ACNA asked its members to provide their impressions of what is happening in their state with regard to medical cannabis. Nine members, including a Canadian, replied. Here are their reports.
The group known as Arkansas for Compassionate Care (ACC) has led the call for legalization of medical cannabis with the slogan, Natural Medicine for the Natural State, and by sponsoring the bill known as the 2016 Arkansas Medical Cannabis Act. (http://arcompassion.com/about/read-the-amca/)
The Act outlines a plan to create and regulate the cannabis program through the Arkansas Department of Health (ADH), and would include 38 non-profit Cannabis Care Centers. Patients would be required to obtain a written recommendation from an Arkansas medical physician (or doctor of osteopathy) and obtain a license from the ADH to obtain cannabis from a center. For low-income patients, prices would be set on a sliding-scale and patients could register to grow up to five plants at home if they reside further than 20 miles from a center.
Back in 2014, the Arkansas Medical Cannabis Act was certified by the Arkansas Attorney General, and since that time, the ACC has been very active in promoting the medical cannabis act through numerous signature signing events, musical concerts, motorcycle shows, and stakeholder meetings. In a recent poll of four-hundred Arkansas voters, 84% either support or strongly support physician-prescribed cannabis (Talk Business & Politics, 2015). So it seems very likely the required 65,000 signatures will be obtained to include the Act on the 2016 ballot.♦
California – by Adam Borowitz, RN
California’s medical cannabis industry will soon undergo a vast transformation due to a set of new regulatory bills passed this during a late-night legislative session on Friday, September 11, 2015 and go into effect on January 1, 2016. It is the first set of bills to regulate California’s medical marijuana industry, which is the oldest and largest in the country, at the state level. As Oakland Assemblyman, Rob Bonata, stated via press release, “This is the first time in the history of California that a medical marijuana regulatory framework has been agreed to by the California State Assembly, the California State Senate, and the Governor’s Office.”
The new legislation puts forth strict regulatory guidelines for every aspect of California’s medical-marijuana industry and creates a new Bureau of Medical Marijuana Regulation to enforce them. It also protects the rights of the patients with doctor’s recommendations to cultivate, process and utilize limited amounts of marijuana for personal use.
For medical marijuana businesses, a license will be required for every phase of cannabis production, including cultivation, manufacturing, transportation, testing and dispensing; and licensing must be obtained at both the state and local levels, giving individual cities more power over medical marijuana operations (i.e., to allow or ban them).
On the manufacturing side of things, cannabis products would be required to be labeled with the source of the cannabis, date of cultivation, a list and amount of the pharmacologically active substances (e.g., THC) per serving, warnings regarding operating motor vehicles under the influence, clear statements in bold type that the product contains medical cannabis, and much more.♦
Canada by Adrienne Harris-Hale, RN
On April 1, 2014, the Health Canada Marihuana for Medical Purposes (MMPR) regulations took effect, federally regulating the use of cannabis for medicinal purposes. The MMPR only allows growers licensed by Health Canada to sell cannabis legally to individuals who have a Health Care Practitioner document (i.e., prescription, which is valid for one year). Once the prescription is obtained, the patient registers with a Licensed Producer and orders their strains, and then the cannabis is delivered directly to their residence or doctor’s office through a secure carrier (with a signature being required for inventory tracking purposes). The maximum amount an individual can obtain at one time is a thirty-day supply of their prescribed amount or up to 150 grams, whichever is less.
Licensed Producers (LP) must adhere to Health Canada’s Physical Security Directive, follow Good Manufacturing Practices, and are subject to both scheduled and surprise inspections. Among other things, LP’s must grow cannabis indoors, test for contaminants, and label their containers with the amount of THC and CBD found in the product. Additionally, they may only sell raw cannabis or cannabis oil. So if a patient wants to use a different formulation such as an edible, they have to make their own using cannabis obtained either from a licensed producer, the black market, or a dispensary.
Dispensaries are mostly associated with Vancouver, British Columbia, but they are located all across the country. They are not regulated by the government. Nor are they connected to the Licensed Producers. Instead, dispensaries must purchase cannabis from an unlicensed producer, i.e., the black market, and if they want to sell edible and topical products, they must make these products themselves. There are no safety controls or regulations, and they are pretty much left alone by law enforcement.
