For this Chief to Chief, I am shifting gears significantly to a subject that has recently surfaced within some of our partner agencies. To be honest, I didn’t know anything about it before I retired. By fortune or luck, our department avoided this issue during my tenure. What I am talking about is Compassionate Use Programs (CUP). In Texas specifically, it is called the Texas Compassionate Use Program or TCUP. The TCUP program is run by the Texas Department of Public Safety and information on the program can be found using this link https://www.dps.texas.gov/section/compassionate-use-program. If you are one of our partners outside of Texas, I can assure you that your state is either looking at or already has some sort of similar law or program enacted. According to the National Conference of State Legislatures (NCSL), there are at least 40 states plus D.C. that now have comprehensive medical cannabis programs. In the last 12-18 months, four of our partner departments have had to address this issue. If it has not affected your department yet, it will at some point.
History
Compassionate Use Programs have gone through three distinct phases over the last 30 years, and public safety employment is just now entering the picture in phase three. In 1996, California passed the country’s original medical marijuana law, and Colorado followed suit in 2000. Over the following decade, about two dozen more states adopted similar comprehensive programs. By 2012, a handful of states had legalized recreational marijuana use entirely.
The second wave took a distinctly more cautious and conservative approach that began to spread through conservative states between 2013 and 2017. The original Texas law, Senate Bill 339, was signed into law by Governor Greg Abbott on June 1, 2015. At the time, Texas was part of this wave of states passing narrow “low-THC/high-CBD” laws, mostly limited to CBD oil for epilepsy, rather than full medical marijuana programs. In 2025, with the passage of HB46 and the Governor’s signature, the Texas program has effectively graduated out of its original 2015 category and for all practical purposes is a comprehensive medical cannabis program. Like many other state programs, qualifying conditions include chronic pain (>90 days), traumatic brain injury, PTSD, cancer, epilepsy/seizure disorders, terminal illness, and others. All of these are common diagnoses among police, fire, and EMS personnel. Because of individual state laws and programs, many public safety employees across the United States are now potentially eligible for state legal, physician-prescribed cannabis products.
The third and newest development in these programs is the employee protection layer. This is an entirely separate question from whether a patient can legally, under state laws, obtain cannabis at all. Most of the original laws give no job protection whatsoever and herein lies the problem. These state laws are forcing fire, EMS, and law enforcement agencies to address the employment protection issue. Regardless of state laws, federally, marijuana remains a Schedule I drug. For departments that use NFPA 1580 as their medical standard, Chapter 13.13 specifically prohibits the use of marijuana for recreational or medical reasons. Employers may test for THC and take adverse action against a registered patient. Agencies are not required to accommodate use. However, an underlying condition, like PTSD or chronic pain, may be ADA-protected, and adverse actions against the employee require careful documentation. Compassionate Use Programs create real gaps for public safety employees and their departments.
A Few Things to Consider
Specifically for law enforcement agencies and fire marshal offices, cannabis use could result in a federal firearms disqualification. Marijuana remains Schedule I. Under the Gun Control Act (18 U.S.C. § 922(g)(3)), any “unlawful user” of a controlled substance is prohibited from possessing firearms or ammunition, and a state prescription is no defense. Active use under Compassionate Use laws is incompatible with armed duty and truthful completion of ATF Form 4473. Use of cannabis products can have certification, clearance, and evaluation impacts. Participation under Compassionate Use Programs raises issues for state peace officers and first-responder licensing standards, security clearances (federal drug-use criteria), pre-employment psychological screening, and fitness-for-duty determinations.
Impairment and 24-hour recall. Oral THC has delayed onset (30-120 min) and prolonged duration (6-8+ hours at higher doses). Residual deficits in complex divided-attention tasks have been demonstrated up to 24 hours. Personnel subject to call-back cannot reliably guarantee an unimpaired state. Drug testing cannot establish impairment. Urinary THC metabolites persist from days to weeks after use. A positive screen cannot distinguish lawful off-duty use from on-duty impairment, and no validated per se impairment threshold exists, complicating discipline, post-accident review, and litigation.
Many fire and law enforcement departments receive FEMA and other federal grants tied to the Drug-Free Workplace Act, which pushes departments toward zero-tolerance policies regardless of state law. Firefighters who hold a CDL to drive apparatus may face separate DOT drug-testing rules that don’t recognize any state medical exception at all.
“Fit for duty” is a separate question from “legal.” That distinction is the conflict between Compassionate Use Programs and public safety employment. Some departments have negotiated agreements stating that a positive THC test won’t count as a disciplinary positive if the employee holds a valid medical cannabis card. But holding that card doesn’t settle the fitness-for-duty question on its own, since first responders operate heavy apparatus, enter hazardous environments, and provide emergency medical care. In practice, an employee can test positive while properly enrolled in a Compassionate Use Program. That same employee can be evaluated and cleared by a medical professional with no signs of impairment or performance decline and still be deemed unfit for duty by the department. When that happens, the employee may be placed on leave and asked to produce a negative test before returning to work. If paid and unpaid leave run out without that happening, the department may treat the failure to return as a resignation. Unions in these situations have argued that such outcomes violate the spirit of Compassionate Use Program protection and have threatened litigation.
The Americans with Disabilities Act complicates it further. Conditions like PTSD, one of Compassionate Use Program’s qualifying conditions, are often disabilities under the ADA, which triggers an interactive accommodation process. But reasonable accommodation doesn’t have to mean tolerating on-duty impairment risk, so departments can still deny marijuana use as the specific accommodation while accommodating the underlying condition another way.
What to Do
Talk to us up front about what a real fitness-for-duty evaluation for an individual in a Compassionate Use Program should look like. If you are using NFPA 1580 as your medical standard and you are receiving medical recommendation forms, be prepared to deal with an employee we cannot recommend for duty because of cannabis use. We provide medical recommendations, department policy dictates what happens to the employee. Not working this out up front can strain department/medical vendor relationships. It can also result in grievances or lawsuits filed by the individual against the department.
Separate the ADA interactive accommodation conversation about the underlying condition, and the drug testing/discipline conversation about on-duty impairment. Running them together is how good departments end up looking like they punished someone for having PTSD instead of for a safety concern. Train your supervisors on what reasonable suspicion looks like, and document everything. Protection should stop at impairment, and discipline should start there too, nowhere else.
Get your employing organization, your state fire chiefs association, and your labor unions involved. If Illinois and Maryland can pass first-responder-specific legislation, your state legislators can too. State legislatures are far more likely to listen to a coalition of cities, counties, emergency services districts, fire chiefs, and labor unions who have banded together than to a single department scrambling after a bad outcome.
I opened this column admitting I was lucky. My department never had to work through this while I was there. Your department may not have that luxury much longer. Compassionate Use Programs aren’t going away, and the legal landscape around them is still being built in real time, state by state, sometimes department by department. The chiefs who get ahead of it now, with real policy, real training, and real coordination with their legal, legislative, fire department members, and union leaders are the ones who’ll handle this well when it lands on their desk. The ones who wait are the ones who’ll be reading about their own department in a headline. Go to https://frontlinemobilehealth.com/ and download our one-page information sheet and get ahead of it.
John Sherwood, M.S., CFE, FSCEO Chief of Staff, Front Line Mobile Health
