With more than 300,000 medicinal cannabis users across NSW, the government is forging its own path by giving an exemption to drivers who are prescribed the drug with a fit-for-purpose scheme.
A bill that adopts "a more commonsense approach" will be introduced to parliament that is fairer to a growing community while still keeping the roads safe with several provisions.
"This is a significant reform for NSW, but it's one we are approaching carefully and with road safety at the centre of every decision," Premier Chris Minns said.
To be eligible for scheme, drivers on an unrestricted licence only will be required to enrol as a registered medicinal cannabis user with Transport for NSW and provide proof of a valid prescription.
Under the proposed arrangements, registered medicinal cannabis patients who return a roadside THC (tetrahydrocannabinol) result below 50 ng/mL will be permitted to continue driving.
Registered patients will also avoid the automatic licence suspensions that arise when THC is detected and most matters will no longer need to be dealt with through the courts.
A three-strike system will also be enforced if a reading is higher with warnings given twice, followed by a fine of $704 and a minimum three-month licence suspension.
Legalise Cannabis Party MP Jeremy Buckingham praised the proposed reforms for creating a fairer framework while maintaining road safety as the paramount consideration.
"For the first time medicinal cannabis patients will not automatically lose their licence," the long-time advocate said.
"No patient should be forced to choose between following their doctor's advice and keeping their driver's licence."
But the NRMA has previously criticised such proposals citing road safety fears.
"The concern is, how do you police it? How do you measure impairment? That's the challenge that still hasn't been addressed," spokesman Peter Khoury said.
The government maintains the safeguards built in are critical to ensuring police can continue to respond strongly to any dangerous driving behaviour.
In Victoria, a world-first trial is under way to evaluate the effects of THC-prescribed medicinal cannabis on the driving performance of patients within a controlled-track environment.
Since March 2025, Victorian motorists who have medical cannabis in their system but are not impaired by the drug have not faced automatic driving bans.
The number of cannabis medicines dispensed each month in NSW has almost doubled over a 12-month period.
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