On October 19, 2015, Canadians will vote for a new Prime Minister. The outcome is important for patients and the entire medical cannabis industry. The party candidates fall under the categories of: legalization of cannabis, ‘decriminalization’ of cannabis, or remaining status quo. Right now, there is no clear front-runner, so Canadians will have to wait until October to see what happens.♦
Colorado by Shawna Patrick, RN
Colorado residents are fortunate to have access to both the recreational and medical cannabis programs. But which is safer for the consumer? The laws suggest the former. Surprised? You should be. After all, in the first state to legalize recreational use, one would think the medical cannabis program would be structured in a similar way to protect the safety of patients. Medical cannabis patients are sick and can be adversely effected by consuming improper dosages of edibles or by inhaling contaminated cannabis. Think of the chemotherapy patient who smokes cannabis to quickly alleviate nausea but may be immunocompromised and unable to fight off intruding organisms. Contaminants like Salmonella and E. coli, could actually make a patient sicker, and in some, could lead to death. Does this sound backwards to you? This author agrees. But such is the current state of Colorado. So let’s compare the two programs.
Recreational cannabis-infused products (concentrates, edibles and topicals) must be tested for potency (milligrams of THC) and consistency by a state-approved laboratory before sale. This safety measure ensures that the maximum dosage in a single-serving contains no more than ten milligrams of THC, the state-recommended starting dose, and no more than one-hundred milligrams of THC per container. How wonderful for consumers and sellers alike! The consumer now knows the exact dosage in a product, and the seller can educate the customer with confidence in the product. This is in stark contrast to the medical cannabis laws that do not require manufacturers to have their products tested for potency. So a manufacturer can add any amount of THC to a product (or none at all, as in the case of one manufacturer a few years ago whose employee was stealing the cannabis oil), label the product as a higher dosage than is actually contained in the product and sell it for a higher price. Recreational infused-products must also be labeled with ingredients, instructions for use, and numerous warning statements—some of which have been proposed for adoption into the medical cannabis program sometime in 2016. In both the recreational and medical programs, legislation may soon require all edibles to be stamped with a universal symbol (which looks like a diamond with the word “THC” in the center), and the word “candy” may have to be removed from the label of some infused products, in order to protect the children from accidental ingestion.
When it comes to recreational cannabis, every strain must be tested for potency by a state-approved laboratory before sale, and four batches of each strain must be tested in order to become state-validated. In the upcoming weeks, a new law requiring contaminant testing will go into effect, requiring cultivation facilities to test every harvest batch of each strain produced during a 12 week period of time for E. coli, mold, yeast, and Salmonella, as well as residual solvents for concentrates. If a batch does not pass all required tests the cannabis cannot be sold. Unfortunately, the medical cannabis program does not currently require any of these safety measures. Still, there is hope for change.
Laws have been proposed to set up a framework for state-approved medical testing laboratories by July 2016, so that cultivators and infused-product manufacturers may provide samples for testing and research. Although it would only be voluntary, it’s at least a step in the right direction. But do patients have time to wait? Maybe not. So wake up, Colorado, and enact this legislation sooner rather than later. Your medical cannabis patient’s health may depend on it!♦
Maryland – by Dawn Merrill, LPN
Former member ACNA Board of Directors and Chair of Nominations Committee
With medical cannabis becoming an acceptable therapy around the country, I would like to recommend that EVERY nurse contact their legislative bodies developing new regulations to advocate nurses in the dispensary space. The work done in Maryland has been successful with many applicants contacting me looking for nursing staff to hire for various facilities! NURSES are the key to accurate education and superior patient outcomes!
It was a lot of hard work, with many meetings and networking events, but we ARE being taken seriously in the Maryland landscape! Carry this wherever you may be and lead the charge for our patient’s benefit and safe professional practice! ♦
New York – by Eileen Konieczny, RN
In July 2014, the New York (NY) State Legislature and Governor Cuomo enacted the Compassionate Care Act. A year later, on July 31, 2015, the NY State Department of Health (NYS-DOH) awarded licenses to the top five scoring candidates from a field of forty-three applicants (PharmaCann, Columbia Care NY, Empire State Health Solutions, Etain, and Bloomfield Industries). As required by law, companies must be vertically integrated with cultivation, production, and four dispensaries (for a total of twenty dispensaries in the state). Each company will have 6 months from licensure to have medicine available for patients, and will be limited to five “brands” or cannabinoid profiles. Dispensaries will be located in Nassau, Onondaga, Erie, Monroe, Suffolk, New York, Fulton, Broome, Albany, Westchester, Queens, Warren and Ulster counties.
NY physicians must register with the NY State Department of Health (NYS-DOH) and take a 4-hour CME course, in order to write recommendations. Patients must have one of the following physician-documented conditions in order to obtain a medical marijuana recommendation card: cancer, HIV or AIDS, ALS, MS, IBD, Parkinson’s disease, nerve/spinal cord damage with objective neurological indication or intractable spasticity, epilepsy, neuropathies, Huntington’s disease, and a clinically associated condition such as cachexia, severe or chronic pain, severe nausea, seizures, severe or persistent muscle spasms, or other conditions added by the commissioner. Patients will be allowed to possess up to a 30-day supply of medicine extracted into standardized products. No flower or edible products will be allowed, as the regulations are intended to promote a reproducible, medical grade product (good news for patients). The patient cost has yet to be determined, but will be suggested by the licensee and approved or altered by the NYS-DOH.
