Implications of Legalized Marijuana for EMS Agencies

First, I would like to say “thank you” to those states that legalized either marijuana or medical marijuana this past November! Colorado (and Alaska, Oregon and Washington) will no longer be the “butt” of the jokes when people find out where I’m from.

All kidding aside, this last election season saw a number of states follow our lead by legalizing recreational marijuana, and quite a few more legalized medical marijuana. As of November 2016, eight states have now legalized recreational marijuana and twenty-one states have legalized medical marijuana.1 While it appears that this issue will continue to gain momentum, one key fact for EMS agencies to remember is that marijuana is still considered illegal by the federal government, and this brings with it many challenges.

First and foremost is the issue of federal funding. The federal government requires entities to be drug-free workplaces in order to receive any federal funding. If your agency receives any money from federal programs, such as homeland security/UASI or FIRE act grants, Medicare/Medicaid payments, DHS, HHS or DOT funding, your agency has to comply with the Drug-Free Workplace Act. This means that no employee can use any form of marijuana or the agency risks losing any and all federal funding. Think about the impact to your agency if it were to lose just your Medicare/Medicaid funding, much less any other federal funds.

Another challenge is the issue of workers’ compensation, Line of Duty Death (LODD) benefits and life insurance. If an employee is injured or killed in the line of duty and tests positive for marijuana, workers compensation can deny benefits because the employee was using an illegal drug. The office that oversees the Public Safety Officers Benefit (PSOB) has also said that payments could be dWenied if the employee tests positive for illegal substances. A number of life insurance companies have also indicated that they, too, would more than likely deny benefits if a policyholder tested positive for marijuana.2 This also opens up the possibility of lawsuits against your agency if an individual is harmed by your employee who tested positive. Again, all of this stems from the fact this it is still illegal at the federal level.

So, what impacts have we seen operationally since we legalized first medical marijuana and then recreational marijuana? Honestly, we haven’t seen many significant issues at all associated with its legalization. There have been some increases in pediatric and pet overdoses associated with marijuana edibles when they are accidentally ingested by kids and dogs, and we have seen some adult cases as well. The edibles range from brownies to cookies to gummi bears and other candies, and most are very potent. For example, an edible brownie is typically four servings, not one, but who only eats a quarter of a brownie? The individual eats the entire brownie and then can’t understand why they feel sick.

One unintended consequence of our legalized marijuana was the increase in heroin use and overdoses. Previously, Mexican marijuana was the predominant product available and contained a tetrahydrocannabinol (THC) content of about 10%. Colorado growers refined their methods and are able to produce a product that contains almost 30% THC. Buyers opted not to purchase the Mexican marijuana due to the lower THC content, so the cartels simply adjusted their business model. They quit shipping in marijuana, started shipping in more heroin instead, and are selling the heroin cheaper than what one can pay for legal marijuana. Thus, we have seen an increase in heroin overdoses and deaths. While other states have seen increases in heroin use, ours does appear to be directly related to legalized marijuana.

Otherwise, we haven’t seen many other problems. We have experienced the occasional hash oil lab, drivers who are impaired by marijuana and not alcohol, smoking in public, and grow operations in private homes (which are also legal). While local regulations have helped stem most of the challenges associated with grow operations, they do remain a hazard. And, we have not experienced any cases where our personnel have become impaired due to second-hand smoke or exposure. The amount and time required to cause an exposure is far greater than what we are typically exposed to. Not to say that it can’t occur as the THC content continues to increase, but if an individual tests positive, there’s a good chance that they are using.

Legalized marijuana is not without its challenges, but it certainly hasn’t proven to be the great evil that many had predicted. I, personally, am not in favor of either medical or recreational marijuana, but I also don’t get the final say. That resides with the federal government, and our new administration may decide that those 29 states need to repeal their laws or they could end up in the “joint.”

Norris W. Croom III, EFO, CEMSO, CFO, is Deputy Chief of Operations for the Castle Rock (Colo.) Fire and Rescue Department. He currently serves as International Director for the International Association of Fire Chiefs (IAFC) EMS Section and as the EMS Representative on the Center for Public Safety Excellence (CPSE) Commission on Professional Credentialing.


1. Robinson M, Gould S. (Nov. 9, 2016) Where is marijuana legal? Business Insider. Retrieved Jan. 18, 2017 from

2. Croom, N. (2011). Medical marijuana: A loss of benefits? EFO Paper. Learning Resource Center, National Fire Academy, U.S. Fire Administration. Emmitsburg, MD. 45500:1-62.

No posts to display