Recreational and medical use of marijuana, CBD, and cannabis products are legal in many states across the US. However, there are issues that doctors, nurses, and other healthcare license holders should be aware of before they do smoke weed, pot, hash oil, honey oil, or use medical marijuana or other psychoactive THC products.
Licensed healthcare workers are subject to more restrictive marijuana use standards than the general public, even with a medical card and even in legal states, such as California, Colorado, and Washington. Our professional license defense attorney published this guide to help you avoid triggering license board or employer disciplinary actions that put your career at risk.
Marijuana, CBD, medical, and nursing license FAQ
Here our nursing license defense attorney reviews seven common questions professionals have about cannabis, cannabidiol (CBD), tetrahydrocannabinol (THC) and medical marijuana:
Nurses can smoke weed in legal states, like California and Colorado, as long as:
the nurse is not impaired when treating patients,
they follow their employer drug policies,
they do not work for the federal government, and
they do not violate DUI or other drug criminal laws.
The primary issue for nurses is that most nurse employers prohibit marijuana use, even when legal. Even if recreational or medicinal marijuana use is permitted under a state’s laws, employers have the right to maintain a drug-free workplace for safety-sensitive positions. They can terminate nurses who smoke weed for failing a drug test, even when they have a medical card. Each employer establishes their workplace policy for drug usage, and you should consult HR to understand yours. Employers are entitled to require a pre-employment nurse drug test as a condition to employment.
The federal government still categorizes marijuana as a Schedule I controlled substance. Federal employees are not permitted to use medicinal or recreational marijuana regardless of state laws, nor whether they have a medical card. The Veteran’s Health Administration, Department of Health and Human Services, and other federal agencies can fire nurses for using marijuana.
Testing for THC impairment is complex since no drug tests reliably measure whether someone is currently impaired. Unlike alcohol usage, a nurse can test positive for marijuana use weeks after their last usage.
Arguing that THC impairs someone typically requires combining drug test results with other objective signs of impairment to establish a totality of evidence. Using cannabis can add risk for nurses that if a workplace incident occurs, the employer or nursing board could argue that the incident was due to drug impairment at work.
Multi-state travel nurses must take extra care to be aware of the marijuana laws in every state they are licensed to practice. Legal use in one state can trigger a failed drug screening test at a new assignment in another.
If the level of marijuana usage turns into a substance abuse problem that interferes with a nurse’s work performance, the Board of Nursing can initiate nurse license disciplinary actions.
they do not violate DUI or other drug criminal laws, and
they do not work for the federal government.
State medical boards essentially treat legal cannabis use like alcohol; they only care about it when a physician is impaired while working. For example, the Medical Board of California (MBC) does not have rules regarding a doctor’s use of cannabis for recreational or medicinal purposes. But the MBC has strict rules about practicing while impaired and patient safety. If the MBC receives an impaired physician complaint, an investigation and medical evaluation can be ordered (BPC § 820).
Doctors that smoke weed can cause a workplace violation if their employer has a drug-free workplace policy. Physicians are considered safety-sensitive positions. Employers have the right to require pre-employment drug tests and establish a drug-free workplace. If you are not self-employed, it is essential to understand what your employer’s policies are.
The federal government still defines marijuana as a Schedule I controlled substance, even when legal under state laws. As a result, the federal government prohibits its employees from using medicinal and recreational marijuana. The US Department of Veterans Affairs, Centers for Disease Control and Prevention (CDC), Food and Drug Administration (FDA), National Institutes of Health (NIH), and other federal agencies can fire doctors for failing federal workplace drug testing.
Given the hassle, expense, and serious potential risks of medical board investigations, physicians need to consult with a medical license defense attorney for guidance whenever contacted by their board. Having THC in your system can add practice risk if a patient incident occurs that triggers in-depth scrutiny; the patient or board could allege it was due to drug impairment. As a result of the risks, many physicians err on the conservative side and avoid THC.
Three percent of doctors smoke weed, according to a Medscape physician survey of prior 12 months marijuana usage (1). In contrast, 12% of the general population reported that they currently used marijuana in a nationwide Gallup poll in 2019 (2). Therefore, doctors use marijuana at about one-quarter the rate of the general population.
A doctor’s history of ever using marijuana varies by medical specialty. The Medscape survey found emergency medicine physicians report the highest historical rate of marijuana use at 31%, followed by plastic surgery at 29%. The lowest reported rates of historical marijuana usage are for nephrology at 15% and endocrinology at 16%. In comparison, 38% of Americans overall report they’ve tried marijuana, according to the 2019 Gallup poll.
