Act, also known as “Ryan’s Law,” builds on the rights granted to patients through Proposition 215, the 1996 voter initiative also known as the Compassionate Use Act. The law exempts patients and their designated caregivers from criminal penalties relating to the use, possession, and cultivation of cannabis with an oral or written recommendation or approval from a physician. In 2003, the California legislature passed the Medical Marijuana Program Act, expanding rights for patients and establishing a voluntary ID card program that exempts patients from arrest.
Medical professionals’ legal right to recommend cannabis is protected under the First Amendment to the US Constitution, as confirmed by the US Supreme Court in 2004 when it upheld an earlier ruling in Conant v. Walters in which the Ninth Circuit Court of Appeals barred the federal government from punishing or threatening a doctor merely for recommending the use of cannabis to a patient. In 2022, Congress granted medical professionals the explicit right to discuss and recommend cannabis as a treatment in any state, for adult and juvenile patients, with the passage of the Medical Marijuana and Cannabidiol Research Expansion Act (Title III section 301).
While cannabis remains a Schedule I drug, Congress has restricted federal enforcement of cannabis laws through amending the Commerce-Justice-Science (CJS) funding bill, prohibiting Justice Department funds from being used to prevent states from implementing medical cannabis laws. Known as the Rohrabacher-Farr or CJS amendment, it was first signed into law on December 16, 2014, and must be passed each year as part of the federal budget.
In 2022, President Biden initiated the rescheduling process by issuing a statement that called on the Health and Human Services (HHS) and the Department of Justice (DOJ) to revisit the scheduling of cannabis. Americans for Safe Access (ASA) provided guidance and data to the Food & Drug Administration (FDA), which were incorporated into the FDA's approach to the scheduling process. In August 2023, HHS concluded that cannabis has “currently accepted medical use” and recommended that cannabis be moved to Schedule III.
On May 1, 2023, the DOJ confirmed that it is moving forward with the rescheduling process based on HHS's recommendation. As of March 2026, the official rescheduling process is in the DOJ's hands, awaiting a final determination.
The Compassionate Access to Medical Cannabis Act (SB311), also known as “Ryan’s Law”, was signed by Governor Gavin Newsom on September 28, 2021, requiring healthcare facilities to allow the use of medical cannabis on their premises for terminally ill patients with a valid Medical Marijuana Identification Card (MMIC) or/ recommendation from a physician. The California legislature passed SB 988 in 2022 to clarify the requirements for healthcare facility staff, and in 2023, they expanded the Act's provisions to include patients aged 65 years or older with a chronic disease and home health agencies through the passage of SB 302.
The Compassionate Access to Medical Cannabis Act defines a “terminally ill patient” as a patient with a medical condition resulting in a prognosis of life of one year or less, if the disease follows its natural course.
“Health care facilities” are defined as licensed general acute care hospitals, special hospitals, skilled nursing facilities, congregate living health facilities, hospice providers, and home healthcare agencies. Chemical dependency recovery hospitals, emergency departments of health care facilities, and state hospitals are explicitly excluded.
Facility — Required Actions
- Do not interfere with or prohibit a terminally ill or otherwise qualified patient from using medical cannabis on premises.
- Document the use of medicinal cannabis in the patient’s medical record.
- Develop, disseminate, and train staff on written guidelines for the use, storage, and disposal of medicinal cannabis within the facility.
- Do not deny admission in whole or in part because a patient uses medicinal cannabis.
- Adopt a policy and procedure for the disposal of medicinal cannabis left by patients.
Facility — Prohibitions
-
No smoking or vaping of cannabis on premises.
- Home health agencies (HHAs): must prohibit smoking or vaping immediately before or while HHA staff are present in the residence.
- Staff may not handle/administer cannabis: healthcare professionals and facility staff (including physicians, nurses, and pharmacists) are prohibited from administering medicinal cannabis or retrieving it from storage.
Additional Provisions
- Facilities may use a waiver of liability for lost or stolen medical cannabis.
- Facilities are not required to provide a physician’s recommendation to patients.
- Facilities may not suspend compliance solely because cannabis is a Schedule I substance.
- Facilities may temporarily suspend compliance if a federal agency (HHS, DOJ, or CMS) initiates enforcement action or expressly prohibits compliance under the Act.
Patient / Caregiver Responsibilities
- Provide a valid MMIC or written physician recommendation.
- Acquire, retrieve, and administer medicinal cannabis themselves (patient or designated caregiver).
- Store securely at all times in a locked container in the patient’s room, another designated area, or with the caregiver.
- Remove all remaining medicinal cannabis upon discharge.
