state by state laws report 2011

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For now, federal law is blind to the wisdom of a future day when the right to use medical marijuana to alleviate excruciating pain may be deemed fundamental. Although that day has not yet dawned, considering that during the last ten years eleven states have legalized the use of medical marijuana, that day may be upon us sooner than expected. — Ninth Circuit Court of Appeals, Raich v. Gonzales, March 2007 Since the March 2007 decision, five additional states have passed effective medical marijuana laws, bringing the total number to 16, plus Washington, D.C. State-By-State Medical Marijuana Laws How to Remove the reat of Arrest 2011 236 Massachusetts Ave. NE Suite 400 Washington, D.C. 20002 Issued by the Marijuana Policy Project Phone: (202) 462-5747 Fax: (202) 232-0442 [email protected] www.marijuanapolicy.org

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Page 1: State by State Laws Report 2011

“ For now, federal law is blind to the wisdom of a future day when the right to use medical marijuana to alleviate excruciating pain may be

deemed fundamental. Although that day has not yet dawned, considering that during the last ten years eleven states have legalized the use of

medical marijuana, that day may be upon us sooner than expected.” — Ninth Circuit Court of Appeals, Raich v. Gonzales, March 2007

Since the March 2007 decision, five additional states have passed effective medical marijuana laws,

bringing the total number to 16, plus Washington, D.C.

State-By-State Medical Marijuana

LawsHow to Remove the Threat of Arrest

2011

236 Massachusetts Ave. NE Suite 400Washington, D.C. 20002

Issued by the Marijuana Policy ProjectPhone: (202) 462-5747

Fax: (202) [email protected]

www.marijuanapolicy.org

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CONTENTS i

State-By-State Report 2011ContentsExecutive Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Marijuana’s Medical Uses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Criminalizing Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Changing Federal Law . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5

Changing State Laws: From 1978 to 1995 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Changing State Laws: Since 1996 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

What the New State Laws Do . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Is There Conflict Between Modern State Laws and Federal Law? . . . . . . . . . . . . . . . . . . . . . 11

Federal Law Enforcement and State Medical Marijuana Programs . . . . . . . . . . . . . . . . . . . . 13

Federal Court Rulings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Overview of Kinds of State Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Where Things Are Going From Here . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

TABLESTable 1: Effective Medical Marijuana Laws in 16 States and Washington, D .C . . . . . . . . . . . 20

Table 2: Tally of State Medical Marijuana Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25

Table 3: Medical Conditions Approved for Treatment with Marijuana in the 16 States and One District With Medical Marijuana Laws . . . . . . . . . . . . . . . . . . . . . . . . . 27

MAPSStates with effective medical marijuana laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

States with medical marijuana laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

States that considered medical marijuana legislation in 2011 . . . . . . . . . . . . . . . . . . . . . . . . . 13

APPENDICESAppendix A: State Medical Marijuana Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1

States with effective medical marijuana laws (removal of criminal penalties) . . . . . . . . A-2States with workable medical marijuana laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-8States with medical marijuana research laws (therapeutic research programs) . . . . . . . A-9States with symbolic medical marijuana laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-11States in which medical marijuana laws have expired or been repealed . . . . . . . . . . . . . A-13States that have never had medical marijuana laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-15States that have passed non-binding resolutions urging the federal government to make marijuana medically available . . . . . . . . . . . . . . . . . . . . . . . A-16

Appendix B: Medical Marijuana Briefing Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B-1

Appendix C: Excerpts from the Institute of Medicine 1999 Report . . . . . . . . . . . . . . . . . . . C-1

Appendix D: Surveys of Public Support for Medical Marijuana . . . . . . . . . . . . . . . . . . . . . D-1Nationwide medical marijuana public opinion polling results . . . . . . . . . . . . . . . . . . . . . D-1State-specific medical marijuana public opinion polling results . . . . . . . . . . . . . . . . . . . . D-3

Appendix E: The Federal Controlled Substances Act (and Drug Schedules) . . . . . . . . . . . E-1

Appendix F: How the 17 Effective State and District Laws Are Working . . . . . . . . . . . . . . F-1

State-By-State Report 2011

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CONTENTS ii

Delaware . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-2Arizona . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-3New Jersey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-4Michigan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-5New Mexico . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-6Rhode Island . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-7Montana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-8Vermont . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-9Hawaii . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-10Colorado . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-12Nevada . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-14Maine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-15Oregon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-16Alaska . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-19District of Columbia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-20Washington . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-21California . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . F-23

Appendix G: Types of Legal Defenses Afforded by Effective State Medical Marijuana Laws . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G-1

Appendix H: Types of Physician Documentation Required to Cultivate, Possess, or Use Medical Marijuana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .H-1

Appendix I: Federal Litigation Related to Effective State Medical Marijuana Laws . . . . . .I-1Dr. Marcus Conant v. John L. Walters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I-2United States of America v. Oakland Cannabis Buyers’ Cooperative . . . . . . . . . . . . . . . . . . .I-3Gonzales v. Raich . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I-5County of Santa Cruz, et al. v. Ashcroft, et al. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I-7Arizona v. United States . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .I-9

Appendix J: Therapeutic Research Programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . J-1

Appendix K: Medical Necessity Defense . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . K-1

Appendix L: State Medical Marijuana Legislation Considered in 2011 . . . . . . . . . . . . . . . . L-1

Appendix M: Model Resolution of Support . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .M-1

Appendix N: States That Have the Initiative Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . N-1

Appendix O: Effective Arguments for Medical Marijuana Advocates . . . . . . . . . . . . . . . . . O-1

Appendix P: Partial List of Organizations with Favorable Positions on Medical Marijuana . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . P-1

Appendix Q: MPP’s Model State Medical Marijuana Bill . . . . . . . . . . . . . . . . . . . . . . . . . . . . Q-1

Appendix R: Overview and Explanation of MPP’s Model Bill . . . . . . . . . . . . . . . . . . . . . . . . R-1

Appendix S: Federal Law Enforcement and State Medical Marijuana Laws . . . . . . . . . . . . S-1

Appendix T: Teen Marijuana Use in Medical Marijuana States . . . . . . . . . . . . . . . . . . . . . . T-1

Appendix U: State Medical Marijuana Program Finances . . . . . . . . . . . . . . . . . . . . . . . . . . . U-1

Appendix V: Medical Marijuana Program Implementation Timelines . . . . . . . . . . . . . . . . V-1

Appendix W: Medical Marijuana Laws and Civil Protections . . . . . . . . . . . . . . . . . . . . . . W-1

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State-By-State Report 2011Executive Summary• Favorable medical marijuana laws have been enacted in 37 states and the

District of Columbia since 1978. (Five of these states’ laws have since expired or been repealed.) However, nearly half of the laws that remain on the books are ineffectual, due to their reliance on the federal government to directly pro-vide or authorize a legal supply of medical marijuana.

• Currently, 32 states and the District of Columbia have laws on the books that recognize marijuana’s medical value:

- Since 1996, 16 states and the District of Columbia have enacted laws that effectively allow patients to use and access medical marijuana despite federal law. To be effective, a state law must remove criminal penalties for patients who use and possess medical marijuana with their doctors’ ap-proval or certification. Effective laws must also allow patients to grow their own marijuana and/or allow a provider to do so for the patient.

- A 17th state, Maryland, has established an affirmative defense law that pro-tects patients who possess marijuana from jail sentences, but it does not allow cultivation or distribution. It also does not protect patients from ar-rest and prosecution.

- Eight states solely have “Therapeutic Research Program” laws that fail to give patients legal access to medical marijuana because of federal obstructionism.

- Seven states have symbolic laws that recognize marijuana’s medical value but fail to provide patients with protection from criminal penalties.

• Eleven of the 17 effective medical marijuana laws were enacted through the ballot initiative process — in Alaska, Arizona, California, Colorado, Maine, Michigan, Montana, Nevada, Oregon, Washington state, and Washington, D.C. The other six effective laws were passed by the state legislatures of Delaware, Hawaii, New Jersey, New Mexico, Rhode Island, and Vermont. Some of the laws enacted by voters were later revised or added to by the state’s legislature or the district’s council.

• The federal government cannot force states to criminalize conduct that is il-legal under federal law, nor can the federal government force state and local police to enforce federal laws.

• Because 99% of all marijuana arrests in the nation are made by state and local (not federal) officials, properly worded state laws effectively protect at least 99 out of every 100 medical marijuana users who would otherwise be prosecuted. Indeed, there aren’t any known cases in which the federal government has prosecuted patients for small amounts of marijuana in the 16 states that have enacted medical marijuana laws since 1996.

• Since 2001, federal courts have handed down decisions on three signifi-cant medical marijuana cases: U.S. v. Oakland Cannabis Buyers’ Cooperative (OCBC), Gonzales v. Raich, and Conant v. Walters. The U.S. Supreme Court issued opinions on the first two of these cases and declined to hear the third.

- In OCBC, the court determined that the medical necessity defense cannot be used to avoid a federal conviction for marijuana distribution; in Raich,

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1the court held that the federal government can arrest and prosecute pa-tients in states where medical marijuana is legal under state law. Despite issuing unfavorable decisions in both cases, the U.S. Supreme Court did not in any way nullify effective state medical marijuana laws, nor did it prevent additional states from enacting similar laws.

- The U.S. Supreme Court also sent the Raich case back to the Ninth U.S. Circuit Court of Appeals to consider additional legal issues. The Ninth Circuit ruled that there is not yet a constitutional right to use marijuana to preserve one’s life. It also held that the “medical necessity” criminal defense cannot be used in a civil suit to prevent a federal prosecution.

- In deciding Conant, the Ninth U.S. Circuit Court of Appeals held that doc-tors cannot be prosecuted for recommending that their patients use medical marijuana. By choosing not to hear Conant, the U.S. Supreme Court let this protection stand.

• A handful of courts have considered or are considering whether specific medi-cal marijuana laws — or specific provisions of those laws — are preempted (or nullified) by federal law. In 2008 and 2009, the U.S. Supreme Court re-fused to hear appeals of two California court decisions finding that federal law does not preempt the challenged parts or applications of California’s medical marijuana laws. Two California appellate courts ruled on preemption charges related to cities licensing dispensaries. One court found that Anaheim licens-ing dispensaries would not be preempted, while another struck down Long Beach licensing dispensaries and setting up a lottery for licenses, but ruled that the decriminalization of collectives and many regulations were not pre-empted. In addition, in May 2011, Arizona Gov. Jan Brewer asked a federal court to rule whether federal law preempts the state’s medical marijuana law. The U.S. Department of Justice, the ACLU, and others have asked the court to dismiss Brewer’s case.

• Ultimately, the federal executive branch should allow marijuana to move through the FDA approval process so that marijuana can be approved as a prescription medicine and sold through pharmacies. In addition, Congress and the president should enact legislation giving states the right to make mari-juana medically available in any way they choose without federal interference. Because the federal government refuses to budge, the only way to protect marijuana-using patients from arrest is through legislation in the states.

• This report describes all favorable medical marijuana laws ever enacted in the United States, details the differences between effective and ineffective state laws, and explains what must be done to give patients immediate legal access to medical marijuana. Accordingly, a model bill and a compilation of resourc-es for effective advocacy are provided.

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State-By-State Report 2011Overview

Despite marijuana’s widely recognized therapeutic value, the medical use of marijuana remains a criminal offense under federal law. Nevertheless, favorable medical marijuana laws have been enacted in 37 states since 1978.1

Many of the favorable state laws are ineffectual, due to their reliance on the federal government to directly provide or authorize a legal supply of medical marijuana. Fortunately, since 1996, 16 states and the District of Columbia have found ways to help seriously ill people use medical marijuana with virtual impunity, despite federal law.2

An 18th law, enacted in Maryland in May 2003 and amended in May 2011, is weaker than the other laws because it does not include any method of access, such as home cultivation and/or dispensaries. Patients’ only option to obtain their supply of medical marijuana is from drug dealers. In addition, the law only allows patients to raise a defense at trial; it does not prevent an arrest. The Maryland law should not be used as a model for other states.

Although the U.S. Supreme Court ruled in U.S. v. Oakland Cannabis Buyers’ Cooperative (OCBC) (532 U.S. 483) that the medical necessity defense cannot be used to avoid a federal conviction for marijuana distribution, a state may still remove its own criminal penalties from citizens who possess, grow, or distribute medical marijuana. Furthermore, a 2007 Ninth Circuit Court of Appeals decision — Gonzales v. Raich — left open the possibility that a patient may be able to raise a medical necessity defense to prevent a federal criminal conviction. The OCBC ruling does not nullify the 17 effective state and district medical marijuana laws, nor does it prevent other states from enacting similar laws.

This is important because the overwhelming majority of marijuana arrests are made at the state and local levels, not the federal level. The relatively few medi-cal marijuana arrests made at the federal level almost always involve larger-scale distribution. In the past two and a half years, the raids on larger-scale distribution have been limited to states without a clear state law explicitly allowing and strictly regulating large-scale medical marijuana cultivation and distribution. In a June 2011 memo, U.S. Deputy Attorney General James Cole stated, “it is likely not an efficient use of federal resources to focus enforcement efforts on individuals with cancer or other serious illnesses who use marijuana as part of a recommended treatment regimen consistent with applicable state law, or their caregivers.”3

This report analyzes the existing fed-eral and state laws and describes what can be done to give patients legal ac-cess to medical marijuana. The most effective way to allow patients to use medical marijuana is for state legisla-tures to pass bills similar to the laws in New Mexico, Rhode Island, and Maine.

“The most effective way to allow patients to use medical marijuana is for state legislatures to pass

bills similar to the laws in New Mexico, Rhode

Island, and Maine.”

1 See Appendix A.2 See Table 1 for details on the 17 effective laws.3 Cole, James M. Memorandum for United States Attorneys: Guidance Regarding the Ogden Memo in

Jurisdictions Seeking to Authorize Marijuana for Medical Use. U.S. Department of Justice, Office of the Deputy Attorney General, June 29, 2011.

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1A model state medical marijuana law, which is influenced by the aforementioned

laws, can be found in Appendix Q.

Marijuana’s Medical UsesMarijuana has a wide range of therapeutic applications, including:

• relieving nausea and increasing appetite;

• reducing muscle spasms and spasticity;

• relieving chronic pain; and

• reducing intraocular (“within the eye”) pressure.

Thousands of patients and their doctors have found marijuana to be beneficial in treating the symptoms of HIV/AIDS, cancer, multiple sclerosis, glaucoma, and other serious conditions.4 For many people, marijuana is the only medicine with a suitable degree of safety and efficacy.

In March 1999, the National Academy of Sciences’ Institute of Medicine (IOM) released its landmark study, “Marijuana and Medicine: Assessing the Science Base.” The scientists who wrote the report concluded that “there are some limited circumstances in which we recommend smoking marijuana for medical uses.”5

In 2010, the Center for Medicinal Cannabis Research, which was created and funded by the California State Legislature to “coordinate rigorous scientific studies to assess the safety and efficacy of cannabis,” presented its findings. They included clinical research showing that marijuana is effective at relieving muscle spasticity associated with multiple sclerosis and at alleviating neuropathic pain, which is notoriously unresponsive to traditional medications.6

Marijuana is comprised of over 85 cannabinoids, or components. The most well-known cannabinoid, which is responsible for the “high,” is tetrahydrocannabinol (THC). Although other cannabinoids also have therapeutic value, THC (currently in synthetic form), is the only cannabinoid that can be obtained by prescription in the U.S., under the brand name Marinol. Researchers discovered that the body has receptor proteins for THC and other cannabinoids, and that it makes its own similar substances, called endocannabinoids.7

It should come as no surprise that public opinion polls find that most Americans support legal access to medical marijuana.8

4 See Appendix B for a more detailed briefing paper about marijuana’s medical uses.5 See Appendix C for excerpts from the IOM report.6 Grant, Igor M.D., et al. Report to the Legislature and Governor of the State of California: presenting findings

pursuant to SB847 which created the CMCR and provided state funding. UC San Diego Health Sciences, University of California, February 11, 2010.

7 Seppa, Nathan. “Not just a high,” Science News: Vol. 177 #13 (p.16), June 19, 2010.   http://www.sciencenews.org/view/feature/id/59872/title/Not_just_a_high

8 A January 2010 ABC News/Washington Post poll found 81% of Americans support legalizing marijuana for medical use. (Langer, Gary. “High Support for Medical Marijuana,” ABC News, January 18, 2010.)

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State-By-State Report 2011Criminalizing Patients

Federal marijuana penalties assign up to a year in prison for as little as one marijuana cigarette — and up to five years for growing even one plant. There is no exception for medical use, and many states mirror federal law.

There were 858,408 marijuana arrests in the United States in 2009, 88% of which were for possession (not sale or manufacture).9 Even if only 1% of those arrested were using marijuana for medical purposes, then there are more than 7,000 medi-cal marijuana arrests every year!

In addition, untold thousands of patients are choosing to suffer by not taking a treatment that could very well cause them to be convicted in 34 states.

Changing Federal LawThe federal Controlled Substances Act of 1970 established a series of five “sched-

ules” (categories) into which all illicit and prescription substances are placed. Marijuana is currently in Schedule I, defining the substance as having a high potential for abuse and no currently accepted medical use in treatment in the United States.10 The federal government does not allow Schedule I substances to be prescribed by doctors or sold in pharmacies. Schedule II substances, on the other hand, are defined as having accepted medical use “with severe restrictions.” Schedules III, IV, and V are progressively less restrictive.

The DEA has the authority to move marijuana into a less restrictive schedule. Despite multiple petitions and years of litigation, it has essentially been deter-mined that the DEA will not move a substance into a less restrictive schedule without an official determination of “safety and efficacy” by the U.S. Food and Drug Administration (FDA).11 The DEA most recently rejected a petition to re-schedule marijuana on July 8, 2011.12

Unfortunately, current federal research guidelines make it nearly impossible to do sufficient research to meet the FDA’s exceedingly high standard of medical efficacy for marijuana.13 Since 1995, MPP has been helping scientists attempt to navigate federal research obstacles, and it has become clear that it will take at least a decade — if ever — for the FDA to approve the use of natural marijuana as a prescription medicine. And this assumes that a privately funded company is will-ing to spend the tens of millions of dollars necessary to do the research.

Nonetheless, there are several other ways to change federal law to give patients legal access to medical marijuana:14

• Because the FDA is part of the U.S. Department of Health and Human Services (HHS), the U.S. Secretary of Health and Human Services can declare that marijuana meets sufficient standards of safety and efficacy to warrant rescheduling. However, rescheduling alone will not provide patients prescrip-tion access to marijuana.

9 FBI Uniform Crime Reports, Crime in the United States: 2009, published in September 2010.10 See Appendix E for more details on the federal Controlled Substances Act.11 Appendix B provides more information about this litigation.12 Federal Register, Vol. 76, No. 131, July 8, 2011, P. 40552. 13 See Appendix B for details on the difficulties involved with marijuana research.14 Appendix B details some of these other routes.

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1• Because Congress created the Controlled Substances Act (CSA), Congress can

change it. Some possibilities include: passing a bill to move marijuana into a less restrictive schedule, moving marijuana out of the CSA entirely, or even replacing the entire CSA with something completely different. In addition, Congress can remove criminal penalties for the medical use of marijuana re-gardless of what schedule it is in.

• HHS can allow patients to apply for special permission to use marijuana on a case-by-case basis. In 1978, the Investigational New Drug (IND) compassion-ate access program was established, enabling dozens of patients to apply for and receive marijuana from the federal government. Unfortunately, the pro-gram was closed to all new applicants in 1992, and only four are still receiving medical marijuana through the program.

All of these routes have been attempted, but have failed. Until a more sympa-thetic president and Congress are in power, there is little chance of changing federal policies to give patients legal access to medical marijuana. Consequently, the greatest chance of success is in the states.

Changing State Laws: From 1978 to 199515 States have been trying to give patients legal access to marijuana since 1978. By

1991, favorable laws had been passed in 34 states and the District of Columbia. (The 35th state, Hawaii, enacted its law in 2000, Maryland, the 36th state, enacted its law in 2003, and Delaware, the 37th state, enacted its law in 2011.)

Unfortunately, because of numerous federal restrictions, most of these laws have been largely symbolic, with little or no practical effect. For example, several states passed laws stating that doctors may “prescribe” marijuana. However, federal law prohibits doctors from writing “prescriptions” for marijuana, so doctors are un-willing to risk federal sanctions for doing so. Furthermore, even if a doctor were to give a patient an official “prescription” for marijuana, the states did not account for the fact that it is a federal crime for pharmacies to distribute it, so patients would have no way to legally fill their marijuana prescriptions.

Changing State Laws: Since 1996The tide began to turn in 1996 with the passage of a California ballot initiative.

California became the first state to effectively remove criminal penalties for quali-fying patients who possess and use medical marijuana. California’s law, like the initial wave of effective state laws, provided access by allowing patients to cultivate their own medicine or to designate a caregiver to do so.

California’s law specifies that qualifying patients need a doctor to “recommend” marijuana. By avoiding issuing a prescription, doctors are not violating federal law in order to certify their patients. (Of note, Arizona voters also passed a medi-cal marijuana initiative in 1996, but it turned out to be only symbolic because it required a prescription — an order to dispense a medication — rather than a recommendation — a statement of a doctor’s professional opinion.)

15 See “Overview of Kinds of State Laws” on page 16.

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State-By-State Report 2011Over the next four years, seven states and the District of Columbia followed in

California’s footsteps. Alaska, Oregon, Washington, and the District of Columbia passed similar initiatives in 1998. (Until 2010, Congress was able to prevent the D.C. initiative from taking effect because D.C. is a district, not a state, and is there-fore subject to strict federal oversight.) Maine passed an initiative in 1999, and Colorado and Nevada followed suit in 2000.

Also in 2000, Hawaii broke new ground, when it became the first state to enact a law to remove criminal penalties for medical marijuana users via a state legisla-ture. Gov. Ben Cayetano (D), who submitted the original bill in 1999 and signed the final measure into law on June 14, 2000, said, “The idea of using marijuana for medical purposes is one that’s going to sweep the country.”

On May 22, 2003, Gov. Robert Ehrlich of Maryland became the first Republican governor to sign workable medical marijuana legislation into law. Gov. Ehrlich signed H.B. 702, the Darrell Putman Compassionate Use Act, in the face of staunch opposition from White House drug czar John Walters. This law was a very limited sentencing mitigation — patients still faced arrest, a fine of $100 and possible related court costs, and had no means of accessing their medicine.

In fall 2003, California’s legislature and Gov. Gray Davis (D) expanded the state’s existing law to allow patients and caregivers to collectively or cooperatively culti-vate marijuana as long as it was not done for “profit.” The improved law forms the legal basis for dispensaries operating in the state, but it does not explicitly allow them, and it does not include any state regulation or registration.

Vermont became the ninth state to pass an effective medical marijuana law on May 26, 2004, when Gov. James Douglas (R) allowed S. 76, An Act Relating to Marijuana Use by Persons with Severe Illness, to become law without his signa-ture. Gov. Douglas, too, was pressured by the White House drug czar to reject the bill, but due to the high profile of the medical marijuana bill in the media and overwhelming public support by Vermonters, he decided against a veto.

In November 2004, 62% of Montana voters approved an initiative to allow quali-fied patients to use and cultivate marijuana for their medical use.

Rhode Island became the 11th state to pass an effective medical marijuana law in 2006 — and the first state to enact a medical marijuana law since the U.S. Supreme Court’s decision in Gonzales v. Raich.

Beginning in 2007, some states began to include state-regulated dispensaries in their laws. In 2007, Gov. Bill Richardson (D) signed SB 523, making New Mexico the 12th state to protect medical marijuana patients from arrest. New Mexico’s law was the first to allow state-regulated and state-licensed larger-scale providers. In addition, patients are allowed to obtain a cultivation license to grow their own medicine.

On November 4, 2008, 63% of Michigan voters approved a medical marijuana initiative, making Michigan the 13th state with an effective medical marijuana law, and the first in the Midwest. Michigan’s was the last effective state medical marijuana law enacted that relied only on home cultivation and caregivers, with-out providing for state-regulated dispensaries.

In 2009, the Rhode Island General Assembly broke new ground by becoming the first state to add regulated non-profit dispensaries, called compassion centers, to

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1its existing law. Like the state’s initial law, this was enacted over Gov. Carcieri’s veto. Maine’s voters followed suit in November 2009, approving an initiative that added non-profit dispensaries, a patient and caregiver registry, and additional qualifying conditions to the state’s medical marijuana law.

On January 18, 2010, New Jersey became the 14th medical marijuana state and the first to enact a medical marijuana law that relied solely on dispensaries, with-out providing for home cultivation. Gov. Jon Corzine (D) signed the bill into law during his last week in office, one week after the legislature approved it.

In spring 2010, the D.C. Council put the initiative voters had approved in 1998 on hold, while it significantly revised the law Congress had finally allowed to go into effect. The revisions significantly restricted the law, by removing the option of home cultivation and eliminating most of the qualifying conditions. The law allows five to eight dispensaries and up to 10 cultivation centers.

Also in spring 2010, Colorado’s legislature approved a bill that expanded the state’s existing medical marijuana law by explicitly allowing, regulating, and li-censing dispensaries (called “medical marijuana centers”) and infused product manufacturers.

In November 2010, Arizona voters approved an initiative that made their state the 15th with an effective medical marijuana law. Unlike the state’s 1996 measure, this law used “certification” instead of “prescription” to ensure it would be effec-tive. The law allows about 125 non-profit dispensaries and for patients or their caregivers to cultivate if they do not live near dispensaries. However, in May 2011, Gov. Jan Brewer suspended the dispensary portion of the law and announced a federal lawsuit questioning the validity of the state’s law.

In May 2011, the Delaware Legislature passed and Gov. Jack Markell (D) signed legislation making Delaware the 16th medical marijuana state. Like many of the more recent laws, Delaware’s new law allows for a limited number of non-profit dispensaries, three of which will be chosen based on a competitive process by January 1, 2013.

Also in 2011, Vermont’s legislature and Gov. Peter Shumlin (D) enacted leg-islation that added four non-profit dispensaries to the state’s existing medical marijuana law. The state’s Department of Public Safety must issue four dispensary registrations by June 2, 2012.

In addition, in spring 2011, Maryland’s legislature and Gov. Martin O’Malley (D) approved legislation that expanded the state’s very limited law and established a medical marijuana work group. The new law provides an affirmative defense that can prevent a conviction — but not an arrest or prosecution — for simple marijuana possession. The law still does not allow a safe means of access, such as by cultivation or dispensaries.

More than 90 million Americans — about 29% of the U.S. population — now live in the 16 states, or the federal district, where medical marijuana users are protected from criminal penalties under state law. See the chart in Appendix F for information on the number of registered patients in each state.

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State-By-State Report 2011What the New State Laws Do

The 11 initiative-created laws and the six laws created by state legislatures are similar in what they accomplish.16 Each of the 16 states and the District of Columbia allow patients to possess and use medical marijuana if approved by a medical doctor.17 Depending on the state, patients may cultivate their own mari-juana, designate a caregiver to do so, and/or obtain marijuana from a dispensary.

Fourteen of the laws allow patients to cultivate a modest amount of marijuana in their homes — all but Delaware, New Jersey, and the District of Columbia. In Arizona, patient cultivation is only allowed if the patient lives more than 25 miles away from a dispensary.

Eight states’ and the District of Columbia’s laws allow for state-regulated dis-pensing, though some of the laws are so new that their dispensaries are not yet up and running, and the dispensing programs in Arizona and Rhode Island are currently on hold. The states with laws providing for state-registered dispensaries are Arizona, Delaware, Colorado, New Mexico, Maine, New Jersey, Rhode Island, and Vermont. In addition, California has hundreds, or even thousands, of dis-pensaries, many of which are regulated at the local level, but there is no statewide licensing or regulation of them.

Hawaii

Sixteen states and the District of Columbia have laws that protect patients who possess marijuana with their doctors’ approval and allow patients to cultivate marijuana or acquire it from providers.

16 States and D.C. Have E�ective Medical Marijuana Laws

Alaska

In addition to state laws, some state courts — including the Idaho Supreme Court and a Florida Court of Appeals — have found that patients can avoid a conviction for either possession or cultivation by proving a medical necessity defense. Other states have ruled against a necessity defense. Details are available at Appendix K.

16 See Table 1 for specifics on each state law. Also see Appendix F for how these laws are working in the real world.17 The text of New Mexico’s law does not specify that patients can cultivate marijuana; it provides for state-

regulated distribution and allows the department to determine how much marijuana patients and their caregivers can possess. The New Mexico Department of Health enacted rules allowing the amount of marijuana patients can possess to include plants.

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1In addition, under each of the state laws, physicians are immune from liability

for discussing or recommending medical marijuana in accordance with the law.

To qualify for protection under the law, patients must have documentation veri-fying they have been diagnosed with a specified serious illness. The conditions are not specified in California, although in most states there is a defined list of medical conditions.

States generally require a statement of approval signed by the patient’s physi-cian. To help law enforcement identify qualifying patients, all but one of the states (Washington) have implemented formal state registry programs that issue identi-fication cards to registered patients and their caregivers, though the ID cards are voluntary in California and Maine.

Patients’ marijuana possession and cultivation limits are generally restricted to a concrete number: one to 24 ounces of usable marijuana and six to 24 plants, sometimes limiting the number that can be mature. (California’s 1996 medical marijuana law permits enough marijuana “for the personal medical purposes of the patient.” A 2003 addition to the law, S.B. 420, guarantees protection from ar-rest for patients who possess state-issued ID cards and up to eight ounces of usable marijuana and six mature plants or 12 immature plants.)

In many states, regardless of whether patients grow their own, get it from a care-giver or dispensary, or buy it from the criminal market, a patient in possession of an allowable quantity of marijuana and otherwise in compliance with the law is protected from arrest and/or conviction. However, New Jersey and Washington, D.C. only allow patients to possess marijuana that was obtained from dispensaries.

To illustrate how the laws work, consider the following prototypical vignette:

“Joe” has AIDS. His doctor advised him that marijuana could boost his appetite, so he has three marijuana plants growing in a locked closet in his apartment, and he uses a smoke-free vaporizer to consume four puffs of marijuana every evening before dinner. One day, Joe’s neighbor smells marijuana and calls the police. The officer knocks on Joe’s door, and when Joe opens it, the officer sees the vaporizer on the table.

Luckily, Joe lives in one of the 16 states with an effective medical marijuana law. Joe acknowledges using marijuana, but then shows the officer his state-issued ID card. The officer calls the state health department to verify the ID card, gives Joe his best wishes, and goes on his way.

If Joe lived in one of the 34 other states, he would be arrested, prosecuted, and possibly sent to prison.

