UPDATED 1/30/14 7:08 a.m.

Hawaii has a reputation for being a pot-friendly state. But living in the islands isn’t all Maui Wowie and Kona Gold. We’re a long way from seeing Honolulu police officers hand out bags of Doritos at a public hempfest, as cops in Seattle did.

So even though Hawaii lawmakers are talking about making the lucrative green weed legal, there are still strict regulations about pakalolo in the aloha state.

Here’s what you need to know.

Who’s allowed to use marijuana in Hawaii?

Generally, marijuana remains illegal in Hawaii. But people who get state approval due to a medical condition can consume it. Illnesses, diseases or other conditions that make a person eligible include cancer, HIV or AIDS, glaucoma, severe pain or nausea, seizures, multiple sclerosis, Crohn’s disease, and other health problems.

How many people in Hawaii are allowed to smoke marijuana — and which island has the most people using medical marijuana?

The Big Island has the most registered medical marijuana users, according to the most recent figures from the Narcotic Enforcement Division of the state Department of Public Safety, which is currently responsible for approving medical marijuana use. Here’s how it breaks down, according to division data through last month:

Island Number of Patients
Big Island 5,131
Maui 2,833
Oahu 2,609
Kauai 1,783
Molokai 204
Lanai 28
Niihau 2

What kind of doctors can prescribe marijuana?

Actually, doctors in Hawaii can’t legally prescribe pot, which is a Schedule I drug. At the federal level, this means that even though at least 20 states have adopted laws allowing for medical marijuana use, the Department of Justice does not accept that marijuana has a medical application, so it would be illegal for doctors to prescribe a Schedule I drug. But Hawaii’s medical marijuana law means they can recommend it to patients. This semantic difference reflects marijuana’s peculiar legal status at a time when it’s considered both an illegal drug and a medical aide by different levels of government.

Beginning in January 2015, only a person’s primary care doctor will be authorized to recommend marijuana in Hawaii. Right now, there are 191 doctors statewide who recommend marijuana, according to the most recent data from the Department of Public Safety.

Can any doctor recommend marijuana?

No. Physicians who want to be permitted to recommend it have to register with the Narcotics Enforcement Division at the Department of Public Safety. (Check out the complete rules here.)

The state’s Medical Use of Marijuana Program is being transferred from the Department of Public Safety to the Health Department, a switch that will be complete by Jan. 2, 2015.

What does a doctor do before recommending marijuana?

A doctor is required to complete a face-to-face assessment, including reviewing the patient’s medical history to confirm that he or she has a debilitating medical condition. The doctor has to come to the conclusion that the potential benefits of marijuana use would outweigh the health risks for the patient. Physicians’ assistants aren’t allowed to recommend marijuana in Hawaii.

My doctor said she’d recommend marijuana for me. Now what?

Don’t light up yet. First you need a registry ID card. To get this card, you and your doctor need to send some key documents to the Narcotics Enforcement Division of the Department of Public Safety, including a copy of your current Hawaii ID card or a copy of your passport.

You also need to include a check to the Narcotics Enforcement Division to cover the $25 registration fee and the completed registration form, signed by you and your doctor. Applications aren’t available online, and can only be obtained through a doctor, a measure that the Narcotics Enforcement Division says is meant to curb fraudulent applications.

Once the Narcotics Enforcement Division receives and verifies your info, they’ll send a registry ID card to your doctor. At that point, your doc has to sign the card before handing it over to you.

And remember, authority over the medical marijuana program is soon being transferred from the Public Safety department to the state Health Department.

Now that I have my registry ID card, can I smoke weed in Hawaii for life?

Nope. It’s only valid for one year from the time your doctor signed it.

So where are all the dispensaries where I can buy my medical marijuana?

The state government allows people to grow marijuana for medical use, but unlike states like California, there aren’t any dispensaries where approved patients can buy the stuff.

Some patients who get approval to use medical marijuana have complained that they don’t know how to find it. House Speaker Joe Souki said on the opening day of this legislative session that it’s an issue he hopes to tackle.

For now, Hawaii residents with approval to use medical marijuana must grow their own plants or ask a designated “caregiver” to do it for them. If you have a caregiver grow for you, you can’t grow your own. It has to be one or the other. And if you grow your own plants, no one else is allowed to help manage or care for them.

I don’t have approval from the state to use marijuana, but can I just call myself a caregiver and start growing it?

No. The person who’s authorized to use marijuana has to select a primary caregiver — that is, someone other than himself who is going to grow the marijuana. The caregiver has to be at least 18 years old and is only allowed to grow marijuana for one patient at a time.

When a patient submits paperwork to the Department of Public Safety to apply for a registry ID card, the patient needs to include photocopies of two forms of ID from his or her caregiver.

These days, there are about 1,540 registered caregivers across the state, according to Public Safety numbers.

Even if a caregiver is only growing for one patient, are there any rules about how much marijuana that caregiver can grow at a time?

Yep. Right now, the law says that an authorized patient or caregiver can have seven total plants — four immature plants and three mature ones. (Immature plants have no visible buds.) But the law is changing. In January 2015, the “immature” language will be removed. This means that those who are allowed to grow marijuana will be able to grow a total of seven plants of any maturity at a given time.

How big of a stash is someone with medical marijuana approval allowed to keep?

For now, you’re not allowed to have more than three ounces of usable marijuana in your possession — that’s one ounce per mature plant. Starting in January 2015, the maximum amount is getting bumped up to four ounces. (Here’s the legislation from last year that explains the changes.)

What else is changing in January 2015?

The governor also signed a law that will establish a special marijuana medical registry fund within the state treasury. Theoretically, the creation of that fund paves the way for broader distribution — via state-approved dispensaries, for instance — or even legalization somewhere down the line. In Colorado, where recreational marijuana use became legal Jan. 1, economists project more than $578 million in annual marijuana sales will yield nearly $70 million in state tax revenue.

Since I’m authorized by the state to use marijuana, I can light up a joint on the beach or when I’m stuck in Honolulu traffic, right?

No. You’re not authorized to use marijuana in public, even when the state approves your use of medical marijuana. The only place you can toke is in your own home.

What about when I hop a flight to another island?

Airports are run by the federal government, so it’s best to leave your marijuana at home.

So as long as I stay at home, can I take any form of THC once I have my signed state registry card?

Again, no. Straight THC is not permitted. Neither is butane honey oil, also known as hash oil.

CORRECTION: An earlier version of this article said medical marijuana users in Hawaii are allowed to keep up to one ounce of marijuana at a time. We’ve updated the article to reflect Hawaii law, which says approved users can have up to one ounce of marijuana per mature plant — that adds up to a maximum of three ounces.


DISCUSSSION: Do you think marijuana should be legalized in Hawaii? What do you think of the policy as it stands now?

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