Qualifying Conditions for Medical Cannabis (2022 Update)
As of now, marijuana is still classed as a Schedule I drug and considered illegal under Federal criminal law. This means that those caught with marijuana can still receive hefty fines, and in some states, can even still serve jail time.
Regardless of individual state laws, ALL forms of cannabis are still illegal at the federal level.
Despite marijuana being illegal on a Federal level, though, individual states have of course adopted different laws that allow patients to consume medical marijuana for a wide variety of diseases and conditions. Some states have taken it one step further, even, and have permitted the recreational use of weed. (Please note however that using marijuana is subject to not only the state you reside in, but also the county or township. In some cases, it may be even further defined by the city).
Need a Medical Marijuana Card ?
Qualifying Conditions for Medical Marijuana: The Turning Point
2009 was a major turning point for the marijuana industry as President Barack Obama announced that the federal government would not seek to arrest or prosecute medical marijuana users and suppliers, as long as they conformed to state legal laws.
I don’t think [smoking marijuana] is more dangerous than alcohol…
-President Barack Obama, January 2014
This newfound “leniency” led many states to give the green light as far as implementing a medical marijuana program, as they knew millions of dollars in potential state tax revenue loomed once a valid program – with licensed dispensaries – was up and running. Moreover, independent agencies within each state’s Department of Health were tasked with coming up with a list of qualifying medical conditions – an assignment that, if you can imagine, is no small task.
In this article, we’ve compiled a list of the most common medical conditions that are eligible for MMJ use in the United States. As you’ll see, most states have a pretty similar list, which makes sense considering that doctor recommendations are based on the availability of scientific research and clinical trials that show positive results on each condition.
There are additional qualifying conditions other than the ones listed below, and in fact, most states with an MMJ program allow conditions to be added under special circumstances and case-by-case bases. Therefore, if you suffer from a condition not stated below, we recommend contacting your state’s Department of Health to see if any exceptions can be made.
The Most Common Qualifying Conditions for Medical Marijuana in the U.S. (Updated for This Year)
*[Please note that these are only the most common qualifying conditions for medical marijuana in the U.S. – not all states will include every condition listed below].
ADD/ADHD is a condition associated with a wide range of symptoms, including:
Over the years there hasn’t been much research on medical marijuana and ADHD, but several initial studies have provided evidence that cannabis may be able to be used as an effective treatment for this disorder.
Despite no clinical recommendations [existing] that support the beneficial effects of cannabis use for ADHD, online discussions indicate that cannabis is [indeed] considered therapeutic for ADHD.
2) HIV / AIDS
Contrary to what most people think, AIDS is not a virus in itself but rather a set of symptoms that are caused by the human immunodeficiency virus, or HIV. HIV is a virus that attacks the immune system and destroys helper-T cells (aka CD4 cells, a type of white blood cell), then clones itself inside the cells in order to replicate non-stop.
AIDS is the term used when a patient with HIV can no longer fight the infection due to a weakened immune system. This causes them to develop certain defining symptoms and illnesses, and is also the last stage of HIV, when the infection is very advanced.
From “Marijuana as Medicine? The Science Beyond the Controversy” (2000):
While cannabis is NOT known to reverse the actual effects of HIV, it is commonly used to help treat symptoms of the virus, including relief from nausea and vomiting, wasting syndrome, appetite loss, pain, and decreased mood.
Anorexia divides into different types, with Anorexia and Anorexia Nervosa being the most common. It is a potentially a life-threatening eating disorder, and is often accompanied by a severe psychological disorder.
In general, anorexia:
- Is a general loss of appetite or a loss of interest in food
- Is a serious mental illness – patients do not necessarily lose interest in food, but intentionally restrict their food intake because of an irrational fear of being or becoming fat (anorexia nervosa)
As of now, Anorexia has no single cause but it does have several risk factors, including:
- Having a tendency towards depression
- Being overly worried about one’s weight and shape
- Having had an anxiety disorder during childhood
Marijuana is known to help those that suffer from Anorexia, and it has been classed by some marijuana doctors as an effective treatment.
Arthritis is of course very common, but it is unfortunately still a condition that is not very well understood – particularly rheumatoid arthritis. In fact, “arthritis” is a general term used to describe over 100 different types of conditions that are related to joint pain or joint disease.
People of all ages can have arthritis, and it is the leading cause of disability in America. Common symptoms of arthritis include:
- Swelling in the joints
- Joint pain and inflammation
- Decreased the range of motion
DID YOU KNOW: Arthritis is the leading cause of employment disability in the U.S.?
In 2000, researchers found that marijuana contains anti-inflammatory compounds, as well as natural analgesics (pain relievers) which can make it a very beneficial arthritis treatment for a wide range of patients.
From a 2017 publication in Clinical and Experimental Rheumatology:
…preclinical data exists indicates that the use of cannabis should be taken seriously as a potential treatment of joint pain.
5) Cachexia (wasting syndrome)
Cachexia is essentially a condition which denotes an excessive loss of weight. It most commonly happens due to depletion of adipose tissue and muscle mass in individuals suffering from a chronic disease such as cancer or HIV.
Cachexia is also known as “wasting syndrome,” and it is known for causing excessive muscle wasting, weakness, fatigue, and loss of appetite in patients. The word “cachexia” originates from the Greek terms -kakos, meaning “bad,” and -hexis, which means “condition.”
