Iowa Democratic lawmakers seeking to expand medical cannabis law

Iowa Senate Ways and Means Committee Chair Joe Bolkcom has introduced a bill to make medical marijuana more broadly available to Iowans suffering from life-threatening or chronic illnesses. Senate Study Bill 1243 would allow the possession and use of medical cannabis (not just the cannabis oil derivative legalized last year) 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, or post-traumatic stress syndrome. Scroll to the end of this post for a detailed summary of the bill.

The latest Des Moines Register poll by Selzer & Co indicates that 70 percent of Iowans favor allowing medical marijuana use. Yet Iowa’s new law allowing cannabis oil treatments has yet to benefit a single patient. Nevertheless, persuading Iowa House Republicans and Governor Terry Branstad to legalize marijuana for additional medical conditions may be an uphill battle. Follow me after the jump for more background on this issue, and excerpts from recent testimony before members of the Iowa Senate.

Last year, the Iowa legislature approved and the governor signed a bill legalizing the use of cannabis oil to treat certain seizure disorders. However, none of the several hundred Iowa families affected by those diseases have been able to obtain cannibidiol under the law.

Since the Iowa Department of Public Health started accepting applications for permits to possess cannabis oil, only nine patients have applied, Tony Leys reported for the Des Moines Register last week. Many of those who advocated for the law have concluded that it is too limited and unworkable.

During last year’s legislative session, some Iowa House Republicans and Governor Branstad made clear that they were not open to any bill that would allow the medical use of smokeable marijuana. Asked recently how Iowans will be able to obtain cannabis oil, Branstad suggested that Illinois policy-makers might solve the problem:

He spoke today about a dispensary that will be created in Rock Island that could give access to Eastern Iowans.

“There might be a possibility that we could work something out with a neighboring state,” Branstad said. “But I want to be careful that we avoid unintended consequences. We want this to be available for children with epilepsy that it could help. But we also don’t want to get it into the hands of other people who are not authorized to use it.”

I’ve never understood why Branstad believes only children with severe epilepsy should be allowed access to medical cannabis. But even if you accept his limited view of the potential benefits, why would he want to rely on Illinois politicians to solve Iowa families’ problems?

In any event, Branstad’s idea looks like a non-starter:

At least one Illinois lawmaker involved with passing that state’s medical marijuana law said it’s unrealistic.

“Not plausible at all. Probably will never be proposed,” said Rep. Lou Lang, a Democrat from Skokie. “The governor of Iowa is talking nonsense.”

Branstad’s spokesman, Jimmy Centers, didn’t respond to Lang’s comment but said Branstad wants to meet with Illinois Gov. Bruce Rauner to talk about the idea while both men are attending meetings in Washington.

Bolkcom responded to the governor’s idea with this shot across the bow:

Governor Branstad, here is the “unintended consequence” you need to address: not one Iowa family has been helped so far by the legislation signed last year, even though your administration has spent more than $100,000 so far on this project.

All Iowa families continue to be denied access to the same lifesaving medicines that a majority of Americans living in other states can already use with the approval of their doctor.

According to the AP story, the Branstad Administration is preparing to block sincere efforts to fix Iowa’s law by pretending Illinois will change their laws to accommodate the Branstad Administration’s failure to lead.  Governor, stop pretending to care and start doing your job.  80% of Iowans support the medical use of cannabis with the consent of their doctor.  They didn’t vote for a Governor who plays political games with the health of suffering Iowans.

Last month, several people affected by serious health problems spoke at an Iowa Senate hearing on medical cannabis. Click through to read testimony from Jeri Goodell, whose grandson has epilepsy; Brandon Brase, who has Crohn’s disease; Lori Tassin, facing side effects from chemotherapy to treat her cancer; Jon Custis, a Vietnam veteran with PTSD, and Dan Endreson, who spoke on behalf of the National Multiple Sclerosis Society.

Today other patients spoke at a press conference where Democratic lawmakers unveiled Senate Study Bill 1243. Besides Bolkcom, legislators who attended included State Senators Bill Dotzler, Steve Sodders, and Tom Courtney, and State Representatives Bob Kressig and John Forbes (a pharmacist).

This bill will not be subject to the Iowa legislature’s “funnel” deadline coming later this week. However, some Republican supporters will need to step forward if this bill is to have any prayer of passing. All twelve of the Iowa Senate Republicans who voted for the final version of last year’s medical cannabis bill still serve in the upper chamber. In the Iowa House, 28 of the 32 Republicans who voted for the limited cannabis oil bill still serve in the legislature. How many of them would support a proposal as broad as Senate Study Bill 1243 remains unclear.

Any relevant comments are welcome in this thread.