Most of the state laws protect patients who are complying with the state’s law and have an ID card from being arrested. The other states have a defense that can be raised in court to prevent a conviction.18

18 See Appendix G for more detailed definitions of these defenses.

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State-By-State Report 2011Is There Conflict Between Modern State Laws and Federal Law?

In the 15 years since California and other states began protecting medical mari-juana patients from arrest, many questions have surfaced regarding the status of those laws in relation to federal law. Some believe that the federal government can nullify state laws, or that state laws have no real value in the face of conflicting federal law. That is not the case.

Even though federal authorities can penalize patients for violating federal mari-juana laws, and a state cannot require its employees to violate federal law, a state government is not required to have laws identical to those of the federal gov-ernment. A state may remove its criminal penalties for possessing, growing, or distributing marijuana for medical (or even non-medical) purposes.

This crucial distinction is often misunderstood: It is true that the federal gov-ernment can enforce federal laws anywhere in the United States, even within the boundaries of a state that rejects those laws. Nevertheless, the federal government cannot force states to criminalize conduct that is illegal under federal law, nor can the federal government force state and local police to enforce federal laws.

Hawaii

Alaska

Washington,DC

Sixteen states and Washington, D.C. have laws that protect patients who possess marijuana with their doctors’ approval and allow patients to cultivate or acquire marijuana.

Fifteen states have laws that recognize marijuana’s medical value, but these laws are ineffective because they rely on federal cooperation.

Maryland protects medical marijuana patients from a criminal conviction. It does not allow cultivation or dispensaries, and it does not prevent patients’ arrest.

32 States With Medical Marijuana Laws, 2011

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1A handful of state courts have ruled on arguments that federal law preempts

(or overrules) some or all of a state’s medical marijuana law. All appellate-level decisions on the issue have found that removing a state’s criminal penalties is not preempted by federal law, and two decisions finding against preemption were denied review by the U.S. Supreme Court. However, there have been conflict-ing appellate court rulings in California about whether a city can actively license dispensaries, rather than just decriminalizing and regulating them. In addition, the Oregon Supreme Court found that the state’s medical marijuana law was pre-empted in its application to employment law protections, though the case strongly indicated that the act’s criminal law protections were not preempted.

Beginning in 2005, three California counties — San Diego, San Bernardino, and Merced — that did not want to implement the state’s medical marijuana ID card program filed suit. The counties claimed that the ID cards and much of the rest of California’s medical marijuana law were invalid because of federal law and treaties. The counties lost in the superior court in December 2006. Merced then dropped out of the case, and the two remaining counties lost a unanimous ruling at the appellate level in July 2008. The court noted, “Congress does not have the authority to compel the states to direct their law enforcement personnel to enforce federal laws.” The counties next appealed to the California Supreme Court, which denied the petition for review in October 2008. The United States Supreme Court denied the counties’ petition for certiorari (review) in May 2009, finalizing the case and allowing the appeals court decision to stand.19

At least three other cases in California raised the issue of federal preemption. In City of Garden Grove v. Superior Court, the Fourth District of the California Court of Appeals held that the police must return medical marijuana to a patient and that returning the medicine is not precluded by principles of federal preemption.20

In Qualified Patient Association v. Anaheim, the same court ruled against a claim of federal preemption in the context of a city refusing to allow a dispensing col-lective to operate.21 However, in Ryan Pack v. Long Beach, a different California appellate court ruled that the city could not issue permits on a lottery basis that do more than confirm that the entity is exempt from state criminal penalties, but that the state could decriminalize collectives and cooperatives and the city could issue regulations.22

In May 2011, Arizona Gov. Jan Brewer and Attorney General Tom Horne filed a lawsuit in federal court questioning the validity of the medical marijuana program established in Arizona by the passage of Proposition 203 in November of 2010. As of publication, the federal Department of Justice, the ACLU, and attorneys for medical marijuana patients and providers have asked a federal judge to dismiss the case, but there have not yet been any rulings.

19 County of San Diego v. San Diego NORML, 165 Cal.App.4th 798, (Cal.App. 4th Dist. 2008), review denied (Cal. 2008), cert denied, 129 S.Ct. 2380 (2009).

20 City of Garden Grove v. Superior Court, 68 157 Cal.App.4th 355 (Cal.App. 4 th Dist. 2007), review denied (Cal. 2008), cert denied 129 S.Ct 623 (2008).

21 Qualified Patients Association v. City of Anaheim, 187 Cal.App.4th 734 (Cal.App. 4 Dist., 2010).22 Ryan Pack v. Long Beach, 2011 WL 4553155 (Cal.App. 2 Dist., 2011).

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State-By-State Report 2011Federal Law Enforcement and State Medical Marijuana Programs

The federal-state division of power is extremely advantageous to patients who need to use marijuana: Because 99% of all marijuana arrests in the nation are made by state and local — not federal — officials, favorable state laws effectively protect 99 out of every 100 medical marijuana users who otherwise would have been prosecuted. Federal drug enforcement agents simply do not have the re-sources or the mandate to patrol the streets of a state to look for cancer patients growing a few marijuana plants.23

32 States Considered Medical Marijuana Legislation in 2011

Hawaii

During the 2011 legislative session:

Eighteen states considered bills to create new laws protecting medical marijuana patients and providers from arrest and prosecution.

Texas considered a bill to protect medical marijuana patients from being convicted, but not arrested. Maryland passed a law that protects patients from conviction, but not arrest, for possession.

Twelve states considered bills to amend existing, effective medical marijuana laws.

Tennessee considered a bill that would have been only symbolic because of the use of the word “prescribe.”

For more information about these bills and their statuses, please see Appendix L.

23 See FBI Uniform Crime Reports 2002. (U.S. Government Printing Office, 2003) p. 223, Table 4.1 and p. 224, Table 29 and Compendium of Federal Justice Statistics 2002. (Bureau of Justice Statistics, 2004), p. 13, Figure 1.1. Calculations derived from the two cited Uniform Crime Reports tables show that there were a total of 697,082 marijuana arrests nationwide during 2002. The Compendium of Federal Justice Statistics table states that there were 7,464 arrests for federal marijuana offenses in the 12-month period ending on September 30, 2002. Thus, the arrests for federal marijuana charges are 1.07% of the total marijuana arrests. Note, however, that the actual number of persons arrested by federal agents on federal charges is even lower than 7,464 — 5% of persons arrested on federal charges were arrested by state and local agencies.

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1In fact, the federal government has declared its intention not to pursue patients

and their caregivers who possess or use small amounts of marijuana for medical use. However, distributors of medical marijuana are on the federal radar screen, particularly if they are large-scale and not registered or licensed by their states.

In October 2009, the Department of Justice issued a memorandum to the United States attorneys. Then Deputy Attorney General David Ogden stated that U.S. attorneys in medical marijuana states “should not focus federal resources . . . on individuals whose actions are in clear and unambiguous compliance with existing state laws providing for the medical use of marijuana.”24

The DOJ issued a narrower memorandum in June 2011. This memo reiterated “that it is likely not an efficient use of federal resources to focus enforcement ef-forts on individuals with cancer or other serious illnesses who use marijuana as part of a recommended treatment regimen consistent with applicable state law, or their caregivers.” However, it also stated that “prosecution of significant traffick-ers of illegal drugs, including marijuana, remains a core priority.”25 It also defined caregivers as people caring for individuals with cancer or other serious illnesses, not “commercial operations cultivating, selling or distributing marijuana.”

What does this mean in practice? Since the Ogden memo was issued, the vast ma-jority of federal medical marijuana raids have taken place in four of the 16 medical marijuana states — California, Montana, Michigan, and Washington. Although different in their specific language, the medical marijuana laws of these four states share a common characteristic — their respective state medical marijuana laws do not set up any state regulation or registration system to identify those larger-scale providers that are operating in compliance with state laws. Colorado is the only state where raids have occurred that provides for state licensing of larger-scale growers and distributors, but the licensing law passed after the raids.

In states that have enacted laws that provide for state-regulated and registered medical marijuana distribution centers, such as New Mexico and Maine, we have seen no federal raids on providers legally operating under state law. As of fall 2011, it appears that, in practice, U.S. attorneys and the DEA have not been target-ing providers who are in clear compliance with tightly regulated state laws that include state licensing or registration. (See Appendix S.)

24 Ogden, David. Memorandum for Selected United States Attorneys: Investigations and Prosecutions in States Authorizing the Medical Use of Marijuana. United States Department of Justice, Office of the Deputy Attorney General, October 19, 2009.

25 Cole, James M. Memorandum for United States Attorneys: Guidance Regarding the Ogden Memo in Jurisdictions Seeking to Authorize Marijuana for Medical Use. U.S. Department of Justice, Office of the Deputy Attorney General, June 29, 2011.

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State-By-State Report 2011Federal Court Rulings

Although most medical marijuana cases are resolved in state courts, some cases have been heard in the federal courts.

To date, there have been only two medical marijuana cases heard by the U.S. Supreme Court: U.S. v. Oakland Cannabis Buyers’ Cooperative (OCBC) and Gonzales v. Raich.26 These cases do not challenge the legitimacy of state medical marijuana laws and therefore do not affect the ability of states to protect medical marijuana patients under state law. Instead, they focus solely on federal issues. (Three more cases, Conant v. Walters and two cases where state courts ruled against preemption challenges, were appealed to the U.S. Supreme Court, but the court chose not to hear the cases.)

In the OCBC case, the U.S. Supreme Court unanimously ruled (8–0) that medi-cal marijuana distributors cannot assert a “medical necessity” defense against federal marijuana distribution charges. The ruling, issued on May 14, 2001, does not overturn state laws allowing seriously ill people to possess and grow their own medical marijuana.

OCBC dealt exclusively with federal law and was essentially limited to distribu-tion issues. The case did not question a state’s ability to allow patients to grow, possess, and use medical marijuana under state law, and it presents no foreseeable barriers to additional state-level protections.

At issue in Gonzales v. Raich was whether the federal government has the constitu-tional authority to arrest and prosecute patients who are using medical marijuana in compliance with state laws. On June 6, 2005, the U.S. Supreme Court ruled 6-3 that the federal government can continue arresting patients who use medical marijuana legally under their state laws. However, the court did not overturn state medical marijuana laws or in any way interfere with their continued operation.

Gonzales v. Raich does not affect states’ ability to pass medical marijuana laws — and it does not overturn the laws now protecting the rights of Americans liv-ing in Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, Washington state, and the District of Columbia to use medical marijuana legally under state laws.

Conant considered whether the federal government can punish physicians for discussing or recommending medical marijuana. The U.S. District Court for the Northern District of California ruled in September 2000 that the federal govern-ment cannot gag doctors in this fashion; the ruling was upheld in an October 2002 opinion from the Ninth U.S. Circuit Court of Appeals. The federal government filed an appeal with the U.S. Supreme Court, which chose not to hear the case on October 14, 2003. This is the only appellate court decision on the issue of phy-sicians recommending medical marijuana, and it is controlling law in the eight medical marijuana states in the Ninth Circuit. This unanimous decision in the Ninth Circuit is solidly grounded in the First Amendment, and physicians who evaluate the risks and benefits of the medical uses of marijuana outside the Ninth Circuit should also have nothing to fear.

26 See Appendix I.

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1There are other important federal cases that have not (yet) made it up to the U.S.

Supreme Court; these are reviewed in Appendix I.

At the state level, the vast majority of cases that have emerged have questioned whether individuals or organizations are in compliance with state law and the extent of protections they are entitled to — such as regarding employment rights and the right to use medical marijuana while on probation.

Generally, state-level cases have focused on whether individuals qualify as pa-tients or caregivers or whether they possess an amount of marijuana in excess of the specified legal limit.

Overview of Kinds of State LawsAt various times since 1978, 37 states and the District of Columbia have had

favorable medical marijuana laws.

Laws in five states have either expired or been repealed, but 32 states and D.C. currently have laws on the books. Although well-intentioned, most of these laws do not provide effective protection for patients who need to use medical marijuana.

Because some states have enacted more than one type of law, the totals for the following subsections add up to more than 37.

Effective lawsThe only laws that currently provide meaningful protection for patients are ones

that remove state-level criminal penalties for possession and use of medical mari-juana and provide a means of access. Sixteen states – Alaska, Arizona, California, Colorado, Delaware, Hawaii, Maine, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, and Washington – and the District of Columbia have effective laws of this nature, all of which have been enacted since 1996.

Workable lawsMaryland is the only state that has what MPP considers a “workable law.”

Maryland’s law does not address cultivation or distribution, leaving only one op-tion for patient access – drug dealers. In addition, Maryland only provides medical marijuana patients with an affirmative defense at trial, meaning they are protected from jail sentences and fines, but not from arrest.

Therapeutic research programs27 The eight states listed under this title in Appendix A, plus California, New Jersey,

New Mexico, Rhode Island, and Washington, currently have laws that allow pa-tients to legally use medical marijuana through state-run therapeutic research programs. During the late 1970s and early 1980s, at least seven states obtained all of the necessary federal permissions, received marijuana from the federal govern-ment, and distributed the marijuana to approved patients through pharmacies.

27 See Appendix J for details on therapeutic research programs.

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State-By-State Report 2011The federal approval process for medical marijuana research is excessively cum-

bersome. As a result, state health departments are generally unwilling to devote their limited resources to the long and probably fruitless application process, nor are they willing to spend taxpayer money administering the program. Additionally, many patient advocates oppose research programs as the primary mode of access to medical marijuana because enrollment in such programs is highly restrictive.

In sum, therapeutic research program laws are no longer effective because of federal obstructionism.

Symbolic measures/Pseudo-prescriptive accessEight states have laws that allow patients to possess marijuana if obtained di-

rectly through a valid prescription. The problem is that there is no legal supply of marijuana to fill such a prescription. Federal law prohibits the distribution of marijuana and other Schedule I substances for any reason other than research. Doctors cannot “prescribe” marijuana, and pharmacies cannot dispense it.

Prescriptive-access laws demonstrate a state’s recognition of marijuana’s thera-peutic value, but they are not effective as written without a change in federal policy.

Establishing provisions for the state government to distribute confiscated marijuana

Before it was repealed in 1987, an Oregon law allowed physicians to prescribe confiscated marijuana. Several other states have considered similar legislation, although it does not appear that confiscated marijuana has ever been distributed in any state.

It is one thing for state governments to look the other way while patients grow medical marijuana for themselves, but it’s another thing for the state government itself to distribute a Schedule I substance for anything other than federally-approved research. State officials could be subject to federal prosecution for marijuana distribution if they provide marijuana to patients. Another concern is that confiscated marijuana may contain adulterants and would require screening, which could be prohibitively expensive.

Rescheduling marijuanaStates have their own controlled substance schedules, which typically mirror

the federal government’s. However, states are free to schedule substances as they see fit.

Five states — Alaska, Iowa, Montana, Oregon, and Tennessee — and the District of Columbia currently place marijuana in schedules that recognize its therapeutic value.

However, there is little or no practical significance to rescheduling marijuana on the state level because the federal schedule supersedes state schedules, and the federal government does not permit marijuana prescriptions. As with “pseudo-prescriptive access” laws, it is unclear whether courts would interpret these laws as permitting a “medical necessity” defense.

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1Non-binding resolutions

At least seven state legislatures — California, Michigan, Missouri, New Hampshire, New Mexico, Rhode Island, and Washington—have passed non-binding resolutions urging the federal government to allow doctors to prescribe marijuana. Non-binding resolutions are passed by one or both chambers of a state’s legislature and do not require the governor’s signature. The resolutions send a message, officially proclaiming the legislatures’ positions, but do not change state policy and are unlikely to be of any practical help to patients.

Laws that have expired or been repealedIn addition to the 32 states with current laws, Arkansas, Florida, North Carolina,

and West Virginia have repealed their medical marijuana laws. In Ohio, one law expired and a second law was repealed. A few other states have had laws that have expired or been repealed, but subsequently enacted other medical marijuana laws that are still on the books.

And, finally, 13 states have never had favorable medical marijuana laws.

Where Things Are Going From HereThe 11 medical marijuana initiatives that voters approved have been described

as the first wave of activity to protect medical marijuana patients nationwide. Not only do they provide legal protection for patients in states that collectively contain almost 25% of the U.S. population, they also verify Americans’ strong support for favorable medical marijuana laws.

In turn, the successes in Hawaii and five subsequent legislatures are the second wave, whereby state legislatures are enacting effective laws to protect medical marijuana patients. In the 2011 legislative session, Delaware’s legislature enacted medical marijuana legislation, and 17 other state legislatures considered bills to allow medical marijuana under state law.

In addition, many medical marijuana states are considering adding dispensa-ries or collective cultivation to existing laws, or regulating existing dispensaries or producers. Eight state laws and the District of Columbia’s now provide for state-regulated, state-registered larger-scale providers. Six additional states saw the introduction of proposals to add dispensaries or collectives to existing laws in 2011. Many of these proposals, as well as the new medical marijuana laws, call for competitive licensing of dispensary operators to ensure best practices in the industry.

The role of state legislatures in the movement to protect medical marijuana pa-tients cannot be overstated. Only 23 states and the District of Columbia have the initiative process, which means that citizens in 27 states cannot directly enact their own laws. They must rely on their state legislatures to enact favorable medical marijuana laws, and the number of future legislative victories will depend on how many people effectively lobby their state officials. Moreover, legislation is much more cost-effective than ballot initiatives, which can be very expensive endeavors.

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State-By-State Report 2011The passage of additional state medical marijuana laws will have the added ben-

efit of pressuring the federal government to change its laws.

The third and final wave will be a change in federal law. While it is unlikely that federal law will change in the immediate future, the more states act, the sooner federal law will change. In 2011, Rep. Barney Frank (D-Mass) introduced H.R. 1983, which would remove marijuana from Schedule I and remove federal crimi-nal penalties for those acting in compliance with state medical marijuana laws.

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1TABLE 1: Effective Medical Marijuana Laws in 16 States and Washington, D.C.

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8

(bal

lot i

niti

ativ

e/58

%)

Nov

embe

r 3, 1

998

(mod

ified

by

S.B

. 94,

ef

fect

ive

June

2, 1

999)

Affi

rmat

ive

defe

nse

prov

ided

onl

y fo

r tho

se

regi

ster

ed w

ith

the

stat

eb

Wit

h st

ate

Dep

artm

ent

of H

ealt

h an

d So

cial

Se

rvic

es

One

oun

ce o

f mar

ijuan

a in

us

able

form

and

six

mar

ijuan

a pl

ants

, wit

h no

mor

e th

an

thre

e m

atur

e an

d flo

wer

ing

plan

ts p

rodu

cing

usa

ble

mar

ijuan

a at

any

one

tim

e

One

pri

mar

y an

d on

e al

tern

ate

care

give

r who

m

ay se

rve

only

one

pa

tien

t at a

tim

e, w

ith

limit

ed e

xcep

tion

s

Not

allo

wed

No

Ari

zona

Prop

osit

ion

203

(bal

lot

init

iati

ve/5

0.1%

) N

ovem

ber 2

, 201

0

Exem

ptio

n fr

om a

rres

t and

pr

osec

utio

n if

in la

wfu

l po

sses

sion

of a

regi

stry

ca

rd; a

lso

an a

ffirm

ativ

e de

fens

e th

at su

nset

onc

e ca

rds b

ecam

e av

aila

ble

Wit

h st

ate

Dep

artm

ent

of H

ealt

h Se

rvic

es2.

5 ou

nces

of u

sabl

e m

ariju

ana.

Pat

ient

s loc

ated

m

ore

than

25

mile

s fro

m a

m

edic

al m

ariju

ana

disp

ensa

ry

may

cul

tiva

te 1

2 pl

ants

in a

n en

clos

ed, l

ocke

d fa

cilit

y

One

car

egiv

er p

er

pati

ent;

a ca

regi

ver m

ay

assi

st u

p to

five

pat

ient

s at

a ti

me

Dep

artm

ent o

f Hea

lth

Serv

ices

-reg

ulat

ed

not-

for-

prof

it d

ispe

nsar

ies,

up to

125

may

be

regi

ster

ed (

one

for e

very

10

pha

rmac

ies)

, but

the

disp

ensa

ry a

pplic

atio

n pr

oces

s was

hal

ted

in M

ay

2011

Yes,

for p

atie

nts

wit

h co

ndit

ions

that

qu

alify

und

er A

rizo

na

law

, but

not

for

obta

inin

g m

ariju

ana

from

dis

pens

arie

s

Cal

ifor

nia

Prop

osit

ion

215

(b

allo

t ini

tiat

ive/

56%

)N

ovem

ber 5

, 199

6(m

odifi

ed b

y S.

B. 4

20,

effe

ctiv

e Ja

nuar

y 1,

200

4)

Exem

ptio

n fr

om a

rres

t fo

r tho

se w

ith

volu

ntar

y ID

car

ds; a

ffirm

ativ

e de

fens

e or

dis

mis

sal f

or

thos

e w

ith

only

wri

tten

re

com

men

dati

ons

Vol

unta

ry p

atie

nt

regi

stry

syst

em;

care

give

rs a

nd p

atie

nts

wit

h ID

s are

ver

ified

th

roug

h th

e C

alifo

rnia

M

edic

al M

ariju

ana

Prog

ram

Web

site

The

stat

e in

itia

tive

, whi

ch

cann

ot b

e am

ende

d by

le

gisl

atio

n, d

id n

ot in

clud

e lim

its;

the

legi

slat

ure

late

r en

acte

d sa

fe h

arbo

r am

ount

s, w

hich

are

not

cap

s, se

e A

ppen

dix

F fo

r det

ails

The

indi

vidu

al

desi

gnat

ed b

y th

e pa

tien

t w

ho h

as c

onsi

sten

tly

assu

med

resp

onsi

bilit

y fo

r th

e ho

usin

g, h

ealt

h, o

r sa

fety

of t

hat p

erso

n; th

is

may

incl

ude

a pe

rson

who

w

as d

esig

nate

d by

mor

e th

an o

ne p

atie

nt if

they

al

l res

ide

in th

e sa

me

city

or

cou

nty

Col

lect

ives

and

co

oper

ativ

es a

re a

llow

ed;

ther

e is

no

stat

e lic

ensi

ng

or re

gist

rati

on; t

hey

pay

the

gene

ral s

tate

sale

s ta

x an

d so

me

citi

es h

ave

spec

ific

taxe

s and

fees

No

Col

orad

oA

men

dmen

t 20

(bal

lot

init

iati

ve/5

4%)

Nov

embe

r 7, 2

000

(mod

ified

by

HB

128

4,

effe

ctiv

e Ju

ly 1

, 201

0)

Exem

ptio

n fr

om

pros

ecut

ion

if in

law

ful

poss

essi

on o

f a re

gist

ry

card

; affi

rmat

ive

defe

nse

if no

t reg

iste

red

but i

n co

mpl

ianc

e w

ith

the

law

Wit

h st

ate

Dep

artm

ent

of P

ublic

Hea

lth

and

Envi

ronm

ent

Two

usab

le o

unce

s and

six

plan

ts, t

hree

of w

hich

may

be

mat

ure;

pat

ient

s may

use

af

firm

ativ

e de

fens

e to

arg

ue

that

gre

ater

am

ount

s are

m

edic

ally

nec

essa

ry

An

indi

vidu

al w

ho h

as

sign

ifica

nt re

spon

sibi

lity

for m

anag

ing

the

wel

l-be

ing

of th

e pa

tien

t; ge

nera

lly, a

car

egiv

er

cann

ot a

ssis

t mor

e th

an

five

pati

ents

Yes,

abou

t 1,0

00

disp

ensa

ries

– c

alle

d “m

edic

al m

ariju

ana

cent

ers”

– a

re re

gula

ted

and

regi

ster

ed b

oth

loca

lly a

nd b

y th

e st

ate

Dep

artm

ent o

f Rev

enue

; m

edic

al m

ariju

ana

is

subj

ect t

o sa

les t

ax,

thou

gh th

ere

is a

n ex

empt

ion

for i

ndig

ent

pati

ents

No

Page 25: State by State Laws Report 2011

21

State-By-State Report 2011TA

BLE

1: E

ffect

ive

Med

ical

Mar

ijuan

a La

ws i

n 16

Sta

tes a

nd W

ashi

ngto

n, D

.C.

Stat

e;

Mea

sure

/% o

f vot

e;

Dat

e en

acte

d

How

law

pro

tect

s pat

ient

s (d

efen

ses p

rovi

ded)

aRe

gist

ry sy

stem

for

patie

nts a

nd

care

give

rs

Mar

ijuan

a

quan

tity

limits

Car

egiv

er p

rovi

sions

Disp

ensa

ries

Reco

gniz

es

out-

of-s

tate

ID

car

ds

Del

awar

eSB

17

(ena

cted

by

legi

slat

ure)

M

ay 1

3, 2

011

Exem

ptio

n fr

om a

rres

t and

pr

osec

utio

n if

in la

wfu

l po

sses

sion

of a

regi

stry

ca

rd; a

ffirm

ativ

e de

fens

e un

der c

erta

in c

ondi

tion

s, su

ch a

s bef

ore

regi

stry

ID

car

ds a

re a

vaila

ble

and

whi

le w

aiti

ng fo

r the

de

part

men

t to

proc

ess a

pa

tien

t app

licat

ion

Wit

h st

ate

Dep

artm

ent

of H

ealt

h an

d So

cial

Se

rvic

es

Six

ounc

es o

f usa

ble

mar

ijuan

a; th

ree

ounc

es c

an

be o

btai

ned

from

a d

ispe

nsar

y ev

ery

14 d

ays

One

car

egiv

er p

er

pati

ent;

a ca

regi

ver m

ay

assi

st u

p to

five

pat

ient

s at

a ti

me;

car

egiv

ers m

ay

not c

ulti

vate

mar

ijuan

a

Dep

artm

ent o

f Hea

lth

and

Soci

al S

ervi

ces-

regu

late

d no

t-fo

r-pr

ofit

di

spen

sari

es a

re a

llow

ed;

ther

e w

ill b

e th

ree

non-

prof

it c

ompa

ssio

n ce

nter

s by

Jan.

1, 2

013,

thre

e m

ore

by 2

014,

and

mor

e ca

n be

add

ed

Yes,

for p

atie

nts

wit

h co

ndit

ions

th

at q

ualif

y un

der

Del

awar

e la

w, b

ut a

D

elaw

are

regi

stry

car

d is

nee

ded

to o

btai

n m

ariju

ana

from

di

spen

sari

es

Dis

tric

t of

Col

umbi

aIn

itia

tive

59

(bal

lot

init

iati

ve/6

9%)

Nov

embe

r 3, 1

998

(effe

ctiv

e da

te d

elay

ed

by C

ongr

essi

onal

act

ion,

am

ende

d by

B-1

8-62

2 —

en

acte

d by

legi

slat

ure

— Ju

ly

27, 2

010

)

Exem

ptio

n fr

om a

rres

t and

pr

osec

utio

n if

in la

wfu

l po

sses

sion

of a

regi

stry

car

d

Wit

h D

epar

tmen

t of

Hea

lth

Two

ounc

es o

f dri

ed

mar

ijuan

a, th

ough

the

law

al

low

s the

may

or to

incr

ease

th

e lim

it to

four

oun

ces b

y ru

lem

akin

g

Car

egiv

ers m

ay n

ot

cult

ivat

e m

ariju

ana,

bu

t may

obt

ain

it fr

om

a di

spen

sary

on

the

pati

ent’s

beh

alf a

nd a

ssis

t w

ith

adm

inis

trat

ion;

pa

tien

ts m

ay h

ave

one

care

give

r, an

d ca

regi

vers

m

ay a

ssis

t onl

y on

e pa

tien

t

Yes,

regu

late

d by

the

Dep

artm

ent o

f Hea

lth;

10

cul

tiva

tion

cen

ters

are

to

be

issu

ed re

gist

rati

ons

in Ja

nuar

y 20

12, a

nd

five

disp

ensa

ries

will

be

regi

ster

ed sh

ortl

y th

erea

fter

; the

may

or m

ay

incr

ease

the

num

ber o

f di

spen

sari

es to

eig

ht b

y ru

le, t

here

is n

o lim

it o

n th

e nu

mbe

r of c

ulti

vati

on

cent

ers

No

Haw

aii

S.B

. 862

HD

1

(ena

cted

by

legi

slat

ure)

June

14,

200

0

Exem

ptio

n fr

om

pros

ecut

ion

if in

law

ful

poss

essi

on o

f a re

gist

ry

card

; “ch

oice

of e

vils

” de

fens

e al

so o

n th

e bo

oks,

inde

pend

ent o

f thi

s sta

tute

Wit

h st

ate

Dep

artm

ent

of P

ublic

Saf

ety

Seve

n pl

ants

, thr

ee o

f w

hich

may

be

mat

ure,

and

on

e ou

nce

per m

atur

e pl

ant

One

car

egiv

er p

er

pati

ent,

and

a ca

regi

ver

may

serv

e on

ly o

ne

pati

ent a

t any

giv

en ti

me

Not

allo

wed

No

Mai

neQ

uest

ion

2

(bal

lot i

niti

ativ

e/61

%)

Nov

embe

r 2, 1

999

(mod

ified

by

L.D

. 611

in

2002

; by

Que

stio

n 5

in 2

009,

a

ballo

t ini

tiat

ive/

59%

; by

LD 1

811

in 2

010;

and

by

LD

1296

in 2

011)

Exem

ptio

n fr

om a

rres

t and

pr

osec

utio

n if

in la

wfu

l po

sses

sion

of a

regi

stry

car

d or

a w

ritt

en c

erti

ficat

ion

from

a p

hysi

cian

Yes,

wit

h th

e D

epar

tmen

t of H

ealt

h an

d H

uman

Ser

vice

s, th

ough

regi

ster

ing

is

opti

onal

for p

atie

nts

and

care

give

rs o

f pa

tien

ts w

ho a

re fa

mily

or

hou

seho

ld m

embe

rs

2.5

ounc

es o

f usa

ble

mar

ijuan

a an

d si

x m

atur

e pl

ants

; pat

ient

s cha

rged

w

ith

poss

essi

on o

f exc

ess

mar

ijuan

a m

ay p

lead

, as a

de

fens

e, th

at su

ch e

xces

s m

ariju

ana

was

nec

essa

ry

to e

nsur

e un

inte

rrup

ted

avai

labi

lity

Pati

ents

who

do

not

obta

in m

ariju

ana

from

a

disp

ensa

ry m

ay a

ppoi

nt

one

care

give

r to

cult

ivat

e up

to si

x m

atur

e pl

ants

on

thei

r beh

alf;

care

give

rs

may

ass

ist u

p to

five

pa

tien

ts

Yes,

the

Dep

artm

ent

of H

ealt

h an

d H

uman

Se

rvic

es re

gula

tes e

ight

no

n-pr

ofit

dis

pens

arie

s; pa

tien

ts m

ay o

nly

obta

in

mar

ijuan

a fr

om th

eir

desi

gnat

ed d

ispe

nsar

y

Yes,

but v

isit

ing

pati

ents

may

not

ob

tain

mar

ijuan

a fr

om a

Mai

ne

disp

ensa

ry

Page 26: State by State Laws Report 2011

22

Stat

e-By

-Sta

te R

epor

t 201

1

TABL

E 1:

Effe

ctiv

e M

edic

al M

ariju

ana

Law

s in

16 S

tate

s and

Was

hing

ton,

D.C

.St

ate;

M

easu

re/%

of v

ote;

D

ate

enac

ted

How

law

pro

tect

s pat

ient

s (d

efen

ses p

rovi

ded)

aRe

gist

ry sy

stem

for

patie

nts a

nd

care

give

rs

Mar

ijuan

a

quan

tity

limits

Car

egiv

er p

rovi

sions

Disp

ensa

ries

Reco

gniz

es

out-

of-s

tate

ID

car

ds

Mic

higa

n Pr

opos

al 1

(b

allo

t ini

tiat

ive/

63%

)N

ovem

ber 4

, 200

8

Exem

ptio

n fr

om a

rres

t and

pr

osec

utio

n if

in la

wfu

l po

sses

sion

of a

regi

stry

car

d

Wit

h th

e st

ate

Dep

artm

ent o

f C

omm

unit

y H

ealt

h

2.5

usab

le o

unce

s and

12

plan

tsO

ne c

areg

iver

per

pa

tien

t, fiv

e pa

tien

ts p

er

care

give

r

Not

pro

vide

d fo

r in

stat

e la

w (

see

Peop

le v

. C

ompa

ssio

nate

Apo

thec

ary,

Is

abel

la C

ount

y C

ourt

of

App

eals

(A

ug. 2

3,

2011

)), t

houg

h so

me

mun

icip

alit

ies l

icen

se a

nd

regu

late

dis

pens

arie

s

Yes

Mon

tana

Init

iati

ve 1

48 (

ballo

t in

itia

tive

/62%

) N

ovem

ber 2

, 200

4 (m

odifi

ed b

y S.