From the National Comprehensive Cancer Network (NCCN):
The NCCN guidelines cautiously mention cannabinoids as a breakthrough treatment for chemotherapy-induced nausea, [as well as] vomiting not responsive to other antiemetics…
6) Cancer (and cancer treatments)
Cancer is classed as a group of diseases characterized by out-of-control cell growth. As of now, there are well over 100 different types of cancer, each being classified by the specific type of cell that it affects.
Cancer alters cellular growth and reproduction, and may cause lumps or masses of tissue (tumors) to form. If untreated, tumors can grow and interfere with the digestive, nervous, and circulatory systems, and may even release hormones that alter body function.
Research in mice and rats has suggested that cannabinoids may inhibit tumor growth by:
- Causing apoptosis (programmed cell death)
- Blocking cell growth
- Blocking the development of blood vessels needed by tumors to grow.
Other research on animal models has shown that cannabinoids may be able to kill cancer cells, though this is not the reason why some states include cancer and cancer treatments within their list of qualifying conditions for medical marijuana.
From Dr. D.I. Abrams (San Francisco General Hospital, Integrative Oncology) in a 2016 report for Current Oncology:
Cannabis and cannabinoids are useful in managing symptoms related to cancer and its treatment.
Current Oncology, 2016
7) Chronic pain
About 100 million Americans suffer from chronic pain – pain that is defined as lasting longer than six months – on a daily basis. The most common sources of pain stem from:
- Joint pain
- Acute/traumatic injury
- Back pain
- Sinus pain
- Carpal tunnel syndrome
Studies on chronic pain with both neuropathic and inflammatory origins have found marijuana to be an effective treatment, as cannabinoids are known to release endogenous opioids which moderate the pain response system. While some studies have suggested that cannabis is no more effective than codeine in controlling pain, the side effects of marijuana versus narcotic pain relievers show that marijuana is a much safer option to use.
From “Cannabis and Pain: A Clinical Review” (2017):
As more patients turn to cannabis for pain relief, there is a need for additional scientific evidence to evaluate this increase.
8) Epilepsy / Seizures
Epilepsy is a group of neurological disorders characterized by intractable epileptic seizures, which are defined as episodes of uncontrollable electrical activity in the nervous system that can last from just a few seconds to several minutes.
Marijuana has anti-convulsant properties thanks in part to the presence of cannabidiol (CBD), a compound found at higher levels in hemp and some rare strains of marijuana. This makes cannabis an excellent treatment for epilepsy, as it helps to control spasms associated with the condition without providing any kind of psychoactive or intoxicating effects.
In fact, in June 2018 Epidiolex became the first-ever CBD-based drug to gain FDA approval for Dravet syndrome, which is a rare form of intractable epilepsy.
From a 2016 report in Innovations in Clinical Neuroscience:
The endocannabinoid system has a role in neuronal balance and ictal control … [and there] is clinical evidence of success in diminishing seizure frequencies with cannabis derivatives.
Glaucoma is a disease that affects and damages the eye’s optic nerve, as it tends to happen when pressure from intraocular fluid accumulates behind the retina.
Glaucoma is actually a leading cause of blindness in people over 60 years old, and forces many thousands of patients each year to undergo optic surgery. Current research has shown that there are cannabinoid receptors within the eye, implying that the endocannabinoid system may have dictation over aqueous humoural outflow and production.
In other words, specific marijuana strains have been known to reduce intraocular pressure inside the eye, therefore suggesting a potential ability to slow the progression of the disease.
From “Marijuana as Medicine? The Science Beyond the Controversy” (2000):
Glaucoma ranks among the most frequently cited reasons for using medical marijuana, and is one of the [conditions] for which the federal government once granted permission for compassionate marijuana…
Post-Traumatic Stress Disorder, aka PTSD, is an anxiety-based disorder that may develop after exposure to a traumatizing event in which significant physical or emotional harm occurred.
These events may include violent personal assaults, natural or human-caused disasters, accidents, or military combat. Individuals that suffer from PTSD may:
- Have persistent frightening thoughts and memories
- Feel detached or numb
- Be easily distracted
Researchers have found that people with PTSD have lower levels of anandamide, which is an endogenous cannabinoid compound that works to regulate neurochemical balance within the central nervous system.
In fact, endogenous anandamide has been known to trigger the same receptors that are activated by THC (and other components of the marijuana), making PTSD a qualifying condition treatment for many states’ medical marijuana programs.
From “Medical Marijuana for PTSD: A Review of Clinical Effectiveness and Guidelines” (2017):
There is evidence from very low-quality studies that smoked marijuana, oral THC, and nabilone are efficacious in treating some symptoms of PTSD, particularly nightmares and sleep quality and quantity.
We’ve done the research for yo…
What About Anxiety and Insomnia — Are They Qualifying Conditions?
Even though anxiety, depression, and insomnia are some of the most common uses of cannabis among recreational patients, very few states actually include them in their list of qualifying conditions. This is due mostly in part to their ambiguous diagnostic nature; in other words, it can be difficult for a doctor to objectively determine (either through blood testing, tissue sampling, etc) whether or not a patient suffers from anxiety, insomnia, etc.