UPDATE: It should be noted that while this bill would legalize other products from marijuana plants besides the cannabis oil extract that was the focus of last year’s law, smoking marijuana would remain prohibited, even for patients with medical conditions that could be treated with cannabis.

Iowa Senate news release, March 3:

BACKGROUND

Iowa enacted the Medical Cannabidiol Act in 2014, legalizing the possession and use of up to 32 ounces of cannabidiol for the sole purpose of treating intractable epilepsy and its side-effects. Iowans with intractable epilepsy and their caregivers can now apply for a cannabidiol registration card from the Department of Public Health (DPH) and, upon approval, acquire a registration card from the Department of Transportation (DOT). A neurologist must provide a written recommendation for the use of cannabidiol, and the cannabidiol must be acquired from an out-of-state source.

An interim legislative study committee reviewed the medical cannabidiol program in September 2014 and, upon hearing from numerous persons suffering from debilitating diseases, advocates, and other stakeholders, determined that the 2014 Act is ineffective. In particular, the following shortcomings were identified:

• Acquiring cannabidiol from an out-of-state source requires families to break laws in other states, and results in financial, travel and other hardships.

• The list of eligible medical conditions is unnecessarily limited, including just one condition – intractable epilepsy. While the very existence of the program recognizes the medical benefits of cannabis, the extremely limited nature of the program maintains a barrier to relief for most Iowans suffering from debilitating conditions and diminishes any economies of scale that could be realized during the production and dispensing of the medicine.

Building from those findings, this bill establishes a comprehensive, safe, and secure medical cannabis program for Iowans seeking relief from debilitating medical conditions. Highlights include:

• Expands the list of conditions eligible for medical cannabis to include cancer, multiple sclerosis, epilepsy, AIDS/HIV, glaucoma, Hepatitis C, Crohn’s Disease, amyotrophic lateral sclerosis, Ehlers-Danlos Syndrome, and post-traumatic stress syndrome.

• Establishes a Medical Advisory Board that will provide oversight of the program and consider additional medical conditions that should be eligible for medical cannabis.

• Allows for the cultivation, production, and dispensing of medical cannabis at multiple locations in Iowa.

• Allows various forms of medical cannabis to be sold. However, smoking medical cannabis is not allowed.

Eleven states have enacted limited medical cannabis programs of a similar nature to Iowa’s current program while 23 states have enacted comprehensive medical cannabis programs. Comprehensive programs generally legalize multiple forms of cannabis for the treatment of multiple medical conditions, and provide for local acquisition of cannabis. Two of those states are neighbors of Iowa: Minnesota and Illinois.

A February 15-18, 2015 poll conducted by Selzer & Company for the Des Moines Register found that 70% of Iowans support legalizing the use of medical cannabis, up from 59% last year.

BILL OVERVIEW

This bill strikes the entire Medical Cannabidiol Act (Iowa Code Chapter 124D) and replaces it with a new Medical Cannabis Act (Iowa Code Chapter 124E). Key highlights:

• Medical Cannabis

The allowable form of medical cannabis is expanded beyond cannabidiol to include any species of the genus cannabis plant, or any mixture or preparation of them, including whole plant extracts and resins. Forms beyond cannabidiol have been found to be more helpful for various medical conditions. The DPH is directed to promulgate administrative rules to establish the form and quantity of medical cannabis allowed to be dispensed. Smoking of medical cannabis is prohibited.

• Registration Card

The bill utilizes the same registration card application, approval and dispensing processes as those used by the DPH and DOT for medical cannabidiol. However, the DPH is directed to establish medical cannabis registration card fees to cover administrative costs. Law enforcement has the same access to the registration list for the purpose of verifying compliance. All information from patients is to be kept confidential.

• Affirmative Defense

The bill utilizes the same affirmative defense for the possession, use and administration as last year’s Medical Cannabidiol Act and applies it to the possession and use of medical cannabis for the expanded set of debilitating medical conditions. The same affirmative defenses are also applied to health care practitioners as was applied to neurologists under the Medical Cannabidiol Act. Affirmative defenses are also extended to medical cannabis manufacturers and their dispensaries and employees.

• Eligible Conditions & Medical Advisory Board

The debilitating medical conditions list is expanded beyond intractable epilepsy to include cancer, multiple sclerosis, epilepsy, AIDS or HIV, glaucoma, hepatitis C, Crohn’s Disease, amyotrophic lateral sclerosis, Ehlers-Danlos Syndrome, and post-traumatic stress syndrome (PTSD).

