State Laws Surrounding Medical Marijuana Reciprocity

August 24, 2017|4:50 p.m.| ASTHO Staff

As more states legalize medical marijuana, questions may arise about whether dispensaries can provide marijuana to patients who are registered in other states. Maine and Nevada appear to be the only two states that allow visiting qualifying patients to purchase medical marijuana products from in-state dispensaries. Other states (AZ, MI, NH, and RI) allow visiting qualifying patients to use and possess medical marijuana, typically subject to any in-state limits on dosage or amount, but cannot legally purchase marijuana within the state. Below is a brief summary of the reciprocity requirements in Maine and Nevada and considerations for states when dealing with reciprocity.

Maine’s medical marijuana law allows a qualifying patient who is visiting from another jurisdiction to “engage in conduct authorized for a qualifying patient” from Maine (Me. Stat. tit. 22 §2423-D (2017)). Visiting qualifying patients must have a valid, Maine-approved physician certification form, a valid medical marijuana certificate from the visitor’s home jurisdiction, and a valid photo ID issued by the home-jurisdiction (10-144-22 Me. Code R. § 2.1.3).

In Nevada, medical marijuana may be dispensed to the holder of a “nonresident card”—i.e. “a card or other identification that is issued by a state or jurisdiction other than Nevada; and is the functional equivalent of a registry identification card or letter of approval” (Nev. Rev. Stat. §453A.364 (3)). Last year, an attorney general opinion concluded that under this definition, written physician recommendations did not constitute a nonresident card. This opinion addressed medical marijuana tours in which physicians in California would provide medical marijuana recommendations via teleconference. At that time, under California law, patients only needed a physician recommendation and a photo ID to purchase medical marijuana. To be recognized in Nevada, current regulations require the card’s issuing jurisdiction to grant an exemption from criminal prosecution for the medical use of marijuana and a physician to advise that the medical use of marijuana may mitigate the symptoms or effects of the cardholder’s medical condition. The nonresident card must have an expiration date and be unexpired, and the cardholder must sign an affidavit stating the entitlement to use medical marijuana in the home jurisdiction and agree to abide by the legal possession limits of Nevada.

Beginning April 1, 2018, the requirements for recognizing nonresident medical marijuana cards will change. The most important changes include requirements for data-sharing and access. In order to recognize nonresident cards, the issuing jurisdictions must maintain a medical marijuana registry or database and allow Nevada access to that information. The requirement for a signed affidavit will also be eliminated. It is unclear whether other states or jurisdictions have allowed Nevada to access their medical marijuana registries or databases to effectuate the new requirements for reciprocity.

Neither Maine nor Nevada currently has a system requiring registration and verification of visiting qualifying patients. In both states, responsibility for verifying that visiting qualifying patients meet state requirements falls on dispensaries rather than the state. In both states, visitors are subject to the same sales and possession restriction as in-state patients. Visiting patients must be using medical marijuana to treat a condition that qualifies under Maine or Nevada law. In addition, as neither state directly registers visiting qualifying patients, there are no fees collected from them. For now, both states have fairly limited regulations pertaining to visiting qualifying patients.

As other states consider the reciprocity issue, lessons can be learned from Maine and Nevada’s experience. ASTHO will continue to monitor the issue as it evolves.