Reforming Drug-Testing Policies for Nurses and Nursing Students Who Use Cannabis
The Time is Now!
Dear Green Nurse,
Are nurses still subjected to drug testing for cannabis? As someone who uses cannabis for medical purposes, I’m wondering about the current laws, rules, and regulations. I’m considering pursuing a career in nursing but I'm hesitant about the possibility of having to give up my medication. What are your thoughts on this?
Sincerely,
Concerned About the Rules and Laws
Dear Concerned,
I understand your concern completely—that's a key reason I chose to step away from conventional care as a Registered Nurse. I revolutionized my approach to health and self-care by replacing over 18 pharmaceutical medications with cannabis and hemp-derived CBD. It wasn’t until I made the switch that I realized the harm caused by the overwhelming number of prescriptions I was taking. I had become a textbook case of polypharmacy, but this shift allowed me to reclaim balance and wellness in my life. This evolution from pharmaceuticals to plant medicine allowed me to reclaim balance in my mind, body, and spirit, helping me truly live my best life and is what brought me to cannabis nursing. Needless to say, I was not invited back to my nursing job as a cannabis consumer.
A significant issue also lies within nursing education. Nursing schools in the United States prohibit students from holding medical cannabis cards, even if they have a valid prescription. This creates an environment of fear, discouraging students from pursuing medical cannabis as a legitimate treatment option. If a student tests positive for cannabis—even with a valid medical card—it doesn’t matter; they still face consequences. Inconsistent policies across nursing schools exacerbate the issue, making it challenging for nurses and nursing students to maintain autonomy over their self-care and wellness routines.
This gap in understanding and acceptance is what inspired one of my colleagues, Dr. Deanna Sommers, to get involved in the field of cannabis advocacy. She is now part of the American Cannabis Nurses Association currently on the Board of Directors and will be serving as President starting in 2026. I, too, am deeply committed to this work, serving on the organization’s board of directors. Together, with the Policy and Government Affairs Committee at ACNA, we aim to address these challenges and champion change in both nursing education and healthcare policy. Two fellow nurses and I from the Policy and Government Affairs Committee will be presenting a poster at this year's ACNA virtual conference. The poster will focus on essential strategies for nurses to safeguard their nursing licenses as they explore cannabis for themselves and their patients. For those of you concerned about the laws, this blog post is made just for you!
Sincerely,
Your Favorite Green Nurse
The Time is Now: Reforming Drug-Testing Policies for Nurses and Nursing Students Who Use Cannabis
As cannabis legalization expands across the country, one important question continues to surface: Why are nurses and nursing students still being penalized for legal, off-duty cannabis use?
Despite growing clinical and cultural acceptance of cannabis, outdated drug-testing policies continue to put nurses at risk—professionally, ethically, and personally. In response to these concerns, the American Cannabis Nurses Association (ACNA) is currently updating its 2021 policy statement on cannabis and drug-testing in nursing to reflect today’s legal and scientific landscape.
Here’s why this matters—and what needs to change.
Cannabis Use is Legal—But Drug Testing Hasn’t Caught Up - Nurses are among the most burned-out, injury-prone professionals in healthcare (American Nurses Association, 2010). Many seek relief through natural and plant-based therapies—including cannabis—for conditions like chronic pain, PTSD, anxiety, or insomnia.
But even in states where medical or adult-use cannabis is legal, nurses remain vulnerable. Why? Because many employers and licensing boards still rely on outdated urine drug tests that detect cannabis metabolites (like THC-COOH), which linger in the body long after impairment has passed. Testing positive for THC does not indicate current impairment or reflect a nurse’s ability to function safely and effectively in clinical practice. Standard drug tests, particularly urine tests, detect the presence of non-psychoactive THC metabolites, such as THC-COOH, which can remain in the body for days to weeks after cannabis use, especially among regular consumers. These metabolites do not correlate with intoxication, motor impairment, or diminished cognitive function at the time of testing (Grabenauer, 2020; Cary).
In fact, studies demonstrate that individuals can test positive for THC long after the psychoactive effects have subsided—meaning a positive test is more reflective of past exposure than real-time capability. This is particularly problematic for nurses who use medical cannabis under the supervision of a healthcare provider to manage chronic pain, anxiety, PTSD, or other qualifying conditions. Punitive action based on metabolite detection unfairly targets legal, responsible users and fails to assess actual job performance or fitness to practice.