B. 4

23,

effe

ctiv

e Ju

ly 1

, 201

1)c

Exem

ptio

n fr

om a

rres

t and

pr

osec

utio

n if

in la

wfu

l po

sses

sion

of a

regi

stry

car

d

Wit

h st

ate

Dep

artm

ent

of P

ublic

Hea

lth

and

Hum

an S

ervi

ces

One

oun

ce o

f usa

ble

mar

ijuan

a; e

ithe

r pat

ient

s, or

pro

vide

rs o

n be

half

of

pati

ents

(bu

t not

bot

h), m

ay

poss

ess f

our m

atur

e pl

ants

an

d 12

seed

lings

One

pro

vide

r per

pat

ient

; if

S.B

. 423

is h

eld

to b

e co

nsti

tuti

onal

, pro

vide

rs

will

onl

y be

abl

e to

ass

ist

thre

e pa

tien

ts a

t a ti

me

and

will

not

be

able

to

rece

ive

com

pens

atio

n

Not

allo

wed

und

er S

.B.

423;

how

ever

, due

to a

co

urt c

ase

chal

leng

ing

S.B

. 423

, as o

f fal

l 201

1,

prov

ider

s can

ass

ist a

n un

limit

ed n

umbe

r of

pati

ents

and

rece

ive

com

pens

atio

n

No

Nev

ada

A.B

. 453

(en

acte

d by

the

legi

slatu

re; i

mpl

emen

ts b

allo

t in

itiat

ive

Que

stio

n 9,

whi

ch

pass

ed w

ith 5

9% o

f the

vot

e in

19

98 a

nd a

gain

with

65%

on

Nov

embe

r 7, 2

000)

June

14,

200

1(m

odifi

ed b

y A

.B. 5

19,

effe

ctiv

e Ju

ly 1

, 200

5)

Exem

ptio

n fr

om

pros

ecut

ion

if in

law

ful

poss

essi

on o

f a re

gist

ry

card

; affi

rmat

ive

defe

nse

if no

t reg

iste

red

but i

n co

mpl

ianc

e w

ith

the

law

Wit

h st

ate

Dep

artm

ent

of H

ealt

h an

d H

uman

Se

rvic

es

One

usa

ble

ounc

e an

d se

ven

plan

ts, t

hree

of w

hich

may

be

mat

ure;

pat

ient

s may

use

af

firm

ativ

e de

fens

e to

arg

ue

that

gre

ater

am

ount

s are

m

edic

ally

nec

essa

ry

One

car

egiv

er p

er

pati

ent,

alth

ough

ca

regi

vers

can

serv

e m

ulti

ple

pati

ents

si

mul

tane

ousl

y

Not

allo

wed

No

New

Jer

sey

S. 1

19 (

enac

ted

by

legi

slat

ure)

Ja

nuar

y 11

, 201

0

Exem

ptio

n fr

om

pros

ecut

ion

if in

law

ful

poss

essi

on o

f a re

gist

ry c

ard

Wit

h st

ate

Dep

artm

ent

of H

ealt

h an

d Se

nior

Se

rvic

es

No

mor

e th

an tw

o ou

nces

ca

n be

dis

pens

ed to

a p

atie

nt

in 3

0 da

ys

One

car

egiv

er p

er

pati

ent;

a ca

regi

ver m

ay

assi

st o

nly

one

pati

ent

Yes,

Dep

artm

ent o

f H

ealt

h an

d Se

nior

Se

rvic

es-r

egul

ated

“a

lter

nati

ve tr

eatm

ent

cent

ers”

(A

TC

s) a

re

allo

wed

; in

Mar

ch 2

011,

th

e de

part

men

t reg

iste

red

six

AT

Cs;

it m

ay re

gist

er

mor

e in

the

futu

re

No

Page 27: State by State Laws Report 2011

23

State-By-State Report 2011TA

BLE

1: E

ffect

ive

Med

ical

Mar

ijuan

a La

ws i

n 16

Sta

tes a

nd W

ashi

ngto

n, D

.C.

Stat

e;

Mea

sure

/% o

f vot

e;

Dat

e en

acte

d

How

law

pro

tect

s pat

ient

s (d

efen

ses p

rovi

ded)

aRe

gist

ry sy

stem

for

patie

nts a

nd

care

give

rs

Mar

ijuan

a

quan

tity

limits

Car

egiv

er p

rovi

sions

Disp

ensa

ries

Reco

gniz

es

out-

of-s

tate

ID

car

ds

New

Mex

ico

SB 5

23 (

enac

ted

by

legi

slat

ure)

Apr

il 2,

200

7

Exem

ptio

n fr

om a

rres

t and

pr

osec

utio

n if

in la

wfu

l po

sses

sion

of a

regi

stry

car

d

Wit

h st

ate

Dep

artm

ent

of H

ealt

hA

n “a

dequ

ate

supp

ly”

not t

o ex

ceed

six

ounc

es o

f usa

ble

mar

ijuan

a, fo

ur m

atur

e pl

ants

, and

12

seed

lings

, or a

th

ree-

mon

th su

pply

of t

opic

al

trea

tmen

t

A c

areg

iver

may

hav

e up

to fo

ur p

atie

nts a

nd

poss

ess u

p to

six

ounc

es

of u

sabl

e ca

nnab

is, f

our

mat

ure

plan

ts, a

nd th

ree

seed

lings

for e

ach

pati

ent

Yes,

the

New

Mex

ico

Hea

lth

Dep

artm

ent

regu

late

s non

-pro

fit

prod

ucer

s; as

of S

ept.

15,

2011

, the

re w

ere

25; e

ach

may

cul

tiva

te u

p to

150

pl

ants

No

Ore

gon

Mea

sure

67

(b

allo

t ini

tiat

ive/

55%

)N

ovem

ber 3

, 199

8 (m

odifi

ed b

y H

.B. 3

052,

ef

fect

ive

July

21,

199

9, a

nd

S.B

. 108

5, e

ffect

ive

Janu

ary

1, 2

006)

Exem

ptio

n fr

om

pros

ecut

ion

if in

law

ful

poss

essi

on o

f a re

gist

ry

card

; affi

rmat

ive

defe

nse

if no

t reg

iste

red

but i

n co

mpl

ianc

e w

ith

the

law

; “c

hoic

e of

evi

ls”

defe

nse

also

aut

hori

zed

by st

atut

e

Wit

h st

ate

Dep

artm

ent

of H

uman

Ser

vice

s24

oun

ces o

f usa

ble

mar

ijuan

a, si

x m

atur

e m

ariju

ana

plan

ts, a

nd 1

8 se

edlin

gs p

er p

atie

nt jo

intl

y w

ith

his o

r her

car

egiv

er;

pati

ents

no

long

er h

ave

an

affir

mat

ive

defe

nse

to a

rgue

th

at g

reat

er a

mou

nts a

re

med

ical

ly n

eces

sary

One

car

egiv

er p

er p

atie

nt

who

has

“si

gnifi

cant

re

spon

sibi

lity

for

man

agin

g th

e w

ell-

bein

g of

the

pati

ent”

; car

egiv

ers

can

serv

e m

ulti

ple

pati

ents

sim

ulta

neou

sly,

bu

t can

not g

row

for m

ore

than

four

pat

ient

s at a

ti

me

Not

allo

wed

No

Rho

de I

slan

d H

605

2 an

d S

710

(ena

cted

by

legi

slat

ure)

Ja

nuar

y 3,

200

6 (m

ade

perm

anen

t by

H 6

005

and

S 79

1 in

200

7; m

odifi

ed

by H

535

9 an

d S

185,

ef

fect

ive

June

16,

200

9)

Exem

ptio

n fr

om a

rres

t and

pr

osec

utio

n if

in la

wfu

l po

sses

sion

of a

regi

stry

ca

rd; a

ffirm

ativ

e de

fens

e if

not r

egis

tere

d bu

t in

com

plia

nce

wit

h th

e la

w

Wit

h st

ate

Dep

artm

ent

of H

ealt

h2.

5 us

able

oun

ces a

nd 1

2 pl

ants

Pati

ents

are

allo

wed

up

to tw

o ca

regi

vers

, wit

h a

disp

ensa

ry c

onsi

dere

d a

care

give

r; no

n-di

spen

sary

ca

regi

vers

can

ass

ist u

p to

fiv

e pa

tien

ts

Yes;

the

heal

th

depa

rtm

ent a

ppro

ved

thre

e no

n-pr

ofit

di

spen

sari

es c

alle

d “c

ompa

ssio

n ce

nter

s”

but h

as n

ot is

sued

fina

l re

gist

rati

ons

Yes

Ver

mon

tS.

76

(ena

cted

by

legi

slat

ure)

May

26,

200

4 (m

odifi

ed b

y S.

7 in

200

7 an

d S.

17 in

201

1)

Exem

ptio

n fr

om a

rres

t and

pr

osec

utio

n if

in la

wfu

l po

sses

sion

of r

egis

try

card

Wit

h st

ate

Dep

artm

ent

of P

ublic

Saf

ety

Two

usab

le o

unce

s and

nin

e pl

ants

, tw

o of

whi

ch m

ay b

e m

atur

e

One

car

egiv

er p

er

pati

ent,

and

a ca

regi

ver

may

serv

e on

ly o

ne

pati

ent a

t a ti

me;

a

care

give

r can

not h

ave

a dr

ug-r

elat

ed c

onvi

ctio

n an

d m

ust b

e re

gist

ered

w

ith

the

stat

e

S. 1

7, p

asse

d in

201

1,

will

allo

w u

p to

four

no

n-pr

ofit

dis

pens

arie

s re

gula

ted

by th

e D

epar

tmen

t of P

ublic

Sa

fety

; pat

ient

s may

ob

tain

up

to tw

o ou

nces

of

mar

ijuan

a ev

ery

30

days

, by

appo

intm

ent o

nly

No

Page 28: State by State Laws Report 2011

24

Stat

e-By

-Sta

te R

epor

t 201

1

TABL

E 1:

Effe

ctiv

e M

edic

al M

ariju

ana

Law

s in

16 S

tate

s and

Was

hing

ton,

D.C

.St

ate;

M

easu

re/%

of v

ote;

D

ate

enac

ted

How

law

pro

tect

s pat

ient

s (d

efen

ses p

rovi

ded)

aRe

gist

ry sy

stem

for

patie

nts a

nd

care

give

rs

Mar

ijuan

a

quan

tity

limits

Car

egiv

er p

rovi

sions

Disp

ensa

ries

Reco

gniz

es

out-

of-s

tate

ID

car

ds

Was

hing

ton

Mea

sure

692

(ba

llot

init

iati

ve/5

9%)

Nov

embe

r 3, 1

998

(mod

ified

by

SB 5

073,

ef

fect

ive

Apr

il, 2

9, 2

011)

Affi

rmat

ive

defe

nse

avai

labl

e if

in c

ompl

ianc

e w

ith

the

stat

ute

d

N/A

24 o

unce

s of u

sabl

e m

ariju

ana

and

15 p

lant

s; a

pati

ent m

ay

exce

ed th

is li

mit

so lo

ng a

s he

or sh

e ca

n pr

esen

t evi

denc

e of

med

ical

nee

d

An

indi

vidu

al w

ho h

as

sign

ifica

nt re

spon

sibi

lity

for m

anag

ing

the

wel

l-be

ing

of th

e pa

tien

t; ge

nera

lly, a

car

egiv

er

cann

ot a

ssis

t mor

e th

an

one

pati

ent

Not

allo

wed

No

a Se

e A

ppen

dix

G fo

r def

init

ions

of “

affir

mat

ive

defe

nse,

” “e

xem

ptio

n fr

om p

rose

cuti

on,”

and

“ch

oice

of e

vils

.”b

In a

ddit

ion

to A

lask

a’s m

edic

al m

ariju

ana

law

, the

stat

e’s c

onst

itut

iona

l rig

ht to

pri

vacy

has

bee

n in

terp

rete

d as

incl

udin

g pr

otec

tion

for p

osse

ssio

n of

a m

odes

t am

ount

of m

ariju

ana

for p

erso

nal

u

se in

one

’s ho

me.

c T

he c

onst

itut

iona

lity

of se

vera

l pro

visi

ons o

f S.B

. 423

are

bei

ng d

ecid

ed in

a st

ate

cour

t cas

e, M

onta

na C

anna

bis I

ndus

try

Ass

ocia

tion

, et a

l. v.

Mon

tana

, and

thes

e pr

ovis

ions

hav

e no

t yet

gon

e

in

to e

ffect

. See

App

endi

x F

for m

ore

deta

ils.

d In

pra

ctic

e, W

ashi

ngto

n la

w e

nfor

cem

ent r

arel

y ar

rest

or p

rose

cute

pat

ient

s and

car

egiv

ers w

ho h

ave

thei

r doc

tors

’ wri

tten

cer

tific

atio

ns a

nd a

smal

l am

ount

of m

ariju

ana.

Page 29: State by State Laws Report 2011

25

State-By-State Report 2011TABLE 2: Tally of State Medical Marijuana Laws

TABLE 2: Tally of State Medical Marijuana Laws

State

Effective

Workable

Therapeutic Research Program

Symbolic

Non-Binding

Resolution

Prev

ious

ly h

ad

Cur

rent

ly h

as

Prev

ious

ly h

ad

Cur

rent

ly h

as

Prev

ious

ly h

ad

Cur

rent

ly h

as

Prev

ious

ly h

ad

Cur

rent

ly h

as

Alabama √Alaska √ √Arizona √ √ √Arkansas √California √ √ √Colorado √ √Connecticut √Delaware √District of Columbia √ √Florida √Georgia √Hawaii √IdahoIllinois √IndianaIowa √ √KansasKentuckyLouisiana √ √Maine √ √Maryland √Massachusetts √Michigan √ √ √Minnesota √MississippiMissouri √Montana √NebraskaNevada √ √New Hampshire √ √New Jersey √ √New Mexico √ √ √

Page 30: State by State Laws Report 2011

26

Stat

e-By

-Sta

te R

epor

t 201

1

TABLE 2: Tally of State Medical Marijuana Laws

State

Effective

Workable

Therapeutic Research Program

Symbolic

Non-Binding

Resolution

Prev

ious

ly h

ad

Cur

rent

ly h

as

Prev

ious

ly h

ad

Cur

rent

ly h

as

Prev

ious

ly h

ad

Cur

rent

ly h

as

Prev

ious

ly h

ad

Cur

rent

ly h

as

New York √North Carolina √North DakotaOhio √ √OklahomaOregon √ √PennsylvaniaRhode Island √ √ √South Carolina √South DakotaTennessee √ √Texas √UtahVermont √Virginia √Washington √ √ √West Virginia √Wisconsin √Wyoming

Totals 016

plus D.C.

1 1 13 132

plus D.C.

8 7

Grand Totals16 plus

D.C.2 26 10 plus D.C. 7

Thirty-seven states have had favorable medical marijuana laws at one point or another. Fifteen of those 37 states have had more than one type of medical marijuana law. California, for example, has both an effective law and a research law, while the District of Columbia’s law was symbolic until Congress allowed it to go into effect. In addition to state laws, decisions in the Idaho Su-preme Court and a Florida appellate court allow patients using marijuana for medical purposes to assert a necessity defense to marijuana charges in court. See Appendix K for more information.

Page 31: State by State Laws Report 2011

27

State-By-State Report 2011TABLE 3: Medical Conditions Approved for Treatment with Marijuana in the 16 States and One District with Medical Marijuana Laws

TABLE 3: Medical Conditions Approved for Treatment with Marijuana in the 16 States and One District with Medical Marijuana Laws

Alaska Ariz . Calif . Colo . Del . D .C . Hawaii Maine Mich . Mont . Nev . N .J . N .M . Oreg . R .I . Vt . Wash .

Specific DiseasesCancer √ √ √ √ √ √ √ √ √ √ √ √ 4 √ √ √ √ 3 √Glaucoma √ √ √ √ √ √ √ √ √ √ √ 3 √ √ √ √AIDS or HIV √ √ √ √ √ √ √ √ √ √ √ √ 4 √ √ √ √ 3 √Crohn’s disease √ √ √ √ √ √ 7 √ 8 √

Hepatitis C √ √ 2 √ √ √ 3

Multiple sclerosis √ √ √ √ 3 √ALS (Lou Gehrig’s disease) √ √ √ √ 8

PTSD √ √ 8

Debilitating medical conditions or symptoms produced by those conditions

Cachexia, anorexia, or wasting syndrome

√ √ √ √ √ 3 √ √ √ √ √ √8,4 √ √ √ 3 √

Severe or chronic pain √ √ √ √ √ √ √ √ 4 √ √8,4 √ √ 4 √ 3 √ 3

Severe or chronic nausea √ √ √ √ 4 √ √ √ √ √ √8,4 √ √ √ 3 √Seizure disorders (e.g., epilepsy) √ √ √ √ √ √ √ √ √ √ √ 3 √ √ √ √ 3 √Muscle spasticity disorders (e.g., multiple sclerosis)

√ √ √ √ √ √ √ √ √ √ √ √ 3 √ √ √ √

Agitation of Alzheimer’s disease

√ √ √ √ √ 8 √

Allows addition of diseases or conditions by state health agency

√ √ 1 √ √ √ √ √ √5 6 √ √5 √6 √ √ √ 9

1 In addition to the specific diseases and conditions listed, the law covers treatment of “any other illness for which marijuana provides relief.”

2 The law does not actually cover Hepatitis C itself, but instead covers decompensated cirrhosis, a condition that occurs at the end-stage of the disease.

3 Requires that the condition be resistant to conventional medicine or that reasonable medical efforts have been made over a reasonable amount of time without success to relieve the symptoms.

4 There are additional restrictions on this condition in this state or the term used for the symptom or condition is narrower. 5 In addition, the law explicitly covers patients with muscular dystrophy, or “intractable skeletal muscular spasticity,” or “terminal illness,

if the physician has determined a prognosis of less than 12 months of life.”6 In addition to the specific diseases and conditions listed, the law covers certain patients admitted to hospice care.7 Allows medical marijuana to treat “inflammatory bowel disease, including Crohn’s disease.”8 Condition added by state agency.9 In addition, a state agency added chronic renal failure/chronic kidney disease as a qualifying condition.

Page 32: State by State Laws Report 2011

Stat

e-By

-Sta

te R

epor

t 201

1

Page 33: State by State Laws Report 2011

A-1

Appendix A: State M

edical Marijuana Law

s

State-By-State Report 2011St

ates

with

Effe

ctiv

e M

edic

al M

ariju

ana

Law

s (R

emov

al o

f Cri

min

al P

enal

ties)

Stat

e

Med

ical

M

ariju

ana

Law

Ap

prov

ed To

ok E

ffect

Bill/

Initi

ativ

e #

Sess

ion

Law

Cita

tion

for

Med

ical

Mar

ijuan

a La

wM

ariju

ana

Sche

dule

Cita

tion

for S

ched

ules

AK

Nov

. 3, 1

998

Mar

ch 4

, 199

9Ba

llot M

easu

re 8

(mod

ified

by

S.B.

94,

ef

fect

ive

June

2, 1

999)

S.B.

94

— C

hapt

er

37, S

LA 1

999

§ 17

.37

VIA

§ 11

.71.

160

Curr

ent L

aw:

Ballo

t Mea

sure

8 re

mov

ed st

ate-

leve

l crim

inal

pen

altie

s for

med

ical

mar

ijuan

a us

e, po

sses

sion,

and

cul

tivat

ion.

How

ever

, S.B

. 94,

whi

ch to

ok e

ffect

June

2, 1

999,

mad

e th

e st

ate’s

med

ical

mar

ijuan

a re

gist

ry p

rogr

am m

anda

tory

and

rem

oved

the

affir

mat

ive

defe

nse

for p

atie

nts (

or th

eir c

areg

iver

s) w

ho p

osse

ss m

ore

mar

ijuan

a th

an is

per

mit-

ted

by th

e la

w.

Hist

ory:

A

ther

apeu

tic re

sear

ch p

rogr

am —

whi

ch w

as n

ever

ope

ratio

nal —

for c

ance

r che

mot

hera

py a

nd ra

diol

ogy

and

glau

com

a (s

tatu

te §

17.

35) w

as e

nact

ed in

198

2 (s

essio

n la

w §

5 C

h. 4

5). T

he la

w w

as re

peal

ed b

y C

h. 1

46 (1

986)

. Det

ails

of th

e pr

ogra

m in

clud

ed a

dmin

istra

tion

by th

e Bo

ard

of P

harm

acy

and

patie

nt ce

rtifi

catio

n by

a P

atie

nt

Qua

lific

atio

n Re

view

Com

mitt

ee; t

he B

oard

of P

harm

acy

was

also

per

mitt

ed to

incl

ude

othe

r dise

ase

grou

ps if

a p

hysic

ian

pres

ente

d pe

rtin

ent m

edic

al d

ata.

A

s a S

ched

ule

VIA

dru

g, m

ariju

ana

has t

he “l

owes

t deg

ree

of d

ange

r or p

roba

ble

dang

er to

a p

erso

n or

the

publ

ic.”

AZ

Nov

. 2, 2

010

Dec

. 10,

201

0Pr

opos

ition

203

N/A

Ariz

. Rev

. Sta

t. §

36-2

801

et se

q.I

Ariz

. Rev

. Sta

t. §

36-2

512

Curr

ent L

aw:

Prop

ositi

on 2

03 re

mov

ed st

ate-

leve

l crim

inal

pen

altie

s for

med

ical

mar

ijuan

a us

e an

d po

sses

sion,

and

in ce

rtai

n ci

rcum

stan

ces,

for c

ultiv

atio

n. It

crea

ted

a m

anda

tory

ID

card

pro

gram

for p

atie

nts a

nd c

areg

iver

s, an

d al

so p

rovi

ded

for a

stat

e-re

gula

ted

and

licen

sed

nonp

rofit

disp

ensa

ry sy

stem

.

Hist

ory:

O

n N

ov. 5

, 199

6, 6

5% o

f Ariz

ona

vote

rs p

asse

d Pr

op. 2

00 (A

riz. R

ev. S

tat.

§ 13

-341

2.01

), a

ballo

t ini

tiativ

e th

at m

ade

seve

ral d

rug

polic

y ch

ange

s inc

ludi

ng a

n in

oper

able

pr

ovisi

on th

at co

uld

have

allo

wed

med

ical

mar

ijuan

a if

it w

as w

orde

d pr

oper

ly. T

he p

rovi

sion

relie

d on

a p

hysic

ian

“pre

scrib

ing”

med

ical

mar

ijuan

a (a

fede

ral c

rime)

, as

oppo

sed

to “r

ecom

men

ding

” it.

Prop

. 200

wou

ld h

ave

allo

wed

phy

sicia

ns to

pre

scrib

e an

y Sc

hedu

le I

drug

to se

rious

ly il

l pat

ient

s, in

clud

ing

hero

in a

nd L

SD.

In 1

997,

the

legi

slatu

re p

asse

d H

.B. 2

518,

whi

ch re

peal

ed P

rop.

200

’s pr

ovisi

on o

n pr

escr

ibin

g Sc

hedu

le I

drug

s, by

add

ing

a co

nditi

on p

rohi

bitin

g A

rizon

a ph

ysic

ians

fr

om p

resc

ribin

g su

ch d

rugs

unt

il th

e FD

A ap

prov

ed th

eir m

edic

al u

se. O

n N

ov. 3

, 199

8, 6

4% o

f Ariz

ona

vote

rs re

ject

ed H

.B. 2

518

in a

refe

rend

um, t

hus p

rese

rvin

g Pr

op.

200’s

sym

bolic

med

ical

mar

ijuan

a pr

ovisi

on.

In a

dditi

on, a

law

crea

ting

a m

edic

al m

ariju

ana

(and

TH

C) t

hera

peut

ic c

ance

r and

gla

ucom

a re

sear

ch p

rogr

am (§

36-

2601

) —

whi

ch w

as n

ever

ope

ratio

nal —

was

en

acte

d on

Apr

il 22

, 198

0 (H

.B. 2

020:

Ch.

122

) and

exp

ired

on Ju

ne 3

0, 1

985.

Und

er th

e la

w, th

e D

irect

or o

f the

Dep

artm

ent o

f Hea

lth S

ervi

ces w

as au

thor

ized

to ap

poin

t a

Patie

nt Q

ualif

icat

ion

Revi

ew B

oard

, whi

ch w

as su

ppos

ed to

revi

ew p

atie

nts a

nd d

octo

rs fo

r par

ticip

atio

n in

the

prog

ram

. The

Uni

vers

ity o

f Ariz

ona

was

to o

btai

n m

ariju

ana

or T

HC

from

NID

A (N

atio

nal I

nstit

ute

on D

rug

Abu

se).

In 1

981,

S.B

. 102

3 (C

h. 2

64) m

oved

the

ther

apeu

tic re

sear

ch p

rogr

am p

rovi

sions

from

§ 3

6-10

31 to

§

36-2

601.

Ariz

ona

orig

inal

ly sc

hedu

led

mar

ijuan

a du

ally

in S

ched

ules

I an

d II

(pro

visio

nally

). U

ltim

atel

y, m

ariju

ana

was

sole

ly sc

hedu

led

in S

ched

ule

I and

synt

hetic

TH

C in

Sc

hedu

le II

I.

Appendix A: State Medical Marijuana Laws

Page 34: State by State Laws Report 2011

Appe

ndix

A:

Stat

e Med

ical

Mar

ijuan

a Law

s

A-2

Stat

e-By

-Sta

te R

epor

t 201

1

Stat

es w

ith E

ffect

ive

Med

ical

Mar

ijuan

a La

ws (

Rem

oval

of C

rim

inal

Pen

altie

s)

Stat

e

Med

ical

M

ariju

ana

Law

Ap

prov

ed To

ok E

ffect

Bill/

Initi

ativ

e #

Sess

ion

Law

Cita

tion

for

Med

ical

Mar

ijuan

a La

wM

ariju

ana

Sche

dule

Cita

tion

for S

ched

ules

CA

Nov

. 5, 1

996

Nov

. 6, 1

996

Ballo

t Ini

tiativ

e,

Prop

ositi

on 2

15

(add

ed to

by

S.B.

420

, effe

c-tiv

e Ja

nuar

y 1,

200

4)

S.B.

420

Cha

pter

875

, Sta

t-ut

es o

f 200

3

Cal

. Hea

lth &

Saf

ety

Cod

e §

1136

2.5,

et

seq.

IC

al. H

ealth

& S

afet

y C

ode

§ 11

054

Curr

ent L

aw:

Prop

ositi

on 2

15 re

mov

ed st

ate-

leve

l crim

inal

pen

altie

s for

med

ical

mar

ijuan

a us

e, po

sses

sion,

and

cul

tivat

ion.

S.B

. 420

, whi

ch w

as p

asse

d in

200

3, m

ade

seve

ral p

osi-

tive

clar

ifica

tions

to th

e m

edic

al m

ariju

ana

law.

It sp

ecifi

cally

allo

wed

non

prof

it co

oper

ativ

e an

d co

llect

ive

patie

nt g

arde

ns a

s wel

l as t

he e

xcha

nge

of m

oney

for i

ncur

red

expe

nses

and

serv

ices

per

form

ed b

y ca

regi

vers

. It a

lso cr

eate

d an

ID c

ard

prog

ram

, whi

ch is

opt

iona

l for

bot

h pa

tient

s and

car

egiv

ers,

but w

hich

pro

vide

s pro

tect

ion

from

ar

rest

. It a

lso se

t thr

esho

ld a

mou

nts o

f mar

ijuan

a th

at p

atie

nts a

re a

llow

ed to

pos

sess

. In

addi

tion,

S.B

. 847

, whi

ch to

ok e

ffect

in 1

999,

est

ablis

hed

the

Cal

iforn

ia C

ente

r fo

r Med

icin

al C

anna

bis R

esea

rch

to re

sear

ch m

ariju

ana’s

safe

ty a

nd e

ffica

cy, u

sing

fede

ral m

ariju

ana.

Hist

ory:

Fr

om Ju

ly 2

5, 1

979,

unt

il Ju

ne 3

0, 1

989,

a th

erap

eutic

rese

arch

pro

gram

—w

hich

was

ope

ratio

nal—

for c

ance

r and

gla

ucom

a ex

isted

(H &

S §

112

60 a

nd H

& S

§ 1

1480

); en

acte

d vi

a S.