Administrators should take the following steps to ensure that health care facilities remain in compliance with the new law:
- Adopt a policy banning smoking or vaporizing cannabis on premises, as required by HSC §1649.2(a)(1).
- Train staff to verify the status of a patient’s MMIC or physician’s recommendation (see Sample SOP).
- Adopt a policy to include the use of medicinal cannabis within patient medical records per HSC §1649.2(a)(2).
- Create a plan for the disposal of medicinal cannabis left by patients, as required by HSC §1649.3.
- Create a waiver of liability for lost or stolen medical cannabis (optional).
- Create written guidelines for staff dissemination as required by HSC §1649.2(a)(5).
Notice of New Policies:
The Compassionate Access to Medical Cannabis Act or “Ryan’s Law”
Background: The Compassionate Access to Medical Cannabis Act, also known as “Ryan’s Law,” became effective on January 1, 2022. The bill requires healthcare facilities to allow the use of medical cannabis on their premises for terminally ill patients and patients 65 years or older with a chronic condition, with a valid MMIC or recommendation from an attending physician. Ryan’s Law builds on the rights granted through Proposition 215 (1996), also known as the Compassionate Use Act, which exempts patients and caregivers from criminal penalties for the medical use of cannabis.
The following guideline outlines policies and procedures adopted to adhere to the requirements of Ryan’s Law and is disseminated to all staff in accordance with HSC §1649.2(a)(5).
Effective Immediately:
Terminally ill patients and patients 65 years or older with a chronic condition who have a valid medical cannabis card or recommendation from their physician may use non-inhalable forms of cannabis on the premises. Smoking or vaporizing cannabis or cannabis goods is prohibited on hospital premises.
Staff should follow the protocols:
- Verify patient has a valid MMIC or/ recommendation from an attending physician by following the CA Medical Cannabis Card and Recommendations Verification SOP (See pages 9-12).
- Give the patient a copy of the facility’s The Compassionate Access to Medical Cannabis Act policy and put the completed signature page in the patient's file (See page 14).
- Sign a waiver of liability of the healthcare facility for lost or stolen medical cannabis (See page 14).
- Note the use of cannabis in the patient’s records.
Patients or their primary caregiver are responsible for acquiring, retrieving, and administering medical cannabis. It must be stored securely in a locked container in the patient’s room, another designated area, or with their caregiver, and removed upon discharge.
Health care professionals, health care facility staff, and home health agency staff, including, but not limited to, physicians, nurses, and pharmacists, are prohibited from administering medicinal cannabis or retrieving medicinal cannabis from storage. In the event that medical cannabis is left by the patient, it should remain in its locked storage container until staff dispose of it by [insert policy or procedure].
Note: Attending physicians are not required to provide patients with a physician’s recommendation for medical cannabis use.
“Qualified Patient” means an individual who possesses or cultivates cannabis for personal medicinal purposes upon the written or oral recommendation or approval of a physician licensed to practice medicine in California (HSC 11362.5(d)).
“Primary Caregiver” is the individual designated by the Qualified Patient who has consistently assumed responsibility for the housing, health, or safety of the Qualified Patient (HSC 11362.7(e) and 11362.7(d)).
“Medical Marijuana Identification Card” (MMIC) is a photo identification issued by the California Department of Public Health per HSC 11362.71 that verifies the validity and expiration date of the Qualified Patient’s letter of recommendation for the medicinal use of cannabis.
“Attending physician” means an individual who possesses a license in good standing to practice medicine, podiatry, or osteopathy issued by the Medical Board of California, the California Board of Podiatric Medicine, or the Osteopathic Medical Board of California and who has taken responsibility for an aspect of the medical care, treatment, diagnosis, counseling, or referral of a patient and who has conducted a medical examination of that patient before recording in the patient’s medical record the physician’s assessment of whether the patient has a serious medical condition and whether the medical use of cannabis is appropriate (HSC 11362.7(a)).
Checking Government-Issued Photo Identification (ID)
Physician’s Instructions for Recommending Cannabis
More information on Cannabis Medicines
California Department of Public Health – MMIC Verification
Medical Board of California – Physician License Verification Tool
Medical Marijuana & Cannabidiol Research Expansion Act (Title III section 301).
Zanker T, Sacco J, Prota J, Palma M, Viola Lee KA, Wang RR, Liang Y, Cunningham J, Mackary M, Ovchinnikova P. . Am J Hosp Palliat Care. 2024 Sep;41(9):1002-1010. doi: 10.1177/10499091231213359. Epub 2023 Dec 15. PMID: 38100655. https://pubmed.ncbi.nlm.nih.gov/38100655/
Text of Compassionate Access to Medical Cannabis Act (Ryan’s Law) Text
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