To ensure both patient safety and nurse protection, institutions must move toward performance-based assessments and validated impairment tools, which offer a more accurate and equitable measure of workplace readiness. Continuing to rely on THC metabolite testing as a proxy for impairment contributes to stigma, workplace discrimination, and workforce attrition in an already strained healthcare system.
This disconnect puts nurses in an impossible situation: choose between managing their health with legal plant medicines—or risk losing their job.
Americans With Disabilities Act - Despite increasing state-level legalization of medical cannabis, the Americans with Disabilities Act (ADA) does not protect nurses or nursing students who use cannabis—even when recommended for legitimate medical conditions. Because cannabis remains a Schedule I substance under federal law, individuals who use it are considered to be “engaging in the illegal use of drugs,” and are therefore excluded from ADA protections. This legal gap has significant implications in nursing: students may be dismissed from educational programs, and practicing nurses may face employment termination or licensure consequences after testing positive for THC. While some states have passed laws offering limited workplace protections for registered medical cannabis users, these do not override federal policies or the ADA’s exclusionary stance (U.S. Commission on Civil Rights, 2000).
Updating The Position Statement - I anticipate the revised policy statement will strengthens its original stance with these key updates:
Impairment—not THC presence—should guide policy. Routine testing for THC metabolites doesn’t reflect current impairment and unfairly punishes legal consumers.
Replace urine screens with validated behavioral assessments. Cognitive tools and psychomotor evaluations are more accurate for workplace safety.
End discrimination against nurses & nursing students for legal, off-duty legal cannabis use. Attending a cannabis event, networking within the industry or working in the cannabis arena shouldn’t put a license at risk.
Expand anti-discrimination protections nationwide. Policies like California’s AB 2188 and Washington’s 2023 law should become the standard, not the exception.
Nurses Shouldn’t Have to Choose Between Healing and Employment - Fear of testing positive—even from CBD products—drives many nurses to avoid therapeutic options altogether. Some even resort to extreme measures like synthetic urine or detox kits, putting both their health and professional integrity at risk. This fear isn’t just unproductive. It’s harmful. It creates a climate of secrecy, isolation, and unnecessary suffering—at a time when the healthcare workforce is already stretched thin.
As written in the new book “Scope and Standards of Cannabis Nursing”, the therapeutic use of cannabis refers to the use of cannabis products for medicinal, wellness, or healing purposes. Its effects are personal and subjective to each consumer, with objective criteria enhancing functionality across one or more of the five key health domains—biological, mental, emotional, spiritual, and social—while ensuring no negative impact on any of the others. The Scope and Standards of Cannabis Nursing provides a comprehensive guide to the who, what, when, where, and why of cannabis nursing. It defines the role of cannabis nurses, the skills and knowledge they require, and the best practices they should follow. This framework is essential for understanding how nurses can effectively integrate cannabis-based care into their practice while maintaining safety, professionalism, and compliance with legal and ethical standards. (American Nurses Association, 2024).
The Landscape is Shifting: Employers Are Catching On - Recent moves from major employers and states show a clear trend toward reform:
Amazon stopped THC testing for most positions in 2021.
California and Washington now protect workers from discrimination based on off-duty, legal cannabis use.
Trucking industry shortages are increasingly tied to cannabis-related disqualifications—despite drivers using cannabis instead of alcohol.
The reality? THC detection is not the same as impairment. Research confirms this again and again (Grabenauer, 2020; Cary, n.d.).
It’s Time to Prioritize Safety, Science, and Equity- Reforming cannabis drug-testing policies isn’t simply about being pro-cannabis—it’s about being pro-nurse. At its core, this conversation centers on protecting the health and rights of the nursing workforce. It’s about ensuring access to safe, therapeutic plant medicine without fear of losing one’s job or professional license. And above all, it’s about shifting away from outdated, fear-based policies toward one's rooted in modern science, fairness, and compassion. For over 23 years, nurses have been the most trusted profession—a testament to the care and dedication we provide. (Gallup, 2025) Yet, it’s equally important that we are trusted to make our own choices when it comes to the medicines, wellness practices, and healing tools we rely on to care for ourselves.