B. 1

84, s

essio

n la

w C

h. 3

00 (1

979)

. The

Res

earc

h A

dviso

ry P

anel

coor

dina

ted

rese

arch

with

mar

ijuan

a an

d its

der

ivat

ives

; $10

0,00

0 w

as ap

prop

riate

d fo

r th

e fir

st y

ear.

Min

or a

men

dmen

ts b

y ch

. 374

(198

0) a

nd ch

. 101

(198

3). H

& S

§ 1

1260

wou

ld h

ave

expi

red

on Ju

ne 3

0, 1

985,

but

the

prog

ram

was

ext

ende

d an

d m

odifi

ed

sligh

tly b

y ch

. 417

(198

4); t

he p

rogr

am fi

nally

exp

ired

on Ju

ne 3

0, 1

989;

§ 1

1480

rem

ains

on

the

book

s.

CO

Nov

. 7, 2

000

June

30,

200

1Ba

llot I

nitia

tive,

Am

end-

men

t 20

(mod

ified

by

HB

1284

, effe

ctiv

e Ju

ly 1

, 201

0)

HB

1284

– C

hapt

er

355,

Ses

sion

Law

s of

Col

orad

o, 2

010

Con

stitu

tiona

l A

men

dmen

t 20,

A

rtic

le X

VII

I,

Sect

ion

14; C

.R.S

§

12-4

3.3-

101,

18

-918

-406

.3, a

nd

25-1

.5-1

06 e

t seq

.

N/A

§ 18

-18-

203

Curr

ent L

aw:

Am

endm

ent 2

0 re

mov

ed st

ate-

leve

l crim

inal

pen

altie

s for

med

ical

mar

ijuan

a us

e, po

sses

sion,

and

cul

tivat

ion.

HB

1284

, pas

sed

in 2

010,

set u

p cl

ear l

icen

sing

proc

edur

es

and

stan

dard

s for

for-

prof

it re

tail

disp

ensa

ries,

culti

vatio

n ce

nter

s, an

d m

ariju

ana-

infu

sed

prod

uct m

anuf

actu

rers

.

Hist

ory:

A

ther

apeu

tic re

sear

ch p

rogr

am —

whi

ch w

as n

ever

ope

ratio

nal —

for c

ance

r and

gla

ucom

a (§

25-

5-90

1 to

-907

) was

ena

cted

and

took

effe

ct o

n Ju

ne 2

1, 1

979

(H.B

. 104

2,

Ch.

265

). Th

e pr

ogra

m w

as a

dmin

ister

ed b

y th

e C

hanc

ello

r for

Hea

lth A

ffairs

at th

e U

nive

rsity

of C

olor

ado

Med

ical

Cen

ter.

The

Phar

mac

y an

d Th

erap

eutic

s Com

mitt

ee

(PTC

) of t

he m

edic

al b

oard

of C

olor

ado

Gen

eral

Hos

pita

l was

char

ged

with

revi

ewin

g ap

plic

ants

and

thei

r pra

ctiti

oner

s and

cert

ifyin

g th

eir p

artic

ipat

ion

in th

e pr

ogra

m.

Add

ition

ally,

the

PTC

coul

d in

clud

e ot

her d

iseas

e gr

oups

afte

r rev

iew

ing

pert

inen

t dat

a pr

esen

ted

by a

“pra

ctiti

oner

,” w

ho w

as au

thor

ized

to p

resc

ribe

and

adm

inist

er

drug

s, an

d th

e ch

ance

llor w

ould

appl

y to

rece

ive

mar

ijuan

a fr

om th

e N

atio

nal I

nstit

ute

on D

rug

Abu

se (N

IDA

). If

unab

le to

obt

ain

mar

ijuan

a fr

om N

IDA

, the

chan

cello

r w

ould

inve

stig

ate

the

feas

ibili

ty o

f usin

g m

ariju

ana

acqu

ired

from

oth

er so

urce

s, in

clud

ing

seiz

ed m

ariju

ana

that

had

bee

n te

sted

for i

mpu

ritie

s; $1

5,00

0 w

as ap

prop

ri-at

ed fo

r the

pro

gram

. In

1981

, the

pro

gram

was

am

ende

d by

H.B

. 122

4 (C

h. 3

22),

whi

ch st

ipul

ated

that

oth

er d

iseas

e gr

oups

coul

d be

incl

uded

afte

r per

tinen

t dat

a w

as

pres

ente

d by

a “c

linic

al re

sear

cher

” who

was

lice

nsed

to e

xper

imen

t with

, stu

dy, o

r tes

t any

dan

gero

us d

rug

with

in th

e st

ate

and

who

had

an

IND

(Inv

estig

atio

nal N

ew

Dru

g) n

umbe

r iss

ued

by th

e FD

A. T

he a

men

dmen

t also

pro

vide

d th

at th

e ch

ance

llor w

ould

appl

y to

rece

ive

mar

ijuan

a fr

om th

e “f

eder

al g

over

nmen

t” ra

ther

than

NID

A.

The

law

was

repe

aled

by

H.B

. 95-

1020

in 1

995

(Ch.

71)

.

Page 35: State by State Laws Report 2011

A-3

Appendix A: State M

edical Marijuana Law

s

State-By-State Report 2011St

ates

with

Effe

ctiv

e M

edic

al M

ariju

ana

Law

s (R

emov

al o

f Cri

min

al P

enal

ties)

Stat

e

Med

ical

M

ariju

ana

Law

Ap

prov

ed To

ok E

ffect

Bill/

Initi

ativ

e #

Sess

ion

Law

Cita

tion

for

Med

ical

Mar

ijuan

a La

wM

ariju

ana

Sche

dule

Cita

tion

for S

ched

ules

DC

Nov

embe

r 3,

1998

July

27,

201

0,

thou

gh it

will

no

t be

lega

l fo

r pat

ient

s to

pos

sess

m

ariju

ana

until

di

spen

sarie

s are

op

erat

iona

l

Initi

ativ

e 59

(mod

ified

by

B18-

622,

effe

ctiv

e Ju

ly 2

7,

2010

)

L18-

0210

D.C

. Cod

e §

7-16

71II

ID

.C. C

ode

§ 48

-902

.08

Curr

ent L

aw:

B18-

622

rem

oved

dist

rict-

leve

l crim

inal

pen

altie

s for

the

use

and

poss

essio

n of

mar

ijuan

a fo

r med

ical

pur

pose

s by

qual

ifyin

g pa

tient

s and

allo

wed

regu

late

d cu

ltiva

tion

cent

ers a

nd d

ispen

sarie

s.

Hist

ory:

A

fter i

t was

pas

sed

in 1

998,

Con

gres

siona

l opp

onen

ts im

med

iate

ly st

eppe

d in

to p

reve

nt im

plem

enta

tion

of In

itiat

ive

59. I

nitia

lly, C

ongr

essio

nal o

ppon

ents

mov

ed to

pr

even

t the

coun

ting

of th

e vo

tes,

but a

fter a

dvoc

ates

soug

ht a

nd w

on a

cour

t vic

tory

allo

win

g th

e ba

llots

to b

e co

unte

d, th

e so

-cal

led

“Bar

r Am

endm

ent,”

a p

rovi

sion

in

the

Dist

rict’s

ann

ual C

ongr

essio

nal a

ppro

pria

tions

bill

nam

ed a

fter s

pons

or a

nd th

en-C

ongr

essm

an B

ob B

arr,

prev

ente

d th

e D

istric

t fro

m u

sing

any

fund

s to

impl

emen

t th

e ac

t (C

ongr

ess h

as co

ntro

l ove

r all

D.C

. bud

get m

atte

rs, i

nclu

ding

the

use

of lo

cal f

unds

, not

just

fede

ral f

unds

as w

ith th

e 50

stat

es).

That

pro

visio

n w

as re

mov

ed in

late

20

09, a

nd th

e D

.C. C

ounc

il so

on a

fter p

asse

d B1

8-62

2 w

hich

nar

row

ed th

e la

w b

y, am

ong

othe

r thi

ngs,

shor

teni

ng th

e lis

t of q

ualif

ying

cond

ition

s (to

just

can

cer,

HIV

/A

IDS,

gla

ucom

a, a

nd m

ultip

le sc

lero

sis),

prev

entin

g ho

me

culti

vatio

n, a

nd m

anda

ting

that

pat

ient

s may

onl

y us

e m

ariju

ana

obta

ined

from

a D

.C. d

ispen

sary

. As o

f Sep

t. 15

, 201

1, th

e D

epar

tmen

t of H

ealth

was

acc

eptin

g ap

plic

atio

ns fr

om p

rosp

ectiv

e cu

ltiva

tion

cent

er p

ropr

ieto

rs a

nd e

xpec

ting

to fu

lly im

plem

ent t

he la

w b

y Sp

ring

2012

.

DE

May

13,

201

1Ju

ly 1

, 201

1SB

17

78 D

el. L

aw c.

23

(201

1)D

el. C

ode

Ann

. tit.

16

, § 4

901A

et s

eq.

ID

el. C

ode

Ann

. tit.

16,

§

4714

Curr

ent L

aw:

SB 1

7 re

mov

ed st

ate-

leve

l crim

inal

pen

altie

s for

med

ical

mar

ijuan

a us

e an

d po

sses

sion

and

prov

ided

ext

ensiv

e ci

vil p

rote

ctio

ns a

gain

st d

iscrim

inat

ion

base

d on

pat

ient

st

atus

. It c

reat

ed a

man

dato

ry ID

car

d pr

ogra

m fo

r pat

ient

s and

car

egiv

ers,

and

also

pro

vide

d fo

r a st

ate-

regu

late

d an

d lic

ense

d no

npro

fit d

ispen

sary

syst

em. T

his i

s Del

a-w

are’s

firs

t med

ical

mar

ijuan

a la

w o

f any

kin

d.

HI

June

14,

200

0Ju

ne 1

4, 2

000

S.B.

862

Act

228

, SLH

200

329-

121

329-

14

Curr

ent L

aw:

S.B.

862

rem

oves

stat

e-le

vel c

rimin

al p

enal

ties f

or m

edic

al m

ariju

ana

use,

poss

essio

n, a

nd c

ultiv

atio

n. T

his w

as th

e fir

st la

w o

f thi

s nat

ure

to b

e en

acte

d by

a st

ate

leg-

islat

ure,

rath

er th

an b

y a

ballo

t ini

tiativ

e. (O

ther

stat

e le

gisla

ture

s had

ena

cted

med

ical

mar

ijuan

a re

sear

ch la

ws a

nd sy

mbo

lic la

ws r

elat

ing

to m

ariju

ana

sche

dulin

g or

pr

escr

iptiv

e ac

cess

.) Th

is is

Haw

aii’s

firs

t med

ical

mar

ijuan

a la

w o

f any

kin

d.

Page 36: State by State Laws Report 2011

Appe

ndix

A:

Stat

e Med

ical

Mar

ijuan

a Law

s

A-4

Stat

e-By

-Sta

te R

epor

t 201

1

Stat

es w

ith E

ffect

ive

Med

ical

Mar

ijuan

a La

ws (

Rem

oval

of C

rim

inal

Pen

altie

s)

Stat

e

Med

ical

M

ariju

ana

Law

Ap

prov

ed To

ok E

ffect

Bill/

Initi

ativ

e #

Sess

ion

Law

Cita

tion

for

Med

ical

Mar

ijuan

a La

wM

ariju

ana

Sche

dule

Cita

tion

for S

ched

ules

ME

Nov

. 2, 1

999

Dec

. 22,

199

9Re

fere

ndum

Ele

ctio

n Ba

llot

Que

stio

n 2

(Mod

ified

by

LD 6

11, e

ffec-

tive

April

1, 2

002;

Que

stio

n 5,

Nov

. 3, 2

009;

LD

181

1,

effe

ctiv

e Ap

ril 9

, 201

0; a

nd

LD 1

296,

effe

ctiv

e Se

pt. 2

7,

2011

)

Law

s of M

aine

199

9,

Initi

ated

Bill

Ch.

1

L.D

. 611

— L

aws o

f M

aine

200

1, C

hap-

ter 5

80

Que

stio

n 5

– La

ws

of M

aine

200

9, In

iti-

ated

Bill

s, C

h. 1

LD 1

811

– La

ws o

f M

aine

200

9, C

hap-

ter 6

31

LD 1

296

– Pu

blic

La

w, C

hapt

er 4

07

22 M

RSA

§ 2

383-

BZ

17-A

MRS

A §

110

2

Curr

ent L

aw:

Que

stio

n 2

rem

oves

stat

e-le

vel c

rimin

al p

enal

ties f

or m

edic

al m

ariju

ana

use,

poss

essio

n, a

nd c

ultiv

atio

n. L

.D. 6

11, e

ffect

ive

April

1, 2

002,

clar

ified

pro

tect

ions

for p

atie

nts

and

care

give

rs a

nd in

crea

sed

the

amou

nt o

f usa

ble

mar

ijuan

a a

patie

nt m

ay p

osse

ss.

Que

stio

n 5

adde

d qu

alify

ing

cond

ition

s, al

low

ed fo

r the

est

ablis

hmen

t of e

ight

med

ical

mar

ijuan

a di

spen

sarie

s in

the

stat

e, an

d es

tabl

ished

a re

gist

ry sy

stem

for p

atie

nts

and

care

give

rs. L

D 1

296,

am

ong

othe

r thi

ngs,

mad

e re

gist

ratio

n op

tiona

l for

pat

ient

s, as

wel

l as c

areg

iver

s who

se p

atie

nts a

re fa

mily

or h

ouse

hold

mem

bers

.

Hist

ory:

A

ther

apeu

tic re

sear

ch p

rogr

am —

whi

ch w

as n

ever

ope

ratio

nal —

for g

lauc

oma

and

canc

er ch

emot

hera

py (2

2 §

2401

-241

0) w

as e

nact

ed o

n Se

pt. 1

4, 1

979

(H.B

. 665

, Ch.

45

7). T

he p

rogr

am e

xpire

d in

198

1, b

ut a

n al

mos

t ide

ntic

al la

w re

inst

ated

the

prog

ram

on

Sept

. 23,

198

3 (H

.B. 1

025,

Ch.

423

, 22

§ 24

11-2

420)

. Tha

t law

, whi

ch e

xpire

d on

Dec

. 31,

198

7, h

ad au

thor

ized

a re

sear

ch p

rogr

am w

ithin

the

Dep

artm

ent o

f Hum

an S

ervi

ces t

o us

e fe

dera

l mar

ijuan

a or

, if n

eces

sary

, mar

ijuan

a co

nfisc

ated

by

stat

e la

w e

nfor

cem

ent a

genc

ies;

a Pa

rtic

ipat

ion

Revi

ew B

oard

wou

ld ap

prov

e ph

ysic

ians

.

C

ontr

olle

d su

bsta

nces

are

in S

ched

ules

W, X

, Y, a

nd Z

, whi

ch d

eter

min

e th

e se

verit

y of

pen

altie

s for

pos

sess

ion,

man

ufac

ture

, and

dist

ribut

ion

of th

ese

subs

tanc

es. T

he

sche

dule

s mak

e no

stat

emen

t as t

o th

e m

edic

al v

alue

of t

he co

ntro

lled

subs

tanc

es.

MI

Nov

. 4, 2

008

Dec

embe

r 4,

2008

Ballo

t ini

tiativ

e, Pr

opos

al 1

N/A

MC

L §

333.

2642

1-26

430

I33

3.72

12; M

AC

338

.311

4 an

d 33

8.31

19a

(198

6 A

nnua

l Su

pple

men

t); M

AC

338

.311

3 (1

988

Ann

ual S

uppl

emen

t)

Curr

ent L

aw:

The

Mic

higa

n M

edic

al M

arih

uana

Act

rem

oves

stat

e-le

vel c

rimin

al p

enal

ties f

or m

edic

al m

ariju

ana

use,

poss

essio

n, a

nd c

ultiv

atio

n.

Hist

ory:

O

n O

ct. 2

2, 1

979,

a la

w w

as e

nact

ed to

allo

w p

atie

nts w

ith g

lauc

oma

and

canc

er ch

emot

hera

py to

use

med

ical

mar

ijuan

a. It

also

allo

wed

pat

ient

s with

oth

er d

iseas

es to

us

e TH

C o

r mar

ijuan

a if

they

had

an

IND

(Inv

estig

atio

nal N

ew D

rug)

per

mit

from

the

FDA

. It a

lso au

thor

ized

pat

ient

s to

use

mar

ijuan

a co

nfisc

ated

by

stat

e la

w e

nfor

ce-

men

t age

ncie

s (w

hich

alm

ost c

erta

inly

nev

er h

appe

ned)

. The

pro

gram

was

ope

ratio

nal a

nd u

sed

fede

ral m

ariju

ana

and

was

adm

inist

ered

by

the

Dep

artm

ent o

f Pub

lic

Hea

lth. T

he la

w e

xpire

d on

Nov

embe

r 1, 1

982.

A m

onth

late

r, a

near

ly id

entic

al la

w w

as e

nact

ed, w

hich

exp

ired

on N

ovem

ber 1

, 198

7.

Page 37: State by State Laws Report 2011

A-5

Appendix A: State M

edical Marijuana Law

s

State-By-State Report 2011St

ates

with

Effe

ctiv

e M

edic

al M

ariju

ana

Law

s (R

emov

al o

f Cri

min

al P

enal

ties)

Stat

e

Med

ical

M

ariju

ana

Law

Ap

prov

ed To

ok E

ffect

Bill/

Initi

ativ

e #

Sess

ion

Law

Cita

tion

for

Med

ical

Mar

ijuan

a La

wM

ariju

ana

Sche

dule

Cita

tion

for S

ched

ules

MT

Nov

. 2, 2

004

Nov

. 2, 2

004

Initi

ativ

e 14

8 (m

odifi

ed b

y S.

B. 4

23, e

ffect

ive

July

1,

2011

)

2011

Mon

t. La

ws

419

(S.B

. 423

)M

CA

§ 5

0-46

; MC

A

§ 37

-1-1

36; M

CA

§

45-9

-101

(S.

B. 4

23

not y

et co

difie

d)

IM

CA

§ 50

-32-

222

Curr

ent L

aw:

Initi

ativ

e 14

8 re

mov

ed st

ate-

leve

l crim

inal

pen

altie

s for

med

ical

mar

ijuan

a us

e, po

sses

sion,

and

cul

tivat

ion

and

crea

ted

a m

anda

tory

ID c

ard

prog

ram

for p

atie

nts a

nd

care

give

rs. S

.B. 4

23 si

gnifi

cant

ly re

stric

ted

Mon

tana

’s m

edic

al m

ariju

ana

law.

It m

ade

it m

uch

mor

e di

fficu

lt fo

r pai

n pa

tient

s to

get r

ecom

men

datio

ns a

nd in

valid

ated

ou

t-of

-sta

te ID

car

ds, a

llow

ed c

areg

iver

s onl

y to

serv

e th

ree

patie

nts a

nd p

rohi

bite

d th

em fr

om re

ceiv

ing

com

pens

atio

n, b

anne

d al

l adv

ertis

ing,

and

requ

ired

phys

icia

ns

that

mak

e m

ore

than

25

med

ical

mar

ijuan

a re

com

men

datio

ns p

er y

ear t

o pa

y fo

r an

auto

mat

ic B

oard

of M

edic

al E

xam

iner

s inv

estig

atio

n in

to th

eir p

ract

ice.

The

con-

stitu

tiona

lity

of se

vera

l pro

visio

ns o

f S.B

. 423

is st

ill b

eing

dec

ided

in a

stat

e co

urt c

ase,

Mon

tana

Can

nabi

s Ind

ustr

y A

ssoc

iatio

n, et

al.

v. M

onta

na, a

nd, a

s a re

sult,

som

e pr

ovisi

ons h

ave

not g

one

into

effe

ct.

Hist

ory:

M

onta

na’s

sym

bolic

law

— §

50-3

2-22

2(7)

— w

as e

nact

ed o

n M

arch

26,

197

9. It

wou

ld au

tom

atic

ally

resc

hedu

le T

HC

and

mar

ijuan

a to

Sch

edul

e II

if th

e fe

dera

l gov

ern-

men

t aut

horiz

es th

e pr

escr

iptio

n or

adm

inist

ratio

n of

thes

e su

bsta

nces

.

NJ

Janu

ary

18,

2010

Oct

ober

10,

20

10S.

119

2009

N.J.

Law

s c.

307

N.J.

Sta

t. A

nn. §

24

:6I a

nd §

45:

1-45

.1

IN

.J. S

tat.

Ann

. § 2

4:21

-5 a

nd

N.J.

Adm

in. C

ode

§ 8:

65-1

0

Curr

ent L

aw:

S. 1

19, w

hich

is p

roba

bly

the

stric

test

med

ical

mar

ijuan

a la

w in

the

coun

try,

rem

oved

stat

e-le

vel c

rimin

al p

enal

ties f

or m

edic

al m

ariju

ana

use

and

poss

essio

n. It

crea

ted

a m

anda

tory

ID c

ard

prog

ram

for p

atie

nts a

nd c

areg

iver

s, an

d al

so p

rovi

ded

for a

stat

e-re

gula

ted

and

licen

sed

disp

ensa

ry sy

stem

.

Hist

ory:

O

n M

arch

23,

198

1, th

e N

ew Je

rsey

Leg

islat

ure

enac

ted

A.B

. 819

(ch.

72

1981

), a

law

crea

ting

a m

edic

al m

ariju

ana

ther

apeu

tic re

sear

ch p

rogr

am (§

26:

2L)

— w

hich

was

ne

ver o

pera

tiona

l. U

nder

the

law,

pat

ient

s with

life

- or s

ense

-thr

eate

ning

dise

ases

par

ticip

atin

g in

rese

arch

pro

gram

s con

duct

ed b

y th

e FD

A w

ere

elig

ible

to jo

in a

stat

e th

erap

eutic

rese

arch

pro

gram

to re

ceiv

e an

y Sc

hedu

le I

subs

tanc

e (n

ot sp

ecifi

c to

mar

ijuan

a). T

he D

epar

tmen

t of H

ealth

and

Sen

ior S

ervi

ces w

as to

adm

inist

er th

e pr

o-gr

am, a

nd a

The

rape

utic

Res

earc

h Q

ualif

icat

ion

Boar

d w

as to

cert

ify p

atie

nts a

nd p

hysic

ians

. The

Sch

edul

e I s

ubst

ance

s wer

e to

com

e fr

om N

IDA

(Nat

iona

l Ins

titut

e on

D

rug

Abu

se).

NM

April

2, 2

007

July

1, 2

007

SB 5

23C

h. 2

10 (2

007)

NM

SA §

26-

2B-1

-7I (

II fo

r pur

-po

ses o

f the

Ly

nn an

d Er

in

Com

pass

iona

te

Use

Act

)

§ 30

-31-

6, 7

NM

SA

Curr

ent L

aw:

SB 5

23 re

mov

ed st

ate-

leve

l crim

inal

pen

altie

s for

the

use,

poss

essio

n, o

r cul

tivat

ion

of m

ariju

ana

for m

edic

al p

urpo

ses.

It al

so a

llow

ed n

on-p

rofit

pro

duce

rs to

regi

ster

to

culti

vate

mar

ijuan

a fo

r pat

ient

s.

Page 38: State by State Laws Report 2011

Appe

ndix

A:

Stat

e Med

ical

Mar

ijuan

a Law

s

A-6

Stat

e-By

-Sta

te R

epor

t 201

1

Stat

es w

ith E

ffect

ive

Med

ical

Mar

ijuan

a La

ws (

Rem

oval

of C

rim

inal

Pen

altie

s)

Stat

e

Med

ical

M

ariju

ana

Law

Ap

prov

ed To

ok E

ffect

Bill/

Initi

ativ

e #

Sess

ion

Law

Cita

tion

for

Med

ical

Mar

ijuan

a La

wM

ariju

ana

Sche

dule

Cita

tion

for S

ched

ules

NV

June

14,

200

1O

ct. 1

, 200

1Q

uest

ion

9 pa

ssed

in 1

998

and

2000

; A.B

. 453

pas

sed

the

legi

slatu

re in

200

1 (m

odifi

ed b

y A

.B. 5

19, e

ffec-

tive

July

1, 2

005)

Stat

utes

of N

evad

a 20

01, C

h. 5

92Ti

tle 4

0-C

h. 4

53A

of

NRS

, and

Art

. 4,

Sec.

38 o

f the

N

evad

a Con

stitu

-tio

n

I45

3.51

0 N

AC

Curr

ent L

aw:

A.B

. 453

rem

oves

stat

e-le

vel c

rimin

al p

enal

ties f

or m

edic

al m

ariju

ana

use,

poss

essio

n, a

nd c

ultiv

atio

n. Q

uest

ion

9, a

n in

itiat

ive

on th

e ba

llot i

n 19

98 a

nd 2

000,

am

ende

d th

e st

ate

cons

titut

ion

to re

quire

the

legi

slatu

re to

impl

emen

t a m

edic

al m

ariju

ana

law.

A.B

. 519

, pas

sed

in 2

005,

allo

ws t

he D

epar

tmen

t of A

gric

ultu

re to

revo

ke th

e re

gis-

try

iden

tific

atio

n ca

rd o

f a p

artic

ipan

t in

the

stat

e’s m

edic

al m

ariju

ana

prog

ram

who

has

bee

n co

nvic

ted

of d

rug

traf

ficki

ng o

r has

inte

ntio

nally

pro

vide

d fa

lse in

form

atio

n on

his

or h

er ap

plic

atio

n.

Hist

ory:

A

ther

apeu

tic re

sear

ch p

rogr

am —

whi

ch w

as n

ever

ope

ratio

nal —

for g

lauc

oma,

can

cer c

hem

othe

rapy

, and

oth

er ap

prov

ed co

nditi

ons (

453.

740

- 453

.810

and

453

.740

N

AC

) was

ena

cted

on

June

2, 1

979

(S.B

. 470

, Ch.

610

). A

dmin

ister

ed b

y th

e H

ealth

Div

ision

of D

epar

tmen

t of H

uman

Ser

vice

s and

a B

oard

of R

evie

w fo

r Pat

ient

s. Th

e la

w w

as re

peal

ed b

y A

.B. 6

95 in

198

7 (C

h. 4

17).

OR

Nov

. 3, 1

998

Dec

. 3, 1

998

Ballo

t Mea

sure

67

(mod

ified

by

H.B

. 305

2, e

ffect

ive

July

21

, 199

9, a

nd S

.B. 1

085,

ef-

fect

ive

Janu

ary

1, 2

006)

Ore

gon

Law

s 199

9,

Ch.

4

H.B

. 305

2 —

Or-

egon

Law

s 199

9,

Ch.

825

475.

300

II47

5.03

5 an

d O

AR

855-

080-

0022

Curr

ent L

aw:

Mea

sure

67

rem

oves

stat

e-le

vel c

rimin

al p

enal

ties f

or m

edic

al m

ariju

ana

use,

poss

essio

n, a

nd c

ultiv

atio

n. M

inor

am

endm

ents

wer

e m

ade

via

H.B

. 305

2, w

hich

took

effe

ct

July

21,

199

9. It

man

date

s tha

t pat

ient

s may

not

use

med

ical

mar

ijuan

a in

a co

rrec

tiona

l fac

ility

; lim

its p

atie

nts a

nd c

areg

iver

s to

grow

ing

mar

ijuan

a at

one

loca

tion

each

; re

quire

s tha

t a p

atie

nt b

e di

agno

sed

with

in 1

2 m

onth

s prio

r to

arre

st to

ass

ert a

n af

firm

ativ

e de

fens

e; a

nd re

lieve

s pol

ice

from

the

resp

onsib

ility

to m

aint

ain

live

mar

i-ju

ana

plan

ts w

hile

a c

ase

is pe

ndin

g. S

.B. 1

085,

pas

sed

by th

e le

gisla

ture

in 2

005,

incr

ease

s the

lim

its to

24

plan

ts —

six

of w

hich

may

be

mat

ure

— a

nd 2

4 ou

nces

of d

ried

mar

ijuan

a pe

r pat

ient

or c

areg

iver

. How

ever

, the

bill

elim

inat

es th

e af

firm

ativ

e de

fens

e fo

r goi

ng o

ver t

hese

lim

its.

Hist

ory:

A

law

to a

llow

phy

sicia

ns to

pre

scrib

e m

ariju

ana

for c

ance

r che

mot

hera

py a

nd g

lauc

oma

(§ 4

75.5

05) w

as e

nact

ed o

n Ju

ne 1

8, 1

979

(H.B

. 226

7, C

h. 2

53).

Ore

gon

Stat

e Po

lice

coul

d m

ake

conf

iscat

ed m

ariju

ana

avai

labl

e to

the

Hea

lth D

ivisi

on to

test

it fo

r con

tam

inan

ts; i

f mar

ijuan

a w

ere

foun

d to

be

free

of c

onta

min

ants

, the

Hea

lth D

ivi-

sion

coul

d m

ake

mar

ijuan

a av

aila

ble

to p

hysic

ians

upo

n w

ritte

n re

ques

t; pa

tient

s who

are

pre

scrib

ed su

ch m

ariju

ana

coul

d po

sses

s les

s tha

n an

oun

ce. I

n 19

80, t

he H

ealth

D

ivisi

on re

ceiv

ed fe

dera

l per

miss

ion

to d

istrib

ute

mar

ijuan

a, p

ursu

ant t

o th

e st

atut

e, an

d a

fede

ral s

uppl

y of

mar

ijuan

a; h

owev

er, i

t is u

nlik

ely

that

dist

ribut

ion

ever

oc-

curr

ed. T

he la

w w

as re

peal

ed b

y S.

B. 1

60 in

198

7 (C

h. 7

5).

Page 39: State by State Laws Report 2011

A-7

Appendix A: State M

edical Marijuana Law

s

State-By-State Report 2011St

ates

with

Effe

ctiv

e M

edic

al M

ariju

ana

Law

s (R

emov

al o

f Cri

min

al P

enal

ties)

Stat

e

Med

ical

M

ariju

ana

Law

Ap

prov

ed To

ok E

ffect

Bill/

Initi

ativ

e #

Sess

ion

Law

Cita

tion

for

Med

ical

Mar

ijuan

a La

wM

ariju

ana

Sche

dule

Cita

tion

for S

ched

ules

RI

Jan.

3, 2

006

and

June

21,

200

7Ja

n. 3

, 200

6 an

d Ju

ne 2

1, 2

007

H 6

052

and

S 71

0 (2

006)

; H

6005

and

S 7

91 (2

007)

; H

5359

and

S 1

85 (2

009)

Ch.

72

& 4

75, L

aws

of 2

007;

Ch.

16,

La

ws o

f 200

9

RISA

§ 2

1-28

.6-1

et se

q.