And in fact, few people know that cannabis with high amounts of THC will actually induce or worsen anxiety, which often leads to enhanced insomnia or even bouts of paranoia. CBD oil is a non-psychoactive extract that is being used more and more for the treatment of anxiety, as it seemingly possesses all of the therapeutic properties of whole-plant cannabis, without producing any high.
CBD is a non-psychoactive cannabis extract that is increasingly being used for anxiety and insomnia, as it appears to possess the therapeutic properties of cannabis WITHOUT producing a high.
Depression and Anxiety
Depression and anxiety are serious and common medical illnesses that affect how we feel. They negatively affect the way we think and how we act, and can lead to serious medical implications over time if not adequately dealt with.
Fortunately, depression and anxiety are also both treatable, and an increasingly common treatment over the last few years has been cannabidiol, or CBD. Unlike anxiolytics or antidepressant medications that are associated with a broad range of serious side-effects, CBD is classed as a safer, more natural alternative solution.
From a 2014 report in CNS: Neurological Disorders and Drug Targets:
Cannabidiol (CBD) is a Cannabis sativa [extract] with great psychiatric potential, including uses as an antidepressant-like and anxiolytic-like compound.
Insomnia is a sleep disorder that affects millions of people across the globe. It is normally divided into three types:
- Transient Insomnia – Symptoms last from a few days to a couple of weeks.
- Acute Insomnia – Symptoms persist for several weeks.
- Chronic Insomnia – Can last for months, and sometimes years.
Insomnia is another neurochemical balance disorder that non-psychoactive CBD is increasingly being used for, due to its sedative therapeutic nature and the fact that it poses little side effects and no intoxicating cerebral changes.
From a 2017 publication in Current Psychiatry Reports:
Preliminary research into cannabis and insomnia suggests that CBD may have therapeutic potential for the treatment of insomnia…
Final Thoughts: List of Qualifying Conditions for Medical Marijuana
Unfortunately, while marijuana is still classed as illegal on a federal level, there is no one set of rules that dictates the exact healthcare conditions under which a patient is eligible to be treated with marijuana. Simply put, this means that each state has its own exact list of qualifying conditions.
Of course, the conditions listed above are general ones that are accepted in most states — if you suffer from an illness or medical condition that is NOT mentioned on the above list, your best bet would be to contact your local physician and/or your state’s Department of Health to better understand the exact qualifications.
FAQs: Medical Marijuana
The Oklahoma State Department of Education (OSDE) has received a number of questions about how State Question 788 (now codified at 63 O.S. § 420A, et seq.) relates to public schools. This document is non-binding, does not create or impose a legal requirement and is not intended to serve as legal advice or to replace or supplement the advice of a school district’s retained legal counsel. Rather, it is general in nature in response to questions that the OSDE has received as of September 10, 2018. School districts, and their personnel, are urged to seek the legal advice of their respective licensed school attorney with regard to any legal issue(s) encountered, including the matters set forth below.
State Superintendent of Public Instruction
1. Where can I read the Medical Marijuana Amendment?
Click here . See 63 O.S. § 420 et seq.
2. Where can I read the complete Oklahoma State Department of Health (the “Department of Health”) rules for the Oklahoma Medical Marijuana Authority?
Click here . See OAC 310:681.
3. What is a medical marijuana patient license (a “license”)?
A medical marijuana patient license allows an individual with an approved medical marijuana license application to legally buy, use and grow medical marijuana and medical marijuana products in Oklahoma. This license will be in the form of an identification card that can be used to prove an individual is a license holder. This card will contain the individual’s name, photo, date of birth, city and county of residence, the type of license (i.e, patient, processor, distributor, etc.), the date the license expires and the patient’s unique medical marijuana license number.
4. Are there restrictions on the location of a licensed medical marijuana dispensary?
Yes. A licensed medical marijuana dispensary may not be located within one thousand (1,000) feet of a public or private school. See SQ 788; see also OAC 310:681-5-3. The distance measured shall be from any entrance of the school to the nearest property line point of the dispensary.
5. When will applications for a license be available, and what is the timeline for processing them?
The Oklahoma State Department of Health began receiving and processing applications for a license on August 25, 2018, and responses will be provided to applicants within fourteen (14) days. While it is not known how long it can take an individual to acquire medical marijuana from a licensed dispensary in the State of Oklahoma, it is reasonably foreseeable that an individual could have a license in September 2018.
6. Who can obtain a medical marijuana license in Oklahoma?
Adults and minors may obtain a license; however, there are separate and distinct requirements for a minor to obtain one. See SQ 788; see also Oklahoma Administrative Code (OAC) 310:681-2-2, and Question 7 below.
7. What are the requirements for a minor to obtain a license?
A medical marijuana license allows an individual under the age of 18 to legally possess, use and grow medical marijuana and medical marijuana products in Oklahoma. These licenses will be in the form of an identification card that can be used to prove that a minor is a license holder. This card will contain the minor’s name, photo, date of birth, city and county of residence, the type of license, the date the license expires and the minor patient’s unique medical marijuana license number.
Among other information, an application for a minor’s license must include a signed recommendation by two (2) physicians and the signature and date of each parent or legal guardian. See SQ 788; see also Oklahoma Administrative Code (OAC) 310:681-2-2. Minor patient licenses are valid for a term of two (2) years, or until the minor turns age eighteen (18), whichever occurs first. For more information, see Minor Patient License Information .
