Guide for Patients, Caregivers, Physicians, Law Enforcement, and the
Washington State voters
passed the Medical Use of Marijuana Act in 1998 as a ballot initiative
(I-692). Before beginning treatment, it is extremely important that
patients, caregivers, and physicians take time to understand the
Medical Use of Marijuana Act, which is codified in Chapter 69.51A of
the Revised Code of Washington. The information here provides a
general explanation of the law. For legal advice on how the law
applies or does not apply to you personally, you should speak with an
attorney who is familiar with this law.
What does the Medical Use of Marijuana Act do?
Washington State's medical
marijuana law protects qualifying patients and their caregivers from
being punished in state courts for growing, possessing, and using
marijuana. The law also clarifies that doctors may discuss medical
marijuana as a treatment option with their patients.
Passage of I-692 did not,
however, change federal marijuana laws. This law does not legalize
marijuana for recreational use or any other use of marijuana that is
not specifically covered by the law. The law applies to only
the medical conditions listed in the statute and others approved by
the Washington State
Assurance Commission after I-692 passed in 1998 (see below).
All other uses of marijuana
are still illegal.
While the law does protect
covered patients and caregivers from conviction, it does not
technically protect them from arrest or prosecution. However, police
and prosecutors usually hesitate to arrest or charge patients and
caregivers who are clearly complying with its legal requirements.
Who is a protected qualifying patient?
Washington's law protects
some people who suffer from specified terminal or debilitating
medical conditions. To be protected by the law, a person must be a
patient of a physician who is licensed to practice in Washington
State. The patient must be a resident of Washington State at the time
he or she is diagnosed by that physician with a covered illness. The
patient must be advised by the physician (1) about the risks and
benefits of medical marijuana and (2) advised that he or she may
benefit from the medical use of marijuana.
The medical marijuana law does not cover all terminal or debilitating
medical conditions only those illnesses and categories of illnesses
listed in the statute or approved by the Medical Quality Assurance
Commission (MQAC). The law itself lists:
(a) Cancer, human immunodeficiency virus (HIV), multiple sclerosis,
epilepsy or other seizure disorder, or spasticity disorders; or
(b) Intractable pain, limited for the purpose of this chapter to mean
pain unrelieved by standard medical treatments and medications; or
(c) Glaucoma, either acute or chronic, limited for the purpose of this
chapter to mean increased intraocular pressure unrelieved by standard
treatments and medications; or
(d) Any other medical condition duly approved by the Washington state
medical quality assurance board [commission] as directed in this
69.51A.010(4). The public may petition the Medical Quality Assurance
Commission to add other terminal or debilitating conditions to the
list. Since I-692 passed, the MQAC has added:
Crohn's Disease with debilitating symptoms unrelieved by
standard treatments or medications;
Hepatitis C with debilitating nausea and/or intractable pain
unrelieved by standard treatments or medications; and
Any disease, including anorexia, which produces nausea, vomiting,
wasting, appetite loss, cramping, seizures, muscle spasms, and/or
spasticity, when these symptoms are unrelieved by standard treatments
Patients who meet all of
these requirements must also have proof of their identity,
such as a
Washington state driver's license or identicard,
and valid documentation
of their physician's recommendation and show it to any law enforcement
officer who questions the patient regarding his or her use of medical
marijuana. Valid documentation can be either (1) a statement signed
by the physician or (2) a copy of the qualifying patient's pertinent
medical records. The physician's statement or patient's medical
records must say that,
physician's professional opinion, the potential benefits of the
medical use of marijuana would likely outweigh the health risks for
Who is a protected "primary caregiver"?
qualifying patients need help obtaining, storing, and using their
medication, so the law allows them to designate a primary
caregiver. This person must be at least 18 years old and be
responsible for the housing, health, or care of the patient. This
is very broad because in some cases the only health-related tasks or
care needed by the patient will be to grow or obtain medical-grade
marijuana. The purpose in allowing a patient to be assisted by a
caregiver is to make sure that the patient has sufficient medication.
The patient must designate
the caregiver in writing before the caregiver assumes responsibility
for the patient's medication. If requested by a law enforcement
official, a primary caregiver must provide a copy of (1) the
qualifying patient's valid documentation and (2) the evidence of
designation to act as the patient's primary caregiver under the
medical marijuana law.
The law allows a primary
caregiver to assist only one patient at any one time, and a
caregiver (who is not also a qualifying patient) may not personally
consume marijuana obtained for the qualifying patient.
marijuana can qualifying patients and caregivers possess?
patients are permitted to possess no more marijuana than is necessary
for the patient's personal, medical use, not exceeding the amount
necessary for a sixty-day supply. RCW 69.51A.040(2)(b).
possess, in combination with and as an agent for the qualifying
patient, no more marijuana than is necessary for the patient's
personal, medical use, not exceeding the amount necessary for a
sixty-day supply. RCW 69.51A.040(4)(b).
