In 2021, California made national headlines by passing Senate Bill 311, Ryan’s Law, a landmark piece of legislation allowing terminally ill patients in healthcare facilities to access medical cannabis without fear of reprisal. 

Named after U.S. Coast Guard veteran Ryan Bartell, who died of pancreatic cancer in 2018, the law was born from a deeply personal family battle: one where cannabis provided relief when traditional opioids failed. Three years later, advocates, patients, and policymakers alike reflect on the progress and the persistent roadblocks of implementing this compassionate care law. 

A Victory Rooted in Compassion and Advocacy 

Ryan Bartell’s final weeks became a catalyst for legislative change. After being denied access to medical cannabis in a hospital setting, his father, Jim Bartell, moved Ryan to a more accommodating facility where he spent his last days in awake and surrounded by loved ones. The experience launched a movement. 

“Ryan’s Law was always about dignity and quality of life,” said Jim Bartell, founder of the Ryan’s Law Foundation. “It ensures that no family has to fight for compassionate access while also facing the trauma of losing a loved one.” 

Since 2021, California’s SB 311 has served as a model for other states, inspiring similar legislation in Maryland (2024) and North Dakota (2023).

Impact in California 

Effective January 1, 2022, hospice and palliative care centers, and skilled nursing facilities across the Golden State were required to adopt policies enabling patient use of medical cannabis in compliance with federal regulations. Anecdotal evidence shows the law has helped many terminally ill patients find relief in their final days. 

“Patients who were once given morphine drips with intense side effects, or even worse, Fentanyl, now have an alternative,” said Heather Manus, registered nurse specializing in all aspects of medical cannabis care and founding member of the Cannabis Nurses Network. “Cannabis makes their end-of-life experience more humane.” 

After Ryan’s Law was adopted in California, the nationwide medical cannabis patient advocacy organization, What’s Next for Ryan’s Law? , developed and published guidelines for healthcare administrators and advocates to help streamline compliance and education. 

Shelby Huffaker, Harm Reduction Researcher and Chair of Americans for Safe Access San Diego advised that “A law is only as effective as its implementation. That’s why ASA created a framework hospitals can actually use, to eliminate confusion, reduce liability concerns, and make Ryan’s Law a standard of care, not an exception.” 

Between May 2022 and June 2024, UCLA Santa Monica Medical Center’s solid tumor oncology unit saw eight inpatients use medical cannabis under Ryan’s Law. No safety incidents were reported during this time. A follow-up survey found that five of the eight nurses involved felt comfortable integrating Ryan’s Law into their practice, while seven believed medical cannabis was effective in managing symptoms such as anxiety, pain, nausea, sleep disturbances, and appetite loss. Patients self-administered the medicine during their hospital stay. 

While these outcomes and patient testimonials are encouraging, they remain limited by the small sample size, the single-institution scope, and the fact that only patients with terminal cancer were studied, excluding those with other terminal conditions. As such, broader research is needed to assess Ryan’s Law’s full potential and impact in diverse healthcare settings. 

Persistent Challenges and Systemic Barriers 

However, the law’s implementation hasn’t been seamless. One of the most significant shortcomings stems from ambiguity in federal law. Because cannabis remains federally illegal, many institutions fear liability or insurance complications. As a result, some care facilities choose not to participate, citing potential legal or financial risk. On social media, patients and caregivers have voiced their frustrations. “California is failing Ryan’s Law right now,” reads a comment from @enthea.care. “Health care providers are prohibited from administering cannabis to patients who can’t do it themselves, including dementia patients and those near death.”

Another caregiver wrote: “They treat cannabis like it’s plutonium… because they’re IGNORANT of basic biology.” 

While the law does allow terminally ill patients to use non-smokable cannabis while in hospital grounds, it does not mandate staff assistance. This leaves many immobile patients, including those with ALS, late-stage cancer, or severe neurodegenerative diseases, without access unless a family member or caregiver intervenes. 

Advocates argue that clearer guidance and federal reform are needed to close the gap between intention and practice. “Now’s the time to empower providers with clear legal guidance and federal reform, so the law does not compromise patient dignity, comfort, and relief at a time when they need it most” added Sandra Guynes, RN, Cannabis Patient Advocate in San Diego.

What’s Next for Ryan’s Law? 

Ryan’s Law Foundation and allied organizations like Americans for Safe Access and NORML chapters are working with lawmakers in other states to introduce legislation modeled after California’s SB 311. 

In April 2025, stakeholders gathered in San Diego for Ryan’s Law Day, a moment to reflect, remember, and recommit. “It’s not just about cannabis,” said Linda Davies, Chair of the San Diego chapter of NORML. “It’s about compassion, autonomy, and quality of life, especially when life is slipping away.” 

The push for nationwide adoption continues.