Marijuana Legalization and Potential Workplace Pitfalls for Nurses Who Partake

Julianna Paradisi, RN, OCN, writes a monthly post for this blog and works as an infusion nurse in outpatient oncology.

Mount Hood, Oregon as seen from the Washington State side of the Columbia River Gorge/photo by Julianna Paradisi

Mount Hood, Oregon, as seen from the Washington State side of the Columbia River Gorge/photo by Julianna Paradisi

Wednesday, July 9, 2014, marked the first day of legal, recreational marijuana sales in the state of Washington, not long behind similar new laws in Colorado earlier this year. As in Colorado, the marijuana supply in Washington was initially insufficient to keep up with demand; stores ran out of cannabis before all customers waiting hours in line got through the front door.

The following weekend, my husband and I (we live in Portland, Oregon) took a road trip through the Columbia Gorge on the Washington side of the river.

“Hey, we could buy a joint here, and share it,” I joked. (Neither of us actually partakes.)

My husband, a pharmacist, remarked, “It may be legal, but testing positive at work could get either of us fired or invite state board investigation.”

For my husband and me, as Oregon residents, the point is moot: no amount of THC in our urine or blood is legal. For Washington and Colorado residents, however, the newly legalized status of marijuana creates confusion for employers and employees alike. In Washington and Colorado, a drug test positive for THC is no longer illegal, but being under the influence of legal substances like alcohol, for instance, violates employer policies.

This fact was illustrated in the news on the very first day of marijuana sales in Washington. A Spokane resident was fired when his purchase became public. Since then, the man has been rehired. After considerable media coverage, the company decided that, since he had the day off when he made the purchase, he was not under the influence while at work, the possibility of which is the underlying rationale for their drug testing policy.

Does being a nurse or health care provider add another layer of complexity to this issue? I think so. Positive drug tests are not acceptable for the majority of nurses and health care professionals. Smoking a joint legally in Washington over the weekend means that THC may remain detectable in urine for about a week, and longer for regular smokers.

You can see the dilemma: It may be legal for a nurse, pharmacist, or surgeon to smoke cannabis in Washington, or Colorado, but you probably also want to know that they are not under the influence of any mind-altering substances, legal or otherwise, during patient care. And, crucially, a positive drug level indicating intoxication has not been established for cannabis, as it has for alcohol.

What I foresee as an initial solution is that hospitals and clinics may make clean drug tests a requirement of employment (many already do). This may sound invasive or behind the times, but remember, marijuana use, recreational or medical, remains illegal on the federal level. The current administration takes a relatively lenient approach to the matter, but future administrations are under no compulsion to do likewise. Then there’s the issue of workmen’s compensation insurance, which often requires drug tests to differentiate employee or employer liability for on-the-job injuries, experienced injury attorneys are the only ones that can properly navigate these waters, don’t be a hero and try it on your own.

Further, compare hospital policies requiring drug-free employees to those applied by a rapidly growing number of hospitals to tobacco, which is legal throughout the United States. (See this recent AJN post on the ethics of such no-smoking policies.) In the same manner, hospital employers may be able to independently establish work policies that exclude the use of marijuana.

Recreational marijuana use may come to be restricted by state boards of nursing in a way that parallels their approach to alcohol use: impairment on the job will not be tolerated and will result in license suspension.

Surveys suggest that most people support decriminalization of recreational marijuana; however, the enforcement of safe workplace standards where it is legal is still in development. The presence of THC in blood or urine is not an indication of intoxication, but without an agreed upon blood level by which to measure intoxication, a more conservative approach to positive tests may win out in health care until a more nuanced approach becomes possible.

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2017-01-29T10:53:02+00:00 July 30th, 2014|Nursing|27 Comments

About the Author:

Julianna Paradisi, RN, OCN, finds inspiration where science, humanity, and art converge, creating compelling images as both a writer and a painter. She is the author of, and also blogs frequently for and, the blog of the American Journal of Nursing (AJN).


  1. Dmitri Wilkins November 25, 2017 at 8:30 pm

    Obvious solution: If nurse is suspected of on-the-job use, blood test them. Otherwise why should they be punished for use on their days off?

  2. Dmitri Wilkins November 25, 2017 at 8:28 pm

    My husband, a pharmacist, remarked, “It may be legal, but testing positive at work could get either of us fired or invite state board investigation.”