Additionally, a caregiver license is available to designated individuals of certain homebound patients of all ages. Only patients who have a physician certification of their medical need for a caregiver may have a caregiver license; the status of the applicant as a minor alone does not qualify the applicant for a caregiver. The caregiver license allows an individual to assist a homebound patient with the purchase, application and administration of medical marijuana. Otherwise, a parent/guardian can assist a minor in the purchase, application and administration of medical marijuana. For more information, see Caregiver License Information .
8. Are there differences, relating to educational services and the provision thereof, between a minor patient license and an adult license (i.e., age 18 and above)?
Generally, for purposes of this document, no. Unless otherwise specifically indicated below, as relating to school districts and the provision of education services to students, a license and the associated privileges do not apply differently regardless of whether the license holder is a minor or an adult.
Student License Holder Services
9. Can a student self-administer medical marijuana on school property?
No. There is not a current Oklahoma law authorizing a student to use, possess and/or self-administer medical marijuana on school property. Oklahoma laws authorizing students to self-administer medication are limited to sunscreen, inhaled asthma medication and anaphylaxis medication. See 70 O.S. §§ 1-116.2 – 1-116.3.
10. Can school personnel, including but not limited to a school nurse, possess (on behalf of) and/or administer medical marijuana to a student?
No. Some states, such as Colorado and Illinois, have enacted statutes specifically authorizing school personnel, including school nurses, to store, possess and administer medical marijuana to a license holder. However, in Oklahoma, there is not a current law authorizing school personnel to administer medical marijuana. Oklahoma laws authorizing a school nurse, or other designated school employee in absence of a school nurse, to administer are limited to a filled prescription medicine (defined by 59 O.S. § 353.1), assisting in the application of sunscreen and administering a nonprescription medicine. See 70 O.S. § 1-116.2.
11. Can a parent/guardian administer medical marijuana treatments to a student license holder while on school property?
Marijuana (in any form) remains a controlled illegal substance under federal law, and federal program assurances that are signed in exchange for the receipt of federal funds remain unchanged and continue to require that districts assure that they are compliant with the Safe and Drug Free Schools Act and the Drug Free Workplace Act. As such, a district authorizing the possession, use or administration of medical marijuana is at risk of losing (and having to repay) federal funds. It should be noted, however, that we are not aware of a state with a marijuana authorization law (medical or otherwise), or a school district in such a state, that has lost or been required to repay federal funds as a result of its authorizing the possession, use or administration of marijuana on school property consistent with that state’s law.
As clear as the prohibition in federal law is, equally clear is that as a part of State Question 788, Oklahomans affirmatively put in state law that if an individual meets the requirements to have a license, that individual, including qualifying minors, shall have access to medical marijuana. Further, neither in State Question 788 nor in the Department of Health’s administrative rules are there limitations on a patient license holder having access to and/or receiving treatments on school property. Notably, State Question 788 and the Department of Health’s rules contain limitations on medical marijuana dispensaries being located within a certain distance (1,000 feet) of school property. This absence of a restriction in one part of the provisions, and affirmative placement of a restriction on dispensaries in another part (see Question 4 above), indicates Oklahomans’ intent that there are not to be restrictions on a patient license holder’s access to medical marijuana on school property.
In light of the foregoing, school districts may adopt a policy authorizing a student license holder to have access to his or her medical treatment on school property. If a district adopts such a policy, a student’s parent(s), legal guardian and/or caregiver should be permitted to bring an appropriate dosage of a student’s recommended medical marijuana product(s) to the school for the parent/legal guardian/caregiver (as applicable) to administer to the student.
Additionally, if a district adopts such a policy, the school should establish a place for a parent/legal guardian/caregiver to meet the student and administer the student’s dosage of medical marijuana product(s). In the same manner, schools must provide an appropriate space for the administration of insulin injections or space for a student to nurse or express milk for an infant. (This could be one designated space for all such student medical needs, or separate spaces, depending on the school’s available space and any relevant scheduling or privacy considerations.) Further, a school district policy should require that a record be kept of the name of the student to whom the medicine was administered, the date the medicine was administered, the dosage administered and the name of the person who administered the medicine.
12. If a district adopts a policy authorizing the administration of medical marijuana on school property, what should be included in the policy?
As a part of any policy, schools should require a parent/legal guardian/caregiver (as applicable) to provide the current and valid license for the student, any caregiver license(s) associated with the student, and a written authorization form, to include the following as applicable:
- Copy of the student’s current and valid medical marijuana license and any associated caregiver’s license;
- Purpose of the medication;
- Time to be administered;
- Dosage to be administered;
- Termination date for the administration of the medicine;
- Side effects to be observed, if any, the management of such effects and student allergies to food and/or medicine;
- Emergency instructions, as appropriate;
- Written acknowledgement assuming all responsibility for the provision, administration, maintenance and use of medical marijuana under state law, and release of liability for any injury, personal or otherwise, to a student which results from the acts or omissions of the parent/guardian/other licensed caretaker in administering or possessing the medical marijuana; and,
- Other appropriate information.
13. Are there barriers to enrollment or access to instructional services based on the qualification for a medical marijuana license or use of medical marijuana by a student patient license holder?
