Hawaii

Overview

Hawaii was the first US state to legalize medical cannabis via the legislature rather than a ballot initiative, doing so via Act 228 of June 14, 2000 (Senate Bill 862), signed by Governor Benjamin Cayetano and codified at Hawaii Revised Statutes Chapter 329 Part IX. The medical-cannabis dispensary system was added by Act 241 of 2015 and codified at HRS Chapter 329D. Possession of small amounts of cannabis was decriminalized in 2020 via Act 273 (3 grams or less, civil $130 fine). Hawaii has not legalized adult-use cannabis; multiple legislative attempts have failed.

The Hawaii Department of Health administers the medical-cannabis program.

Adult-use status

Adult-use cannabis remains illegal. Possession of 3 grams or less is a civil violation with a $130 fine (Act 273 of 2020). Possession of larger amounts is a misdemeanor; substantial quantities or sale-related conduct is a felony under HRS Chapter 712.

Medical program (Chapter 329 Part IX, 2000)

Qualifying conditions

Hawaii's medical program enumerates qualifying conditions including:

• Cancer, glaucoma, HIV/AIDS
• ALS, multiple sclerosis, Parkinson's disease
• Crohn's disease
• Severe and chronic pain, severe nausea
• Cachexia / wasting
• Seizure disorders, epilepsy
• Post-traumatic stress disorder
• Terminal illness
• Any other condition added by Department of Health rule (the list has been expanded administratively)

Patient access

• Possession: up to 4 ounces over any 15-day period under medical registration.
• Home cultivation: registered patients may grow up to 10 plants (mature or immature). Cultivation must occur in a registered location.
• Reciprocity: Hawaii honors out-of-state medical cards for up to 60 days per year for visiting patients ("329V" out-of-state patient program).
• Approved forms: flower, edibles, oils, tinctures, capsules, vapes, topicals.

Recreational penalties

Beyond the 3-gram decriminalized threshold, possession is governed by HRS Chapter 712-1249 et seq. Possession over 1 ounce is generally a misdemeanor; commercial-quantity possession or distribution scales to felony.

Patients and caregivers

• Patient minimum age: 18. Minor patients require a parent or legal guardian as designated caregiver plus physician certification.
• Caregiver minimum age: 18.
• Caregivers per patient: up to 1 designated caregiver per patient.
• Caregiver registration: via the Hawaii Department of Health; background check.

Patient registration steps

1. Schedule a visit with a Hawaii-licensed physician, advanced practice registered nurse, or physician assistant willing to certify a qualifying condition. The certifying provider must establish a bona fide patient-provider relationship and conduct an evaluation. Initial in-person visits are required; subsequent renewals may use telehealth under Department of Health rules.
2. The provider submits a written certification through the Department of Health Medical Cannabis Program portal.
3. The patient applies through the DOH portal, submits identity documents, proof of Hawaii residency, and a current photo. The standard registration fee is $38.50; one-year and three-year registration terms are available.
4. Approved patients receive a state-issued Registry ID card. The card authorizes purchases at any licensed Hawaii dispensary and home cultivation within the 10-plant cap.

Minor patients require a parent or legal guardian as designated caregiver and a second physician's concurring certification for certain conditions. Caregivers complete a separate application and background check.

329V out-of-state patient program

Hawaii operates a formal reciprocity framework under HRS §329-123.5 (the "329V" program). The framework:

• Eligibility: valid medical-cannabis card from another US state or territory, plus government-issued photo ID.
• Application: out-of-state patients apply through the Department of Health 329V portal, submit their home-state card and identity documents, and pay the application fee.
• Validity: the 329V card is valid for 60 days per calendar year (renewable in subsequent years for additional 60-day periods).
• Purchase access: authorized at any licensed Hawaii dispensary.

The 60-day annual cap is significant for repeat tourists and snowbirds. The reciprocity framework does not extend any non-purchase protections (employment, federal jurisdiction on military bases or National Park Service land).

Employment and workplace

Hawaii is an at-will employment state. The medical-cannabis statute includes limited patient-protection language, but the protection has been narrowly construed:

• Safety-sensitive positions: employers may continue to enforce drug-free workplace policies for safety-sensitive roles as defined by the employer.
• Federal contractor and DOT-regulated positions: federal drug-free workplace and DOT testing rules supersede state-level protection.
• Pre-employment testing: Hawaii law does not prohibit pre-employment cannabis testing or adverse hiring action based on positive results.
• Workers' compensation: post-incident testing positive for THC may result in benefit denial unless the patient documents medical use within certified parameters.

Public-employee positions (state, county, and Department of Defense civilian positions on the islands), healthcare licensing, and CDL holders face additional licensing-board exposure beyond employer discipline.

Hemp-derived intoxicants

Hawaii has tightened restrictions on hemp-derived intoxicating cannabinoids in recent legislative sessions. Act 263 of 2023 and follow-on rulemaking by the Hawaii Department of Health treat delta-8 THC, delta-10 THC, THC-O, and HHC products as controlled substances when produced outside the licensed medical-cannabis framework. Retail availability persists in some channels but is legally contested.

Recent legislative history

Hawaii has seen multiple legislative attempts at adult-use legalization without success:

• 2024: SB 3335 (adult-use legalization) passed the Senate but did not clear the House.
• 2025: HB 1246 and SB 1613 (adult-use legalization) failed to clear committees.
• 2026: SB 1283 (adult-use legalization with social-equity framework) advanced through Senate committees but did not reach a House floor vote.

The medical program has continued to expand incrementally. Recent rulemaking added conditions, expanded telehealth authorization for renewals, and adjusted possession-cap calculations. The April 2026 federal Schedule III rescheduling order produced no immediate Hawaii legislative response, though Senator Jarrett Keohokalole (the primary adult-use sponsor) cited the federal action as supportive context for the 2026 SB 1283.

Federal context

Federal jurisdiction layers additional exposure on federal land, federal courthouses, military installations (Joint Base Pearl Harbor-Hickam, Marine Corps Base Hawaii, Schofield Barracks, Pohakuloa Training Area, Wheeler Army Airfield), and National Park Service land (Haleakala National Park, Hawai'i Volcanoes National Park, Pu'uhonua o Honaunau National Historical Park, Kalaupapa National Historical Park). The substantial federal military and National Park footprint across the islands creates compliance complexity for both patients and operators. TSA checkpoint policies treat cannabis as contraband regardless of state medical authorization; inter-island flights pass through TSA screening.