Navigating Washington’s Medical Cannabis Program

Many weed industry veterans are old enough to remember the state’s original medical cannabis program. Largely unregulated at the time, Washington’s medical cannabis infrastructure was one giant gray area, making it so patients could enjoy “deli style” flower that was weighed to order, on-site consumption at dispensaries, edibles in any form and potency you can imagine, and cannabis farmer’s markets which let patients smell and even sample products before purchasing.

Honestly, it was even more fun than it sounds. If you ever hear old heads using the catchall phrase “medical was better,” they’re most likely referring to how laid back the system used to be. That being said, there were some notable drawbacks to this system, including high prices, limited options, and zero arrest protections.

Though the state’s original medical cannabis system was relatively loose and permissive, our current medical cannabis program is highly structured, well regulated, and designed to provide greater flexibility and protections for the patients who depend on cannabis to alleviate their symptoms from serious medical conditions. However, nearly 10 years after the new program was established, most of us are still confused about how the medical cannabis program actually works in Washington. Here’s everything you need to know…

The Cannabis Patient Protection Act

In April 2015, the Cannabis Patient Protection Act (SB 5052) was signed into law by Governor Inslee, which effectively merged Washington’s half-baked medical program into the new and highly regulated adult use cannabis industry. The primary goals of this law, according to the Washington State Department of Health (DOH), were to:

• Clarify what is meant by the medical use of cannabis,
• Support patients having access to higher quality products to meet their medical needs,
• Allow for state sales and use tax breaks for medical cannabis patients who are entered into the authorization database, and
• Provide protection from arrest and prosecution for patients who are entered into the authorization database.

Qualifying Conditions for Medical Cannabis

The old medical program provided support for patients whose qualifying conditions included serious ailments like:

• cancer,
• human immunodeficiency virus (HIV),
• multiple sclerosis,
• epilepsy,
• glaucoma,
• Chron’s disease,
• hepatitis C, and
• intractable pain that is unrelieved by standard medications.

Though these are not the only ailments that medical cannabis can relieve, petitions to include bipolar disorder, severe depression, and anxiety disorders (specifically debilitating social phobias) were explicitly denied in February of 2010, following testimony from Dr. Andrew Saxon who said, “these conditions are not uniform and each individual who has these conditions has unique symptoms and may respond differently to different medications and treatment regiments,” before Dr. Saxon then claimed that he has, “seen hundreds of patients who have been made worse by marijuana and whose conditions improved when they stopped using marijuana.”

Posttraumatic stress disorder (PTSD) and traumatic brain injury were added as qualifying conditions in 2015. PTSD is currently the only mental health disorder that is considered a qualifying condition for medical cannabis in Washington; Unfortunately the Cannabis Patient Protection Act removed the option for Washingtonians to petition for new conditions to be added, making it so this can only be done through legislation (so contact your representatives).

Benefits of Being a Registered Medical Cannabis Patient

The main aspect of Washington’s medical cannabis program that patients are skeptical of is the authorization database; joining the database is voluntary and is not a requirement to be a patient, unless the patient is under 18.

So what are the benefits of joining the patient registry?

• Arrest protection, as opposed to an affirmative defense
• Ability to purchase products from a medically endorsed cannabis retailer without sales or excise tax (~47% off)
• Ability to purchase edibles with higher amounts of THC
• Ability to purchase clones or seeds from licensed I502 producers
• Ability to grow up to 6 cannabis plants
• Ability to possess up to 8 ounces

Cons of Being a Registered Medical Cannabis Patient

Other than individual privacy concerns that come along with being registered in a database, there are very few drawbacks to being a registered patient. Prior to June of 2024, registered patients could only get a tax exemption on a very small pool of products, but now they’re able to apply that exception to many commercially available products.

Patients who are not registered in the database are subject to the same purchase limits as anyone else, however they will also have, “an affirmative defense to criminal prosecution if they possess no more than four plants and six ounces.” Affirmative defense means that the patient could still be arrested for growing 4 plants for their own medicinal use, but they would be able to present their medical cannabis authorization in court and have a greater likelihood of having the charges against them dropped. This is in contrast to straight up arrest protection for being registered in the patient database (RCW 69.51A.040).

How to Obtain a Medical Cannabis Authorization in Washington

The DOH outlines the process for obtaining a medical cannabis authorization as follows:

• Step 1: Schedule an appointment with your health care practitioner.
• Step 2: Obtain a medical cannabis authorization from your practitioner.
• Step 3: Visit a medically-endorsed store to get a medical cannabis card.
• Step 4: Use the card to purchase cannabis products without sales tax.

The intent of steps 1 and 2 is to have patients obtain a medical authorization from their primary health care practitioner, however many doctors may still be uncomfortable with recommending a Schedule I controlled substance to their patients, so this is a challenge that potential patients may have to navigate.

How Medically Endorsed Dispensaries Work

After training & certifying employees to be Medical Cannabis Consultants under the DOH’s standards, a dispensary can obtain status as a medically-endorsed retail store. A medically-endorsed dispensary can not only sell cannabis to medical patients, but they are also able to get patients registered into the database and issue identification cards as well.

As of June 8, 2024, registered patients are no longer required to pay Washington state’s 37% excise tax on cannabis products, but only when they’re purchasing from a medically-endorsed retail store, and only on products that are DOH compliant. Previously, patients were only exempt from paying sales tax on their medicine (approximately 10%, depending on the city), but now that the excise tax is also waived, patients can purchase their medicine for nearly half the price that a recreational user would pay.

As an added benefit to medical patients, DOH compliant cannabis products undergo additional testing for prohibited pesticides, heavy metals, and mycotoxins, and several of Washington’s cannabis producers have since made the effort to get all or most of their products DOH certified. This benefits recreational users as well, as they are also able to purchase these cleaner DOH cannabis products.

There are many pros [and a few cons] to consider if you’d like to be a medical cannabis patient in Washington. Aside from being able to purchase cleaner medicine at a more affordable price, medical patients are permitted to grow their own cannabis without fear of being arrested, a privilege that non-medical users have been fighting for for over a decade in Washington.

If you have a qualifying condition that can be alleviated through the use of cannabis, consider talking to your primary health care provider about a medical cannabis authorization, then come and see us to get your medical identification card.