What Happens if You Fail a Drug Test but Have a Medical Card?

Federal vs State Law

Federal law doesn’t recognize medical marijuana use, and that affects jobs tied to federal regulations. If your position involves federal safety rules or if your employer receives federal funding, they may have strict drug-free policies that override your state’s protections.

Even if your state has legalized medical marijuana, employers may still enforce drug testing policies based on federal law. For example, jobs like truck driving, aviation, or pipeline work often follow Department of Transportation (DOT) guidelines that do not allow any THC use, medical card or not.

A Note on DOT-Regulated Jobs and CBD Use

If you work in a safety-sensitive position regulated by DOT, you are subject to strict drug testing under federal law.

According to the DOT’s 2020 notice, drug tests screen for THC, not CBD. However, many CBD products are mislabeled and may contain more THC than advertised. Because the FDA doesn’t verify THC content in CBD products, using them could lead to a positive drug test, even if the label says it’s THC-free.

DOT policy is clear:

• • THC remains a Schedule I drug under federal law.

• • CBD use is not accepted as a valid medical explanation for a positive drug test.

• • Safety-sensitive employees can be removed from duty or terminated for testing positive, even if they claim it was from CBD.

If your role is federally regulated, it’s safest to avoid all cannabis products, including over-the-counter CBD, unless specifically approved by your employer or a legal advisor.

Drug-Free Workplace Act

Employers who accept federal grants or contracts are required to follow the Drug-Free Workplace Act. But here’s the catch: this law only requires employers to ban illegal drug use at work. It doesn’t force them to fire someone for legal cannabis use off the clock. Still, many employers believe they must terminate anyone who tests positive, which creates confusion and uneven enforcement.

Private vs Government Jobs

Private employers have more freedom to set their own drug policies. Some may be willing to make exceptions for medical marijuana use outside of work hours. Others may stick to zero-tolerance rules regardless of your medical status.

Government jobs, however, are usually stricter. Federal employees and contractors are often subject to mandatory drug testing, and testing positive (even with a card) can lead to discipline or job loss.

States That Protect Medical Marijuana Users

Some states do offer legal protections for medical marijuana cardholders. For example:

• • Pennsylvania protects workers from being fired solely for holding a medical marijuana card.

• • California and New York have updated laws that prevent discrimination against off-duty cannabis use.

• • Minnesota makes it illegal to fire someone for testing positive if they’re enrolled in the state’s medical cannabis program (unless they are impaired on the job).

States Where You Can Still Be Fired

Other states don’t provide protections for medical marijuana patients. In Florida and Texas, for instance, your employer can still terminate you for testing positive, even if you’re using marijuana legally for health reasons. These states leave employment decisions fully up to the employer.

What Happens if a Drug Test Comes Back Positive?

When your drug test shows THC in your system, your employer may take action depending on their policies and the laws in your state.

General Company Policies

Every company handles drug testing differently. Some may offer a second test or allow you to explain your use if you have a medical card. Others may have a zero-tolerance policy and treat any positive test as grounds for immediate firing, even if you’re not impaired at work.

Always review your company’s drug policy before using medical cannabis, and consider speaking with HR or a legal advisor if you’re unsure about the rules.

Safety-Sensitive Jobs

Certain jobs come with higher safety responsibilities. If you operate heavy machinery, drive vehicles, or care for others, your employer may hold you to stricter standards. These roles are often governed by federal rules that don’t allow THC use at all. A positive test in these positions can result in suspension or termination, no matter your medical status.

Insurance and Workers’ Comp

A failed drug test may also affect your eligibility for workers’ compensation or insurance coverage. If you’re injured at work and test positive afterward, your claim could be denied. Some states protect workers in this situation if they’re not impaired at the time, but others do not.

Mandatory Reporting

In certain industries, employers are required to report failed drug tests to licensing boards or regulatory agencies. This is common in healthcare, aviation, and transportation. A positive result could impact your ability to work or keep your professional license.

So, What Happens if You Fail a Drug Test but Have a Medical Card?

If your drug test comes back positive and you have a valid medical marijuana card, what happens next depends on several key factors: your job type, your state’s laws, and your employer’s policy.

First, expect that your result will be reviewed by a Medical Review Officer (MRO). The MRO will typically confirm the presence of THC and ask whether you have a prescription or a valid medical card. 

But here’s the catch: unlike other medications, medical marijuana isn’t recognized at the federal level. That means the MRO won’t accept a cannabis prescription or card as a legitimate reason for the result, especially if your employer follows federal regulations.

From there, your employer decides how to respond. Some may take no action if your job isn’t safety-sensitive and you aren’t impaired at work. Others may immediately move forward with discipline or termination, particularly if they have a zero-tolerance policy or operate under federal guidelines.

You might also be asked to sign paperwork, submit additional documentation, or speak with HR. If your state protects medical cannabis users, you may have a legal argument for keeping your job. If not, your options could be limited.

Bottom line: a failed drug test with a medical card doesn’t automatically mean you’re safe. It may protect you in some states or companies, but in others, it could still cost you your job. 

Knowing your rights, reading your company policy carefully, and getting legal advice if needed can help you take the next steps with clarity.

Protect Yourself With the Right Medical Marijuana Card Provider

If you’re facing drug testing concerns, the last thing you need is uncertainty around your certification. Elevate Holistics offers fast, legitimate medical marijuana card evaluations that hold up under scrutiny, and we keep your information secure and confidential at every step.

Don’t leave your rights or records up to chance.

Get your medical marijuana card from a trusted source. Book online with Elevate Holistics today.