A comprehensive medical cannabis bill received strong bipartisan support in the Iowa Senate Appropriations Committee today and could pass the full chamber as early as tomorrow.

The big question now is whether key House Republicans will accept a giant step toward relief for thousands of sick and suffering Iowans.

When a broad medical cannabis bill last came before the Iowa Senate in April 2015, it barely passed with 26 votes (all but one of the Democrats, joined by GOP Senator Brad Zaun). That bill, championed by Democratic Senator Joe Bolkcom, would have permitted the use of some cannabis derivatives (but not smokeable marijuna) for any of the following “debilitating medical conditions”:

Cancer
Multiple sclerosis
Epilepsy
AIDS or HIV
Glaucoma
Hepatitis C
Crohn’s disease or ulcerative colitis
Amyotrophic lateral sclerosis (often known as Lou Gehrig’s disease)
Ehlers-danlos syndrome
Post-traumatic stress disorder
“Severe, chronic pain caused by an underlying medical condition that is not responsive to conventional treatment or conventional treatment that produces debilitating side effects”
“Any other chronic or debilitating disease or medical condition or its medical treatment” approved by the Iowa Department of Public Health

That bill didn’t advance in the House in 2015. The following year, it was scaled back in one House committee before dying in another. Democratic efforts to bring it to the House floor failed, as Bleeding Heartland discussed in detail here.

Although Senator Charles Schneider voted against Bolkcom’s bill two years ago, he has repeatedly promised this year to push for medical cannabis legislation that covers more Iowans and is more workable than the current law. As chair of the Senate Appropriations Committee, Schneider can bring up bills that did not make it through the legislature’s “funnel,” and he has been consulting with lawmakers from both parties.

The fruit of their labor appeared on the legislature’s website on April 11. Senate Study Bill 1190 would reclassify “marijuana, including tetrahydrocannabinols, from a schedule I controlled substance to a schedule II controlled substance.” It would allow Iowans to use medical cannabis in more forms than the cannabis oil permitted under current law (but still not smokeable marijuana). It would expand the number of diseases or conditions for which a doctor could prescribe medical cannabis even further than the 2015 bill:

Cancer, if the disease or its treatment produces intractable pain, nausea or severe vomiting, or cachexia or severe wasting
Multiple sclerosis
Epilepsy or seizure disorders
AIDS or HIV
Glaucoma
Hepatitis C
Crohn’s disease or ulcerative colitis
Amyotrophic lateral sclerosis
Ehlers-Danlos syndrome
Post-traumatic stress disorder
Tourette’s syndrome
Any terminal illness, with a probable life expectancy of under one year, if the illness or its treatment produces intractable pain, nausea or severe vomiting, or cachexia or severe wasting
Intractable pain
Parkinson’s disease
Muscular dystrophy
Huntington’s disease
Alzheimer’s disease
Complex regional pain syndrome, type I and II
Rheumatoid arthritis
“Any other chronic or debilitating disease or medical condition or its medical treatment” approved by the Iowa Department of Public Health.

The bill also spells out conditions for in-state medical cannabis manufacturers and dispensaries, subject to regulation, and would allow Iowans with a medical cannabis registration card to use dispensaries in Minnesota.

Under the new legislation, health care professionals could not be prosecuted for possession or administration of marijuana arising from providing treatment to people with debilitating medical conditions. Patients with a valid medical cannabis registration card would have an affirmative defense to any prosecution for unlawful possession of marijuana.

The new bill contains a couple of provisions designed to placate skeptics. First, as mentioned above, patients would still be prohibited from smoking marijuana. Second, employers would be allowed to enforce zero-tolerance policies on cannabis, including medical cannabis, and those policies could not be considered unfair or discriminatory.

The bill would take effect immediately upon enactment, rather than at the start of the next fiscal year.

This morning, a Senate Appropriations subcommittee approved Senate Study Bill 1190, and later today, the full Appropriations Committee passed the bill, with eleven Republicans voting in favor (Schneider, Tim Kraayenbrink, Craig Johnson, Mark Lofgren, Mark Chelgren, Julian Garrett, Tom Greene, Dennis Guth, Ken Rozenboom, Tom Shipley, and Dan Zumbach) and only one opposed (Mark Costello). Senator Rick Bertrand was absent.

Bolkcom and fellow Democrats are confident a strong bipartisan vote will send this bill to the House in the next few days. After clearing the committee, the bill was renamed Senate File 506.

Why are so many more Republican lawmakers willing to support a comprehensive medical cannabis bill now, compared to two years ago? Speaking after today’s committee hearing, Democratic State Senator Bill Dotzler attributed the “astounding turnaround” to people speaking directly to senators about why they or their loved ones need access to this medical treatment. Bolkcom and State Senator Matt McCoy urged Iowans to contact House members now.