By August 15, 2015, the Director of the DPH is directed to establish a Medical Advisory Board consisting on nine board-certified health care practitioners knowledgeable about the use of medical cannabis. Duties of the Board include reviewing and recommending for approval to the DPH additional debilitating medical conditions that qualify for the use of medical cannabis; accepting and reviewing petitions to add debilitating medical conditions to the list of those that qualify for the use of medical cannabis; advising the DPH on the location of dispensaries, the form and quantity of allowable medical cannabis that may be dispensed, and general oversight of manufacturers; and convene at least twice per year to conduct public hearings and evaluate petitions.

The DPH is directed to promulgate administrative rules to identify criteria and set forth procedures for including additional debilitating medical conditions that qualify for the use of medical cannabis.

• Health Care Practitioner’s Certification

Recognizing the longer list of eligible conditions, the written recommendation from a neurologist in the Medical Cannabidiol Act is replaced with a written certification provided by a health care practitioner that attests to the patient suffering from a debilitating medical condition that is eligible for the medical cannabis program. Health care practitioners licensed under Chapter 148 to practice medicine or surgery, physicians assistants licensed under Chapter 148C or advanced registered nurse practitioners licensed under Chapter 152 or 152E may provide written certifications. The patient or caregiver may present the written certification to the DPH when applying for the medical cannabis registration card. Written certifications expire after one year and may be renewed annually. Health care practitioners are not required to provide a written certification. This process is modeled after Minnesota’s certification.

• Manufacturers & Dispensaries

Four medical cannabis manufacturers are to be selected and licensed by the DPH to possess, cultivate, supply, transport, and dispense medical cannabis within the state. These four manufacturers are each to establish three

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dispensaries each (for a total of 12) across the state for the purpose of selling medical cannabis to patients and caregivers who possess a medical cannabis registration card. The locations of the dispensaries are to be based on the geographic need across the state. The DPH is directed to solicit applications and license the two manufacturers by December 1, 2015. Licenses are to be approved or re-issued by December 1 of each year. The manufacturers must agree to begin supplying medical cannabis to patients at a minimum of one location by July 1, 2016. The DPH must consider the following factors in determining whether to license a manufacturer: technical medical cannabis expertise, qualifications of employees, long-term financial stability, ability to provide appropriate security measures, ability to meet production demands, and projection and ongoing assessment of fees to patients for medical cannabis. Manufacturers are required to contract with the State Hygienic Lab to test the medical cannabis for content, contamination, and consistency.

Manufacturers must implement security requirements, including requirements for protection of each location by a fully operational security alarm system, facility access controls, perimeter intrusion detection systems, and a personnel identification system. Manufacturers are prohibited from sharing office space with, referring patients to, or having any financial relationships with health care practitioners. Consumption of medical cannabis on the premises of a manufacturer is prohibited. Reasonable inspections of manufacturers by the DPH are permitted. Manufacturers are prohibited from employing persons under age 21 or any person who has been convicted of a disqualifying felony offense. Employees must be subject to a background investigation conducted by the Division of Criminal Investigation and a national criminal history background check. A manufacturer and associated dispensaries are not allowed within 1,000 feet of a public or private school. The DPH may establish reasonable restrictions concerning signage, marketing, displays, and advertising of medical cannabis.

Manufacturers are required to provide a reliable and ongoing supply of medical cannabis for all eligible patients. All manufacturing, harvesting, packaging, and processing of medical cannabis is to take place in an enclosed, locked facility at a physical address provided to the DPH during the licensure process.

Prior to dispensing medical cannabis, the manufacturer is required to verify that the patient or caregiver has a valid medical cannabis registration card, assign a tracking number to the medical cannabis, ensure proper packaging including child resistant packaging and exemptions for packaging for elderly patients, and affix a label with a list of all active ingredients and patient/caregiver identifying information.

Any manufacturer or dispensary acting without a valid license shall be assessed a civil penalty of up to $1,000 per violation in addition to any other applicable penalties.

• Fees

The medical cannabis program is intended to be financially self-sufficient. The manufacturer license application fee is set at $7,500 and the manufacturer is authorized to charge fees to the patient/caregiver to dispense medical cannabis.

• Reciprocity

Medical cannabis registration cards or their equivalent issued in another state shall be considered valid in Iowa for the purposes of possession and use of medical cannabis, but medical cannabis is only to be dispensed to Iowa residents.

• Reports

The University of Iowa Carver College of Medicine and College of Pharmacy maintains their responsibility to provide an annual report to the Legislature and DPH outlining the scientific literature, studies, and clinical trials regarding the use of medical cannabis on patients with a debilitating medical condition.

• Emergency Rules & Transition Provisions

The DPH is authorized to adopt emergency administrative rules to implement this bill. Medical cannabidiol registration cards issued prior to July 1, 2015, remain in effect for the 12-month period following their issuance and may be renewed prior to the expiration of this 12-month period.

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