Nurses who use cannabis legally—often to manage conditions like chronic pain, PTSD, or anxiety—should not be punished by policies that rely on the presence of THC metabolites rather than true indicators of impairment. It’s time we demand that employers adopt performance-based assessments that measure actual workplace ability, not historical use. Licensing boards must also re-evaluate disciplinary frameworks that fail to reflect the legal realities of medical and adult-use cannabis in many states.
Federal policy, too, needs a serious update. As the landscape of cannabis legality evolves, so must our national standards. The continued disconnect between federal law and state protections not only creates legal ambiguity—it places nurses in precarious situations where they must choose between personal wellness and professional safety. (For more on this, see our companion blog on reclassifying cannabis to Schedule VI.)
Who’s Leading the Way? Change is already underway, with some key players moving the needle. In California, Assembly Bill 2188 was a game-changer—it prohibits employers from firing employees for legal, off-duty cannabis use. Washington followed suit in 2023 with legislation designed to protect workers from cannabis-related discrimination. Even large corporations like Amazon have taken public stances in favor of reform and have eliminated THC testing for most positions. Meanwhile, healthcare systems across the country are quietly updating their internal drug policies to reflect both the shifting legal framework and the reality that the healthcare workforce is evolving.
These reforms are not just policy upgrades; they’re cultural shifts. They send a message that holistic wellness, autonomy, and science-backed decisions are finally taking priority over punitive models
The Call to Action - Now is the time to act—not tomorrow, not next year. Nurses, nursing students, healthcare professionals, and patient advocates must collectively push for policy that aligns with the modern healthcare environment. The current system is no longer sustainable. Nurses are burned out, disillusioned, and often left to choose between managing their health and maintaining their license and employment. This is unacceptable.
We must work to normalize therapeutic cannabis use as part of a larger commitment to mental wellness and integrative care. That starts with education—about the science of cannabis and the endocannabinoid system, about its safety profile compared to other pharmaceuticals, and about the growing body of evidence supporting its use in clinical contexts. It means having real conversations in hospital boardrooms, policy meetings, and nursing schools. It means demanding legal protections that mirror the lived realities of professionals on the ground.
The American Cannabis Nurses Association, along with allied organizations and reform-minded institutions, continues to advocate for these changes. But real momentum comes from collective effort—from informed voices, unified advocacy, and a shared vision of a more equitable future for nurses and all healthcare professionals.
Together, we can foster a healthier, more supportive environment for nurses, nursing students, and healthcare professionals alike. Let’s work toward a healthcare system that not only cares for patients but also values the well-being of the nurse behind the stethoscope.
References
Amazon. (2021). Amazon is supporting the effort to reform the nation’s cannabis policy. https://www.aboutamazon.com/news/policy-news-views/amazon-is-supporting-the-effort-to-reform-the-nations-cannabis-policy
American Nurses Association. (2010). Occupational injuries and illnesses among registered nurses. https://www.nursingworld.org/practice-policy/workforce/
American Nurses Association. (2024). Cannabis nursing: Scope and standards of practice. Nursesbooks. https://www.nursingworld.org/nurses-books/cannabis-nursing-scope-and-standards-of-practice/ [nursingworld.org]
BMC Law. (2024). Understanding California’s new cannabis testing laws. https://bmcclaw.com/2024/12/understanding-californias-new-cannabis-testing-laws-what-employees-need-to-know/
Cary, P. L. The marijuana detection window. National Drug Court Institute.
https://www.ndci.org/
Clark, C. (Ed.). (2021). Cannabis: A handbook for nurses. Wolters Kluwer. https://shop.lww.com/Cannabis--A-Handbook-for-Nurses/p/9781975144265
Gallup. (2025, January 13). Americans' ratings of U.S. professions stay historically low. https://news.gallup.com/poll/655106/americans-ratings-professions-stay-historically-low.aspx
Grabenauer, M. (2020). Differences in cannabis impairment and its measurement (NIJ Grant Report No. 255884). U.S. Department of Justice. https://www.ncjrs.gov/pdffiles1/nij/grants/255884.pdf
Marijuana Moment. (2024). Trucking industry and cannabis testing. https://www.marijuanamoment.net/trucking-industry-says-positive-marijuana-tests-and-sometimes-outdated-federal-regulations-are-contributing-to-national-driver-shortage/
U.S. Commission on Civil Rights. (2000). Chapter 4: The ADA and illegal drug use. In Sharing the dream: Is the ADA accommodating all? https://www.usccr.gov/files/pubs/ada/ch4.htm