    I’m pretty sure that was not an exact quote

  3. Steven J Winn June 22, 2017 at 9:55 pm

    For all of those people who keep saying that people who smoke weed should not come to work stoned I agree. Problem is the THC can stay in your system up to a week or more. So unless you are going to only work one day every week or so until the THC is out of your system (Unlikely a medical doctor or nurse is only going to work one day a week) then you should be fine….NOT!

  4. Cindy Pitt May 14, 2016 at 12:33 pm

    I do not advocate the recreational use of marijuana but have seen the benefits of the oil of canitubus helping patients. The oil is extracted from the plant so the hallucinogenic part is removed. I have a family member who had stage IV cervical cancer who was treated with the oil injected into the tumors and is now cancer free for the last year. She delivered a healthy baby girl last week. Granted she had to go to Colorado for treatment and not our local MD Anderson Cancer Center. I have also heard reports of children with seizures that were poorly controlled until treated with the oil in pill form. Now instead of 10-20 seizures a day, they might have one. Their quality of life is 100% better that what it was. They are functioning without side effects or “appearing” stoned. As they do not smoke it and the oil has had the hallucinogenic properties removed from it.

  5. The dude January 23, 2016 at 11:10 pm

    If you are a drinker, do you go to work drunk? No? So why is it ASSUMED that marijuana users will show up to work stoned? “I wouldn’t want a stoned surgeon operating on me”, well no kidding, and you ESPECIALLY don’t want a drunk surgeon operating on you, right? I live in Washington State. Us Washingtonians voted in favor for recreational use of marijuana (majority won). Now shall Washingtonians say who should and should not be able to use? Is that right? Do we do that with alcohol or ANYTHING else (okay nicotine–but that’s a another sensitive subject). Because Washington nurses do not have this right that our people voted for–they are excluded. Why? Because apparently every pothead goes to work high (pretty ridiculous assumption, yeah?). Now as for detecting intoxicating THC levels go, there is a blood test that will detect toxicating nanograms (this is how law enforcement is able to charge a stoned driver with a DUI). Medical Marijuana patients who are nurses cannot legally practice. This needs to change. Because if that nurse was Rx a more serious drug (like Valium), they could still practice. Malarkey!!

  6. carolyn November 29, 2015 at 5:02 pm

    solution- remove marijuana from the drug test… not every thing that is mind altering is tested.

  7. Raymond Holt September 3, 2015 at 2:40 pm

    An employee should not come to work under the influence at all. This includes alchohol,marijuana and any other substances that may potentially impare thier judgement. Using responsibly is the key here.

  8. Bitchynurse June 15, 2015 at 7:44 pm

    I am a nurse and have been for 15 years. I am in Colorado. My mother just died in April. She used marijuana regularly for pain with no unwanted side effects,(large edible doses). I know many nurses, including myself, (I am not working at this time), who use marijuana off hours. I have also known OF medical professionals, not just nurses, who were drunks, pill heads, junkies, meth users, etc ad nauseum, who still worked until they were caught, (one lovely was sucking morphine out of kids IV lines). If I were a patient, I would much rather have care from someone who smoked a bowl the night before, than from someone who tied one on the night before and was called in to work hungover. When I decide to go back to work, I will have to not smoke for at least a month. Just the way it is right now. I don’t agree with it, but I don’t run the world, yet…..

  9. Michele April 22, 2015 at 9:47 pm

    If you have never smoked marijuana & have commented, you might as well delete your post, because your opinion on something you know NOTHING about is not useful. I am going to be a nurse and have to quit smoking because of it. It helps me study, I am much more focused, yet I can’t smoke it because it’s a “drug”; the only way it alters my mind is by making it work better. Weed grows in the ground!!! We have every right! I’d much rather smoke weed, than take a prescription, which could give me worse side effects than my original issue. By the way, whoever said weed kills, you’re a complete moron. I never drink alcohol or do actual drugs (especially pain medicine, which is highly addictive and prescribed!!), because I don’t like giving up my cognitive abilities, which from personal experience, weed enhances, not inhibits. I wouldn’t mind a stoned nurse, I’d mind an alcoholic/junkie one-which weed prevents.

  10. Abena Sara March 30, 2015 at 7:17 am

    I wouldn’t want to be treated by a medical professional under the influence of anything. I agree that deciding on a level of THC that indicates “intoxication” will be important as more states legalize marijuana, or have medical marijuana programs. I also agree with a previous commenter who stated that she wished she could use medical marijuana to manage her back pain at work. Medical marijuana has its uses and a true medical-needs user is not using it ‘to get high’. Thanks for your article! Sara

  11. Lincoln March 20, 2015 at 7:41 pm

    We as nurses know the effects of drugs on the body. We took a vow to care for people. We should hold ourselves to a higher standard. We owe it to our patients and ourselves to be clean of alcohol and drugs.

