Medical Staff Oversight with Marijuana Legalization

January 14, 2018
Rebecca Fox, MD

Is recreational marijuana now legal in your state? There are new concerns for medical practices to contemplate.

On Jan. 1, 2018, California became the seventh state to legalize recreational marijuana (along with Alaska, Colorado, Oregon, Nevada, Washington DC, Washington State) and Massachusetts is set to legalize recreational use in July of this year. Many other states are actively pursuing legalization as well.

While the justice department has announced that they are going to become even stricter with enforcing the federal statutes, I highly doubt they will be able to stop the wave of legalization that is sweeping the country.

Marijuana has been classified as a Schedule I drug (meaning it has a high risk for abuse) thus limiting the scope of research on medicinal usefulness. It would be terrific if more research would be allowed on the medicinal uses of marijuana (especially for seizure disorders and generalized pain) and maybe the general national wide decriminalization will allow this to move forward.

However, that leads me to have worries about the impact of marijuana use by members of a medical staff in those states (and adjoining states) in which it is readily available. Since it can impair judgement, I worry if a staff member is still under its influence while on duty. While cannabis does show up in drug testing, there is no way to determine the extent that someone is affected while acutely high (unlike alcohol intoxication where a blood alcohol level is accurate).

Drug testing will have its limits. If one of your staff members legally enjoys marijuana only on a Friday night, they would not still be under the influence by Monday morning. However, urine drug tests for cannabis will be positive for up to a month after use, so routine screening of staff members is limited in its usefulness. There is no way to determine if a staff member uses marijuana on the way to work on Monday morning and is possibly intoxicated with it.

There are many professions in which marijuana intoxication would be worrisome: bus drivers, pilots and police officers to name a few. But medical practices add an additional risk to patients if judgement is impaired.

I’m afraid I don’t know how to offer advice about this new and expanding legalization of marijuana. I suppose having a mission statement about appropriate use of intoxicating substances for members of your staff would be a start. Additionally, having each staff member sign a written statement pledging to not use marijuana nor alcohol within a certain number of hours before they are scheduled to work (in those states where both are legal for adults). One would think it would be self-evident for medical personnel to know the risks of working under the influence. But I have been in this business long enough to not assume everyone who works in a medical office is so well informed and disciplined.


This topic is most definitely important for your practice to discuss openly and honestly if you are in or close to a state with recent legalization of marijuana. I would love to hear your solutions and approach to this subject.