What constitutes a 60-day
supply of marijuana? The 60-day supply provisions are the single most
confusing part of the law for everyone involved. Qualifying patients
and caregivers understandably want to ensure that the patient has
enough medication available so that they do not have to purchase
marijuana on the illegal market if the patient's plants fail to mature
or her supply is depleted. Police officers who are trained to
punish marijuana use feel that it is their duty to make sure that
even qualifying patients and their caregivers have no more marijuana
than necessary. The courts have had an equally difficult time
explaining in a coherent way what the 60-day supply requirement
Ultimately, a 60-day
supply means the amount a particular patient can reasonably expect to
use over the course of 60 days. Daily dosage will vary depending on
the medical condition being treated and the severity of daily
symptoms. The potency of marijuana also varies. Medication of
sufficient potency will allow the patient to smoke or ingest smaller
amounts of marijuana. Low-grade medical marijuana can force the
patient to use more to be effective.
police and prosecutors have disagreed with patients and caregivers
about the 60-day supply requirement, especially when patients are
growing their own medical marijuana. Police departments often focus
on the number of plants that a patient or caregiver possesses, rather
than the amount of usable marijuana that is readily available from
those plants. Under this law, patients and their caregivers may,
combined, have up to the amount of marijuana that is necessary for
the patient's personal, medical use, not exceeding the amount
necessary for a sixty-day supply. See RCW 69.51A.040(2)(b)
and (4)(b). Immature plants and unusable plant parts should not be
included in this amount, because they cannot be used for the the
patient's personal, medical use.
Here are two contrasting
Example 1: Intending to
ensure that some of the plants reach maturity and will be of medical
grade, a caregiver might possess 50 immature seedlings with no usable
medical marijuana. That caregiver possesses 0-days supply of medical
marijuana and therefore is in compliance with the medical marijuana
law at that time.
Example 2: Another
caregiver possesses 4 large, mature (harvestable) female plants of
medical-grade marijuana for a patient who uses a very small amount of
medication each day. It is possible that the usable marijuana that is
available to the caregiver's patient is over the amount necessary for
a 60-day supply. If so, that caregiver is out of compliance with the
Patients and caregivers
might wish to be conservative in their estimate of the patient's
60-day needs and grow or possess no more than is clearly needed by
the patient. While Example 1 above might be true under the law,
police officers could nevertheless decide to make an arrest. Patients
and caregivers will themselves have to make reasonable estimates of
the patient's 60-day supply amount and be prepared to defend the
reasonableness of their estimate in court.
The ACLU believes police
and prosecutors, on the other hand, should be flexible in evaluating
whether a patient or caregiver meets the 60-day supply limitation. If
a patient underestimates her 60-day needs, she or her caregiver may be
forced to make up the difference by purchasing marijuana elsewhere.
It is not in the interest of law enforcement to drive patients to the
How does the
medical marijuana law protect physicians?
law states that licensed physicians shall not be penalized in any
manner, or denied any right or privilege for:
patients about the risks and benefits of medical marijuana or
2) Providing a
qualifying patient with valid documentation that the potential
benefits of the medical use of marijuana would likely outweigh the
health risks for the particular qualifying patient.
also protected from threats made by the federal Drug Enforcement
Administration and other government agencies. The federal Ninth
Circuit Court of Appeals ruled, in
Conant v. Walters,
that the DEA may not
punish doctors who
recommend medical marijuana. But physicians still cannot formally
prescribe or provide marijuana to their patients only patients and
their caregivers may possess marijuana for the patient's medical use.
States Supreme Court refused to review this Ninth Circuit case on
appeal, so it protects physicians in most states with medical
marijuana laws, including Washington, California, Oregon, Alaska,
Hawaii, Nevada, and Arizona.
How does the medical marijuana law affect other people?
No one can be
punished solely for being in the presence or vicinity of
medical marijuana or someone using medical marijuana. RCW
69.51A.050(2). So long as they are not violating the medical
marijuana law or committing some other crime, family members, friends,
medical services providers, social workers, and anyone else may be
around medical marijuana users without fear of prosecution.
marijuana law only allows qualifying patients and their caregivers to
possess medical marijuana and only qualifying patients to use the
marijuana. The law does not allow anyone else to possess, deliver, or
use marijuana for any purpose.
What are the limits of the medical marijuana law?
The Medical Use of
Marijuana Act protects only the individuals described in the
statute (see above). Except for the assistance given by a designated
caregiver to a qualifying patient, growing marijuana or giving
marijuana to anyone is still a crime under Washington state law. Even
qualifying patients can be prosecuted for giving their medical
marijuana to someone for whom they are not also the designated
The medical marijuana law
creates two new state criminal offenses and exceptions:
It is a
misdemeanor to use or display medical marijuana in a manner or place
which is open to the view of the general public.
It is a class
C felony to fraudulently produce or alter any document or medical
record for use as valid documentation.
And the law sets certain
insurer can be forced to pay for medical use of marijuana.
are not required to authorize medical marijuana for a patient.
of employment, in any school bus or on any school grounds, or in any
youth center can be forced to accommodate the use of medical
v The law does
not protect medical use of marijuana in a way that
endangers the health or well-being of any person through the use of a
motorized vehicle on a street, road, or highway. In other words,
medical marijuana users cannot drive under the influence of their
Federal marijuana offenses
are not changed by any of the state medical marijuana laws.
Some local law enforcement officials who disagree with the medical
marijuana law have threatened qualifying patients and their caregivers
with referrals to federal authorities for prosecution in federal
courts. This practice might violate state and local officials' duty
to uphold Washington's laws, including the Medical Use of Marijuana
Act, but that has not yet been decided by a court.
 110 Wn. App. 544 (Div. III 2003), required that this exact language be
included in the patient's documentation. We believe that this was an incorrect
ruling. However, until the Washington State Supreme Court considers this issue,
physicians must use exactly those words in providing a statement or including a
recommendation in the patient's medical records. The Washington State Medical
Association provides a model form on the Internet at