IRI

SA §

21-

28-2

.08

Curr

ent L

aw:

The

Edw

ard

O. H

awki

ns a

nd T

hom

as C

. Sla

ter M

edic

al M

ariju

ana

Act

rem

oved

stat

e-le

vel p

enal

ties f

or m

edic

al m

ariju

ana

use,

poss

essio

n, a

nd c

ultiv

atio

n fo

r pat

ient

s an

d th

eir c

areg

iver

s who

are

regi

ster

ed w

ith th

e st

ate.

Am

endm

ents

mad

e to

the

law

in 2

009

crea

ted

thre

e, st

ate-

regi

ster

ed a

nd li

cens

ed m

edic

al m

ariju

ana

disp

ensa

ries,

calle

d co

mpa

ssio

n ce

nter

s.

Hist

ory:

A

ther

apeu

tic re

sear

ch p

rogr

am —

whi

ch w

as n

ever

ope

ratio

nal —

for p

atie

nts w

ith li

fe- o

r sen

se-t

hrea

teni

ng co

nditi

ons w

as e

nact

ed in

198

0 by

H.B

. 79.

6072

(Ch.

375

) an

d am

ende

d in

198

6 (b

y 86

-H 7

817,

Ch.

236

) to

expa

nd th

e la

w fr

om p

atie

nts w

ith sp

ecifi

ed d

iseas

e gr

oups

to p

atie

nts w

ith “l

ife- o

r sen

se-t

hrea

teni

ng co

nditi

ons”

and

to

del

ete

refe

renc

es to

Pat

ient

Qua

lific

atio

n Re

view

Boa

rd. T

he p

rogr

am w

ould

hav

e be

en a

dmin

ister

ed b

y th

e di

rect

or o

f the

Dep

artm

ent o

f Hea

lth.

VT

May

26,

200

4Ju

ly 1

, 200

4S.

76

(mod

ified

by

S.7,

ef

fect

ive

July

1, 2

007,

and

ag

ain

by S

.17,

effe

ctiv

e Ju

ne

2, 2

011)

Act

No.

135

(200

4)18

VSA

§ 4

471

et

seq.

N/A

N/A

Curr

ent L

aw:

S.76

rem

oves

stat

e-le

vel p

enal

ties f

or m

edic

al m

ariju

ana

use,

poss

essio

n, a

nd c

ultiv

atio

n fo

r pat

ient

s and

thei

r car

egiv

ers w

ho a

re re

gist

ered

with

the

stat

e. In

itial

ly, re

gis-

trat

ion

was

per

mitt

ed o

nly

for p

eopl

e di

agno

sed

with

AID

S, c

ance

r, m

ultip

le sc

lero

sis, o

r HIV

. S.7

, effe

ctiv

e Ju

ly 1

, 200

7, e

xpan

ded

the

defin

ition

of “

debi

litat

ing

med

ical

co

nditi

on” b

y ad

ding

cond

ition

s and

trea

tmen

ts th

at c

ause

cac

hexi

a or

was

ting,

seve

re p

ain,

seve

re n

ause

a, o

r sei

zure

s. S.

7 al

so in

crea

sed

the

num

ber o

f pla

nts a

pat

ient

or

car

egiv

er c

an p

osse

ss a

nd a

llow

ed d

octo

rs li

cens

ed to

pra

ctic

e in

New

Ham

pshi

re, M

assa

chus

etts

, and

New

Yor

k to

reco

mm

end

mar

ijuan

a to

thei

r Ver

mon

t pat

ient

s. S.

17, p

asse

d in

201

1, a

llow

ed fo

r the

est

ablis

hmen

t of f

our n

on-p

rofit

med

ical

mar

ijuan

a di

spen

sarie

s. Pa

tient

s may

onl

y pu

rcha

se m

edic

al m

ariju

ana

at th

eir d

esig

nate

d di

spen

sarie

s, an

d th

e nu

mbe

r of p

lant

s disp

ensa

ries c

an c

ultiv

ate

is de

pend

ent o

n th

e nu

mbe

r of p

atie

nts w

ho h

ave

desig

nate

d th

at d

ispen

sary

. S.1

7 al

so a

llow

ed p

hysi-

cian

s ass

istan

ts a

nd a

dvan

ced

prac

tice

regi

ster

ed n

urse

s to

reco

mm

end

mar

ijuan

a.

Hist

ory:

O

n Ap

ril 2

7, 1

981,

the

Verm

ont L

egisl

atur

e pa

ssed

H. 1

30 (A

ct N

o. 4

9, se

ssio

n la

w 1

8 V

SA §

447

1), w

hich

allo

wed

phy

sicia

ns to

pre

scrib

e m

ariju

ana

for c

ance

r and

oth

er

med

ical

use

s as d

eter

min

ed b

y th

e co

mm

issio

ner o

f hea

lth. T

he p

rogr

am w

as a

dmin

ister

ed b

y th

e D

epar

tmen

t of H

ealth

. Cal

led

a “r

esea

rch

prog

ram

,” H

. 130

allo

wed

ph

ysic

ians

to p

resc

ribe

mar

ijuan

a an

d pr

ovid

ed th

at “[

the]

com

miss

ione

r of h

ealth

shal

l hav

e th

e au

thor

ity to

obt

ain

… c

anna

bis a

dmin

ister

ed u

nder

this

prog

ram

.”

Page 40: State by State Laws Report 2011

Appe

ndix

A:

Stat

e Med

ical

Mar

ijuan

a Law

s

A-8

Stat

e-By

-Sta

te R

epor

t 201

1

Stat

es w

ith E

ffect

ive

Med

ical

Mar

ijuan

a La

ws (

Rem

oval

of C

rim

inal

Pen

altie

s)

Stat

e

Med

ical

M

ariju

ana

Law

Ap

prov

ed To

ok E

ffect

Bill/

Initi

ativ

e #

Sess

ion

Law

Cita

tion

for

Med

ical

Mar

ijuan

a La

wM

ariju

ana

Sche

dule

Cita

tion

for S

ched

ules

WA

Nov

. 3, 1

998

Nov

. 3, 1

998

Initi

ativ

e M

easu

re N

o. 6

92;

SB 6

032

(200

7); S

B 57

98

(201

0); S

B 50

73 (2

011)

1999

c 2

§1, C

hapt

er

181,

Law

s of 2

011

RCW

69.

51A

I69

.50.

204

and

W

AC

246

-887

-100

Curr

ent L

aws:

Mea

sure

692

crea

ted

an a

ffirm

ativ

e de

fens

e at

tria

l aga

inst

char

ges o

f mar

ijuan

a us

e, po

sses

sion,

and

cul

tivat

ion

by p

atie

nts a

nd c

areg

iver

s. SB

507

3, p

asse

d by

the

legi

s-la

ture

in 2

011

and

part

ially

vet

oed

by G

ov. G

rego

ire, e

xplic

itly

allo

wed

pat

ient

s and

car

egiv

ers t

o co

llect

ivel

y gr

ow th

eir m

edic

ine,

but m

ade

care

give

rs w

ait f

or 1

5 da

ys

betw

een

assis

ting

two

diffe

rent

pat

ient

s. Pa

ssag

e of

SB

5798

in 2

010

allo

wed

phy

sicia

n’s a

ssist

ants

, ost

eopa

thic

phy

sicia

n’s a

ssist

ants

, nat

urop

aths

, and

adv

ance

d re

gist

ered

nu

rse

prac

titio

ners

to le

gally

reco

mm

end

mar

ijuan

a to

thei

r pat

ient

s.

Hist

ory:

A

ther

apeu

tic re

sear

ch p

rogr

am –

whi

ch w

as o

pera

tiona

l – fo

r can

cer c

hem

othe

rapy

and

radi

olog

y, gl

auco

ma,

and

oth

er d

iseas

e gr

oups

(RC

W 6

9.51

) was

ena

cted

on

Mar

ch 2

7, 1

979

(H.B

. 259

, Ch.

136

) and

rem

ains

on

the

book

s. Pr

ogra

m a

dmin

ister

ed b

y Bo

ard

of P

harm

acy

and

Patie

nt Q

ualif

icat

ion

Revi

ew C

omm

ittee

; “Bo

ard

shal

l ob

tain

mar

ijuan

a th

roug

h w

hate

ver m

eans

it d

eem

s mos

t app

ropr

iate

and

cons

isten

t with

regu

latio

ns p

rom

ulga

ted

by fe

dera

l gov

ernm

ent”

; “bo

ard

may

use

mar

ijuan

a w

hich

has

bee

n co

nfisc

ated

by

loca

l or s

tate

law

enf

orce

men

t age

ncie

s and

has

bee

n de

term

ined

to b

e fr

ee fr

om co

ntam

inat

ion.”

Th

ere

was

dua

l sch

edul

ing

for m

ariju

ana

and

ever

y co

mpo

und

(incl

udin

g TH

C –

tetr

ahyd

roca

nnab

inol

, the

prim

ary

activ

e in

gred

ient

) in

the

mar

ijuan

a pl

ant;

an a

men

d-m

ent i

n 19

86 (C

h. 1

24) r

emov

ed th

e du

al sc

hedu

ling

of m

ariju

ana

and

THC

. O

n M

arch

30,

199

6, W

ashi

ngto

n en

acte

d a

1996

supp

lem

enta

l ope

ratin

g bu

dget

allo

catin

g $1

30,0

00 fo

r tw

o m

edic

al m

ariju

ana-

rela

ted

proj

ects

: $70

,000

to re

sear

ch a

ta

mpe

r-fr

ee m

eans

of c

ultiv

atin

g m

ariju

ana

for m

edic

al p

urpo

ses a

nd $

60,0

00 to

rese

arch

the

ther

apeu

tic p

oten

tial o

f mar

ijuan

a. R

esea

rch,

how

ever

, was

nev

er co

nduc

t-ed

, and

the

$60,

000

appr

opria

tion

expi

red.

Stat

es w

ith W

orka

ble

Med

ical

Mar

ijuan

a La

ws

Stat

eM

edic

al M

ariju

ana

Law

App

rove

d To

ok E

ffect

Bill/

Initi

ativ

e #

Sess

ion

Law

Cita

tion

for

Med

ical

Mar

ijuan

a La

wM

ariju

ana

Sche

dule

Cita

tion

for S

ched

ules

MD

May

22,

200

3O

ct. 1

, 200

3H

.B. 7

02 (m

odifi

ed b

y SB

308

, effe

ctiv

e Ju

ne

1, 2

011)

2003

sess

ion,

Ch.

44

2/20

11 se

ssio

n,

Ch.

215

§ 25

-601

c, 5-

619c

IM

d. C

ode

Ann

., §

25-6

01(c

), 5-

619(

c)

Curr

ent L

aw:

H.B

. 702

allo

wed

indi

vidu

als t

o pr

esen

t evi

denc

e of

a m

edic

al n

eces

sity

durin

g a

cour

t sen

tenc

ing

and,

if a

ccep

ted,

hav

e th

eir s

ente

nce

redu

ced

to a

$10

0 fin

e w

ith n

opo

ssib

ility

of j

ail.

SB 3

08 su

pple

men

ted

this

sect

ion

by a

llow

ing

indi

vidu

als w

ho h

ave

been

dia

gnos

ed w

ith a

“deb

ilita

ting

med

ical

cond

ition

” by

a ph

ysic

ian

with

who

m

they

hav

e a

“bon

a fid

e ph

ysic

ian-

patie

nt re

latio

nshi

p” to

ass

ert t

he m

edic

al u

se o

f mar

ijuan

a as

an

affir

mat

ive

defe

nse,

mea

ning

they

will

be

foun

d “n

ot g

uilty

.” Th

e de

fens

e is

not a

vaila

ble

to th

ose

who

use

mar

ijuan

a in

pub

lic o

r pos

sess

mor

e th

an o

ne o

unce

.

Page 41: State by State Laws Report 2011

A-9

Appendix A: State M

edical Marijuana Law

s

State-By-State Report 2011St

ates

with

Med

ical

Mar

ijuan

a R

esea

rch

Law

s (Th

erap

eutic

Res

earc

h Pr

ogra

ms)

Stat

eM

edic

al M

ariju

ana

Law

App

rove

d To

ok E

ffect

Bill/

Initi

ativ

e #

Sess

ion

Law

Cita

tion

for

Med

ical

Mar

ijuan

a La

wM

ariju

ana

Sc

hedu

leC

itatio

n fo

r Sc

hedu

les

AL

July

30,

197

9Ju

ly 3

0, 1

979

S. 5

59A

ct N

o. 7

9-47

20-2

-110

et s

eq.

20-2

-23(

3) a

nd A

AC

Ch.

42

0-7-

2Cu

rren

t Law

: Fo

r can

cer c

hem

othe

rapy

and

gla

ucom

a.

St

ate

Boar

d of

Med

ical

Exa

min

ers i

s aut

horiz

ed to

crea

te re

view

com

mitt

ee to

adm

inist

er p

rogr

am —

whi

ch h

as n

ever

bee

n op

erat

iona

l.

S.

163

(Act

. No.

81-

506)

mad

e m

inor

chan

ges.

GA

Feb.

22,

198

0Fe

b. 2

2, 1

980

H.B

. 107

7N

o. 7

10 (1

980)

§ 43

-34-

120

et se

q. a

nd

Rule

s and

Reg

ulat

ions

C

hapt

er 3

60-1

2

N/A

O.C

.G.A

. § 1

6-13

-25

Curr

ent L

aw:

For c

ance

r and

gla

ucom

a (m

ariju

ana

or T

HC

).

C

ompo

site

Stat

e Bo

ard

of M

edic

al E

xam

iner

s has

auth

ority

to ap

poin

t a P

atie

nt Q

ualif

icat

ion

Revi

ew B

oard

, whi

ch c

an ap

prov

e pa

tient

s, ph

ysic

ians

, and

pha

rmac

ies f

or

part

icip

atio

n in

the

prog

ram

— w

hich

was

ope

ratio

nal;

no o

ther

ailm

ents

allo

wed

.

ILSe

pt. 9

, 197

8Se

pt. 9

, 197

8H

.B. 2

625

80-1

426

720

ILC

S 55

0/11

, 550

/15

and

77 IA

C C

h. X

, Sec

. 20

85

N/A

720

ILC

S 57

0/20

6 an

d 77

IAC

C

h. X

, Se

c. 2

070

Curr

ent L

aw:

For g

lauc

oma

and

canc

er ch

emot

hera

py a

nd ra

diol

ogy

or o

ther

pro

cedu

res.

The

prog

ram

has

nev

er b

een

oper

atio

nal.

A

llow

s per

sons

“eng

aged

in re

sear

ch” t

o us

e m

ariju

ana

whe

n au

thor

ized

by

phys

icia

n; m

ust b

e ap

prov

ed b

y D

epar

tmen

t of M

enta

l Hea

lth a

nd D

evel

opm

enta

l Disa

bili-

ties.

Th

e la

w a

lso e

ncou

rage

s res

earc

h on

can

nabi

s to

“est

ablis

h m

etho

ds to

ass

ess a

ccur

atel

y th

e ef

fect

of c

anna

bis,”

and

to cr

eate

rela

ted

rese

arch

pro

gram

s.

MA

Dec

. 31,

199

1D

ec. 3

1, 1

991

S. 1

582

Ch.

480

(199

1)94

D §

1 e

t seq

. D

94C

§ 3

1

Curr

ent L

aw:

For c

ance

r che

mot

hera

py a

nd ra

diol

ogy,

glau

com

a, a

nd a

sthm

a (m

ariju

ana

or T

HC

). Th

e pr

ogra

m h

as n

ever

bee

n op

erat

iona

l.

O

n Au

gust

8, 1

996,

Mas

sach

uset

ts p

asse

d a

seco

nd m

edic

al m

ariju

ana

bill

(H. 2

170)

, whi

ch m

anda

ted

that

with

in 1

80 d

ays t

he st

ate’s

pub

lic h

ealth

dep

artm

ent m

ust

esta

blish

the

rule

s and

regu

latio

ns n

eces

sary

to g

et it

s the

rape

utic

rese

arch

pro

gram

runn

ing

and

to a

llow

a d

efen

se o

f med

ical

nec

essit

y fo

r enr

olle

d pa

tient

s. Ru

les w

ere

esta

blish

ed, b

ut fe

dera

l per

miss

ion

for r

esea

rch

was

nev

er o

btai

ned.

C

ontr

olle

d su

bsta

nces

are

in C

lass

es A

, B, C

, and

D, w

hich

det

erm

ine

the

seve

rity

of p

enal

ties f

or p

osse

ssio

n, m

anuf

actu

re, a

nd d

istrib

utio

n of

thes

e su

bsta

nces

. The

cl

asse

s mak

e no

stat

emen

t as t

o th

e m

edic

al v

alue

of t

he co

ntro

lled

subs

tanc

es.

Page 42: State by State Laws Report 2011

Appe

ndix

A:

Stat

e Med

ical

Mar

ijuan

a Law

s

A-10

Stat

e-By

-Sta

te R

epor

t 201

1

Stat

es w

ith M

edic

al M

ariju

ana

Res

earc

h La

ws (

Ther

apeu

tic R

esea

rch

Prog

ram

s)

Stat

eM

edic

al M

ariju

ana

Law

App

rove

d To

ok E

ffect

Bill/

Initi

ativ

e #

Sess

ion

Law

Cita

tion

for

Med

ical

Mar

ijuan

a La

wM

ariju

ana

Sc

hedu

leC

itatio

n fo

r Sc

hedu

les

MN

April

24,

198

0Ap

ril 2

5, 1

980

H.F.

247

6C

h. 6

14 (1

980)

§ 15

2.21

152.

02 a

nd M

R 68

00.4

200

Curr

ent L

aw:

For c

ance

r onl

y (T

HC

onl

y). T

HC

is in

Sch

edul

e I b

ut is

cons

ider

ed to

be

in S

ched

ule

II w

hen

used

for m

edic

al p

urpo

ses.

Th

e 19

80 b

ill o

rigin

ally

appr

opria

ted

$100

,000

to th

e TH

C T

hera

peut

ic R

esea

rch

Act

, but

this

line-

item

was

vet

oed

by th

e go

vern

or. T

he p

rogr

am h

as n

ever

bee

n op

era-

tiona

l.

NY

June

30,

198

0Se

pt. 1

, 198

0S.

B. 1

123-

6C

h. 8

10 (1

980)

Pub

Hea

lth §

339

7-a

et se

q. a

nd P

ub H

ealth

§

3328

IPu

b H

ealth

§ 3

306

Curr

ent L

aw:

For c

ance

r, gl

auco

ma,

and

oth

er li

fe- a

nd se

nse-

thre

aten

ing

dise

ases

appr

oved

by

the

com

miss

ione

r. A

dmin

ister

ed b

y D

epar

tmen

t of H

ealth

and

Pat

ient

Qua

lific

atio

n Re

view

Boa

rd; t

he p

rogr

am w

as o

pera

tiona

l; co

nfisc

ated

mar

ijuan

a m

ay b

e us

ed if

nec

essa

ry.

In

198

1, th

e na

me

of th

e “c

ontr

olle

d su

bsta

nces

ther

apeu

tic re

sear

ch p

rogr

am” w

as ch

ange

d to

the

“Ant

onio

G. O

livie

ri co

ntro

lled

subs

tanc

es th

erap

eutic

rese

arch

pro

-gr

am” b

y C

h. 2

08 (1

981)

.

SCFe

b. 2

8, 1

980

Feb.

28,

198

0S.

350

Act

No.

323

(198

0)§

44-5

3-61

0 et

seq.

44-5

3-16

0 an

d §

44-5

3-19

0

Curr

ent L

aw:

For g

lauc

oma,

can

cer c

hem

othe

rapy

and

radi

olog

y, an

d ot

her d

iseas

e gr

oups

(mar

ijuan

a an

d TH

C).

The

prog

ram

has

nev

er b

een

oper

atio

nal.

A

dmin

ister

ed b

y co

mm

issio

ner o

f Dep

artm

ent o

f Hea

lth a

nd E

nviro

nmen

tal C

ontr

ol a

nd P

atie

nt Q

ualif

icat

ion

Revi

ew A

dviso

ry B

oard

; “Th

e di

rect

or sh

all o

btai

n m

ari-

juan

a th

roug

h w

hate

ver m

eans

he

deem

s mos

t app

ropr

iate

cons

isten

t with

fede

ral l

aw.”

M

inor

am

endm

ents

mad

e by

Act

No.

181

(199

3).

TX

June

14,

197

9Ja

nuar

y 1,

198

0S.

B. 8

77C

h. 8

26 (1

979)

H &

S §

481

.111

and

§

481.

201-

205

IH

& S

§ 4

81.0

32 a

nd §

481

.038

an

d 37

TA

C §

13.

1Cu

rren

t Law

: Fo

r can

cer a

nd g

lauc

oma

(TH

C o

r its

der

ivat

ives

). Th

e pr

ogra

m h

as n

ever

bee

n op

erat

iona

l.

A

dmin

ister

ed b

y Bo

ard

of H

ealth

and

Res

earc

h Pr

ogra

m R

evie

w B

oard

(RPR

B), w

hich

, afte

r app

rova

l of B

oard

of H

ealth

, may

seek

auth

oriz

atio

n to

exp

and

rese

arch

pr

ogra

m to

incl

ude

othe

r dise

ases

; get

TH

C fr

om fe

dera

l gov

ernm

ent.

M

inor

am

endm

ents

mad

e by

S.B

. 688

in 1

983

(Ch.

566

). H

.B. 2

136

in 1

989

(Ch.

678

) mov

ed th

e th

erap

eutic

rese

arch

pro

gram

law

from

Civ

il St

atut

es H

ealth

Art

. 447

6-15

to H

& S

§ 4

81.2

01-2

05.

H

.B. 2

213,

sign

ed in

to la

w b

y Te

xas G

over

nor G

eorg

e W

. Bus

h on

June

18,

199

7, p

rohi

bits

loca

l gov

ernm

ents

in T

exas

from

ado

ptin

g po

licie

s of n

ot fu

lly e

nfor

cing

exi

st-

ing

stat

e dr

ug la

ws.

The

bill

was

insp

ired

by th

e vo

ter i

nitia

tive

in S

an M

arco

s — re

ject

ed b

y vo

ters

on

May

3, 1

997

— w

hich

wou

ld h

ave

allo

wed

pol

ice

to o

verlo

ok th

e m

edic

al u

se o

f mar

ijuan

a. T

his l

aw d

oes n

ot a

ffect

the

exist

ing

ther

apeu

tic re

sear

ch p

rogr

am la

w.

Page 43: State by State Laws Report 2011

A-11

Appendix A: State M

edical Marijuana Law

s

State-By-State Report 2011St

ates

with

Sym

bolic

Med

ical

Mar

ijuan

a La

ws

Stat

eM

edic

al M

ariju

ana

Law

App

rove

dTo

ok E

ffect

Mea

sure

Sess

ion

Law

Cita

tion

for

Med

ical

Mar

i-ju

ana

Law

Des

crip

tion

of

Law

Mar

ijuan

a Sc

hedu

leC

itatio

n fo

r Sc

hedu

les

CT

not a

vaila

ble

July

1, 1

981

Sub.

H.B

. 521

7Pu

blic

Act

No.

81-

440

§ 21

a-24

6 an

d §

21a-

253

phys

icia

ns m

ay

pres

crib

eI

§ 21

a-24

3 an

d §

21a-

243-

7 Re

g.

of C

onn.

Sta

te

Age

ncie

s Cu

rren

t Law

: Fo

r can

cer c

hem

othe

rapy

and

gla

ucom

a.

La

w fo

rmer

ly se

t out

as §

19-

453

and

§ 19

-460

a, b

ut se

ctio

ns w

ere

tran

sfer

red

in 1

983;

allo

ws p

hysic

ians

lice

nsed

by

the

Com

miss

ione

r of C

onsu

mer

Pro

tect

ion

to p

rovi

de

mar

ijuan

a; a

llow

s pat

ient

s to

poss

ess m

ariju

ana

obta

ined

from

a p

resc

riptio

n; m

akes

no

prov

ision

for t

he so

urce

of t

he m

ariju

ana

supp

ly.

IAJu

ne 1

, 197

9Ju

ly 1

, 197

9S.

F. 48

7C

h. 9

(197

9)§

124.

204

and

§ 12

4.20

6sc

hedu

ling

reco

g-ni

zes m

ariju

ana’s

th

erap

eutic

use

I*§

124.

204

and

§ 12

4.20

6

Curr

ent L

aw:

*The

bill

impl

emen

ted

a du

al sc

hedu

ling

sche

me

for m

ariju

ana

and

THC

, whi

ch a

re in

Sch

edul

e I b

ut a

re co

nsid

ered

to b

e in

Sch

edul

e II

whe

n us

ed fo

r med

ical

pur

-po

ses.

Hist

ory:

Th

e bi

ll ap

prop

riate

d $2

47,0

00 to

the

Boar

d of

Pha

rmac

y Ex

amin

ers,

whi

ch w

as co

ntin

gent

upo

n th

e Bo

ard

of P

harm

acy

Exam

iner

s’ es

tabl

ishin

g a

ther

apeu

tic re

-se

arch

pro

gram

with

in 9

0 da

ys o

f the

effe

ctiv

e da

te o

f the

act

(Jul

y 1,

197

9); t

he b

oard

was

man

date

d to

org

aniz

e a

Phys

icia

ns A

dviso

ry G

roup

to a

dvise

the

boar

d on

th

e st

ruct

ure

of th

e pr

ogra

m —

whi

ch w

as n

ever

ope

ratio

nal.

Sc

hedu

ling

info

rmat

ion

was

orig

inal

ly lo

cate

d at

§ 2

04.2

04 b

ut w

as m

oved

to §

124

.204

in 1

993

by th

e Io

wa

Cod

e Ed

itor.

No

dise

ase

grou

ps w

ere

spec

ified

in th

e bi

ll.

The

dual

sche

dulin

g sc

hem

e st

ill e

xist

s in

the

stat

utes

, but

the

lang

uage

for t

he th

erap

eutic

rese

arch

pro

gram

— A

dmin

istra

tive

Cod

e 62

0-12

— w

as a

ctiv

e fr

om O

cto-

ber 1

, 197

9, to

June

30,

198

1, a

nd w

as re

mov

ed o

n Ja

nuar

y 20

, 198

7.

On

Febr

uary

17,

201

0, fo

llow

ing

an a

ctiv

ist la

wsu

it an

d he

arin

gs, t

he Io

wa

Boar

d of

Pha

rmac

y de

cide

d th

at m

ariju

ana

has m

edic

al v

alue

and

reco

mm

ende

d th

at th

e le

gisla

ture

end

the

dual

sche

dulin

g an

d re

sche

dule

mar

ijuan

a so

lely

to S

ched

ule

II. I

t rec

omm

ende

d th

at it

form

a ta

sk fo

rce

to st

udy

how

to a

dmin

ister

a m

edic

al

mar

ijuan

a pr

ogra

m. A

s of t

his p

rintin

g, th

e le

gisla

ture

has

not

take

n ac

tion.

LAJu

ly 1

7, 1

978;

July

23

, 199

1Au

gust

14,

197

8;

Augu

st 2

1, 1

991

S.B.

245

(197

8);

H.B

. 118

7 (1

991)

Act

No.

725

(1

978)

; Act

No.

87

4 (1

991)

§ 40

:102

1ph

ysic

ians

may

pr

escr

ibe

40:9

64

Curr

ent L

aw:

For g

lauc

oma,

can

cer c

hem

othe

rapy

, and

“spa

stic

qua

drip

legi

a.”

Th

e pr

esen

t law

allo

ws p

hysic

ians

with

Sch

edul

e I l

icen

ses t

o pr

escr

ibe

mar

ijuan

a in

acc

orda

nce

with

regu

latio

ns p

rom

ulga

ted

by th

e Se

cret

ary

of H

ealth

and

Hos

pi-

tals.

Hist

ory:

A

pre

viou

s law

, 40:

1021

- 40

:102

6, h

ad b

een

repe

aled

by

H.B

. 122

4 in

198

9 (A

ct N

o. 6

62).

The

prev

ious

law

was

a th

erap

eutic

rese

arch

pro

gram

that

add

ress

ed o

nly

glau

com

a an

d ca

ncer

.

Page 44: State by State Laws Report 2011

Appe

ndix

A:

Stat

e Med

ical

Mar

ijuan

a Law

s

A-12

Stat

e-By

-Sta

te R

epor

t 201

1

Stat

es w

ith S

ymbo

lic M

edic

al M

ariju

ana

Law

s

Stat

eM

edic

al M

ariju

ana

Law

App

rove

dTo

ok E

ffect

Mea

sure

Sess

ion

Law

Cita

tion

for

Med

ical

Mar

i-ju

ana

Law

Des

crip

tion

of

Law

Mar

ijuan

a Sc

hedu

leC

itatio

n fo

r Sc

hedu

les

NH

April

23,

198

1Ju

ne 2

2, 1

981

S.B.

21

Ch.

107

(198

1)31

8-B:

9ph

ysic

ians

may

pr

escr

ibe

I*31

8-B:

1-a

Curr

ent L

aw:

For c

ance

r che

mot

hera

py a

nd ra

diol

ogy.

A

men

ded

by H

.B. 1

563

(ena

cted

June

8, 1

998;

took

effe

ct Ja

n. 1

, 199

9), w

hich

says

doc

tors

may

pre

scrib

e m

ariju

ana

only

if it

is ap

prov

ed b

y th

e FD

A; p

revi

ously

doc

-to

rs co

uld

pres

crib

e it

with

out F

DA

appr

oval

, but

the

abse

nce

of a

lega

l sup

ply

mad

e th

e la

w in

effe

ctiv

e.

*S

tate

follo

ws t

he fe

dera

l gov

ernm

ent’s

sche

dulin

g of

cont

rolle

d su

bsta

nces

as a

rtic

ulat

ed in

the

Cod

e of

Fed

eral

Reg

ulat

ions

[318

-B:1

-a; J

une

11, 1

996,

pho

ne co

nver

-sa

tion

with

John

McC

orm

ick

at N

ew H

amps

hire

Sta

te L

ibra

ry, 6

03-2

71-2

239]

.

TNAp

ril 2

, 198

1Ap

ril 2

, 198

1H

.B. 3

14C

h. 1

14 (1

981)

§ 68

-52-

101

sche

dulin

g re

cog-

nize

s mar

ijuan

a’s

ther

apeu

tic u

se

VI*

§ 39

-17-

408

Curr

ent L

aw:

Onl

y th

e sc

hedu

ling

prov

ision

of t

he th

erap

eutic

rese

arch

pro

gram

rem

ains

on

the

book

s.