Getting this bill through the lower chamber will be a heavy lift. Some House Republicans resist expanding the allowable use of cannabis to cover conditions like PTSD and chronic pain. Republican State Representative Clel Baudler, who introduced a much more limited cannabis bill earlier this year, commented today, “I think the chance of that passing is very, very, very nil at least in the House. Some time three days after hell freezes over that bill will pass in the House.”

Speaker Linda Upmeyer, seen as the primary obstacle to broad medical cannabis legislation (despite being a nurse practitioner by training), told reporters today that the new Senate bill is “a bit too much.” She indicated House Republicans are open to some expansion of the current law, including in-state production and sales. William Petroski and Brianne Pfannenstiel reported for the Des Moines Register,

A bill is still alive in the House that would extend the sunset date of the current cannabis oil program and make available a cannabis-based product called Epidiolex once it’s approved by the Food and Drug Administration.

“Those two things would, I think, be done either way,” Upemeyer said. “But I think there’s an opportunity to do more. I’m just not sure (the Senate’s legislation) is the bill.”

Rep. Jarad Klein, R-Keota, who has had a lead role in drafting medical marijuana legislation in the House, agreed with Upmeyer that the House Republicans favor a more limited approach than offered in the Senate bill. For example, he said he wants to avoid a loosely-regulated system where almost anyone could claim to have an illness in an effort to obtain medical marijuana.

“We are focused on the oil, focused on science,” Klein said. “We want something that cannot be abused. We are definitely opposed to recreational use, so we are trying to not let much through.”

With the latest Des Moines Register poll showing 80 percent support for medical marijuana and the current medical cannabis law due to expire July 1, Republicans are under pressure to do something on this issue before adjourning for the year. I expect the House to take up Senate File 506 but significantly reduce its scope. Then we’ll see whether senators insist on something close to Schneider’s bill or go along with whatever Upmeyer can stomach.

Any relevant thoughts are welcome in this thread.

UPDATE: I forgot to mention the lobbyist declarations. Several health advocacy organizations are registered in favor of the new Senate bill, including the Brain Injury Alliance of Iowa, Easter Seals Iowa, the Epilepsy Foundation, the National Multiple Sclerosis Society-Upper Midwest Chapter, and the Veterans National Recovery Center. The Iowa Medical Society and the Iowa Pharmacy Association are registered against, even though the only two pharmacists who serve in the legislature (House Democrat John Forbes and Senate Republican Tom Greene) support comprehensive medical cannabis reform.

SECOND UPDATE: The Senate Ways and Means Committee approved the medical cannabis bill on April 13 by fourteen votes to one. Republicans Randy Feenstra, Jerry Behn, Bill Anderson, Mike Breitbach, Waylon Brown, Jeff Edler, Jason Schultz, and Roby Smith joined the six committee Democrats to send the bill to the Senate floor. Republican Dan Dawson was the only no vote.

Remarkably, nineteen of the 29 Senate Republicans voted this week for comprehensive medical cannabis reform–and that doesn’t include Brad Zaun, who hasn’t voted on the bill yet because he doesn’t serve on either Appropriations or Ways and Means.

P.S.- Some opponents of medical cannabis worry that marijuana will fall into the wrong hands. Note that no one ever suggests banning any prescription medications for that reason, despite a large and growing opioid addiction problem. Erin Miller, whose son benefits from cannabis oil to treat his rare genetic condition, responded to that argument in a guest column for the Cedar Rapids Gazette last month.

In states with medical cannabis laws, opiate abuse actually declines. According to a study published in the journal JAMA Internal Medicine in October 2016, opiate-related deaths decreased by 33 percent within six years in states that legalized cannabis from 1999-2010. According to the “Healthy Kids Colorado Survey” (conducted by the Colorado Department of Health), teen marijuana use has actually stayed flat and is just below the national average. In fact, 62 percent of middle and high school students in CO say they have never used marijuana at all.

With the 2014 Medical Cannabidiol Bill set to repeal on July 1, 2017, I worry that my son’s medicine will be stripped away in fear of the “what ifs” vs the reality that many sick and suffering Iowans are out of options. Our doctors are recommending cannabis and our lawmakers are standing in the way. […]

Before Cannabis — my son was a regular at the Emergency Rooms and Urgent Care Clinics. We had multiple hospital stays annually with lengthy (and very expensive) stays at out-of-state specialty hospitals. Not to mention the cost of his anti-epileptic drugs which led to increased hospital stays, subspecialty clinic visits and repeat follow-ups for seizure related issues.

After cannabis, my son is going on 600 days seizure-free. He hasn’t had an ambulance ride or a hospital stay due to an emergency since 2015. We have been able to wean him 100 percent off the dangerous anti-epileptic pharmaceuticals and he is thriving on medical cannabis oil thanks to the Legislature that put the 2014 Medical Cannabidiol Bill into place.