California Patient’s Guide to Ryan’s Law

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.

Physicians with patients who are terminally ill or 65 and older with a chronic disease need only to provide a written recommendation for medical cannabis for their patients to be allowed to use medical cannabis in health care facilities. This is the same recommendation as for the Compassionate Use Act qualification. Americans for Safe Access (ASA) has created this guide, along with resources for physicians and their patients. If patients have issues with health care facilities that refuse to comply, please report them immediately to [email protected].

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 November 2025, the official rescheduling process is in the hands of the Drug Enforcement Administration (DEA) to make 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 Requirements:

1. Do not interfere with or prohibit a terminally ill or otherwise qualified patient from using medical cannabis on premises.
2. Document the use of medicinal cannabis in the patient’s medical record.
3. Develop, disseminate, and train staff on written guidelines for the use, storage, and disposal of medicinal cannabis within the facility.
4. Do not deny admission in whole or in part because a patient uses medicinal cannabis.
5. Adopt a policy and procedure for the disposal of medicinal cannabis left by patients.

Facility Restrictions: 

1. 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.
2. 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 for Facilities

1. Facilities may use a waiver of liability for lost or stolen medical cannabis.
2. Facilities are not required to provide a physician’s recommendation to patients.
3. Facilities may not suspend compliance solely because cannabis is a Schedule I substance.
4. Facilities may temporarily suspend compliance if a federal agency (HHS, DOJ, or CMS) initiates enforcement action or expressly prohibits compliance under the Act.

To qualify for rights granted under Ryan’s Law, a patient must be prepared with the following.

Requirements:

1. Bring a copy of your valid MMIC or/ recommendation from your attending physician.
2. Bring a copy of a valid and unexpired government-issued photo identification.
3. Bring non-inhalable forms of cannabis. Smoking and vaping are not permitted. Patients are responsible for their own supply of cannabis.
4. Bring a lockable storage container. 
5. Let hospital staff know you are a medical cannabis patient and will be using cannabis on the premises in accordance with SB 302.

Considerations:

1. Health care facilities may be slow to adopt internal policies. Consider bringing a copy of the law provided in this guide.
2. The law prohibits smoking and vaporizing cannabis, and doing so may result in your losing the right to use cannabis on site.
3. If you meet the requirements above and have any problems with using cannabis in a health care facility or are refused admission as a patient due to your medical cannabis patient status, please report immediately to [email protected].

Sample Written Recommendation

Patient’s guide to medical cannabis