  12. Shay Segura March 19, 2015 at 4:56 pm

    As nurses we should be held at the highest standards! It is not ok to drink or do drugs! Alcohol is legal but it doesn’t mean that it’s good for you and it can kill you if used in excess. Marijuana is legal now but it is defientely not good for you just like smoking it can hurt youor kill you also. Prescription drugs are also not good for you but we must out weight the benefits verses the risks. They have to be written as a prescription from a MD peolpe can’t just decide they want to take a medication, that’s why they are called prescription drugs. I believe marijuana can help many people as a prescription but it should be given as a last resort to people who need it most. But as professionals we should not test positive for any drug!! We should never put ourselves in the position of being addicted to any thing that is not good for us! Be professional we are supposed to have degrees!!

  13. Travis February 2, 2015 at 10:28 am

    The reality is that marijuana is detectable in the body for an extended period of time. Many other mind altering drugs are passed out of the body within 3-4 days. A nurse, theoretically could use heroine, crack/ cocaine, etc on Thursday/ Friday and on Monday when its time to go back to work; pass a drug test. A nurse prone to wanting to alter their LOC, will use hard drugs over marijuana so that they can pass a drug test and keep their job. This is a problem because these nurses have access to these hard drugs. I’m curious if diverting rates would decrease if nurses were allowed to use marijuana in their personal life.

    A frequent/ chronic user of alcohol will have just as many cognitive deficits as a frequent marijuana user. I know many non substance users who have cognitive deficits without any assistance from a drug. Suspending and firing should be strictly based on performance ON the job. Firing someone for using marijuana on their day off is simply ludicrous. If an employer notices that an employee is struggling on the job, they should be given a blood drug test to decide if they came to work under the influence.

  14. Tom January 20, 2015 at 9:56 pm

    i dont uderstand why its ok for me to take Norco at work 2x a day every day and i still have a job they say nothing and i do have random drug testing they know i take my Norco.But on my day off i cant smoke Mary J , I just dont get it …..

  15. Jon doe January 6, 2015 at 12:17 am

    Now that Obama has removed marijuana from the shedule 1 list of drugs, would you be okay with coming up positive on a urine test at work for THC?

  16. Mariago6 November 22, 2014 at 9:20 pm

    To the OR nurse above: I think it is just common sense…you don’t drink wine before work, why would you smoke a joint before work? But you can do whatever you want on your day off or after work, as long as you ensure enough time has passed or you don’t over -do it. As a nurse myself, I would MUCH rather have a nurse who smoked pot the night before take care of me than one who went out drinking, even in moderation.

  17. Eric October 21, 2014 at 4:51 am

    Interesting someone mentioned airline pilots. I feel they could do their job just fine if they smoked some marijuana the night before. Just like I feel they would do fine if they had a few drinks the night before, everything in moderation. Many airline pilots don’t really drink all that much or even think about getting high, none I’ve talked to anyway. One friend of mine who flew for United told me about a pilot who showed up for work still drunk and actually got in the cockpit, this person was a copilot. The captain asked if he was drunk and he admitted he was. The fines and jail time for showing up to work drunk as an airline pilot are much more severe then a DUI in a car. Doing drugs or drinking all the time as an airline pilot is unacceptable behavior to any true professional pilot and the person who does this will not be allowed to fly. Trust me a a true pro looks at the passengers who board their plane and they feel love for the passengers as they do their aircraft. You could legalize all drugs and not test for drugs. I doubt 99% of pilots would use any. The 1% who would would stand out like a sore thumb to the pros and would not be allowed to fly.

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  19. Carrie Glans August 3, 2014 at 9:09 pm

    Great information. However this is a topic that will have many opinions. There are many reasons to use it and not use it, just as narcotics are needed and often become abused. It is a topic of high interest and needs further research before any “real” evidence based answers can be given. As stated above that the two uses are MS and CA patients, I agree but further would say anxiety and depression could possible benefit as well. Again, more research is needed and real peer reviewed literature and evidence based research is needed. I wish all the best on what the future could bring. Mistakes are required to learn, so may we all learn from them and grow on our practice.
    Glans RN, BSN and Grad student for NP

  20. Audry Carman July 30, 2014 at 1:27 pm

    Great article. As a California resident, I feel that legalization of this substance is right around the corner for us too. I also agree that safe workplace standards have not been set in states like Colorado or Washington and that scares me. I’m not against legalization, but this definitely blurs the lines of personal and professional exposures while under the influence.

