In Hawaii, medical cannabis can now be prescribed for any medical reason

Hawaii's legislators have passed a bill that would allow doctors to recommend cannabis for any illness they think it might help, This is a major departure from the traditionally narrow list of eligible diseases.

The reform, integrated into the House Bill 302 (HB 302), is now awaiting the signature of the Governor Josh Green, who has already expressed its support for wider access to cannabis.

The bill, passed overwhelmingly by both houses of the legislature, represents one of the most significant changes to the medical marijuana Hawaii since its creation in 2000. If enacted, Hawaii to join a growing number of states where clinicians, not legislators, decide whether cannabis is appropriate for their patients.

A new era of clinical discretion

Until now, Hawaii's medical cannabis program limited access to patients suffering from a defined list of «incapacitating medical conditions», such as cancer, chronic pain, epilepsy and multiple sclerosis.

Under the HB 302 law, this list will be maintained, but any ailment can now be considered as eligible for cannabis treatment, provided that a attending physician, advanced practice nurse or palliative care provider believes it could be beneficial.

The wording of the bill gives greater room for manoeuvre, recognizing that healthcare is not a one-size-fits-all proposition and that clinicians - not politicians - are best placed to decide what their patients need.

«This change reflects the maturation of the medical cannabis program,» said Karen O'Keefe, Director of State Policy at Marijuana Policy Project (MPP). «It allows clinicians to treat patients holistically, rather than forcing them to fit into narrow bureaucratic definitions.»

Although this reform was initially widely supported by advocates and patients, subsequent amendments diluted the scope of the bill. In particular, the ability to recommend cannabis for any condition is limited to the attending clinician of the patient. Doctors who do not have an established care relationship with the patient will therefore not be able to issue recommendations for unlisted conditions.

This limitation is a potential obstacle for many patients in Hawaii, where access to consenting healthcare providers is already limited.

«Only 6 % Hawaiian physicians practicing currently recommend cannabis,» said M. O'Keefe at Marijuana Moment. «This means that most patients are forced to refer to specialists to access treatment, which increases costs and delays care.»

A victory for telehealth and rural patients

In addition to expanding the list of eligible conditions, the HB 302 bill includes another key modernization: the authorization of telemedicine appointments for medical cannabis assessments. Previously, patients had to establish a face-to-face relationship with a supplier before obtaining a recommendation.

The flexibility of telehealth could be a game-changer for rural communities, patients with reduced mobility and those living in underserved areas where doctors recommending cannabis are hard to find.

«This is an important step towards the standardization of cannabis as a medicine » said a local patient advocate. «People don't have to jump through hoops or travel for hours to get something that helps them manage chronic pain or post-traumatic stress disorder.»

What happens next?

The bill having been approved by the House and Senate, it is now on the desk of the Democratic Governor Josh Green, who is expected to sign it into law. Mr. Green has long been an advocate of the’access to cannabis, both as a doctor and as a civil servant.

«It would make marijuana very accessible to those who choose it,» the governor said last year. «And it would ensure the safety of children, which is everyone's priority.»

He also reiterated its support for the full legalization of cannabis for adults, which he sees as the next logical step but which faces several setbacks.

«I think adults who want to use marijuana responsibly should be able to do so,» Green said.