According to the press, advocates and legislature, there are serious concerns that twenty dispensaries will not be enough for a state-population of nearly twenty-million. There are additional concerns over cost, limited qualifying conditions, and physician willingness to take the required course and sign recommendations. Having played an instrumental role in getting this legislation passed—although many aspects of the original bill were conceded—this author is anxious to see how the program rolls out and evolves.♦
Oklahoma – by Anonymous
Oregon – by Mike Rochlin, RN
Earlier this year, the Oregon Legislature assigned a “joint” legislative committee (pun was unintended by government) to implement Measure 91, legalizing marijuana, passed by voters in November 2014. The committee was bipartisan and composed of both houses (senate and reps). They met twice weekly, held hearings and listened to biweekly public testimony for months. Lots of lessons learned and testimony from other legal states: Washington & Colorado. Our Legislature was near a final bill later this last Spring, but an impasse resulted based upon cities and counties wanting to opt out. A compromise was reached and a bill was produced at the end of the session: HB 3400 was a detailed plan that the Oregon Liquor Control Commission (OLCC) would use to implement the law. One additional bill was passed to allow an “early start” of flower and plants only, to be purchased through Medical Marijuana Dispensaries that were registered by Oct. 1, 2015. The current agency regulating Medical Dispensaries is Oregon Health Authority (OHA), also wrote temporary instructions to Medical Dispensaries for early retail sales which started Oct. 1, 2015.
The early start was a significant issue, as many new “green rush” hopefuls had speculated that they could sell retail on July 1, 2015. When the final dates/bill was set to Oct. 1, 2015, some speculators, already leasing buildings (at a very high cost, due to very few suitable properties available), had closed their doors. It remains to be seen if they will reopen.
OLCC experienced a set back during the Legislative hearings, after firing new OLCC Marijuana Director, but didn’t waste any time to strategize with parallel efforts to obtain industry input to regulations. An OLCC Regulatory Advisory Committee (RAC), with subcommittees, such as retail, labs, producers, etc. was formed, headed by an experienced leader (Chris Lyons) who had previously run OLCC. She set an even-handed tone and OLCC staff worked hard to keep meeting and schedule on track to meet a November 2015 deadline for regulations.
The largest Oregon city, with the most medical dispensaries, Portland, held hearings to review the process of business licensing of retail stores. It was a very interesting three hour meeting. Lots of testimony, mostly from current medical dispensary owners who felt that their business was at risk. The City Council listened and agreed to a reasonable manner in which to accept licenses and limit “saturation,” from too many stores (could there really be too many? It’s uncertain, too early to tell). Welcome news to those who have invested so much of their time and resources helping medical patients.
Much more work will need to be done, and education is key. This author has testified to Oregon Legislature, offered advice to OLCC and Portland, and thinks the Oregon collaborative experience will make the end result a much better experience.♦
Texas – by Stephen Carter for Michael Barefoot, RN
Executive Director, Janice Michaels Foundation, Inc.
Living in the shadow of Fort Hood, Texas, the needs of our veterans is always present. According to the Department of Veterans Affairs (VA), almost 1.7 million veterans reside in Texas, making it the second largest state where veterans call home, and an estimated 1.3 Texans consume marijuana on a regular basis, based on surveys conducted by the Substance Abuse and Mental Health Services Administration. Thus, one may deduce that many veterans are consumers of cannabis. And since numerous studies have shown the medicinal qualities of cannabis, researchers have finally begun to study its effects on those with Post Traumatic Stress Disorder (PTSD).
In a study conducted by the VA, results suggest that at least 18-22 veterans commit suicide each day! Many veterans report that this is often due to the amount of medications they are prescribed. However, for soldiers who have returned home after war, many report that cannabis helps them sleep through the night and takes the edge off, helps treat pain sustained from war injuries, offseting their use of prescription medicine (especially opiates), and it reduces alcohol consumption which is often mixed with medication and leads to further damage including overdose. Therefore, it appears that the consensus among veterans is that cannabis helps far more than it could ever possibly harm.
So if a non-toxic plant can help to reduce a veteran’s medication intake (under the supervision of a doctor), it makes sense that medical professionals should consider adding it to the treatment plan, right? Not so in the Lone Star State. Despite the proven medical efficacy, cannabis is still treated as a Schedule 1 drug in Texas, and if a veteran tests positive, they are immediately cut off from all prescriptions, despite a recent policy change by the VA that prevents this from happening in states where cannabis has been legalized for medical use.♦