Hawaii Lawmakers Send Medical Marijuana Reforms To Governor, Including Letting Patients Qualify For Any Condition A Doctor Sees Fit

Both chambers of Hawaii’s legislature have passed a medical marijuana bill that would, among other changes, allow patients to enroll in the state program for any health condition their treating clinician believes that cannabis would benefit.

HB 302, which was recently revised in a bicameral conference committee, would also allow patients to receive recommend medical cannabis recommendations through telehealth visits rather than having to establish an in-person relationship with a provider.

The Senate on Wednesday voted 23–1 in favor of the proposal, from Rep. Gregg Takayama (D) and others. Sen. Brenton Awa (R) was the lone no vote. Later in the day, the House of Representatives approved the also approved the revised bill, with five lawmakers voting against passage.

Senators did not discuss the bill before casting their final votes. In the House, two members spoke out against the conference committee changes before casting no votes.

Rep. Kim Coco Iwamoto (D) said she opposed a new provision allowing the state Department of Health to access medical marijuana patient records held by doctors.

“This is unprecedented given the degree of respect our state has previously demonstrated for patient–doctor privileges, and how often the state defers to the expertise of physicians and healthcare providers,” Iwamoto said.

“The medical cannabis community has expressed its opposition to this breach of confidentiality,” she continued, “especially since it is authorized without any suspicion of wrongdoing and without a warrant. This will further deter already low patient and provider participation.”

Rep. Della Au Belatti (D) echoed Iwamoto’s opposition.

“I have deep concerns about the authorizing of, essentially, administrative staff to be able to look into patients’ private records,” she said, likening it the Trump administration allowing Department of Government Efficiency (DOGE) employees to access Americans’ tax records.

“This is a very big step that I think we should not cross,” the lawmaker added, “and for those reasons, I’m in opposition to House Bill 302, conference draft one.”

Cannabis reform advocates had broadly supported the legislation until amendments adopted last week by members of a conference committee.

At one point, the bill would have redefined “debilitating conditions” under state medical marijuana law to include any condition that a doctor believes would be well suited to treatment with cannabis. An amendment, however, changed the measure such that only a patient’s treating clinician could recommend marijuana for conditions other than those already listed under state law.

The group Marijuana Policy Project now opposes HB 302 after previously submitting testimony in support of earlier versions. Karen O’Keefe, director of state policies for MPP, noted that data suggest that only a small subset of Hawaii doctors are currently willing to recommend cannabis.

“About 6% of actively treating physicians are recommending medical cannabis in Hawaii,” she told Marijuana Moment, with fewer than 250 doctors statewide having issued recommendations. “So in practice, the vast majority of patients have to go to a specialist for their medical cannabis recommendation.”

The provision could also complicate the process of obtaining a medical marijuana recommendation for patients without a primary care physician, veterans whose primary care doctors work for the federal Department of Veterans Affairs (VA) and others.

MPP likely would have supported the bill despite those changes, O’Keefe said, but the conference committee also made a number of other changes in the revised bill that the group says go too far.

First, the revised bill now authorizes the Department of Health to “inspect a qualifying patient’s medical records held by the physician, advanced practice registered nurse, or hospice provider who issued a written certification for the qualifying patient.”

Providers who don’t comply with a department request for a patient’s records could see their ability to issue medical cannabis revoked.

Another change establishes a new Class C felony for unlicensed operation of a dispensary, adding another major charge on top of the state’s existing laws against illegal distribution of marijuana.

Additionally, the conference committee-revised bill would appropriate $750,000 “or so much thereof that may be necessary” to recruit and hire five investigator positions and one analyst position “to enforce, and mitigate nuisances relating to, illegal cannabis and hemp products.”

With House and Senate approval Wednesday, the bill now proceeds to the desk of Gov. Josh Green (D), who last year announced a plan to expand access to marijuana in light of the legislature’s failure to pass recreational legalization measures.

“This would make it very available—that’s marijuana—for those who choose it in their lives,” the governor said in an interview, “and it would still keep kids safe, which has been everyone’s priority.”

At the same time, Green reiterated his support for full recreational legalization. “I think for adults who can responsibly use marijuana, it should be legal,” he said.

Hawaii was the first U.S. state to legalize medical marijuana through its legislature, passing a law in 2000.

Both legislative chambers on Wednesday also passed a bill, SB 1429, that would allow medical marijuana caregivers to grow marijuana on behalf of up to five patients rather than the current one, among other changes to the existing medical program.

Lawmakers also recently sent a bill to the governor that would help speed the expungement process for people hoping to clear their records of past marijuana-related offenses—a proposal Green signed into law earlier this month.

That measure, HB 132, from Rep. David Tarnas (D), is intended to expedite expungements happening through a pilot program signed into law last year by Gov. Josh Green (D). Specifically, it will remove a distinction between marijuana and other Schedule V drugs for the purposes of the expungement program.

The bill’s proponents said the current wording of the law forces state officials to comb through thousands of criminal records manually in order to identify which are eligible for expungement under the pilot program.

Hawaii’s Senate back in February narrowly defeated a separate proposal that would have increased fivefold the amount of cannabis that a person could possess without risk of criminal charges. The body voted 12–11 against the decriminalization measure, SB 319, from Sen. Joy San Buenaventura (D).

Had the measure become law, it would have increased the amount of cannabis decriminalized in Hawaii from the current 3 grams up to 15 grams. Possession of any amount of marijuana up to that 15-gram limit would have been classified as a civil violation, punishable by a fine of $130.

A Senate bill that would have legalized marijuana for adults, meanwhile, ultimately stalled for the session. That measure, SB 1613, failed to make it out of committee by a legislative deadline.

While advocates felt there was sufficient support for the legalization proposal in the Senate, it’s widely believed that House lawmakers would have ultimately scuttled the measure, as they did last month with a legalization companion bill, HB 1246.

Last session, a Senate-passed legalization bill also fizzled out in the House.

This year’s House vote to stall the bill came just days after approval from a pair of committees at a joint hearing. Ahead of that hearing, the panels received nearly 300 pages of testimony, including from state agencies, advocacy organizations and members of the public.

This past fall, regulators solicited proposals to assess the state’s current medical marijuana program—and also sought to estimate demand for recreational sales if the state eventually moves forward with adult-use legalization. Some read the move as a sign the regulatory agency saw a need to prepare to the potential reform.

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