Several of Dr. Clifton Otto’s medical cannabis patients are facing job termination or fear failing pre-employment drug screenings as Hawaii employers hold fast to zero-tolerance policies when testing workers for drugs.

At least one worker facing termination has been placed into a mandatory rehab program and must go through counseling and follow-up drug tests before being allowed to continue working, said Otto, who runs a medical cannabis clinic with about 800 patients.

“But (his job) is still very much in limbo, and if the patient decides to give up his cannabis registration, then he could face adverse health effects for not using this substance for his medical condition,” he said. “It’s a pretty severe situation right now.”

Hawaii employers are grappling with the growing acceptance of cannabis as medicine and for recreation while trying to keep drugs out of the workplace.

John Fielding, director of risk management at Altres, the state’s largest private employer, which manages human resources, benefits and payroll for more than 2,000 employers with drug-free policies, said the problem is worsening as more states legalize cannabis, which is still considered illegal under federal law.

“It’s this big marijuana push. As an employer … do you want them high or debilitated? That’s the option the state is giving us as employers,” Fielding said. “It’s just like a crapshoot. You are just taking your chances on are they functioning. The problem that we have is that even if they’re in certain jobs, we wouldn’t have them working under the influence of oxycodone or any drug or medication that would make them drowsy, inattentive or not 100% cognizant because it would be detrimental to an employer. Most employers are horrified.”

Fielding said 5% to 10% more workers are trying to use their medical marijuana certification cards every year to justify failed drug tests. Lawmakers this year scrapped a bill that would’ve provided employment protections for cannabis patients by banning employers from taking action against a cardholder who tests positive for pot.

“This is another vice, just like alcohol,” he said.

Altres handles employment services for nearly 25,000 employees and even has its own drug testing facility. Fielding contends that debilitating conditions that qualify patients to use cannabis have been expanded “to almost anything.” Patients must have a qualifying condition, including cancer, epilepsy, post-traumatic stress disorder and severe nausea or pain, to be certified.

“If they have a medical condition, we could find ways to accommodate them, but being high shouldn’t be an accommodation,” Fielding said. “People say it’s just marijuana, but all those accidents I’ve seen over the years, it’s stupid accidents. This guy had an itchy eye and was screwing something in, and he poked his eye out. He wasn’t paying attention. He was high on pakalolo.”

As Hawaii’s medical marijuana patients grow — 26,125 as of May 31 from 21,596 patients a year ago — more workers are testing positive for marijuana. In first-quarter workplace drug tests, use went up to 2.98% from 2.89% year over year, according to Diagnostic Laboratory Services Inc., which typically samples 7,000 to 10,000 drug tests each quarter.

State agencies that receive federal funds are having to adhere to federal drug-free workplace policies, said Otto, who argues that the regulation that lists cannabis as a Schedule I controlled substance similar to heroin does not apply to the medical use of cannabis in Hawaii.

“There’s always been a strong push by the federal government to maintain a drug-free workplace, but it’s becoming more of an issue as recreational use is spreading across the country,” Otto said, adding that urine testing is not appropriate to determine workplace drug use since cannabis can stay in your system for weeks. Instead, blood tests would more accurately detect marijuana use in the workplace, he said. “I agree employees should not be under the influence of cannabis while in the workplace, but that does not mean a patient can’t use cannabis at the end of the day to relieve their seizures, chronic pain or PTSD, and they can still be completely functional the next day without any residual intoxication.”

In the past, workers who tested positive for pot in drug screenings could get a waiver if they were registered patients, avoiding any punishment or adverse actions, he added. However, in recent years some state agencies and unions amended contract agreements eliminating waivers due to the possibility federal agencies would withhold funds.

“What justifies us as a society to say let’s legalize something?” Fielding said. “There has to be some stop to this madness. It is madness.”