Doctor marijuana use by specialty
Source: Medscape Lifestyle Report Survey on Physician Marijuana Use
4) Can doctors or nurses use CBD oil?
Cannabidiol (CBD) oil is widely available and marketed as beneficial for arthritis, glaucoma, insomnia, anxiety, and other medical conditions. Since the 2018 Farm Bill became effective January 1, 2019, all 50 states have legalized the use of hemp-based CBD products. Industrial hemp plants, by definition, must have a delta-9 THC content of not more than 0.3 percent by dry weight.
Nurses and doctors can use hemp-based CBD oil in all 50 states, so long as the oil is THC-free. But many CBD oils can contain THC, even when labeled THC-free. A 2017 study published in JAMA by Dr. Marcel Bonn-Miller, a substance abuse specialist at the University of Pennsylvania Perelman School of Medicine found that 18 out of 84 different CBD oils tested contained THC.
If a doctor or nurse consumes CBD oil with THC, there is a risk of a positive drug test. If your employer or state bans THC use, you could be terminated, refused employment, or disciplined for a failed drug test.
Physicians and nurses need to do their research and be careful about the CBD they consume and trust. Even though most CBD products claim to have less than 0.3% THC content, these claims can be unreliable. The FDA does not regulate CBD, and THC levels are usually not listed on the bottle. Vaping or otherwise consuming certain CBD oils can put your job and license at risk.
5) Where is marijuana legal in the U.S.?
Marijuana laws are changing rapidly across the United States. Possession and recreational use of marijuana are currently legal for individuals over 21 in 15 states and Washington, D.C.: Alaska, Arizona, California, Colorado, Illinois, Maine, Massachusetts, Michigan, Montana, Nevada, New Jersey, Oregon, South Dakota, Vermont, Washington and the District of Columbia.
The medical use of cannabis with a physician’s recommendation is legal in 35 states, including the states listed above, plus: Arkansas, Connecticut, Delaware, Florida, Hawaii, Louisiana, Maryland, Minnesota, Mississippi, Missouri, New Hampshire, New Mexico, New York, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, Utah, and West Virginia.
Under the Controlled Substances Act of 1970, the possession and use of cannabis remain illegal under federal law. Some derivative compounds such as Cesamet (nabilone), Epididiolex (cannabidiol), Marinol, and Syndros (THC), have been approved for prescription use by the FDA.
6) Do nursing and medical schools require drug tests?
Most nursing and medical school programs require drug screen testing during the admission enrollment process. The requirement stems from the fact that schools must maintain compliance with health care organization rules, regulations, and accreditation standards.
Since medical school programs include clinical immersion experiences that involve students in the delivery of health care, medical students are subject to pre-clinical testing through urine drug screening (UDS). Each schools’ drug screening requirements must comply with their affiliated healthcare organizations’ accreditation and regulatory requirements.
Nursing and medical school urine drug screening typically tests for the following drugs: amphetamine (methamphetamine), barbiturates, benzodiazepine, cocaine, marijuana, methadone, methaqualone, opiates (codeine & morphine), phencyclidine, propoxyphene, and oxycodone. Some schools perform hair follicle drug testing in order to determine longer term drug use. Positive tests for prescribed medications usually require a review of the supporting prescription documentation.
7) Can a nurse or doctor with a green card or visa use marijuana?
Doctors and nurses that are visa or green card holders cannot legally use marijuana due to federal immigration laws, even if it is legal under their state laws. Non-US citizens are subject to federal laws that consider the possession and use of cannabis illegal, even for medical purposes.
States that have legalized marijuana do not require that you be a U.S. citizen to use marijuana. But marijuana use can put your federal permanent resident status at risk. If convicted for a violation of federal law relating to marijuana use or any other controlled substance (except simple possession of 30g or less of marijuana), visa and green card holders can become deportable. (USCIS policy)
The firm provides effective and vigorous license defense for licensed businesses and all health care professionals, including physicians, nurses, dentists, pharmacists, and chiropractors.
Attorney Robert K. Weinberg is a former prosecutor with more than 30 years of experience handling professional license defense, federal, DEA, and state criminal defense matters. Robert is an authority in the complex intersection of licensing and criminal law for professional licensees and healthcare corporations. He has handled over 5,000 cases, licensure administrative hearings and jury trials.
This information does not constitute legal advice and does not create an attorney/client relationship. No representations are made as to the accuracy of this information, and appropriate legal counsel should be consulted before taking any actions. Contact us for a consultation regarding your case facts.
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