Oceania: Travelling with medical cannabis

Please note that this information does not constitute legal advice and should not be solely relied upon. It is crucial to thoroughly review the current travel advice for each country before making any travel arrangements or embarking on a journey with medical cannabis.  

Dreaming of idyllic white sand beaches and secluded spots in Polynesia, or experiencing extreme outback adventures in Australasia is a desire shared by many, and places like Hawaii, New Zealand, and Australia feature on many people’s bucket lists. Yet, for medical cannabis patients, planning their dream holiday may be filled with dread - due to the confusing and often conflicting cannabis regulations in different countries.

We’re here to settle those worries. In our travel series so far we’ve established the basics of travelling with medical cannabis, explaining the rules and regulations on how to apply for authorisation, prepare your documents for departure, and package your prescription for the flight itself. We’ve also collated professional guidance from the Home Office, NHS, and International Narcotic’s Control Board, for travelling abroad with prescribed controlled drugs - such as medical cannabis. 

Now, journey with us as we explore further regulations, relating specifically to medical cannabis in Australia, New Zealand, Hawaii, Guam, and The Cook Islands. 

Medical Cannabis and Hawaii

Unbeknownst to many, Hawaii is classed as part of Oceania continentally, as opposed to North America, because it wasn’t an official US state when the continent classifications took place in 1947. With a rich mix of Polynesian, Indigenous and Western culture showcased alongside beach, mountainous, city, and rainforest landscapes - Hawaii certainly deserves its spot near the top of your bucket list. 

Just like in 38 other States in the US, medical cannabis in Hawaii is legal, and has been for over 20 years. However, although cannabis has been legalised for medicinal and therapeutic purposes in over three quarters of American States, cannabis remains illegal at a federal level - and carrying it in American airspace is classed as a federal offence. Therefore, travelling through federal airspaces or jurisdictions with cannabis, regardless of prescription status, is not advised.

Interestingly, though, the American Transportation Security Administration (TSA) website states that cannabis is permitted in hand luggage and hold luggage under ‘special instruction’. But, it is unclear precisely what these instructions are. 

It would be worth getting in touch with the TSA and airline directly for clarification on this if you are unable to travel for such a length of time without your medication. But, to stay safe and avoid the risk of deportation, confiscation, and or prosecution, generally we’d advise against taking your medicinal cannabis with you when travelling to the US.

Instead, the Sanskara platform recommends taking an up-to-date copy of your prescription with you when travelling to America, and purchase your medication in a dispensary once you’ve arrived. In this case, it’s important to remember that Hawaii is a group of islands, so do some research to ensure there is a medical marijuana dispensary that stocks the products you need, on the island that you plan on visiting. 

Luckily, the Office of Medical Cannabis Control and Regulation in the State of Hawaii has provided guidance for those wishing to acquire medical cannabis from a dispensary on their website. Here it says to gain entry to dispensaries in Hawaii, you must have a valid State ID or passport and a valid 329 card – which is their medical marijuana patient card ID. 

In Hawaii, 329 cards are issued by the Department of Health (DoH). To submit an application for a 329 card, patients must create an account, attach a letter of recommendation for cannabis based treatments from a licensed physician or advanced practice registered nurse and then submit it for review by the DoH. If successful, the patient is added to the Patient Registry Program which is also shared with local law enforcement to avoid any misunderstandings, and the patient’s 329 registration card is issued. 

However, at the moment it appears that there is not an international medical cannabis registration process – and so this may only apply to US residents. For absolute clarification, we’d advise contacting not only the American Embassy and airline, but also the Office of Medical Cannabis Control and Regulation at the Hawaiian Department of Health, which can be reached at medicalcannabis@doh.hawaii.gov . 

Medical Cannabis and Australia

In Australia, medical cannabis was legalised in 2016 using a similar framework to the one that exists in the UK, with certain cannabis-based products receiving medical registration, or licensing, and others not. Both registered, and unregistered products can be prescribed depending on the circumstance and patient's eligibility status, and they are available in various forms, including flower, oil, and tablet formulations. 

Although laws can slightly differ from state to state, generally in Australia any doctor can prescribe medical cannabis or cannabis-based products, so long as they have permission from the Therapeutic Goods Administration (TGA) and the relevant health authority in their state or territory. 

Doctors who prescribe medicinal cannabis to numerous patients often have specialist status and have been approved by the TGA as an Authorised Prescriber (AP), meaning they do not have to request permission from the TGA for each individual patient. If the doctor is not an AP, they do have to apply to the TGA to source medicinal cannabis for each specific patient using the Single Access Scheme (SAS), which can cause delays in access. 

However, these rules relate to residents of Australia, not to those visiting for a vacation. To bring any kind of cannabinoid based therapy across the Australian border, passengers must have Traveller’s Exemption documentation that has been recognised by Australian officials, and have the original, and up-to-date copy of their prescription on their person when crossing the border. 