No. Students may not be denied enrollment or services by a public school district or charter school based on their holding of a license. In fact, State Question 788 expressly provides that a school shall not refuse to enroll and may not otherwise penalize a person solely for his or her status as a medical marijuana license holder, unless failing to do so would imminently cause the school to lose a monetary benefit under federal law or regulations.
14. Are there restrictions on smokable medical marijuana and medical marijuana products?
Yes. All smokable, vaporized, vapable and e-cigarette medical marijuana and medical marijuana products ingested, smoked or consumed by a patient license holder are subject to the same restrictions for tobacco under 63 O.S. § 1-1521 et. seq., (i.e., the Smoking in Public Places and Indoor Workplaces Act.)
15. What do these restrictions mean as they relate to school and/or school property?
The same prohibitions that exist relating to the use of tobacco in schools and/or on school property now also extend to all smokable, vaporized, vapable and e-cigarette medical marijuana on such property. As such, and because the Smoking in Public Places and Indoor Workplaces Act and the 24/7 Tobacco-free Schools Act (70 O.S. § 1210.213) prohibit the use of tobacco (now inclusive of all smokable, vaporized, vapable and e-cigarette medical marijuana), these forms of medical marijuana may not in any instance be used or consumed by a patient license holder (adult or minor) on school property.* School property includes, but is not limited to, buildings, physical grounds, motor vehicles and any school-sponsored or school-sanctioned event or activity. See 70 O.S. § 1210.212.
*Note: Notably, this prohibition does not extend to other forms of medical marijuana, such as edible.
16. Are there restrictions on a minor’s use of medical marijuana?
Yes. In addition to the aforementioned prohibitions on the smoking or vaping of medical marijuana in a public place (including a public school), under no circumstance shall a minor patient license holder be authorized to consume, smoke or inhale any smokable or vapable medical marijuana or smokable or vapable medical marijuana products, unless both recommending physicians agree it is medically necessary. See OAC 310:681-2-2(c).
17. Can a school district conduct a random drug testing program of students participating in interscholastic competitions and extra-curricular activities?
Yes. Consistent with the U.S. Supreme Court ruling in Board of Education of Independent School District No. 92 of Pottawatomie County et al v. Earls et al, 536 U.S. 822 (2002) and other court decisions, a school district may implement and conduct a random drug testing program of students participating in interscholastic competitions and extra-curricular activities requiring registration with the Oklahoma Secondary Schools Athletic Association (OSSAA).
A school district conducting a random drug testing program for such students should adopt a policy relating to the scope of such drug testing program, the activities within the scope of the random selection method, what substance(s) are included as being in violation of the policy and any consequences of violation(s). Importantly, any adopted policy should be provided to students and parents/guardians/caregivers.*
*Note: A school district conducting a random drug testing program may adopt a policy providing that a student with a medical marijuana license will not be subject to penalties or loss of privileges associated with testing positive for medical marijuana or its components, other than eligibility restrictions imposed by an outside organization that are beyond the control of the school district. See also Question 18.
18. What policies can school districts put in place relating to a student patient license holder participating in interscholastic athletics and/or extra-curricular activities?
The OSDE does not regulate or oversee secondary interscholastic school activities in the state; rather, this is done through the OSSAA and other associations charged with overseeing such activities (i.e., FFA, FCCLA, etc.). As such, any questions relating to medical marijuana and its relation and/or effects on interscholastic school activity participation should be directed to the OSSAA or the respective organization charged with overseeing such activity.*
A school district may establish its own policies regarding district- or school-specific activities that do not involve competition between schools and do not fall under the authority of OSSAA or other organization (as applicable).
*Note: Marijuana is on the banned substances list for the NCAA, and there is not yet an exemption for medical use – some student-athletes at the college level have lost eligibility through recommended use under medical oversight. It may be advisable for any school district policies that permit student-athletes to compete while testing positive for cannabinoids due to recommended medical use to include language in their policy putting students on notice of NCAA’s total prohibition.
Employment & Human Resources
19. Can employers discriminate against a person in hiring, termination, or other employment matters?
No. State Question 788 provides:
Unless a failure to do so would cause an employer to imminently lose a monetary or licensing related benefit under federal law or regulations, an employer may not discriminate against a person in hiring, terminating or imposing any term or condition of employment or otherwise penalize a person based upon the person’s status as a medical marijuana license holder. See State Question 788.
20. What if an employee exhibits reasonable suspicion of being under the influence of drugs in the workplace? Can an employer take action then?
Yes. State Question 788 further provides:
Employers may take action against a holder of a medical marijuana license if the holder uses or possesses marijuana while in the holder’s place of employment or during the hours of employment. Employers may not take action against the holder of a medical marijuana license solely based upon the status of an employee as a medical marijuana license holder or the results of a drug test showing positive for marijuana or its components.
School districts may adopt policies prohibiting any and all employees – medical marijuana license holder or otherwise –from using, possessing or being under the influence of marijuana while on school district property or while performing duties for the district. Further, districts may adopt policies for medical marijuana similar to those that may already be in existence prohibiting an individual from being under the influence of alcohol or a controlled dangerous substance as defined in 63 O.S. § 2-101.
To the extent an employer implements a drug-testing program of potential and/or current employees, school districts are encouraged to adopt a policy prohibiting the taking of any action against such applicant or employee based on their status as a medical marijuana license holder. Should an individual test positive for cannabinoids, districts should allow the individual an opportunity to provide evidence of a current and valid medical marijuana license.
