13 States have enacted laws allowing qualified patients to possess an amount of marijuana that is reasonably related to their current medical needs and more may follow. Hospital risk managers are posed with the challenges of: the patients assumed right to continue use in the in-patient setting, the decriminalization law in effect or proposed in their State, current Federal law and DEA initiatives, and understanding what a principle based policy affording accommodation of such use could look like. This presentation will synthesize these tensions into a framework within which hospital risk managers can address this particular patient population demand.