To ensure the correct documentation is provided, and it is approved by the right officials, speak to the Australian Embassy, and Customs well in advance of travelling to ensure you won’t have any extra stress at the airport. It’s also recommended to keep your medication in its original packaging, with prescription labels intact from the dispensing pharmacy, in your hand luggage.

It is also important to always declare your medication on arrivals at Customs, and travel with a personalised letter of recommendation from your clinician. The letter should explain your treatment plan, dosing routine and quantities, medication concentrations and international names, as well as the clinicians contact information and your personal information. 

Medical Cannabis and New Zealand

In 2017 the government in New Zealand first announced they were committed to making medical cannabis available to those with chronic pain and terminal illnesses, and the Misuse of Drugs (Medicinal Cannabis) Amendment Act came into force the following year. Since then, various other regulations have taken place, and the Medicinal Cannabis Scheme was launched to ensure cannabis products for medicinal use meet a minimum quality standard. 

In New Zealand, eligible patients can be prescribed medicinal cannabis in a range of forms and concentrations to treat specific conditions by a licensed doctor. The doctor of pharmacy will then dispense these products to the prescription holder. However, this only applies to residents of New Zealand.

For tourists, the New Zealand Customs website explains that when travelling to the country with controlled drugs in your luggage, you must declare them upon your arrival. There is a strict one-month supply limit, and controlled drugs must be in their original labelled containers accompanied by the original prescription, and/or a letter from your doctor. This letter should state the name and strength of the drugs, identify what condition you are using the controlled medicine for, and demonstrate that it has been lawfully obtained and prescribed in the country of origin. 

The Ministry for Primary Industries in New Zealand echo this advice and state that medications, drugs, and supplements, including CBD oil, are allowed into New Zealand so long as they are commercially manufactured and packaged. 

However, the Ministry of Health in New Zealand have released conflicting guidance, stating certain controlled drugs – such as medicinal cannabis products – are not permitted into the country. The Ministry of Health advice relates specifically to medicinal cannabis products from the US, because medical cannabis is illegal in the US at a federal level, but we would still advise caution to those travelling from the UK. Their website reads:

“Medicinal cannabis products supplied in the United States of America cannot be carried with you when entering or leaving New Zealand. A number of US states permit the medical use of medicinal cannabis products. However, under Federal law medicinal cannabis products for medical use are not considered lawfully supplied, unless the product has US Food and Drug Administration approval. To date, no drug product containing or derived from botanical cannabis (the cannabis plant) has been approved by the Food and Drug Administration, except Epidiolex”. 

This could be interpreted in a number of ways, and because of the conflicting information available, it is always best to speak to the Embassy for more information. Here you will find out how to gain the relevant approvals and authorisations before embarking upon a great adventure in New Zealand.

Medical Cannabis and The Cook Islands

The Cook Islands is one of the Pacific’s majestic hidden gems, nestled between New Zealand and Hawaii, and made up of 15 separate, yet serene little islands. Here you can find bright blue seas, luxurious lagoons and white sand beaches, as well as mountainous landscapes, tropical jungles and cityscapes, making it a dream destination for many. 

In ‘free association’ with New Zealand, The Cook Islands is self-governing. And so, although legal in New Zealand, medical cannabis is not yet legal in The Cook Islands. However, legalisation could fast be on the horizon. 

Last year, The Cook Islands held a non-binding referendum, asking their residents whether the general population felt the government should revise their current cannabis laws to allow for medicinal use and scientific research. In August 2022 it was announced 62% voted for medical cannabis legalisation, and so The Cannabis Referendum Committee was created. 

As a part of this committee, the Health Secretary, Bob Williams, as well as a senior and expert Pharmacist, Consultant, and Solicitor have toured New Zealand and Australia to study their current medical cannabis markets. In the next few weeks, it is expected their report will be released, so that The Cook Islands can create and establish a similar healthcare and regulatory system for medical cannabis and cannabis-based products. 

Because the complete legalisation has not been passed, currently medical cannabis is still a controlled and prohibited drug in The Cook Islands. The Ministry of Health called Te Marae Ora (TMO) advises passengers to declare their medications on their arrival cards at customs upon entry to the Islands if they are carrying controlled drugs. However, on the same webpage they also state that it is illegal to bring any controlled or narcotic drugs into the Cook Islands. Due to this ambiguity, we’d recommend speaking to TMO directly on their helpdesk email: tmo.helpdesk@cookislands.gov.ck 

Earlier this year, a couple from New Zealand hit the headlines, finding themselves in hot water after confusion over the rules regarding medical cannabis at Rarotonga Customs. The couple flew into Rarotonga with medical cannabis and declared it upon entry with a copy of their prescription, stating a family member had spoken to Rarotonga’s customs the day before, and was told this would be permitted. However, upon entry, the couple were stopped by border security staff and told they had committed a criminal offence.