21. How, if at all, might State Question 788 impact school district decisions relating to employment of bus drivers?
An individual must possess a Commercial Driver License (“CDL”) in order to legally drive and operate a school bus. CDL holders are regulated by state and federal law. While medical marijuana has been legalized in Oklahoma, federal law does not make an exception for possession or use of medicinal marijuana by an individual with a CDL. In fact, CDL holders are prohibited from failing a drug and alcohol test due to the fact they are in a “safety-sensitive” position. The U.S. Department of Transportation’s drug and alcohol testing regulations do not authorize medical marijuana use under a state law to be a valid medical explanation for a transportation employee’s positive drug test result.
Further, while Oklahoma employers may not make adverse hiring decisions based solely on an individual’s status as a medical marijuana license holder, an employer may make a hiring decision based on the fact that an applicant is not qualified for a certain position (i.e., school bus drivers must possess a valid CDL and provide a negative drug screening in order to be qualified). Finally, bus drivers and bus maintenance employees who are required to have a CDL could be subject to random drug testing.
22. How will SQ 788 affect drug testing employees, including bus drivers?
Random drug testing of a school employee, other than those in a “safety-sensitive” position, has been held to be unconstitutional by several courts. However, for those in a “safety-sensitive” position, such as a bus driver, bus maintenance employee or one required to have a CDL, that employee may be subject to random testing.
23. Is cannabidiol (CBD) the same thing as medical marijuana?
No. Cannabidiol or “CBD” is a derivative of the cannabis plant that also has therapeutic uses, but is not included in Oklahoma’s state definition of “marijuana.” It is therefore not subject to the same restrictions as medical marijuana. By definition, CBD can contain only up to a trace amount of tetrahydrocannabinol (THC), the main psychoactive component of marijuana, so CBD products have no psychoactive effects. This is Oklahoma’s statutory definition for cannabidiol:
“ ‘Cannabidiol’ means a nonpsychoactive cannabinoid found in the plant Cannabis sativa L. or any other preparation thereof, that has a tetrahydrocannabinol concentration of not more than three-tenths of one percent (0.3%) and that is delivered to the patient in the form of a liquid” (63 O.S. § 2-801(3)).
Under state law, only specific uses are authorized for CBD with a detectable THC content (though it must always be below 0.03%). CBD that contains no detectable THC content, however, is commonly sold and used in Oklahoma with few restrictions. In general, the cannabidiol products sold in Oklahoma’s “CBD shops” do not contain detectable THC.
Under federal law, cannabidiol does not have a separate status from other marijuana derivatives, and so is still classified as a Schedule I controlled substance – even when it contains no THC. While legalization of CBD at the federal level has been discussed as a likely possibility, at this time it is still only explicitly legal at the state level under the conditions of state law.
24. Can school districts have different policies for CBD and medical marijuana?
Yes, but separate policies are not necessary. While students may not be restricted from enrolling in or attending public school due to their use of either category of cannabis-derived treatments, because they are classified differently under Oklahoma law, it is permissible for school districts to have different policies addressing CBD and medical marijuana. It is, however, not required for a school district to have a different policy governing CBD, and a district may adopt one policy that applies to both medical marijuana and CBD as long as the policy appropriately protects a student’s access to both school district services and recommended medical treatments.
25. Could CBD products be included in a school district’s general policy on the storage and administration of prescription and non-prescription drugs?
This determination must be made by a school district. There are no provisions of state law that would either require a school district to treat CBD as equivalent to other non-prescription medications, nor prohibit a district from doing so. For CBD, which is not classified as “marijuana” in Oklahoma, this appears to be a local decision. School districts should be aware that cannabidiol has not yet been clearly excluded from the Controlled Substances Act at the federal level, although drug enforcement action involving CBD is unlikely, and clarification of its status is expected to occur in the coming years.
If a school district chooses to consider CBD a non-prescription medication parents/legal guardians may authorize a school to store and administer, the requirements of 70 O.S. § 1-116.2 would apply in addition to any specific policies adopted by the district. Because of the uncertain federal status of cannabidiol, a school district should not compel a school nurse to administer CBD if the school nurse is not comfortable administering it. In such a case, a district that chooses to consider cannabidiol a non-prescription medication should ensure that a parent/guardian’s written authorization for the school to administer CBD gives explicit permission to an administrator or a non-nurse school designee to administer the student’s CBD dosage. All directions for use must be included in the parent/guardian’s written authorization.
If a school district does not choose to consider CBD a non-prescription medication subject to 70 O.S. § 1-116.2 and associated policies, and does not adopt a specific policy addressing how students may access their CBD treatments, then students who are treated using cannabidiol should be permitted to access their CBD treatments in the same manner as the district provides for access to medical marijuana treatments for qualifying students.
If you have additional questions, please contact OSDE’s Office of Legal Services at (405) 521-4906.
California Cannabis Labeling Requirements Explained
All cannabis products sold in California dispensaries are subject to strict labeling requirements. Cannabis was made legal in the state via the Adult Use of Marijuana Act (Proposition 64), but labeling guidelines are set by the California Department of Public Health (CDPH). Failure to abide by these guidelines can expose you to fines or even the loss of your license.
We’ve created this guide to simplify the often-confusing labeling requirements, though you should always have your labels reviewed by an attorney before you distribute them to dispensaries.
