Marijuana laws have changed rapidly across the country, but the rules governing use by EMS professionals vary widely. State legalization, medical marijuana protections, federal law, collective bargaining agreements and individual agency policies can all point in different directions, leaving both employers and providers in limbo.
A recent Florida case illustrates that tension. Hillsborough County firefighter/paramedic Angelo Giambrone was fired after testing positive for marijuana, which he said he used off duty under a physician’s recommendation for PTSD, anxiety and sleep issues. A trial judge initially ruled that the county had to accommodate his medical marijuana use, but a state appeals court later sided with the county, emphasizing that its ruling was narrowly tied to Hillsborough County’s collective bargaining agreement.
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Giambrone now plans to appeal to the Florida Supreme Court.
We asked the EMS1 audience to weigh in on medical marijuana use, and in more than 500 comments, readers largely favored permitting off-duty use.
But their responses also highlighted the unresolved issues behind that position, including how agencies determine impairment, what a positive THC test proves after an accident or patient-care incident, and how employers should reconcile state marijuana laws with federal requirements and workplace policies.
‘Treat it like alcohol’
Many commenters argued that an EMS professional who can legally drink alcohol while off duty should also be permitted to use cannabis, as long as neither affects performance at work.
One commenter wrote: “We are allowed alcohol up to 8 hours before shift. Why should this be any different?”
Another commenter said they would prefer working with someone who used cannabis over someone with an alcohol problem.
Across the discussion, the distinction readers repeatedly made was between use and impairment. For many commenters, the relevant question wasn’t whether an EMT or paramedic had consumed cannabis. It was whether that person arrived at work capable of safely treating patients, driving an ambulance and performing other duties safely.
Additional comments:
- “If alcohol is allowed there is no good argument for marijuana not being allowed off duty.”
- “If you can drink after work; you should be able to smoke a joint after work. Period!”
- “My agency treats it like alcohol. Don’t show up under the influence, don’t use it at work, don’t bring it to work. Do that and you’re fine.”
| Poll call: 92% say providers should be allowed to use THC if legal in their state
Cannabis as a wellness aid
Many readers discussed cannabis in connection with medical conditions, mental health or sleep. Some commenters described it as an alternative to, or compared it with, medications used for anxiety, chronic pain, insomnia and occupational stress.
“Yes. I absolutely support this [medical marijuana use],” one respondent said. “Research has proven the positive impact of THC on mental illnesses, stress and PTSD. It curbs alcoholism, too. As long as you don’t go to work high, all’s good. So yeah, what you do in your off-duty time has no effect on me. So, bake away.”
Some commenters lamented not having the option to use medical marijuana as a mental health treatment.
“I’ve been in this business for 14 years,” one reader wrote. “I wish I didn’t have to be on antidepressants or anti-anxiety medicines because of my job. I wish I could come home and naturally partake of cannabis without any repercussions.”
The discussion raises the question: Should agencies focus on the substance an employee uses, or on whether that substance affects the employee’s ability to safely perform the job?
For EMS leaders, the answer may require policies that address impairment consistently across alcohol, cannabis, prescription medications and other substances.
Additional comments:
- “Medical marijuana is prescribed just like narcotic pain management. I guarantee there’s plenty of fire/EMS personnel using pain killers they are prescribed, some maybe while they’re on shift. Marijuana is no different.”
- “Yes, absolutely! Whatever a provider needs to help them cope with the PTSD and stress that unequivocally comes with the job but that no one is ever warned about.”
- “Goodness forbid someone spend a shift seeing and smelling things you couldn’t imagine, and in their off time use marijuana and eat an entire pack of cream cheese danishes before sleeping and going back to a job where they will again see and smell things you couldn’t imagine.”
- “If I can be allowed to take a clonazepam when I’m off duty, people should be allowed to smoke marijuana or use gummies.”
- “It is a much better alternative to alcohol. Some of us don’t want to ingest THC, but even using the full spectrum balms and gels that have THC isn’t allowed due to absorbing through the skin and getting in the blood stream. The stubborn outdated outlook on THC needs to change.”
The testing problem
Many commenters, including those who support allowing off-duty cannabis use, pointed to a key challenge: there is no widely accepted test that can reliably measure current marijuana impairment. THC can remain detectable for days or even weeks after use, making a positive drug screen an imperfect indicator of whether a provider was impaired at the time of an incident.
Consider an ambulance collision involving a provider who used cannabis while off duty several days earlier. If a post-accident drug test comes back positive, what does that result reliably establish about the provider’s condition when the crash occurred?
Unlike an alcohol breath test, a positive drug test for cannabis can reflect prior use rather than establish that an employee is impaired at the time of testing. Commenters discussed urine, blood and saliva testing, often disagreeing over what the results can actually prove.
“The problem is not using off duty; the problem is there is no way to confirm, without lab results, if you have recently smoked,” one reader wrote.
That creates a practical problem for employers.
Additional comments:
- “Nope, I cannot confirm when you are high. Alcohol I can see that you are sober, but a drug test can’t tell me if you were high today or last week. It opens our agencies to litigation.”
- “I don’t want to be accused of being high without a way to quantify it should something bad happen under my watch.”
- “Unlike alcohol, you can’t be tested for how much is in your system. So, on or off duty, there’s no difference at this time.”
- “Workplaces need to come up with better tests, especially considering how easy it is to buy and carry THC products legally almost everywhere now.”
Federal regulation barriers
Many of the responses also questioned how state legalization interacts with federal requirements, drug-free workplace rules, federal funding and professional driving responsibilities.
“The problem lies deeper,” one respondent wrote. “Federal funding regulations, like Medicare and Medicaid, require employers to maintain a drug-free workplace. Imagine getting in an accident in an ambulance and you test positive for THC? That opens the company up to a massive liability. Most state boards will take action against your license, too.”
Others focused on what happens after an adverse event: “There’s just too much liability in the medical field,” one comment read.
Additional comments:
- “Though I think someone should be able to smoke or have a gummy, the problem is, since it’s not federally legal, if a department gets federal funds, those could be lost if someone pops positive.”
- “No, not while it remains federally illegal.”
The Pulse takeaways
Bottom line: An overwhelming majority of the responses favored greater latitude for off-duty cannabis use, but the lack of ability to reliably determine impairment or liability complicates the issue.
That leaves EMS leaders with a policy challenge that is more complicated than deciding whether marijuana use is acceptable.
Agencies considering changes to cannabis policies need to answer several operational questions:
- What constitutes impairment?
- How will supervisors recognize and document it?
- What testing will be used after a safety event?
- What does a positive result establish?
- How do federal, state, licensing, insurance and driving requirements apply?
The comments suggest many EMS professionals are ready to separate legal off-duty cannabis use from on-duty impairment.
The harder task is building a policy that can reliably tell the difference.
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