Hist

ory:

Th

e bi

ll cr

eate

d a

ther

apeu

tic re

sear

ch p

rogr

am —

whi

ch w

as o

pera

tiona

l — fo

r can

cer c

hem

othe

rapy

or r

adio

logy

or g

lauc

oma

(mar

ijuan

a or

TH

C);

adm

inist

ered

by

Patie

nt Q

ualif

icat

ion

Revi

ew B

oard

(PQ

RB) c

reat

ed w

ithin

Boa

rd o

f Pha

rmac

y; P

QRB

was

auth

oriz

ed to

cont

ract

with

fede

ral g

over

nmen

t for

mar

ijuan

a.

Th

erap

eutic

rese

arch

pro

gram

was

repe

aled

by

S.B.

181

8 in

199

2 (C

h. 5

37),

but d

ual s

ched

ulin

g sc

hem

e st

ill re

mai

ns.

*M

ariju

ana

and

THC

are

in S

ched

ule

VI b

ut a

re co

nsid

ered

to b

e in

Sch

edul

e II

whe

n us

ed fo

r med

ical

pur

pose

s. (S

ched

ule

VI i

nclu

des c

ontr

olle

d su

bsta

nces

that

“s

houl

d no

t be

incl

uded

in S

ched

ules

I th

roug

h V.”

Sch

edul

es I

thro

ugh

V h

ave

the

typi

cal d

efin

ition

s use

d in

oth

er st

ates

.)

VAM

arch

27,

197

9Sp

ring

1979

S. 9

13C

h. 4

35 (1

979)

§ 18

.2-2

50.1

and

§

18.2

-251

.1ph

ysic

ians

may

pr

escr

ibe

N/A

§ 54

.1-3

443

Curr

ent L

aw:

For c

ance

r and

gla

ucom

a (m

ariju

ana

or T

HC

). A

llow

s phy

sicia

ns to

pre

scrib

e an

d ph

arm

acist

s to

disp

ense

mar

ijuan

a an

d TH

C fo

r suc

h pu

rpos

es.

WI

not a

vaila

ble;

Apr

il 20

, 198

8Ap

ril 2

0, 1

982;

Ap

ril 2

8, 1

988

A.B

. 697

; A.B

. 662

Ch.

193

(198

1);

Act

339

(198

7)46

.60

phys

icia

ns m

ay

pres

crib

eI

161.

13; 1

61.4

1(3r

)

Curr

ent L

aw:

No

dise

ase

grou

ps sp

ecifi

ed (m

ariju

ana

or T

HC

).

A

llow

s med

ical

mar

ijuan

a pr

escr

iptio

ns in

acc

orda

nce

with

fede

ral I

ND

(Inv

estig

atio

nal N

ew D

rug)

per

mits

; giv

es co

ntro

lled

subs

tanc

es b

oard

the

auth

ority

to se

t up

regu

latio

ns.

A

.B. 6

62 in

198

7 (A

ct 3

39),

enac

ted

in 1

988,

allo

ws f

or th

e po

sses

sion

of T

HC

if o

btai

ned

dire

ctly

from

a v

alid

pre

scrip

tion.

Page 45: State by State Laws Report 2011

A-13

Appendix A: State M

edical Marijuana Law

s

State-By-State Report 2011St

ates

in W

hich

Med

ical

Mar

ijuan

a La

ws H

ave

Expi

red

or B

een

Rep

eale

dSt

ate

Med

ical

Mar

i-ju

ana

Law

A

ppro

ved

Took

Eff

ect

Bill

#Se

ssio

n La

wC

itatio

n fo

r M

edic

al M

ari-

juan

a La

w

Des

crip

tion

of

Law

Law

Exp

ired

/ R

epea

led

Mar

ijuan

a Sc

hedu

leC

itatio

n fo

r Sc

hedu

les

AR

Jan.

30,

198

1Ja

n. 3

0, 1

981

H.B

. 171

Act

No.

8 (1

981)

§ 82

-100

7 (n

umbe

ring

sys-

tem

has

chan

ged

since

law

was

re

peal

ed)

phys

icia

ns m

ay

pres

crib

ere

peal

ed b

y A

ct

No.

52

(198

7)V

5-64

-215

Curr

ent L

aw:

Mar

ijuan

a an

d TH

C a

re li

sted

in S

ched

ule

VI,

but S

ched

ule

VI s

ubst

ance

s are

def

ined

sim

ilarly

to —

yet

eve

n m

ore

rest

rictiv

ely

than

— S

ched

ule

I sub

stan

ces.

Hist

ory:

Fo

r can

cer (

law

fully

obt

aine

d TH

C).

FLJu

ne 2

6, 1

978

July

1, 1

978

H.B

. 123

7c.

78-4

13 (1

978)

§ 40

2.36

ther

apeu

tic re

-se

arch

pro

gram

repe

aled

by

c.

84-1

15 (1

984)

893.

03

Hist

ory:

Fo

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(mar

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TH

C).

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ffect

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Page 46: State by State Laws Report 2011

Appe

ndix

A:

Stat

e Med

ical

Mar

ijuan

a Law

s

A-14

Stat

e-By

-Sta

te R

epor

t 201

1

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ariju

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pire

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edic

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itatio

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edic

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ari-

juan

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w

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crip

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of

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Exp

ired

/ R

epea

led

Mar

ijuan

a Sc

hedu

leC

itatio

n fo

r Sc

hedu

les

OH

Mar

ch 2

1, 1

980;

19

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ne 2

0, 1

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ly 1

, 199

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ealth

; mar

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ory:

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79 la

w e

stab

lishe

d a

ther

apeu

tic re

sear

ch p

rogr

am fo

r can

cer c

hem

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rapy

and

gla

ucom

a. It

was

to b

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min

ister

ed b

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e di

rect

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f the

Dep

artm

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f Hea

lth

and

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nt Q

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ew B

oard

(PQ

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whi

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as au

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to ce

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s, ph

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ase

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ps if

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his p

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as n

ever

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as re

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199

7.

Page 47: State by State Laws Report 2011

A-15

Appendix A: State M

edical Marijuana Law

s

State-By-State Report 2011States That Have Never Had Medical Marijuana Laws

State Schedule Citation for Schedule

ID I 37-2705

IN I 35-48-2

KS I 65-4105

KY I 218A and 902 KAR 55:020

MO I 195.017

MS I § 41-29-113

ND I 19-03.1-04

NE I § 28-405

OK I 63 § 2-204

PA I 35 § 780-104 and 28 § 25.72 Penn. Code

SD n/a § 34-20B-11

UT I 58-37-4

WY I § 35-7-1012 and 024 059 101 Wyoming Rules

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Stat

e-By

-Sta

te R

epor

t 201

1 States That Have Passed Non-Binding Resolutions Urging the Federal Government to Make Marijuana Medically Available

State Resolution Passed Resolution #

CA Sept. 2, 1993 Sen. Joint Res. No. 8

MI March 17, 1982 Sen. Conc. Res. No. 473

MO Spring 1994 Sen. Conc. Res. 14

NH not available not available

NM Spring 1982 Sen. Memorial 42

RI Spring 2005 Sen. Res. 1158

*This resolution urges the federal government to defund the federal pros-ecution of medical marijuana patients and caregivers.

WA not available not available

NOTES:

1. Some states use the spelling “marihuana” in their statutes — “marijuana” is used in this report.

2. Italics for a citation indicate that it is in the state’s administrative code (developed by state agencies in the executive branch), not the state’s statutes (laws passed by the state legislature).

3. The definitions of Schedule I and Schedule II in state controlled substances acts are always similar to the federal definitions — which can be found in Appendix E of this report — unless noted otherwise. When marijuana is not in Schedule I or Schedule II, a clarifying description is noted.

4. THC is an abbreviation for tetrahydrocannabinol, the only active ingredient in dronabinol and the primary active ingredient in marijuana.

5. Dronabinol is an FDA-approved prescription drug (its trade name is Marinol), and is defined as THC “in sesame oil and encapsulated in a soft gelatin capsule in a U.S. Food and Drug Administration approved drug product.” 21 CFR Sec. 1308.13(g)(1)

6. Trivial amendments are not listed; bills that make minor, non-trivial amendments are listed.

7. Column with drug schedule: “N/A” simply means substance is not scheduled in state statutes or administra-tive code.

8. Statute citations for medical marijuana laws: The administrative code provisions for the therapeutic research programs are cited when possible but are not necessarily cited for all such states.

9. Many states have used a dual scheduling scheme for marijuana and/or THC. In these states, marijuana and THC are in Schedule I but are considered to be in Schedule II when used for medical purposes.

Page 49: State by State Laws Report 2011

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Appendix B: Medical M

arijuana Briefing Paper

State-By-State Report 2011

100% black

white

30% black

60% black

100% PMS286

For thousands of years, marijuana has been used to treat a wide variety of ailments. Until 1937, marijuana (Cannabis sativa L.) was legal in the United States for all purposes. Presently, federal law allows only four Americans to use marijuana as a medicine.

On March 17, 1999, the National Academy of Sciences’ Institute of Medicine (IOM) concluded that “there are some limited circumstances in which we recommend smoking marijuana for medical uses. ” The IOM report, the result of two years of research that was funded by the White House drug policy office, analyzed all existing data on marijuana’s therapeutic uses. Please see http://www.mpp.org/SCIENCE.

MEDICAL VALUE

Marijuana is one of the safest therapeutically active substances known. No one has ever died from an overdose, and it has a wide variety of therapeutic applications, including:

• Relief from nausea and appetite loss;

• Reduction of intraocular (within the eye) pressure;

• Reduction of muscle spasms; and

• Relief from chronic pain.

Marijuana is frequently beneficial in the treatment of the following conditions:

AIDS. Marijuana can reduce the nausea, vomiting, and loss of appetite caused by the ailment itself and by various AIDS medications. Observational research has found that by relieving these side effects, medical marijuana increases the ability of patients to stay on life-extending treatment. (See also CHRONIC PAIN below.)

HEPATITIS C. As with AIDS, marijuana can relieve the nausea and vomiting caused by treatments for hepatitis C. In a study published in the September 2006 European Journal of Gastroenterology & Hepatology, patients using marijuana were better able to complete their medication regimens, leading to a 300% improvement in treatment success.

GLAUCOMA. Marijuana can reduce intraocular pressure, alleviating the pain and slowing — and sometimes stopping — damage to the eyes. (Glaucoma is the leading cause of blindness in the United States. It damages vision by increasing eye pressure over time.)

CANCER. Marijuana can stimulate the appetite and alleviate nausea and vomiting, which are common side effects of chemotherapy treatment.

MULTIPLE SCLEROSIS. Marijuana can limit the muscle pain and spasticity caused by the disease, as well as relieving tremor and unsteadiness of gait. (Multiple sclerosis is the leading cause of neurological disability among young and middle-aged adults in the United States.)

EPILEPSY. Marijuana can prevent epileptic seizures in some patients.

CHRONIC PAIN. Marijuana can alleviate chronic, often debilitating pain caused by myriad disorders and injuries. Since 2007, three published clinical trials have found that marijuana effectively relieves neuropathic pain

Medical Marijuana Briefing Paper The Need to Change State and Federal Law

REVISED 8/11

MARIJUANA POLICY PROJECT • 236 MASSACHUSETTS AVE. NE • SUITE 400 • WASHINGTON DC 20002 • WWW.MPP.ORG

Appendix B: Medical Marijuana Briefing Paper

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ical

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g Pa

per (pain cause by nerve injury), a particularly hard to treat type of pain that afflicts millions suffering from diabetes,

HIV/AIDS, multiple sclerosis, and other illnesses.

Each of these applications has been deemed legitimate by at least one court, legislature, and/or government agency in the United States.

Many patients also report that marijuana is useful for treating arthritis, migraine, menstrual cramps, alcohol and opiate addiction, and depression and other debilitating mood disorders.

Marijuana could be helpful for millions of patients in the United States. Nevertheless, other than for the four people with special permission from the federal government, medical marijuana remains illegal under federal law!

People currently suffering from any of the conditions mentioned above, for whom the legal medical options have proven unsafe or ineffective, have two options:

1. Continue to suffer without effective treatment; or

2. Illegally obtain marijuana — and risk suffering consequences directly related to its illegality, such as:

• an insufficient supply due to the prohibition-inflated price or scarcity; impure, contaminated, or chemically adulterated marijuana;

• arrests, fines, court costs, property forfeiture, incarceration, probation, and criminal records.

BACKGROUND

Prior to 1937, at least 27 medicines containing marijuana were legally available in the United States. Many were made by well-known pharmaceutical firms that still exist today, such as Squibb (now Bristol-Myers Squibb) and Eli Lilly. The Marijuana Tax Act of 1937 federally prohibited marijuana. Dr. William C. Woodward of the American Medical Association opposed the Act, testifying that prohibition would ultimately prevent the medical uses of marijuana.

The Controlled Substances Act of 1970 placed all illicit and prescription drugs into five “schedules” (categories). Marijuana was placed in Schedule I, defining it as having a high potential for abuse, no currently accepted medical use in treatment in the United States, and a lack of accepted safety for use under medical supervision.

This definition simply does not apply to marijuana. Of course, at the time of the Controlled Substances Act, marijuana had been prohibited for more than three decades. Its medical uses forgotten, marijuana was considered a dangerous and addictive narcotic.

A substantial increase in the number of recreational users in the 1970s contributed to the rediscovery of marijuana’s medical uses:

• Many scientists studied the health effects of marijuana and inadvertently discovered marijuana’s medical uses in the process.

• Many who used marijuana recreationally also suffered from diseases for which marijuana is beneficial. By accident, they discovered its therapeutic value.

As the word spread, more and more patients started self-medicating with marijuana. However, marijuana’s Schedule I status bars doctors from prescribing it and severely curtails research.

Page 51: State by State Laws Report 2011

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Appendix B: Medical M

arijuana Briefing Paper

State-By-State Report 2011THE STRUGGLE IN COURT

In 1972, a petition was submitted to the Bureau of Narcotics and Dangerous Drugs — now the Drug Enforcement Administration (DEA) — to reschedule marijuana to make it available by prescription.

After 16 years of court battles, the DEA’s chief administrative law judge, Francis L. Young, ruled on September 6, 1988:

“Marijuana, in its natural form, is one of the safest therapeutically active substances known. ...”

“... [T]he provisions of the [Controlled Substances] Act permit and require the transfer of marijuana from Schedule I to Schedule II.”

“It would be unreasonable, arbitrary and capricious for DEA to continue to stand between those sufferers and the benefits of this substance. ...”

Marijuana’s placement in Schedule II would enable doctors to prescribe it to their patients. But top DEA bureaucrats rejected Judge Young’s ruling and refused to reschedule marijuana. Two appeals later, petitioners experienced their first defeat in the 22-year-old lawsuit. On February 18, 1994, the U.S. Court of Appeals (D.C. Circuit) ruled that the DEA is allowed to reject its judge’s ruling and set its own criteria — enabling the DEA to keep marijuana in Schedule I.

However, Congress has the power to reschedule marijuana via legislation, regardless of the DEA’s wishes.

TEMPORARY COMPASSION

In 1975, Robert Randall, who suffered from glaucoma, was arrested for cultivating his own marijuana. He won his case by using the “medical necessity defense,” forcing the government to find a way to provide him with his medicine. As a result, the Investigational New Drug (IND) compassionate access program was established, enabling some patients to receive marijuana from the government.

The program was grossly inadequate at helping the potentially millions of people who need medical marijuana. Many patients would never consider the idea that an illegal drug might be their best medicine, and most who were fortunate enough to discover marijuana’s medical value did not discover the IND program. Those who did often could not find doctors willing to take on the program’s arduous, bureaucratic requirements.

In 1992, in response to a flood of new applications from AIDS patients, the George H.W. Bush administration closed the program to new applicants, and pleas to reopen it were ignored by subsequent administrations. The IND program remains in operation only for the four surviving, previously approved patients.

PUBLIC AND PROFESSIONAL OPINION

There is wide support for ending the prohibition of medical marijuana among both the public and the medical community:

• Since 1996, a majority of voters in Alaska, Arizona, California, Colorado, the District of Columbia, Maine, Michigan, Montana, Nevada, Oregon, and Washington state have voted in favor of ballot initiatives to remove criminal penalties for seriously ill people who grow or possess medical marijuana.

• A national ABC News/Washington Post poll released January 18, 2010 found that 81% of Americans “think doctors should be allowed to prescribe marijuana for medical purposes to treat their patients.”

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per That figure is up from 69% in 1997. A national Gallup poll released November 1, 2005, found that 78% of

Americans support “making marijuana legally available for doctors to prescribe in order to reduce pain and suffering.” Polls conducted in the 11 states with medical marijuana laws during 2006 found support for the laws was high and steady, or (in nearly all cases) increasing.

• Organizations supporting some form of physician-supervised access to medical marijuana include the American Academy of Family Physicians, American Nurses Association, American Public Health Association, American Academy of HIV Medicine, and many others.

• A 1990 scientific survey of oncologists (cancer specialists) found that 54% of those with an opinion favored the controlled medical availability of marijuana and 44% had already suggested at least once that a patient obtain marijuana illegally. [R. Doblin & M. Kleiman, “Marijuana as Antiemetic Medicine,” Journal of Clinical Oncology 9 (1991): 1314-1319.]

CHANGING STATE LAWS

The federal government has no legal authority to prevent state governments from changing their laws to remove state-level penalties for medical marijuana use. Sixteen states and the District of Columbia have already done so: Delaware, Hawaii, Rhode Island, New Jersey, New Mexico, and Vermont through their legislatures, and the others by ballot initiatives. State legislatures have the authority and moral responsibility to change laws to:

• exempt seriously ill patients from state-level prosecution for medical marijuana possession and cultivation; and

• exempt doctors who recommend medical marijuana from prosecution or the denial of any right or privilege.

Even within the confines of federal law, states can enact reforms that have the practical effect of removing the fear of patients being arrested and prosecuted under state law — as well as the symbolic effect of pushing the federal government to allow doctors to prescribe marijuana.

U.S. CONGRESS: THE FINAL BATTLEGROUND

State governments that want to allow marijuana to be sold in pharmacies have been stymied by the federal government’s overriding prohibition of marijuana.

The U.S. Supreme Court’s June 2005 decision in Gonzales v. Raich preserved state medical marijuana laws but allowed continued federal attacks on patients, even in states with such laws. While the Justice Department indicated in 2009 that it would refrain from raids where activity is clearly legal under state law, that policy change could be reversed anytime. While the Justice department indicated in 2009 that it would refrain from raids where activity is clearly legal under state law, that policy change could be reversed anytime.

Efforts to obtain FDA approval of marijuana also remain stalled. Though some small studies of marijuana have been published or are underway, the National Institute on Drug Abuse — the only legal source of marijuana for clinical research in the U.S. — has consistently made it difficult (and often nearly impossible) for researchers to obtain marijuana for their studies. At present, it is effectively impossible to do the sort of large-scale, extremely costly trials required for FDA approval.

In the meantime, patients continue to suffer. Congress has the power and the responsibility to change federal law so that seriously ill people nationwide can use medical marijuana without fear of arrest and imprisonment.

Page 53: State by State Laws Report 2011

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Appendix C: Excerpts from

the Institute of Medicine 1999 Report

State-By-State Report 2011

What conditions can marijuana treat?

“The accumulated data indicate a potential thera-peutic value for cannabinoid drugs, particularly forsymptoms such as pain relief, control of nausea andvomiting, and appetite stimulation.” [p. ] 3

“[B]asic biology indicates a role for cannabinoids inpain and control of movement, which is consistentwith a possible therapeutic role in these areas. Theevidence is relatively strong for the treatment ofpain and, intriguing although less well established,for movement disorders.” [ . p 0 7 ]

“For patients such as those with AIDS or who are under-going chemotherapy and who suffer simultaneouslyfrom severe pain, nausea, and appetite loss, cannabinoiddrugs might offer broad-spectrum relief not found in anyother single medication. The data are weaker for mus-cle spasticity but moderately promising.” [p. ] 7 7 1

“The most encouraging clinical data on the effects ofcannabinoids on chronic pain are from three studiesof cancer pain.” [ . p 2 4 1 ]

Why can’t patients use medicines that arealready legal?

“[T]here will likely always be a subpopulation ofpatients who do not respond well to other medica-tions.” [Pp. 3, 4]

“The critical issue is not whether marijuana orcannabinoid drugs might be superior to the newdrugs, but whether some group of patients mightobtain added or better relief from marijuana orcannabinoid drugs.” [p. ] 3 5 1

“The profile of cannabinoid drug effects suggests thatthey are promising for treating wasting syndrome inAIDS patients. Nausea, appetite loss, pain, andanxiety are all afflictions of wasting, and all can bemitigated by marijuana. Although some medica-tions are more effective than marijuana for theseproblems, they are not equally effective in allpatients.” [p. ] 9 5 1

What about Marinol®, the major activeingredient in marijuana in pill form?

“It is well recognized that Marinol’s oral route ofadministration hampers its effectiveness because ofslow absorption and patients’ desire for more con-trol over dosing.” [Pp. 205, 206]

Why not wait for more research before makingmarijuana legally available as a medicine?

“[R]esearch funds are limited, and there is a dauntingthicket of regulations to be negotiated at the federallevel (those of the Food and Drug Administration,FDA, and the Drug Enforcement Administration,DEA) and state levels.” [p. ] 7 3 1

“Some drugs, such as marijuana, are labeledSchedule I in the Controlled Substance Act, andthis adds considerable complexity and expense totheir clinical evaluation.” [p. ] 4 9 1

“[O]nly about one in five drugs initially tested inhumans successfully secures FDA approval for mar-keting through a new drug application.” [p. ] 5 9 1

“From a scientific point of view, research is difficultbecause of the rigors of obtaining an adequate supplyof legal, standardized marijuana for study.” [ . p ] 7 1 2

Questions about medical marijuana answered by the

Institute of Medicine’s report

Marijuana and Medicine: Assessing the Science Base*

Excerpts compiled by the Marijuana Policy Pr o j e c t

■ ■ ■

■ ■ ■

“[W]e concluded that there are some limited circumstances in which we recommendsmoking marijuana for medical uses.”

— from principal investigator Dr. John Benson’s opening remarks at IOM’s 3/17/99 news conference

*Copyright 1999 by the National Academy of Sciences (ISBN 0-309-07155-0)

Appendix C: Excerpts from the Institute of Medicine 1999 Report

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Exce

rpts

from

the I

nstit

ute o

f Med

icin

e 199

9 Re

port

“In short, development of the marijuana plant isbeset by substantial scientific, regulatory, and com-mercial obstacles and uncertainties.” [p. ] 8 1 2

“[D]espite the legal, social, and health problems asso-ciated with smoking marijuana, it is widely used bycertain patient groups.” [p. ] 7

Do the existing laws really hurt patients?

“G.S. spoke at the IOM workshop in Louisianaabout his use of marijuana first to combat AIDSwasting syndrome and later for relief from the sideeffects of AIDS medications. … [He said,] ‘Everyday I risk arrest, property forfeiture, fines, and

’ . t n e m n o s i r p m i ” [Pp. 27, 28]

Why shouldn’t we wait for new drugs based onmarijuana’s components to be developed, ratherthan allowing patients to eat or smoke naturalmarijuana right now?

“Although most scientists who study cannabinoidsagree that the pathways to cannabinoid drug devel-opment are clearly marked, there is no guaranteethat the fruits of scientific research will be madeavailable to the public for medical use.” [p. ] 4

“[I]t will likely be many years before a safe and effec-tive cannabinoid delivery system, such as an inhaler,is available for patients. In the meantime there arepatients with debilitating symptoms for whomsmoked marijuana might provide relief.” [ . p 7]

“[W]hat seems to be clear from the dearth of pro s t c u din development and the small size of the companiessponsoring them is that cannabinoid development isseen as especially risky.” [Pp. 211, 212] [IOM later notesthat it could take more than five years and cost $200-300million to get new cannabinoid drugs approved—if ever ] .

“Cannabinoids in the plant are automatically placedin the most restrictive schedule of the ControlledSubstances Act, and this is a substantial deterrentto development.” [p. ] 9 1 2

I s n’t marijuana too dangerous to be used as am e d i c i n e ?

“[E]xcept for the harms associated with smoking, theadverse effects of marijuana use are within the rangeof effects tolerated for other medications.” [ . p 5]

“Until the development of rapid onset antiemeticdrug delivery systems, there will likely remain a sub-population of patients for whom standard antiemetictherapy is ineffective and who suffer from debilitat-ing emesis. It is possible that the harmful effects ofsmoking marijuana for a limited period of time

might be outweighed by the antiemetic benefits ofmarijuana, at least for patients for whom standardantiemetic therapy is ineffective and who suffer fromdebilitating emesis. Such patients should be evaluat-ed on a case-by-case basis and treated under closemedical supervision.” [ . p 4 5 1 ]

“Terminal cancer patients pose different issues. Forthose patients the medical harm associated withsmoking is of little consequence. For terminalpatients suffering debilitating pain or nausea and forwhom all indicated medications have failed to pro-vide relief, the medical benefits of smokedmarijuana might outweigh the harm.” [p. ] 9 5 1

What should be done to help the patients whoalready benefit from medical marijuana, prior tothe development of new drugs and delivery devices?

“Patients who are currently suffering from debilitatingconditions unrelieved by legally available drugs, andwho might find relief with smoked marijuana, willfind little comfort in a promise of a better drug0 1 years from now. In terms of good medicine,

marijuana should rarely be recommended unless allreasonable options have been eliminated. But thenwhat? It is conceivable that the medical and scientif-ic opinion might find itself in conflict with drug reg-ulations. This presents a policy issue that mustweigh—at least temporarily—the needs of individualpatients against broader social issues. Our assessmentof the scientific data on the medical value ofmarijuana and its constituent cannabinoids is butone component of attaining that balance.” [ . p 8 7 1 ]

“Also, although a drug is normally approved formedical use only on proof of its ‘safety and efficacy ’ ,patients with life-threatening conditions are some-times (under protocols for ‘compassionate use’)allowed access to unapproved drugs whose benefitsand risks are uncertain.” [p. ] 4 1

“Until a nonsmoked rapid-onset cannabinoid drugdelivery system becomes available, we acknowledgethat there is no clear alternative for people sufferingfrom chronic conditions that might be relieved bysmoking marijuana, such as pain or AIDS wasting.One possible approach is to treat patients as n 1 - f o -clinical trials (single-patient trials), in whichpatients are fully informed of their status as experi-mental subjects using a harmful drug delivery systemand in which their condition is closely monitoredand documented under medical supervision. ” …

. p [ 8] [The federal government’s “compassionate use”program, which currently provides marijuana to fourpatients nationwide, is an example of an n-of-1 study ] .

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Appendix C: Excerpts from

the Institute of Medicine 1999 Report

State-By-State Report 2011The IOM report doesn’t explicitly endorse statebills and initiatives to simply remove criminalpenalties for bona fide medical marijuana users.Does that mean that we should keep the lawsexactly as they are and keep arresting patients?

“This report analyzes science, not the law. As in anypolicy debate, the value of scientific analysis is thatit can provide a foundation for further discussion.Distilling scientific evidence does not in itself solvea policy problem.” [p. ] 4 1

If patients were allowed to use medicalmarijuana, wouldn’t overall use increase?

“ y l l a n i F , there is a broad social concern that sanc-tioning the medical use of marijuana might increaseits use among the general population. At this pointthere are no convincing data to support this con-cern. The existing data are consistent with the ideathat this would not be a problem if the medical useof marijuana were as closely regulated as other med-ications with abuse potential. … [T]his question isbeyond the issues normally considered for medicaluses of drugs and should not be a factor in evaluat-ing the therapeutic potential of marijuana orcannabinoids.” [P . p 6, 7]

“No evidence suggests that the use of opiates or cocainefor medical purposes has increased the perception thattheir illicit use is safe or acceptable.” [p. ] 2 0 1

“Thus, there is little evidence that decriminalizationof marijuana use necessarily leads to a substantialincrease in marijuana use.” [p. ] 4 0 1[Decriminalization is defined as the removal of criminalpenalties for all uses, even recreational.]

D o e s n’t the medical marijuana debate sendchildren the wrong message about marijuana?

“[T]he perceived risk of marijuana use did not changeamong California youth between 1996 and 1997. In summary, there is no evidence that the medicalmarijuana debate has altered adolescents’ perceptionsof the risks associated with marijuana use.” [p. ] 4 0 1

“Even if there were evidence that the medical use ofmarijuana would decrease the perception that it canbe a harmful substance, this is beyond the scope oflaws regulating the approval of therapeutic drugs.Those laws concern scientific data related to thesafety and efficacy of drugs for individual use; theydo not address perceptions or beliefs of the generalpopulation.” [p. ] 6 2 1

I s n’t marijuana too addictive to be used as am e d i c i n e ?

“Some controlled substances that are approved med-ications produce dependence after long-term use;this, however, is a normal part of patient manage-ment and does not generally present undue risk tothe patient.” [p. ] 8 9

“Animal research has shown that the potential forcannabinoid dependence exists, and cannabinoidwithdrawal symptoms can be observed. However,both appear to be mild compared to dependenceand withdrawal seen with other drugs.” [p. ] 5 3

“A distinctive marijuana and THC withdrawal syn-drome has been identified, but it is mild and subtlecompared with the profound physical syndrome ofalcohol or heroin withdrawal.” [Pp. 89, 90]

Proportion Of Users That Drug Category Ever Became Dependent (%)

l o h o c l A 5 1

Marijuana (including hashish) 9 . p [ ] 5 9

“Compared to most other drugs … dependenceamong marijuana users is relatively rare.” [p. ] 4 9

“In summary, although few marijuana users developdependence, some do. But they appear to be lesslikely to do so than users of other drugs (includingalcohol and nicotine), and marijuana dependenceappears to be less severe than dependence on otherdrugs.” [p. ] 8 9

D o e s n’t the use of marijuana cause people touse more dangerous drugs?

“[I]t does not appear to be a gateway drug to the extentthat it is the e s u a c or even that it is the most signifi-cant predictor of serious drug abuse; that is, care mustbe taken not to attribute cause to association.” [p. ] 1 0 1

“There is no evidence that marijuana serves as a step-ping stone on the basis of its particular physiologicaleffect.” [p. ] 9 9

“Instead, the legal status of marijuana makes it agateway drug.” [p. ] 9 9

S h o u l d n’t medical marijuana remain illegalbecause it is bad for the immune system?

“The short-term immunosuppressive effects are notwell established; if they exist at all, they are probablynot great enough to preclude a legitimate medicaluse. The acute side effects of marijuana use are with-in the risks tolerated for many medications.” [ . p 6 2 1 ]

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D o e s n’t marijuana cause brain damage?