General Cannabis Labeling Requirements in California
California cannabis labels are separated into two sections: the primary panel and the information panel.
The primary panel is typically located on the front or top of the package and contains the most important information.
The information panel may be located on the back of the packaging, beneath the primary panel, or anywhere else that’s visible on the packaging. This panel contains required information that doesn’t have to be located front and center.
Requirements for Cannabis Flower Labels in California
The following prop 64 packaging requirements apply to dry cannabis flower as well as pre-rolls (pre-rolled joints).
The primary panel must include:
- A product identifier. This is a general name or description that identifies the item, such as “Cannabis Flower” or “Cannabis Pre-roll” (or something similar).
- Net weight. The weight of the product is provided in both metric and U.S. customary units—e.g. “Net. Wt. 2.5 oz. (70.9 g).”
- California’s universal symbol. The following symbol is prominently featured on every label. It must be at least 0.5” x 0.5” and printed in black.
The information panel must include:
- UID number. This is the tracking number issued through California’s Track-and-Trace system. Refer to your Track-and-Trace login.
- Licensee information. The licensee may be the cultivator or the business in charge of packaging the product. Every package must include:
- The licensee’s name as listed on the license certificate (either a legal business name or registered DBA)
- The licensee’s phone number or website
- Date of packaging. This is not the harvest date but rather the date in which the product was packaged for retail sale. You must provide the month, day, and year.
- Government warning statement. All cannabis labels must include the following government warning in bold, capital letters:
- GOVERNMENT WARNING: THIS PACKAGE CONTAINS CANNABIS, A SCHEDULE I CONTROLLED SUBSTANCE. KEEP OUT OF REACH OF CHILDREN AND ANIMALS. CANNABIS MAY ONLY BE POSSESSED OR CONSUMED BY PERSONS 21 YEARS OF AGE OR OLDER UNLESS THE PERSON IS A QUALIFIED PATIENT. CANNABIS USE WHILE PREGNANT OR BREASTFEEDING MAY BE HARMFUL. CONSUMPTION OF CANNABIS IMPAIRS YOUR ABILITY TO DRIVE AND OPERATE MACHINERY. PLEASE USE EXTREME CAUTION.
In addition, your label must list the cannabinoid content in percentages (e.g. THC: 18%; CBD: 1.5%). Include information for THC, CBD, and any other cannabinoids present in concentrations above 5%. This information may appear on either the primary panel or the information panel.
Requirements for Manufactured Cannabis Products
Manufactured cannabis products include edibles (cookies, gummies, beverages, etc…), concentrates (hash, wax, etc…), vape oils, tinctures, capsules, and other cannabis-derived preparations.
The primary panel must include:
- A product identifier. This is a general name or description that identifies the item, such as “Cannabis Brownie” or “1:1 THC/CBD Tincture.”
- California’s universal symbol. The universal symbol is clearly visible on the label, printed in black and measuring at least 0.5” x 0.5” (see example in previous section).
- Net weight or volume. The net weight or volume is listed in both metric and U.S. customary units. For example, a cookie’s label might read “Net. Wt. 1.5 oz. (42.5 g)” while the label for a cannabis-infused beverage might read “8 fl. oz. (237 ml).”
- The words “Cannabis-infused.” This requirement only applies to food and drink products like candies, cookies, brownies, gummies, and beverages.
The information panel must include:
- Manufacturer information. The legal name or registered DBA of the product manufacturer is provided alongside valid contact information (phone number or website).
- UID number. This is the tracking number issued through California’s Track-and-Trace system. Refer to your Track-and-Trace login.
- Batch or lot number. Sometimes called a code number or lot code, this is the unique ID number assigned to a batch of products for the purposes of inventory tracking and traceability. This number is assigned by the product manufacturer.
- Date of manufacture/packaging. Only one date is required. Make sure to include the month, day, and year—e.g. MFG/PKG 11/16/2020.
- Expiration or use-by date. If applicable.
- List of ingredients. Ingredients are listed in descending order by weight or volume. Include any plant ingredients, edible ingredients, flavor enhancers, artificial colorings, carrier liquids, base liquids, and any other consumables included in the product.
- Allergens. If your item contains any of the major food allergens (soy, milk, eggs, wheat, tree nuts, peanuts, fish, or shellfish), this information must be disclosed on the label separately from the ingredients list, beginning with the words “Contains”—e.g. “Contains peanuts.”
- Nutrition information. This requirement only applies to edibles. All cookies, gummies, drinks, and other edible preparations must list the total fat, carbohydrates, sodium, and sugar per serving in grams or milligrams.
- CRV recycling information. Beverage manufacturers must follow all state-mandated labeling requirements for beverage containers. More information can be found at CalRecycle.
- Instructions for preparation and/or use. For example, a label for 1 gram of dab wax might read, “Add one serving to a dry herb/wax vaporizer or oil rig (low. temp 600 F).”
- The words “KEEP REFRIGERATED” or “REFRIGERATE AFTER OPENING.” This disclaimer is required for perishable products only.
- The words “FOR MEDICAL USE ONLY.” This disclaimer must be included if the THC content is too high to be legally sold in the adult-use (recreational) market and is intended only for cardholding medical marijuana patients.