  21. Stacy July 30, 2014 at 12:46 pm

    This isn’t true. As an employed professional in Washington state, a great number of employers follow the Federal law not state. Those with locations spanning multiple states apply the more stringent policy. And especially those where safety is a concern and those with contracts with the DOD or federal government.

  22. M. E. Walsh, RN,BSN, Graduate Student July 30, 2014 at 11:59 am

    Ladies and gentlemen, It was brought to my attention that there is a group named the American Cannabis Nursing Association. It is a relatively new group (gee!) and supposedly is for the support of green card patients. However, since proven use of marijuana for medical use is strictly limited (MS and end of life cancer pain) how necessary is this group to advocate for those TWO uses? Also, it must be smoked for any systemic value. So, light up MS patients and CA pts and get some relief. The cookies, brownies, lollipops, drinks, etc., mean nothing. Pain MD from Mesa Az addressed my grad school class and was explicit in the above. He stated that there is NO SCIENTIFIC PROOF marijuana aids anyone but the two above groups. Also, I never want to be taken care of by anyone under the influence. However, THC is in your system for 30 days; alcohol leaves in 24 hours. Think about it. Do you want stoned people giving you drugs, taking care of you, and assisting doctors in clinical decisions? For me, a big resounding NOPE, no dope.

  23. Debbie Puro July 30, 2014 at 11:40 am

    I hope that a happy medium can be identified. As a nurse with Chronic back pain from a combination of arthritis, slipped and herniated discs. I manage to go to work every day, but it is agony most times. I have sleep issues due to the pain. It all affects my ability to concentrate on my job. I hope that someday, healthcare workers will not be discriminated against and will be able to use the legal marijuana for pain management. I have even considered giving up my career just so I can have a chance to manage my pain. How fair is that?

  24. Jacob M July 30, 2014 at 10:35 am

    Just to be clear here, no one is saying in this post that a nurse is intoxicated at work if they smoked marijuana at another time (say, the day before). That’s part of the issue being addressed and the legal gray areas that are associated. Also, the reference to the Huffington Post is unclear…this is not the Huffington Post. It is the blog of the American Journal of Nursing.

  25. Concerned about the people huff post allows to write articles July 30, 2014 at 10:30 am

    This OPINION article is just that. An opinion. Please do not try and pass off ur opinion as valid on smoking marijuana if you do not partake. An individual who partakes Is not necessarily smoking a joint before their shift in the icu or anywhere else. And not to mention, It’s just as possible, if not more possible, that someone could have a drink before coming into wrk. Is there a breath test before you enter into your job at the ICU?? How can I trust that you didn’t hve a drink before you came to work?? Marijuana is less harmful and alters functioning to a lesser degree than alcohol, yet you do not even make mention of the dangers of ur nurse have a glass of wine before a shift. Drug testing is an invasion of someone’s privacy. If someone is suspected to be under the influence at work, then a drug or alcohol test would be appropriate. Otherwise corporations have no right entering the home, telling individuals what they can and cannot do. Huff post, you need to stop allowing these opinion pieces from individuals whose opinion is not valid, as their expertise and personal experience does not match up with the topic they are discussing.

  26. Moira Speed July 30, 2014 at 10:17 am

    Asa patient, I would not want to be treated by any healthcare professional who was a known maijuana user (or any thing else). I am an OR nurse, and have witnessed the effects of a surgeon who was subsequetly suspended for alcoholism. Also, I have had to cover for colleagues who were too hungover to work. I believe that anyone who was caught, would be on precarious ground medico-legally. When judgement and critical decision making are part of a profession, this must be a no-no. The time for discussion is now, before there is a tragic accident. The civil liberties people may be up in arms about the right to choose, but the patients also have a right to, and are paying for,safe care.

  27. Just Me July 30, 2014 at 8:45 am

    Great article. This is the same discussion I get into with my “it’s legal and I can smoke it when I want to” friends. Their defense seems to be it’s ok as long as you’re not doing it at work. They pause when I ask if they’d mind me taking care of their loved on in ICU if I smoked a joint before I came to work. I mean I didn’t do it at work. Do they mind that the airline pilot who is transporting their child, smoked it last night? Seems like the research is lagging behind the law!

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