“Earlier studies purporting to show structural changes inthe brains of heavy marijuana users have not beenreplicated with more sophisticated techniques.” [p. ] 6 0 1

Doesn’t marijuana cause amotivational syndrome?

“When heavy marijuana use accompanies thesesymptoms, the drug is often cited as the cause, butno convincing data demonstrate a causal relation-ship between marijuana smoking and these behav-ioral characteristics.” [Pp. 107, 108]

D o e s n’t marijuana cause health problems thatshorten the life span?

“[E]pidemiological data indicate that in the generalpopulation marijuana use is not associated withincreased mortality.” [p. ] 9 0 1

I s n’t marijuana too dangerous for ther e s p i r a t o ry system?

“Given a cigarette of comparable weight, as much asfour times the amount of tar can be deposited in thelungs of marijuana smokers as in the lungs of tobac-co smokers.” [p. ] 1 1 1

“ r e v e w o H , a marijuana cigarette smoked recreational-ly typically is not packed as tightly as a tobacco ciga-rette, and the smokable substance is about half thatin a tobacco cigarette. In addition, tobacco smokersgenerally smoke considerably more cigarettes per daythan do marijuana smokers.” [Pp. 111, 112]

“There is no conclusive evidence that marijuana caus-es cancer in humans, including cancers usually relat-ed to tobacco use. … More definitive evidence thathabitual marijuana smoking leads or does not lead torespiratory cancer awaits the results of well-designedcase control epidemiological studies.” [p. ] 9 1 1

D o n’t the euphoric side effects diminishmarijuana’s value as a medicine?

“The high associated with marijuana is not generallyclaimed to be integral to its therapeutic value. But

o o m d enhancement, anxiety reduction, and mildsedation can be desirable qualities in medications—particularly for patients suffering pain and anxiety.Thus, although the psychological effects ofmarijuana are merely side effects in the treatment ofsome symptoms, they might contribute directly torelief of other symptoms.” [p. ] 4 8

What other therapeutic potential does marijuanah a v e ?

“One of the most prominent new applications ofcannabinoids is for ‘neuroprotection,’ the rescue ofneurons from cell death associated with trauma,ischemia, and neurological diseases.” [ . p 1 1 2 ]

“There are numerous anecdotal reports that marijuanacan relieve the spasticity associated with multiplesclerosis or spinal cord injury, and animal studies haveshown that cannabinoids affect motor areas in thebrain—areas that might influence spasticity.” [ . p 0 6 1 ]

“High intraocular pressure (IOP) is a known risk fac-tor for glaucoma and can, indeed, be reduced bycannabinoids and marijuana. However, the effect istoo and [sic] short lived and requires too high doses,and there are too many side effects to recommendlifelong use in the treatment of glaucoma. Thepotential harmful effects of chronic marijuana smok-ing outweigh its modest benefits in the treatment ofglaucoma. Clinical studies on the effects of smokedmarijuana are unlikely to result in improved treat-ment for glaucoma.” [p. 177] [Note that IOM foundthat marijuana does work for glaucoma, but was uncom -fortable with the amount that a person needs to smoke.

y l b a m u s e r P , it would be an acceptable treatment forglaucoma patients to eat marijuana. Additionally, MPPbelieves that IOM would not support arresting patientswho choose to smoke marijuana to treat glaucoma.]

Do the American people really support legalaccess to medical marijuana, or were voterssimply tricked into passing medical marijuanaballot initiatives?

“Public support for patient access to marijuana formedical use appears substantial; public opinion pollstaken during 1997 and 1998 generally report 60-0 7 percent of respondents in favor of allowing med-

ical uses of marijuana.” [p. ] 8 1

But shouldn’t we keep medical marijuana illegalbecause some advocates want to “legalize”marijuana for all uses?

“[I]t is not relevant to scientific validity whether anargument is put forth by someone who believes thatall marijuana use should be legal or by someone whobelieves that any marijuana use is highly damagingto individual users and to society as a whole.” [ . p 4 1 ]

The full report by the National Academy of Sciences can be viewed online atwww.nap.edu/openbook.php?record_id=6376

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Appendix D: Surveys of Public Support for M

edical Marijuana

State-By-State Report 2011Appendix D: Surveys of Public Support for Medical Marijuana

Scientifically conducted public opinion polls have consistently found a majority of sup-port for making marijuana medically available to seriously ill patients.

In addition to the following tables, which break down nationwide and state-specific pub-lic opinion poll results, there have been two reports that have analyzed nationwide polls on medical marijuana over time.

Meta-analysis of nationwide polls1997–1998: The Institute of Medicine (IOM), in its 1999 report, Marijuana and Medicine:

Assessing the Science Base, reported that “public support for patient access to marijuana for medical use appears substantial; public opinion polls taken during 1997 and 1998 gen-erally reported 60-70% of respondents in favor of allowing medical uses of marijuana” (p. 18).

1978–1997: A study by the Harvard School of Public Health — published on March 18, 1998, in the Journal of the American Medical Association — analyzed the results of 47 national drug policy surveys conducted between 1978 and 1997. The study reported that more than 60% of the public supports the “legalized use of marijuana for medical purposes.”

Nationwide Medical Marijuana Public Opinion Polling Results

Date Percent in favor Margin of error/ respondents Wording Polling firm/where reported

Jan. 2011 77 N/A/ 1,137 adults

“If a loved one had an illness for which medical marijuana might be prescribed, would you support or oppose that use?”

CBS News interviewing facil-ity (60 Minutes/Vanity Fair poll)

Oct. 2010 70 ± 5.0%/514 adults

“Would you favor or oppose making marijuana legally available for doctors to pre-scribe in order to reduce pain and suffering?”

Gallup

March 2010 73 ± 3.0%/1,500 adults

“Favor their state allowing the sale and use of marijuana for medical purposes if it is prescribed by a doctor?”

Pew Research Center

Jan. 2010 81 ± 3.5%/1,083 adults

“Do you think doctors should or should not be al-lowed to prescribe marijuana for medical purposes to treat their patients?”

ABC News/Washington Post

Jan. 2009 72 ± 3.1%/1,053 adults

“During the presidential campaign, Barack Obama said he would stop fed-eral raids against medical marijuana providers in the 13 states where medical marijuana has become legal. Should President Obama keep his word to end such raids?”

Zogby America

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Date Percent in favor Margin of error/ respondents Wording Polling firm/where reported

Nov. 2005 78 +/- 2% 2,034 adults

“Do you support making marijuana legally available for doctors to prescribe in order to reduce pain and suffering?”

Gallup

2005 41.2 22,587 chiefs of police and sheriffs

“Should marijuana be legal-ized in the United States for those who have a legitimate medical need for the drug?”

National Association of Chiefs of Police

Nov. 2004 72 +/- 2.37% 1,706 adults aged 45 and older

“I think that adults should be allowed to legally use mari-juana for medical purposes if a physician recommends it.”

International Communications Research, on behalf of AARP The Magazine

Nov. 2002 80 +/- 3.1% 1,007 adults

“Do you think adults should be allowed to legally use marijuana for medical purposes if their doctor prescribes it?”

Harris Interactive for Time magazine

Jan. 2002 70 N/A “Should medical marijuana be allowed?”

Center for Substance Abuse Research, Univ. of Maryland

March 2001 73 +/- 3% 1,513 adults

“Regardless of what you think about the personal non-medical use of mari-juana, do you think doctors should or should not be al-lowed to prescribe marijuana for medical purposes to treat their patients?”

Pew Research Center

Mar. 19-21, 1999 73 +/- 5% 1,018 adults

Support “making marijuana legally available for doc-tors to prescribe in order to reduce pain and suffering”

Gallup

1997 66 - Indepen-dents

64 - Democrats

57 - Republicans

N/A responses divided among party affiliations

“Doctors should be allowed to prescribe small amounts of marijuana for patients suf-fering serious illnesses.”

CBS News/The New York Times

1997 74 +/- 2.8 % 1,000 registered voters

“People who find that mari-juana is effective for their medical condition should be able to use it legally.”

Commissioned by the Fam-ily Research Council

1995 79 +/- 3.1% 1,001 registered voters

“It would be a good idea … to legalize marijuana to relieve pain and for other medical uses if prescribed by a doctor.”

Belden & Russonello on behalf of the American Civil Liberties Union

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edical Marijuana

State-By-State Report 2011State-Specific Medical Marijuana Public Opinion Polling Results

State Date % in favor

Margin of error/ respondents Wording Polling firm/

where reported

Alabama July 2004 75 312 respondents “Would you approve or dis-approve of allowing doctors to prescribe marijuana for medical purposes?”

University of South Ala-bama, commissioned by the Mobile Register

Alaska March 2006

74 (54%

strongly favor, 20%

some-what favor)

+/-4.3% 500 adults

“Under present Alaska state law, it is legal for people who have cancer, AIDS, and other serious illnesses to use and grow marijuana for medical purposes, as long as their physician approves. Overall, do you strongly favor, somewhat favor, somewhat oppose, or strongly oppose this law?”

Goodwin Simon Strate-gic Research, on behalf of MPP

Arizona Feb. 2009 64 ± 4.0%/600 likely AZ voters

Support a measure to “al-low Arizona residents with cancer, AIDS, multiple sclerosis, and other seri-ous illnesses to grow and use marijuana for medi-cal purposes, as long as their physician approves? It would also permit the establishment of medical marijuana dispensaries to allow patients to purchase medical marijuana legally.”

Goodwin Simon Victoria Research

Arkansas Nov. 2002 62 +/- 4.1%

600 voters (exit poll)

Support “a law that would allow people with cancer and other debilitating medical conditions to register in a state-regulated program permitting them to grow and use a limited amount of marijuana for medical purposes”

Zogby International poll commissioned by the Arkansas Alliance for Medical Marijuana

California Oct. 2009 74 ± 4.0%/625 regis-tered voters in Los Angeles County

“Do you support or oppose the California law that allows medical patients to use, grow, and purchase medical marijuana to treat their illnesses when medical marijuana is recommended by their doctor?”

Mason-Dixon Polling & Research, Inc.

Colorado Feb. 2002 77 +/- 2.6% to 3.1% between 1,004 and 1,464 adults

“What is your level of sup-port for the current medical marijuana law?”

Lucas Organization and Arlington Research Group, on behalf of MPP

Connecticut March 2011

79 ± 2.4%/1,693 CT voters

“Do you support allow-ing a doctor to prescribe marijuana for medical purposes?”

Quinnipiac, telephone survey

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State Date % in favor

Margin of error/ respondents Wording Polling firm/

where reported

District of Columbia

Jan. 2010 80 ± 3.0%/1,135 adult residents of D.C.

“Do you think doctors should or should not be allowed to prescribe mari-juana for medical purposes to treat their patients?”

Washington Post, telephone survey

Florida June 2006 64 ± 3.4%/811 likely FL voters

“Do you support allowing people with cancer, mul-tiple sclerosis, and other serious illnesses to use and grow their own marijuana for medical purposes, as long as their physician ap-proves?”

Goodwin Simon Victoria Research

Georgia April 2001 69 +/- 4.5% 500 adults

Favor medical marijuana Survey USA for KUSA (Denver), reported in The People Have Spoken

Hawaii Feb. 2000 77 +/- 3.7% 703 registered voters

Favor “the Hawaii State Legislature passing a law in Hawaii to allow seriously or terminally ill patients to use marijuana for medical purposes if supported by their medical doctor”

QMark Research & Poll-ing on behalf of the Drug Policy Forum of Hawaii

Idaho Sept.-Oct. 2010

61 ± 3.9%/400 respondents

“Do you support or op-pose state laws that allow marijuana use for medical purposes with a doctor’s prescription?”

Northwest OpinionScape

Illinois Feb. 2008 68 +/- 4% 625 registered voters

“Do you support allowing seriously and terminally ill patients to use and grow medical marijuana for personal use if their doctors recommend it?”

Mason-Dixon Polling & Reporting, Inc., on behalf of MPP

Iowa Feb. 2010 64 ± 3.5%/805 adults “Do you favor or oppose allowing medical marijuana in Iowa?”

Selzer & Co. for The Des Moines Register

Maine October 2006

67 +/- 4% 625 likely voters

Support “present Maine state law, [which allows] for people who have cancer, AIDS, or other serious illnesses to use and grow marijuana for medical purposes, as long as their physician approves”

Mason-Dixon Polling & Research, Inc. on behalf of MPP

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edical Marijuana

State-By-State Report 2011State-Specific Medical Marijuana Public Opinion Polling Results

State Date % in favor

Margin of error/ respondents Wording Polling firm/

where reported

Maryland Feb. 2011 72 N/A/1,076 MD voters

“The Maryland Legis-lature is considering a bill to make Maryland the 16th state to allow medical marijuana. The bill would allow patients with multiple sclerosis, cancer, debilitating pain, and other serious illnesses to use and purchase marijuana for medical purposes with their doctors’ approval after con-ventional treatments have been tried. Do you support this proposal?”

Public Policy Polling

Massachusetts Sept. 2009 81 N/A/500 registered voters

Support allowing “seriously ill patients to use, grow, and purchase marijuana for medical purposes if they have the approval of their physicians?”

Suffolk University

Michigan Jan. 2011 61 ± 4.0%/600 re-spondents

“If you were voting on this issue again today, would you vote YES to approve the medical use of marijuana in Michigan?”

Marketing Resource Group, Inc.

Minnesota May 2008 64 +/- 4.3% 500 registered voters

“Think marijuana should be legal when used for medicinal purposes”

SurveyUSA

Montana Feb. 2011 63 N/A/2,212 MT voters

“Do you support allow-ing patients with multiple sclerosis, cancer, and other serious illnesses to have the freedom to use marijuana for medical purposes with their doctors’ approval?”

Public Policy Polling

Nebraska Feb. 2002 64 +/- 2.6% to 3.1% between 1,004 and 1,464 adults

Support an initiative that “would remove the threat of arrest and all other penal-ties for seriously ill patients who use and grow their own medical marijuana with the approval of their physicians”

Lucas Organization and Arlington Research Group, on behalf of MPP

Nevada Feb. 2002 79 +/- 2.6% to 3.1% between 1,004 and 1,464 adults

“What is your level of sup-port for the current medical marijuana law?”

Lucas Organization and Arlington Research Group, on behalf of MPP

New Hampshire

April 2008 71 +/- 4% 625 registered voters

Support “changing the law in New Hampshire to allow seriously and terminally ill patients to use and grow medical marijuana for personal use if their doctors recommend it?”

Mason-Dixon Polling & Research, Inc., on behalf of MPP

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State Date % in favor

Margin of error/ respondents Wording Polling firm/

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New Jersey May 2006 86 +/- 3.7% 700 registered voters

“Seriously ill patients should have access to mari-juana for medical purposes if a physician recommends it?”

The Polling Company, Inc.

New Mexico Sept. 2002 72 +/- 5% 421 registered and likely voters

Favor “legalizing marijuana use by those who have serious medical conditions, to alleviate pain and other symptoms”

New Mexican/KOB-TV poll conducted by Mason-Dixon Polling & Research, “Poll: Voters Support Medical Pot,” (Terrell, Steve) Santa Fe New Mexican, October 5, 2002

New York Jan.-Feb. 2010

71 ± 2.1%/2,182 regis-tered NY voters

“Do you support a bill allowing adults to legally use marijuana for legal purposes if their doctor prescribes it?”

Quinnipiac University

North Dakota August 2003

57 +/- 3.6% 800 registered voters

“Support an initiative that would allow seriously ill patients who have ap-proval from their doctors to receive an ID card from the health department, which would allow them to possess up to one ounce of marijuana and grow up to six plants?”

The Southwest Group, on behalf of MPP

Ohio April 2009 73 ± 3.4%/818 adults “Favor allowing Ohio doc-tors to prescribe marijuana for medical purposes to treat their patients?”

The Ohio Poll, Institute for Policy Research, University of Cincinnati

Oregon Sept.-Oct. 2010

64 ± 3.9%/400 respondents

“Do you support or op-pose state laws that allow marijuana use for medical purposes with a doctor’s prescription?”

Northwest OpinionScape

Pennsylvania May 2010 80 ± 3.1%/1,023 adult residents of PA

“Generally speaking, do you favor or oppose al-lowing adults to legally use marijuana for medical purposes if a doctor recom-mends it?”

Center for Opinion Research, Floyd Institute for Public Policy, Frank-lin & Marshall College

Rhode Island Sept. 2006 79 +/- 4.0% 625 likely voters

Support Rhode Island’s law allowing “people who have cancer, AIDS, or other serious illnesses to use and grow marijuana for medical purposes, as long as their physician approves”

Mason-Dixon Polling & Research, Inc.

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edical Marijuana

State-By-State Report 2011State-Specific Medical Marijuana Public Opinion Polling Results

State Date % in favor

Margin of error/ respondents Wording Polling firm/

where reported

South Dakota March 2006

52 N/A/500 respondents

Would you support an initiative that would “allow people with cancer, mul-tiple sclerosis, and other serious illnesses to use and grow their own marijuana for medical purposes, as long as their physician ap-proves?”

Goodwin Simon Strategic Research

Texas May 2010 69 ± 3.5%/800 registered voters

“Support medical marijuana?”

University of Texas/ Texas Tribune

Vermont October 2006

74 +/- 4% 625 registered voters

Support “present Vermont state law, [which allows] for people who have cancer, AIDS, or other serious illnesses to use and grow marijuana for medical purposes, as long as their physician approves”

Mason-Dixon Polling & Research, Inc., on behalf of MPP

Virginia June 2001 75 +/- 3% 686 adults

“Do you agree that doc-tors should be allowed to prescribe marijuana for medical use when it reduces pain from cancer treatment or other illnesses?”

Virginia Tech Center for Survey Research

Washington Sept.-Oct. 2010

78 ± 3.9%/400 respondents

“Do you support or op-pose state laws that allow marijuana use for medical purposes with a doctor’s prescription?”

Northwest OpinionScape

Wisconsin July 2005 76 +/-4% 600 residents

Support a bill that would “allow people with cancer, multiple sclerosis, or other serious illnesses to use marijuana for medical purposes, as long as their physician approves”

Chamberlain Research Consultants, on behalf of MPP

Wyoming Feb. 2002 65 +/- 2.6% to 3.1% between 1,004 and 1,464 adults

Support an initiative that “would remove the threat of arrest and all other penal-ties for seriously ill patients who use and grow their own medical marijuana with the approval of their physicians”

Lucas Organization and Arlington Research Group, on behalf of MPP

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Appendix E: The Federal Controlled Substances A

ct (and Drug Schedules)

State-By-State Report 2011Appendix E: The Federal Controlled Substances Act (and Drug Schedules)

The federal Controlled Substances Act of 1970 created a series of five schedules establishing varying degrees of control over certain substances. Marijuana and its primary active ingredient — tetrahydrocannabinol (THC) — are presently in Schedule I. As such, doctors may not prescribe marijuana under any circumstances.

Although the DEA has not rescheduled marijuana, it has made the drug “dronabinol” available by prescription. Dronabinol — marketed as “Marinol” — is synthetic THC in sesame oil in a gelatin capsule. Dronabinol is currently in Schedule III. The DEA has proposed a rule to also make natural THC, including in forms other than gelatin capsules, Schedule III. This proposal would allow for generic versions of dronabinol. Unfortunately, evidence indicates that dronabinol is less effective than marijuana for many patients.

Most states mirror the scheduling criteria established by the federal government. However, marijuana has been assigned to Schedule II or lower in a few states that have recognized its medicinal value and/or relative safety.1 Rescheduling on the state level is largely symbolic at this time — doctors may not prescribe marijuana in those states because the federal schedules supersede state law.

The criteria for each of the schedules, listed in Title 21 of the U.S. Code, Section 812(b) (21 U.S.C. 812(b)), and a few example substances from Title 21 of the Code of Federal Regulations, Section 1308, are:

Schedule I (includes heroin, LSD, and marijuana)• A. The drug or other substance has a high potential for abuse.

• B. The drug or other substance has no currently accepted medical use in treatment in the United States.

• C. There is a lack of accepted safety for use of the drug or other substance under medical supervision.

Schedule II (includes morphine, used as a painkiller, and cocaine, used as a topical anesthetic)• A. The drug or other substance has a high potential for abuse.

• B. The drug or other substance has a currently accepted medical use in treatment in the United States or a currently accepted medical use with severe restrictions.

• C. Abuse of the drug or other substance may lead to severe psychological or physical dependence.

__________________________________________________________________________________________

1 See Appendix A.

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Schedule III (includes anabolic steroids and Marinol)• A. The drug or other substance has a potential for abuse less than the drugs or

other substances in Schedules I and II.

• B. The drug or other substance has a currently accepted medical use in treatment in the United States.

• C. Abuse of the drug or other substance may lead to moderate or low physical dependence or high psychological dependence.

Schedule IV (includes Valium and other tranquilizers)• A. The drug or other substance has a low potential for abuse relative to the

drugs or other substances in Schedule III.

• B. The drug or other substance has a currently accepted medical use in treatment in the United States.

• C. Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in Schedule III.

Schedule V (includes codeine-containing analgesics)• A. The drug or other substance has a low potential for abuse relative to the

drugs or other substances in Schedule IV.

• B. The drug or other substance has a currently accepted medical use in treatment in the United States.

• C. Abuse of the drug or other substance may lead to limited physical dependence or psychological dependence relative to the drugs or other substances in Schedule IV.

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State-By-State Report 2011Appendix F: How the Effective State Laws Are WorkingKe

y Fi

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DelawareOn May 13, 2011, Gov. Jack Markell (D) signed comprehensive medical mari-

juana legislation into law (SB 17), making Delaware the 16th medical marijuana state. This also made Delaware the second Mid-Atlantic state, and the fifth in the Northeast, with a law removing criminal sanctions for medical marijuana and providing safe access to patients.

The passage of SB 17 followed a two-and-a-half year campaign led by MPP, which involved working closely with patient advocates and legislative champions. On March 31, 2011, the Delaware Senate approved SB 17 in a vote of 18-3. On May 5, 2011, the House of Representatives made amendments and voted 27-14 to approve the final bill. Sixty-six percent of the House and 81% of the Senate (17 senators) voted for the final bill, clearing the required three-fifths vote threshold mandated because of the bill’s revenue provisions. SB 17 also had strong bipartisan support, with bipartisan sponsors in both chambers. It received eight Republican votes, including a majority of Senate Republicans.

The Delaware Medical Marijuana Act, which contains many elements of MPP’s model bill, went into effect on July 1, 2011, and patients may now assert a limited affirmative defense to marijuana possession charges in court until 75 days after registry identification card applications become available. After the Department of Health begins issuing registry identification cards (likely around July 1, 2012), registered patients who comply with the law will be protected from arrest, pros-ecution, and other statewide civil and criminal penalties if they possess no more than six ounces of marijuana.

Patients may have one caregiver to possess and pick up marijuana on their behalf, and the law also includes an organized system of tightly regulated, state-licensed not-for-profit compassion centers to distribute medical marijuana. The state is expected to license six compassion centers, with at least one in each of Delaware’s three counties. The first three must be registered by January 1, 2013. The law does not include home cultivation because there was not enough support for such a provision in the legislature.

To qualify, a patient must have one of the listed debilitating medical conditions — cancer; HIV/AIDS; decompensated cirrhosis; multiple sclerosis; amyotrophic lateral sclerosis (ALS); agitation of Alzheimer’s disease; post traumatic stress disorder (PTSD); or a medical condition that produces wasting syndrome, intrac-table nausea, seizures, severe and persistent muscle spasms, or severe debilitating pain that has not responded to other treatments for more than three months or for which other treatments produced serious side effects. The patient’s doctor must certify in the course of a bona fide physician-patient relationship that “the patient is likely to receive therapeutic or palliative benefit from the medical use of mari-juana to treat or alleviate the patient’s debilitating medical condition.”

Delaware recognizes medical marijuana cards issued by other states for con-ditions that qualify under Delaware law. The law also includes extensive civil discrimination protections for medical marijuana patients in the areas of employ-ment, housing, education, organ transplants, and child custody, visitation, and parental rights.

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State-By-State Report 2011Arizona

On November 2, 2010, Arizona voters enacted a medical marijuana initiative — Proposition 203 — with 50.13% of the vote. Prop. 203 was the only statewide marijuana-related initiative to pass in any state in 2010. The law passed even as that same Arizona electorate flipped control of its Congressional delegation to Republicans and expanded the conservative majority in both chambers of the state legislature, further demonstrating that compassionate medical marijuana laws are supported by voters of both parties.

The law, which MPP drafted and backed the campaign for, went into effect on December 10, 2010. Like Delaware’s law, Arizona’s included a provision allowing patients to raise their medical need for marijuana in court as an affirmative de-fense until the state’s registry ID card program was up and running.

The Arizona Department of Health Services (DHS) finalized dispensary and registry identification card regulations on March 28, 2011. On April 14, 2011, it began accepting applications for registry cards that provide patients and their caregivers with protection from arrest. DHS was preparing to accept dispensary applications starting in June and to register one nonprofit dispensary for every 10 pharmacies in the state, totaling 125. However, on May 27, 2011, Gov. Jan Brewer (R) flouted the will of the people and filed a federal lawsuit seeking a declaratory judgment on whether Arizona’s new medical marijuana program conflicts with federal law.

This lawsuit gave Brewer an excuse to delay implementation, and she ordered DHS to cease moving forward with licensing any dispensaries, although DHS continues to issue patient and caregiver ID cards. A safety valve in the law pro-vides that a doctor’s certification and notarized statement would function as an ID card if DHS ever stopped issuing ID cards. That provision was apparently the reason Gov. Brewer did not seek to halt the ID card portion of Prop. 203.

Arizona’s law also provides that any patient living 25 miles or more away from a dispensary can cultivate marijuana. Because the state is refusing to register dispensaries, patients and their caregivers can cultivate statewide. In addition to Gov. Brewer’s suit, an action has been filed in state court to require DHS to move forward with the dispensary registration process. Neither case had been ruled on at the time of this publication.

To qualify under Arizona’s law, patients must have one of the listed debilitating medical conditions: cancer; HIV/AIDS; hepatitis C; glaucoma; multiple sclerosis; amyotrophic lateral sclerosis (ALS); Crohn’s disease; agitation of Alzheimer’s dis-ease; or a medical condition that produces wasting syndrome, severe and chronic pain, severe nausea, seizures, or severe and persistent muscle spasms. The patient’s doctor must certify in the course of a physician-patient relationship that “the pa-tient is likely to receive therapeutic or palliative benefit from the medical use of marijuana to treat or alleviate the patient’s debilitating medical condition.”

Arizona recognizes medical marijuana cards issued by other states for conditions that qualify under Arizona law. Registered patients may possess up to 2.5 ounces of marijuana, and may designate one caregiver to possess it on their behalf. Those allowed to cultivate can grow up to 12 plants. The law also includes extensive civil discrimination protections for medical marijuana patients in the areas of employ-

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ment, housing, education, organ transplants, and child custody, visitation, and parental rights.

Sadly, in 2011, the Arizona Legislature rolled back some of Prop. 203’s protec-tions with legislation, despite the state’s Voter Protection Act, which was designed to prevent legislative meddling. The legislature passed H.B. 2541, which possibly allows an employer to fire a medical marijuana patient based on a report alleging workplace impairment from a colleague who is “believed to be reliable.” It also seemingly allows termination based on a positive drug test, which contradicts Prop. 203’s explicit language protecting patients from termination without proof of workplace impairment or possession.

The legislature also passed H.B. 2585, which contradicts Prop. 203 by adding confidential medical marijuana patient data to the prescription drug monitoring program, where it could be subject to “fishing expeditions” by law enforcement and others. Legal challenges to these laws are likely.

New JerseyOn January 18, 2010, Gov. Jon Corzine (D) signed the New Jersey Compassionate

Use Medical Marijuana Act into law on his last day in office. The Assembly voted 48-14 (77% of the chamber), and the Senate 25-13 (66%), to pass S. 119, which removed criminal penalties for registered qualified patients possessing marijuana for medical purposes.

Patients with registry identification cards that possess up to two ounces of mari-juana dispensed by an alternative treatment center will be protected from arrest, prosecution, and other statewide criminal penalties. The law allows a patient to have a primary caregiver possess medical marijuana on his or her behalf and includes an organized system of at least six state-licensed alternative treatment centers. It does not include home cultivation.

To qualify, a patient must have one of the listed debilitating medical conditions: cancer and HIV/AIDS (only if the condition or its treatment result in severe or chronic pain, severe nausea or vomiting, cachexia, or wasting syndrome); termi-nal cancer; terminal illness where the physician has determined a prognosis of less than 12 months of life; multiple sclerosis; muscular dystrophy; amyotrophic lateral sclerosis; inflammatory bowel disease, including Crohn’s disease; and, if they are resistant to conventional medical therapy, glaucoma, seizure disorders, and intractable skeletal muscular spasticity. New Jersey’s program is one of only two that does not include a general category for severe, chronic, or debilitating pain. However, the health department can add additional conditions. To qualify, the patient’s doctor must also certify that he or she authorizes the patient to apply for registration for the medical use of marijuana.

After Gov. Corzine’s signing of the bill, newly elected Gov. Chris Christie (R) im-mediately began delaying implementation and asked the legislature to pass S. 2105 to postpone the law’s effective date by three months. New Jersey’s law went into effect on October 1, 2010, but patients still lacked protections because ID cards were mandatory and were not being issued. The bill lacked an affirmative defense for unregistered patients.

Christie’s Department of Health and Senior Services (DHSS) drafted needlessly harsh rules that overstepped DHSS’s authority and did not track the already strict

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State-By-State Report 2011legislation. The legislature pushed back, passing ACR 151, a resolution to repeal the draft rules, forcing DHSS to start over. In January 2011, DHSS re-proposed draft rules and held public comment on them, but has not yet finalized them as of this printing. Three of the rules have again been challenged by the legislature, and it is not clear whether they will be approved. During this process, on March 21, 2011, DHSS approved six nonprofit alternative treatment centers (ATCs), two in each part of the state.

On June 15, 2011, after U.S. attorneys had written letters to legislators in other states, reiterating that marijuana is Schedule I and indicating they may target dis-pensaries, Gov. Christie decided to halt implementation of the medical marijuana program. However, upon further consideration, he reversed himself, and on July 19, 2011, he announced that he was moving forward with program implementa-tion “as expeditiously as possible.” In his press conference, Christie also recognized medical marijuana as compassionate pain relief, and stated, as a former U.S. at-torney, that he does not believe federal law enforcement will expend “significantly lessening resources” raiding New Jersey’s dispensaries.