In court, the pair were not pursued criminally due to this misunderstanding and Alan Richardson, director of the Ministry of Finance and Economic Management, said: “I would advise that cannabis (medicinal or otherwise) is a class B or C drug (depending on its state) under the Narcotics and Misuse of Drugs Act 2004, consequently it is a prohibited import. Notwithstanding this classification, under certain circumstances, medicinal cannabis is able to be imported through TMO (Te Marae Ora)”.

And so, although this couple were not criminally charged, it certainly affected their holiday and this course of action is not recommended. Instead, contact the Embassy or Consulate, the Ministry of Health (TMO), and Cook Island Customs directly to seek out import permission, well in advance of travelling. 

It is important to remember that even if you do gain approval or permission from the Embassy, Consulate, and Customs in The Cook Islands – you will have to do the same for any layovers or stopovers during your journey. Flying to The Cook Islands from the UK takes over 25 hours, and so there are no direct flights. Typically, layovers are in Auckland (New Zealand), Doha (Qatar), San Francisco (US), and Los Angeles (US). 

Medical Cannabis and Guam 

Guam is a breathtakingly beautiful island that geographically sits between Japan and Papua New Guinea. However, Guam is actually a U.S. territory, which means that people born in Guam are classed as American citizens. Much like the majority of the US, Guam has legalised medicinal cannabis and, like certain other US States, it has also legalised the recreational consumption of cannabis. 

In Guam, the Joaquin (KC) Concepción II Compassionate Cannabis Use Act of 2013 allows eligible patients to use medical cannabis for its therapeutic benefits and symptom relief. This legislation allows those with debilitating medical conditions, such as cancer, multiple sclerosis, PTSD and arthritis, to cultivate their own medical cannabis plants at home so long as a doctor or specialist has recommended its usage. 

Now that cannabis has been legalised for recreational use in Guam too, anyone over the age of 21 is permitted to possess up to 1 ounce of cannabis, or 3 flowering and 3 non-flowering plants, at any time for personal use. This limit is increased for those with medical cannabis patient status, who can possess up to 2.5 ounces of cannabis as of 2018. 

Patients in Guam can apply for a DPHSS Registry Card to be able to prove their validity for such quantities in case they are stopped by law enforcement, although this is not legally required. It is important to note that although a US territory, the patient status exceptions only apply to residents of Guam, and Guamanian officials do not recognise medical marijuana cards (even from other US states and territories) as valid or allow reciprocity. 

On top of this, although cannabis can be legally possessed and cultivated for both recreational and medicinal purposes by adults in Guam, currently there are no licensed and established cannabis dispensaries on the island. This makes it very difficult for tourists to source cannabis from a safe, reputable supplier. 

In general, medical facilities in Guam are relatively poor – even in the main cities, and therefore prescription drugs are difficult and expensive to obtain. The Visa HQ website recommends that passengers take their own medication to Guam as opposed to trying to purchase it on the island, and to ensure they have medical and travel insurance before starting their trip. 

However, it is unclear whether this is also true in the case of medical cannabis or cannabis-based products. To stay on the safe side, ask for extra guidance, information, and advice that directly relates to travelling with medical cannabis from the Guamanian Customs, and the Embassy before booking your trip. 

Closing Considerations

As a medical cannabis patient, the allure of exploring these distant corners of the world should never be out of reach just because of the medication you take. Exploring Oceania, its diverse cultures, picturesque locations and natural wonders, is a dream that can become a reality with the right research, preparation, and approvals. 

In this series, we’ve travelled across the continents, unravelling the intricate and individual regulations that govern the transportation of medical cannabis, and dictate travel plans for medical cannabis patients needing to travel with their medicine. 

The main lesson we’ve learnt is that preparation is key. 

Always speak to the Embassy, Customs, airline provider and your own doctor before making any travel arrangements to your destination – not forgetting any countries you may have to stop over or layover in due to the long flight times. 

If these approvals are granted, ensure that you are also following all the recommended guidance provided by the NHS and the UK Home Office surrounding transportation logistics, such as carrying medicine in your hand luggage in its original prescription packaging. 

Our aim is to provide you with relevant information to help you to make better-informed decisions when travelling with your prescribed medical cannabis, but we cannot provide any guarantees, conditions, or warranties as to the accuracy of the information in this article. It is a general guide only and not a substitute for obtaining your own legal advice.

Releaf understands that medical cannabis can be life-changing for many people. That's why we offer tailored monthly packages based on your cannabis prescription, specialist consultations for medical cannabis, and a unique medical cannabis card for protection.