- Government warning statement. All labels must include the following government warning in bold, capital letters:
- GOVERNMENT WARNING: THIS PRODUCT CONTAINS CANNABIS, A SCHEDULE I CONTROLLED SUBSTANCE. KEEP OUT OF REACH OF CHILDREN AND ANIMALS. CANNABIS PRODUCTS MAY ONLY BE POSSESSED OR CONSUMED BY PERSONS 21 YEARS OF AGE OR OLDER UNLESS THE PERSON IS A QUALIFIED PATIENT. THE INTOXICATING EFFECTS OF CANNABIS PRODUCTS MAY BE DELAYED UP TO TWO HOURS. CANNABIS USE WHILE PREGNANT OR BREASTFEEDING MAY BE HARMFUL. CONSUMPTION OF CANNABIS PRODUCTS IMPAIRS YOUR ABILITY TO DRIVE AND OPERATE MACHINERY. PLEASE USE EXTREME CAUTION.
In addition, your label must list the cannabinoid content in percentages (e.g. THC: 18%; CBD: 1.5%). All products must include the THC and CBD content per package. Edibles and concentrates with designated serving sizes must also list the THC and CBD content per serving.
If any other cannabinoids are present at volumes higher than 5%, that information must be included as well. This information may appear on either the primary panel or the information panel.
Additional product information may be included as long as it is accurate (no unsupported health claims).
Prop 65 Warning Label Requirement
On January 3, 2020, California’s Office of Environmental Health Hazard Assessment (OEHHA) added marijuana smoke and THC to the state’s Prop 65 list of chemicals known as reproductive toxins. In addition, cannabis has been recognized by the state as a carcinogen since 2009.
As a result, all cannabis products sold in California must contain a prop 65 warning label. An appropriate warning label may read as follows: “WARNING: This product can expose you to marijuana smoke, which is known to the state of California to cause cancer, birth defects, and other reproductive harm.”
This warning may appear on its own label or sticker separate from the primary panel and information panel. Just make sure it’s visible on the outside of the packaging.
Other California Cannabis Labeling Requirements
There are a few other important details to note when designing your cannabis labels:
- Product packaging cannot be designed in a way that’s appealing to children
- All print must be clear and legible
- Labels must be printed in at least 6 pt. font
- All labeling must be visible on the outer layering of the packaging
- Peel-back labels or inserts may be used on small packaging that can’t accommodate all of the information up front
- All required information must appear on the packaging; it’s not acceptable to direct buyers to a website
- County names may not be included on the packaging unless the product was 100% grown in that county
- Misleading information and unproven health claims are strictly prohibited
- Photos of the product may not be included
For more information about California cannabis labeling requirements, visit the California Department of Public Health website.
Cannabis Waste Labeling Requirements
It’s not just the product packaging that needs to be labeled. California has specific labeling requirements for certain types of cannabis waste, and these requirements are applicable to anyone who cultivates, processes, packages, distributes, or sells cannabis in a licensed commercial capacity.
There are no hard requirements for how organic cannabis waste (i.e. plant material) must be labeled, but it must be separated and distinguished from general refuse. Labeling your receptacles is an easy way to differentiate your cannabis waste and ensure accurate weighing and tracing.
A reputable cannabis waste management services provider will equip you with custom, labeled drums that you can use to store and secure your discarded cannabis on site prior to rendering and removal.
When it comes to hazardous and universal waste, the labeling requirements are a bit more complicated. Hazardous waste streams that a canna-business might accumulate include:
- Discarded vape pens and batteries
- Concentrates and extracts created using solvents like butane and ethanol
- Pesticides used in cultivation
- Chemical-based lab equipment
- Assorted trash like old fluorescent light bulbs, solvent wipes, and cleaning supplies
In many cases, hazardous streams must be sorted into separate drums. Different streams have different chemical properties and physical properties, and they’re not always compatible. Common solvents like ethanol and acetone can be combined into a single receptacle because they’re chemically and physically similar and considered to be in the same class. However, you should never mix a solvent like ethanol with an oxidizing agent like sodium peroxide, as this can result in fire or explosions.
This is where labeling becomes important. Because these waste streams don’t always get along, different classes of hazardous material must be separated into their own drums and labeled accordingly.
- Drums must be labeled “Hazardous Waste” and also contain the profile of the specific waste stream.
- The label must include the Accumulation Date, ensuring that you’re not storing hazardous waste on site longer than is permitted.
- In some cases, generators may be required to include their name and contact information on the label for regulatory purposes.
Hazardous waste violations in California can result in fines of $70,000 per violation per day, so it’s very important to follow the guidelines to the letter. This is yet another reason why it’s so crucial that you work with a reputable waste management provider.
How to Remain Compliant With California Cannabis Labeling Requirements
There are some simple ways to satisfy all Prop 64 packaging requirements:
- Work with a reputable cannabis packaging provider.
- Order rolls of state-compliant labels that you can fill out yourself (if you can’t afford the first option above)
- Order rolls of Prop 65 warning stickers to accompany your labels (if the labels don’t already contain the required warning)
- Have a knowledgeable legal representative review your packaging
And when it comes to cannabis waste labeling, the best thing you can do is work with an experienced waste management provider.
The labeling requirements are constantly evolving, so make sure to keep track of all new cannabis legislation and make changes as required. It’s a small inconvenience when compared to the consequences of upsetting the regulatory authorities.