MichiganOn Tuesday, November 4, 2008, 63% of Michigan voters approved Proposal 1,

the Michigan Medical Marihuana Act, making their state the first in the Midwest to approve an effective medical marijuana law. MPP drafted the measure and its campaign committee led the successful initiative campaign, which received a majority of votes in each of Michigan’s 83 counties.

Michigan’s law allows patients with debilitating medical conditions to register with the state to use marijuana according to their doctors’ recommendations. Patients may possess up to 2.5 ounces of marijuana and may cultivate up to 12 plants in an enclosed, locked facility, or appoint a caregiver to cultivate marijuana on their behalf. Caregivers may assist no more than five patients.

The law provides for increased penalties of up to two years and a $2,000 fine in the event that a patient or caregiver sells marijuana to someone who is not a reg-istered patient. It also provides an affirmative defense intended to protect patients and caregivers who may or may not be registered, but who can establish (1) that a doctor has diagnosed the patient with a serious medical condition for which marijuana is likely to provide relief, (2) the patient was in possession of an amount only reasonably necessary to ensure an uninterrupted supply, and (3) the patient was using marijuana for medical purposes. Finally, Michigan’s law is one of five that provides protections for out-of-state patients; the provision applies only if the patient visits for no more than 30 days.

The Department of Community Health began accepting applications on April 4, 2009. The Department of Heath was initially in charge of administering the program, however, oversight was shifted to the Department of Licensing and Regulatory Affairs (LARA) in 2011. The Department of Health is required to process applications within 15 days, however, it quickly fell behind this sched-ule, and the backlog continues with LARA despite the fact that the ID cards have brought in a surplus of over eight million in less than two years.1 As of this writ-ing, the Department estimates a wait of up to five months to process applications. __________________________________________________________________________________________

1 Report on the Amount Collected and Cost of Administering the Medical Marihuana Program, April 1, 2011. The report showed $9.7 million in revenue through March 31, 2011, with a surplus of $8.1 million.

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Fortunately, a separate provision of the law provides that if the Department fails to act on a completed application within 20 days, it is deemed granted until a decision is made.

Michigan’s law was drafted during the George W. Bush administration, when no state law included regulated dispensaries. It does not provide for the establishment of dispensaries, though some have made the case that it allows patient-to-patient transfers, and this essentially allows a means for some form of dispensaries to operate.

Many businesses – more than 100 by some estimates – began operating as dis-pensaries in 2010, and many cities, including Lansing, Ann Arbor, and Ypsilanti, passed ordinances regulating and recognizing such businesses. However, on August 23, 2011, a Michigan Court of Appeals ruled that dispensary sales are not legal under the law.2 Most dispensaries closed their doors in the wake of the rul-ing, and it is not clear how many remain open now.

New MexicoIn 2007, Gov. Bill Richardson (D) became the first governor in history to sign a

medical marijuana law while running for the presidency by signing SB 523, mak-ing New Mexico the 12th state to protect medical marijuana patients from arrest. According to Department of Health regulations, patients may possess up to six ounces of usable marijuana and, after obtaining a separate permit, cultivate up to four mature plants and three seedlings.

New Mexico’s law was the first in the country to direct the state to implement a system for the distribution of medical marijuana to qualifying patients. The state issued its first license to a dispensary — or “licensed producer” as they are known locally — in March 2009. Four more were issued that November and 20 more in 2010, making for a current total of 25. Initially, there were several reports of shortages and patients who were unable to obtain an adequate supply. However, these concerns were addressed in late 2010 when, in addition to licens-ing eight additional producers, the department also increased the maximum number of plants each could produce from 95 to 150.

Although the law’s initial list of conditions was quite limited and did not include a general category for severe pain, the Department of Health has taken a proactive approach toward adding to the list of conditions for which patients can qualify for the program. The law calls for the establishment of a “Medical Advisory Board” to review petitions to add conditions to the list, and the Department has added conditions to the list in some cases and declined to in others. The current list of qualifying conditions is: severe chronic pain, painful peripheral neuropathy, intractable nausea/vomiting, severe anorexia/cachexia, hepatitis C, infection currently receiving antiviral treatment, Crohn’s disease, post-traumatic stress disorder (PTSD), amyotrophic lateral sclerosis (Lou Gehrig’s disease), cancer, glaucoma, multiple sclerosis, damage to the nervous tissue of the spinal cord with intractable spasticity, epilepsy, HIV/AIDS, inflam-matory autoimmune-mediated arthritis, and hospice patients.

__________________________________________________________________________________________

2 People v. Compassionate Apothecary, LLC (Isabella Co., No. 301951)

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State-By-State Report 2011New Mexico was the first state to explicitly recognize post-traumatic stress

disorder, which affects many veterans returning from Iraq and Afghanistan, as a qualifying condition. In fact, PTSD is the most oft-cited condition for patients applying for registry ID cards.

Rhode IslandIn January 2006, the Rhode Island General Assembly became the first state

legislature to override a medical marijuana veto. Eighty-two percent of voting members in each chamber voted to override the veto of MPP’s medical marijuana bill, while only 60% of their votes were needed to enact it.

The law included a sunset clause, which would have caused it to expire on June 30, 2007. However, the state legislature enacted a bill to make the law permanent and slightly modify it. Gov. Don Carcieri (R) vetoed that bill too, and an even higher percentage of the state legislature overrode his veto on June 21 and June 22, 2007.

The Edward O. Hawkins and Thomas C. Slater Medical Marijuana Act — named in honor of Senate sponsor Rhoda Perry’s nephew, who succumbed to AIDS, and House sponsor Thomas Slater, whose life was subsequently taken by cancer — went into effect upon its passage on January 3, 2006. The Department of Health issued the first medical marijuana ID cards in May 2006. Patients with medical marijuana ID cards are protected from arrest, prosecution, and other statewide civil and criminal penalties if they possess no more than 2.5 ounces of marijuana and 12 plants. They are also allowed to have one or two caregivers cultivate marijuana for their medical use.

In 2008, Rep. Thomas Slater and Sen. Rhoda Perry proposed a bill to improve access for patients, many of whom were unable to grow their own medicine or find reliable caregivers, by allowing up to three state-regulated, nonprofit com-passion centers to distribute medical marijuana to patients. The Senate passed Sen. Perry’s bill, 29-5. The House modified its bill to create a study commission on the issue, which easily passed both chambers. Gov. Carcieri vetoed the study commission resolution.

In 2009, the full Rhode Island General Assembly passed legislation to create compassion centers. H 5359 and S 0185 mirrored the legislation passed by the Senate in 2008. This proposal passed both chambers, but was vetoed by Gov. Carcieri. However, the Rhode Island General Assembly overwhelmingly over-rode the veto with only three of 113 legislators siding with the governor.

The Rhode Island Department of Health set rules and regulations for compas-sion centers and accepted applications, though it ran behind the statutory schedule. In September 2010, the department rejected all 15 applicants, in some cases saying the applications were longer than the rules allowed them to be. After another round of application submissions, the department approved three compassion centers in March of 2011. Unfortunately, after receiving a letter from United States Attorney Peter Neronha suggesting that the federal govern-ment could prosecute individuals operating compassion centers, Gov. Lincoln Chafee (I) placed a hold on issuing the certificates of operation to the entities chosen to operate the compassion centers. In late September 2011, Gov. Chafee announced that he would not lift the hold and called on lawmakers to work with him to create a system of safe and regulated access to medical marijuana that

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would not draw the ire of the federal government. In the meantime, frustrated patients are left without a reliable source for obtaining their physician-recom-mended medicine.

Montana In November 2004, Montana voters enacted a medical marijuana initiative

– Initiative 148 – by what was at the time the largest margin for an initial vote on any effective statewide medical marijuana ballot measure, 62% to 38%. The law, which MPP drafted and campaigned for, went into effect upon its passage. Patients could immediately raise their medical need for marijuana in court, if they were arrested on marijuana charges.

Protection from arrest quickly followed. The Department of Public Health and Human Services (DPHHS) began accepting applications for registry ID cards on December 21, 2004. Registered patients and their caregivers were each able to possess up to an ounce of marijuana and six plants for the patient’s medical use.

Under I-148, caregivers could serve an unlimited number of patients. Responding to patients’ need for safe access to their medicine, by 2009, several had begun to operate as storefront dispensaries. While some localities, such as Bozeman, established sensible regulations, there was also some backlash related to unregulated dispensaries. In addition, “cannabis caravans” began to operate where doctors provided large numbers of recommendations after very short consultations. The Montana Board of Medical Examiners has the authority to regulate doctors to ensure they abide by a standard of care, and it set professional standards for medical marijuana recommendations in May 2010.

According to a February 20, 2011 Public Policy Polling poll, 76% of Montanans wanted to either leave the law as it was enacted by voters or they wanted new regulations, such as licensing and regulating providers. Despite this sentiment, the newly elected, socially conservative Montana Legislature approved H.B. 161, which would have completely repealed the voter-enacted law. On April 13, 2011, Gov. Brian Schweitzer (D) vetoed the repeal bill.

Then, the Montana Legislature passed S.B. 423, restrictive legislation designed to massively reduce participation in the medical marijuana program. Gov. Schweitzer issued an amendatory veto of an earlier version of S.B. 423 on April 28, 2011. After his amendatory veto, the legislature moved swiftly the same day, rejecting most of his proposed changes, and passing “repeal in disguise”, as it was also known to medical marijuana advocates, 88-12 in the House and 33-16 in the Senate. S.B. 423 was sent to Gov. Schweitzer on May 3. With no time left in the legislative session, he reluctantly let it become law without his signature on May 13.

Most of S.B. 423 went into effect on July 1, 2011, but a state court judge has blocked several provisions from going into effect until their validity under the state constitution is decided in court. The Montana Cannabis Industry Association filed this lawsuit to prevent implementation of S.B. 423 and is also leading a ballot referendum campaign for 2012 to repeal the new law.

As of this printing, the Montana medical marijuana program has been changed significantly. To qualify, patients must have one of the listed debilitating medical conditions: cancer; glaucoma; HIV/AIDS; wasting syndrome; intractable nausea

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State-By-State Report 2011or vomiting; epilepsy or an intractable seizure disorder; multiple sclerosis; Crohn’s disease; painful peripheral neuropathy; a central nervous system disor-der resulting in chronic, painful spasticity or muscle spasms; or admittance into hospice care in accordance with rules adopted by the department.

Patients with severe chronic pain will also continue to qualify under the new rules, but only if it is “persistent pain of severe intensity that significantly interferes with daily activities as documented by the patient’s treating physician and by (i) objective proof of the etiology of the pain, including relevant and necessary diagnostic tests that may include but are not limited to the results of an x-ray, computerized tomography scan, or magnetic resonance imaging; or (ii) confirmation of that diagnosis from a second physician who is independent of the treating physician and who conducts a physical examination.” Regardless of the patient’s condition, the doctor must now also create extensive documentation of the condition on the written certification, and it must state that the doctor has a reasonable degree of certainty that the person’s debilitating medical condition would be alleviated by the use of marijuana and thus the person would benefit from its use.

Montana used to give out-of-state medical marijuana cards the same force and effect as Montana registry identification cards, but that ended with S.B. 423. S.B. 423 also changed possession limits to four mature plants, 12 seedlings, and one ounce of marijuana, and cardholders must now always carry their registry ID cards.

There is still no organized system of state-licensed dispensaries, and caregivers had to re-register as providers under many new restrictions. Gardens may not be shared, except for by close relations, and doctors must adhere to much more onerous regulations.

At the time of this writing, the following provisions of S.B. 423 have been preliminarily enjoined until their constitutionality under the state constitution is decided: a requirement that caregivers only serve three patients, a prohibition on caregivers receiving any compensation for their efforts, a provision allowing law enforcement to conduct unannounced inspections of cultivation sites, an adver-tising ban, and a requirement that physicians that make more than 25 medical marijuana recommendations a year must pay for an automatic Board of Medical Examiners investigation into their practice, regardless of whether any evidence of wrongdoing is present.

Aside from the lawsuit and possible 2012 referendum, there is additional hope in Montana. There will be a new legislature in 2013, and the February 2011 poll shows that 63% of the public still supports allowing the medical use of marijuana.

VermontVermont’s medical marijuana law — S. 76 — was the first effective medical

marijuana law to be passed by a state legislature in spite of the public objections of a governor. After MPP organized a robust campaign, Gov. James Douglas (R) allowed S. 76 to become law without his signature on May 26, 2004. The law went into effect on July 1, 2004, and the Vermont Department of Public Safety (DPS) began accepting applications for registry ID cards on October 28, 2004.

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Vermont’s law is unique in that physicians are not required to “recommend” the medical use of marijuana. A physician must only “certify” that his or her patient has a qualifying condition in order for that patient to register with the Department of Public Safety. Unfortunately, unregistered medical marijuana patients — including medical marijuana patients who suffer from illnesses outside of the narrow purview of qualifying conditions — are offered no legal protections under the law.

In May 2005, a 54-year-old former construction worker who had been impaled by a metal rod 30 years earlier was convicted of cultivating 49 plants for his medical use. Although he did not qualify under Vermont’s medical marijuana law, the jury acquitted him of possession of marijuana, finding that his marijuana use was medically necessary.

During the 2007 legislative session, the Vermont Legislature passed S. 7, which improved the medical marijuana law by expanding the qualifying conditions for the program. As he did in 2004, Gov. Douglas allowed the bill to become law without his signature. The new medical marijuana law took effect on July 1, 2007. It allows seriously ill patients suffering from conditions that cause nausea, wasting, chronic pain, or seizures to apply for the program.

It also increased the number of plants patients and caregivers are allowed to grow, to two mature and seven immature plants. Additionally, the law reduced the nonrefundable annual application fee from $100 to $50. Finally, it allowed licensed physicians in New York, Massachusetts, and New Hampshire to certify that Vermont patients have a qualifying condition.

In response to concerns from many patients who were unable to procure medi-cal marijuana despite holding an ID card, the legislature again acted to improve the law in 2011 when it passed S.17, which allows for the establishment of four non-profit medical marijuana dispensaries. Under the law, which was champi-oned and signed by Gov. Peter Shumlin (D), patients designate one dispensary and can only obtain marijuana from their designated dispensary. The dispensa-ries, which will be regulated by the Department of Public Safety, can cultivate a number of marijuana plants that’s dependent on the number of patients that have designated that dispensary. In addition, S.17 also allows physician’s assistants and advance practice registered nurses, in addition to physicians, to certify patients as having qualifying medical conditions.

HawaiiHawaii’s medical marijuana statute was signed into law on June 14, 2000 —

making Hawaii the first state to enact such a law through the state legislature — and took effect on December 28, 2000, when the Department of Public Safety issued administrative regulations and finalized forms allowing patients to register with the state.

In addition to the registry, patients have a “choice of evils” defense to charges of marijuana possession if they have qualifying medical records or signed statements from their physicians attesting that they have debilitating conditions and that the medical benefits of marijuana likely outweigh the risks.

Patient interest in the Hawaii law has been strong since its enactment. The major problems Hawaii patients face are accessing their medicine — since the law does

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State-By-State Report 2011not provide for dispensaries and only allows patient and caregivers to cultivate — and finding physicians willing to provide written certifications in support of their medical use of marijuana.

To help patients and physicians better understand the law, the Drug Policy Forum of Hawaii (DPFH) published a 15-page booklet in October 2001. The booklet, which details the legal protections afforded and the process of registering patients, was mailed to more than 2,400 registered physicians and distributed to clients of certain nonprofit health organizations.

There were several failed attempts to curtail or undercut the medical marijuana law during the 2001-2002 legislative session. In 2003, HB1218 sought to raise the fee ceiling for patients and impose additional penalties on physicians who violated the parameters of the medical marijuana law, but it was tabled and went nowhere.

In 2005, the legislature took up SB128, which sought to raise possession limits, to allow for the addition of qualifying conditions, and perhaps most importantly, to transfer administration of the medical marijuana program from the Department of Public Safety’s Narcotics Enforcement Division to the Department of Health. Many participants in the medical marijuana program find it both inappropriate and intimidating that the Narcotics Enforcement Division oversees the program. While SB128 passed the Senate and several committees in the House, it died in the House Finance Committee after failing to make a deadline.

The legislature, however, did pass Senate Concurrent Resolution 197 on May 5, 2005, to convene a working group to make recommendations to the Department of Public Safety to improve Hawaii’s medical marijuana program. The working group met in late 2005 and included representatives from the Department of Public Safety, the Department of Health, the Drug Policy Forum of Hawaii, and a qualifying patient. Although SCR197 requested the group “to make recommendations to improve Hawaii’s Medical Marijuana Program,” the scope of the work as performed was narrowly defined to: (1) a discussion of the contents of the Narcotics Enforcement Division’s Web page and (2) a discussion on which department should administer the program. The group found that transferring the program from the Department of Public Safety’s Narcotics Enforcement Division to the Department of Health “would have substantial cost implications, including but not limited to, added personnel and operating costs” and that the Narcotics Division should upgrade its computer systems. An official report was submitted to the state legislature during the 2006 session.

In June 2005, the U.S. attorney for Hawaii, Ed Kubo, created a great deal of controversy following the U.S. Supreme Court’s decision in Gonzales v. Raich, when he said that Raich signaled the “death knell” of medical marijuana in Hawaii and threatened to begin investigating doctors who recommend marijuana to patients. The Hawaii attorney general was quick to assure patients that Raich would not change the way the state enforced its medical marijuana laws, and Kubo later retreated from his statements, saying that doctors who merely certify patients to use marijuana would not be prosecuted unless there are extenuating circumstances.

A second major controversy occurred in June 2008, when the Department of Public Safety’s Narcotics Enforcement Division mistakenly released the names and personal information of 4,200 registered medical marijuana patients to the Hawaii Tribune-Herald. Although the department was quick to recover the names (they

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maintain the only people to see the names were the reporter working on the story and the editor) and issue an apology, this serious mishandling of sensitive patient information further eroded patients’ faith in the ability of a narcotics department to handle a health care program. Although several bills have been introduced over the years that sought to move the medical marijuana program from the Narcotics Enforcement Division to the Department of Health, none have passed.

In 2011, the first year of a two-year legislative session, several bills were introduced to improve Hawaii’s medical marijuana program or to study im-provements to it. None of the bills have made it to Governor Neil Abercrombie (D) yet. The Senate voted overwhelmingly to allow medical marijuana dispensaries and to transfer power of the medical marijuana program from the Department of Public Safety to the Department of Health. One dispensary bill passed the House in a much narrower form —allowing only a single dispensary in a pilot program. However, a senator on the conference committee then pro-posed devastating revisions to Hawaii’s core law, including removing severe pain, and the bill did not advance. Ultimately, questions regarding adequate supply, among others, will remain unanswered until at least 2012.

ColoradoColorado voters passed a ballot initiative on November 7, 2000, to remove state-

level criminal penalties for medical marijuana use, possession, and cultivation. On June 1, 2001, less than three weeks after the U.S. Supreme Court’s negative ruling on medical marijuana distribution in U.S. v. Oakland Cannabis Buyers’ Cooperative, the Colorado Department of Public Health and Environment (CDPHE) implemented the Medical Marijuana Registry program and began issuing identification cards to patients and caregivers who qualify for legal protection under state law.

After scrutiny from Gov. Bill Owens (R) and then-Attorney General Ken Salazar (D) — both of whom oppose medical marijuana — no reason could be found to scrap the Medical Marijuana Registry program. Following exhaustive research and vigorous debate by attorneys in their offices, Owens and Salazar jointly said that “the Supreme Court’s holding in the Oakland case was deliberately narrow enough to permit Colorado’s medical registry to go forward.”3

Colorado’s program received a boost in legitimacy when, in July 2001, Kaiser Permanente gave its Colorado doctors permission to recommend medical marijuana.4 Kaiser, one of the nation’s largest health maintenance organizations, has over 400,000 patients in Colorado.

In November 2007, Senior Denver District Judge Larry Naves overturned a Colorado Department of Health and Environment policy limiting the number of patients a caregiver can assist. The department had adopted a limit of five patients per caregiver during a closed meeting, during which no health care professionals, patients, caregivers, or horticulturists were consulted.

Although the Colorado medical marijuana program did not create a legal and regulated medical marijuana dispensing program, some individuals chose to open storefront dispensaries to meet the need for immediate access for patients. With the five-patient cap gone, they did so under the theory that they would __________________________________________________________________________________________

3 “Owens’ and Salazar’s joint statement on medical marijuana,” Denver Rocky Mountain News, May 31, 2001. 4 “Kaiser to allow medical marijuana,” Daily Times-Call, July 7, 2001.

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State-By-State Report 2011be protected as caregivers. Under Amendment 20, caregivers are required to be a person over 18 and to have “significant responsibility for managing the well-being of a patient who has a debilitating medical condition.”

In October 2009, the U.S. Department of Justice issued a memo by then-Deputy Attorney General David Ogden. This memo recommended that United States attorneys in states with medical marijuana laws not waste federal resources investigating and prosecuting individuals acting in clear compliance with a state program. Sensing a more hands-off approach, the number of dispensaries increased substantially.

On October 29, 2009, the Colorado Court of Appeals issued a ruling that signaled that dispensaries and cultivators were potentially vulnerable under ex-isting state law. (People v. Clendenin, 232 P.3d 210) The court ruled against Stacy Clendenin, a woman who cultivated marijuana in her home for distribution through dispensaries. It found a caregiver “must do more than merely supply a patient who has a debilitating medical condition with marijuana.” In a specially concurring decision, Judge Loeb said the state’s law “cries out for legislative ac-tion” because the law does not protect patients’ and caregivers’ suppliers.

In response to the new, unregulated dispensary industry with its murky legal status, the Colorado Legislature became the first governing body to implement a regulatory scheme and clear legal recognition for pre-existing medical marijuana dispensaries. Signed into law on June 7, 2010 by then Gov. Bill Ritter (D), HB 1284 created a clear licensing scheme for the rapidly growing industry.

Under Colorado law, dispensary owners and operators are subject to licensing fees and criminal background checks. Dispensaries may operate as for-profit businesses, but are required to grow at least 70% of their inventory themselves. Moreover, they may not operate within 1,000 feet of a school. HB 1284 also contains provisions licensing growing operations and infused product manufac-turers connected to dispensaries, establishes standards for allowing some on-site consumption of medicine for patients who cannot safely use their medicine elsewhere, and makes medical marijuana purchases for indigent patients exempt from sales tax. Under this new and regulated scheme, the city of Denver brought in $3.5 million in medical marijuana sales taxes in 2010; Boulder realized $1 million in medical marijuana sales taxed.5

The Colorado Legislature took up medical marijuana legislation again in 2011, creating further registration requirements. Signed into law on June 2, 2011 by Governor John Hickenlooper (D), HB 1043 sought to clarify a number of provisions in the “Colorado Medical Marijuana Code.” Although it is generally a good law, HB 1043 contains a provision requiring primary caregivers who grow medical marijuana to register their cultivation sites with the Department of Health. Some expect this provision to be challenged as a violation of the state constitution.6

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5 Hecht, Peter, “Colorado’s medical pot business is for-profit, regulated – and thriving,” The Sacramento Bee, Sunday, August 14, 2011.

6 Denver based medical marijuana attorney Rob Corry asserts that the caregiver registry requirement is unconstitutional because the Colorado Constitution “gives caregivers confidentiality and keeps them out of view of government registration.” Roberts, Michael, “Medical Marijuana: Rob Corry wouldn’t sign MMJ clean-up bill if he were John Hickenlooper,” Denver Westword, May 25, 2011.

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NevadaNevada voters twice approved a constitutional amendment allowing the use

of medical marijuana, most recently in November 2000 (with 65% of the vote). The amendment required the legislature to create implementing legislation for licensing patients and caregivers, which the legislature did in 2001 with A.B. 453, which established the state’s medical marijuana registry program. A.B. 453 originally intended for the state to grow and distribute medical marijuana to patients who are either unable or unwilling to grow their own. That provision was dropped, however, and the bill was amended to resemble Oregon’s law.

Enacted after the U.S. Supreme Court’s May 2001 ruling on medical marijuana in U.S. v. Oakland Cannabis Buyers’ Cooperative, the preamble of A.B. 453 says that “the State of Nevada as a sovereign state has the duty to carry out the will of the people of this state and to regulate the health, medical practices and well-being of those people in a manner that respects their personal decisions concerning the relief of suffering through the medical use of marijuana.”

Nevada’s law is the only one in the nation that includes a requirement that patients undergo a background check to ensure that they have no prior convictions for distributing drugs. The program requires that patients provide a fingerprint card to aid in the background check.

Once patients are approved, they are issued a 30-day temporary certificate, which affords them legal protection and allows them to obtain a one-year photo identification card from one of five Department of Motor Vehicles offices across the state. Patients who fail to register with the program — but are otherwise in compliance with the law — are allowed to argue at trial that they had a medical need to use marijuana.

A.B. 453 also requires the state Department of Agriculture to work aggressively to obtain federal approval for a distribution program for marijuana and marijuana seeds and requires the University of Nevada School of Medicine to seek, in conjunction with the state Agriculture Department, federal approval for a research project into the medical uses of marijuana. Apparently, no work has been done to carry out either of these directives.

In 2003, the legislature passed a bill that slightly amended the medical marijuana law. A.B. 130, introduced on behalf of the Nevada Department of Agriculture, allows osteopathic physicians to qualify as “attending physicians” for the medical marijuana program. This is good for patients in Nevada because it expands the scope of those who may receive legal protection for using medical marijuana. In 2005, the legislature passed a bill that would allow the Department of Agriculture to revoke the registry identification card of a participant in the state’s medical marijuana program who has been convicted of drug trafficking or who has provided false information on his or her application.

Nevada’s registry program was once the only one in the nation that did not charge patients an application or registry fee. Now it is the most expensive, with the Nevada State Health Division charging patients as much as $242 for the ap-plication and its processing, the ID card, and fingerprinting. Unfortunately, A.B. 528, which passed the Nevada Legislature and became law in June 2011, makes it less likely that that price will be reduced any time soon. A.B. 528, will transfer money “that is not needed to carry out” the Medical Marijuana Program to fund

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State-By-State Report 2011alcohol and drug abuse programs for teens in the child welfare system. The fees are too expensive for patients who are often low-income or unemployed, and the legislature instead should have asked the Department of Health to use excess program money to lower patient fees.

Nevada’s medical marijuana program has had few, if any, reports of abuse. However, as one of the older laws, it lacks clearly recognized, regulated dispensa-ries, and many patients are left without access. Nevada caregivers cannot receive compensation for their work. Some have sought to fill the void by providing marijuana at storefronts for donations. Local police raided and closed most of those entities, claiming they were impermissibly receiving donations. More than a dozen people were indicted as a result.

On September 12, 2011, Clark County Judge Donald Mosley dismissed charges against one of them, Leonard Schwingdorf, because the grand jury was not told that the co-op accepted but did not require donations, so marijuana was not sold. Judge Mosley called the law “mind-boggling” and called on the legislature to act saying, “I’m looking at it thinking I can’t make any sense out of this law. ... Are people supposed to give it away? I mean it just makes no sense.”7

MaineMaine, which in 1999 became the fifth state to enact a modern medical

marijuana law, broke new ground in 2002, when its legislature made it the first state to expand an existing medical marijuana law.

Signed into law on April 1, 2002, LD 611 doubled the amount of usable marijuana a patient may possess, from 1.25 ounces to 2.5 ounces. The bill also clarified protections for patients and caregivers, explicitly providing them with an “affirmative defense” against charges of unlawfully growing, possessing, or using marijuana.

In November 2009, 59% of Maine voters approved a measure to expand the law —Question 5, which was drafted by MPP. The measure provided for a registry ID card system, which gave patients and caregivers protection from arrest, and it maintained an affirmative defense that could be raised by unregistered patients in court. It also increased qualifying conditions, including by adding intractable pain, and dramatically improved patients’ access to medical marijuana.

Question 5 required the Department of Health to register eight dispensaries to provide medical marijuana to patients. The Department issued six registrations in July 2010 and the final two the following month. Four of those dispensaries are up and running, and all eight should be operational by the end of 2011.

In 2010, the legislature made several changes to Question 5. Most of the chang-es were relatively minor, but they also eliminated the law’s affirmative defense. In 2011, a new legislature restored some of the affirmative defense, by passing LD 1296. Gov. Paul LePage (R) signed the bill on June 24, 2011. The new law makes registration optional for patients, who can be protected either by having a registry ID card or a “written certification,” a document signed in the last year by a physician with whom the patient has a bona fide doctor-patient relationship

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7 “Nonsensical Law,” Las Vegas Review Journal, September 18, 2011.

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saying the patient has a debilitating medical condition for which marijuana is likely to provide relief. Patients must also have a valid state-issued photo ID.

Notably, the legislative improvements took place with little fanfare or contro-versy. In 2002, LD 611 passed the Senate by a simple voice vote, as did LD 1296, which was sponsored by a Republican, Sen. Deborah Sanderson, in 2011. In fact, Republicans have been relatively supportive of efforts to expand Maine’s medical marijuana law for years. When asked whether federal law served as a hindrance to expanding the law in 2002, Republican Rep. Robert Nutting said the law was “workable under federal law … It’s kind of like driving five miles an hour over the speed limit – no one’s going to [enforce that].”8

OregonThe Oregon Medical Marijuana Program (OMMP) was enacted by a 1998

ballot initiative. Like other effective medical marijuana laws, Oregon’s protects patients from state-level criminal penalties for the use, possession, and cultiva-tion of medical marijuana. The OMMP, run through the Oregon Department of Human Services, issues registry ID cards to qualified patients and caregivers. Like other early medical marijuana laws, Oregon’s allows patients or caregivers to cultivate marijuana, but does not allow dispensaries.

In addition to administering the registry program, the Department of Human Services considers petitions to add new medical conditions to the list of qualifying conditions, diseases, and symptoms covered by the law. In the first year of the program, an expert panel considered eight conditions — agitation of Alzheimer’s disease, anxiety, attention deficit disorder, bipolar disorder, insomnia, post-traumatic stress disorder, schizophrenia, and schizo-affective disorder — and recommended three of them — agitation of Alzheimer’s disease, anxiety, and bipolar disorder — for final approval. The department approved agitation of Alzheimer’s disease, while rejecting the other two. The unapproved conditions may be reconsidered if additional supporting evidence can be offered, but no new medical conditions have since been approved.

In July 1999, less than nine months after the law was passed, the state amended the Medical Marijuana Act when Gov. John Kitzhaber (D) signed H.B. 3052 into law. The changes included:

• Mandating that patients may not use marijuana for medical purposes in correctional facilities;

• Limiting a given patient and primary caregiver to growing marijuana at one location each;

• Requiring that people arrested for marijuana who want to raise the medical necessity defense in court must have been diagnosed with a debilitating medi-cal condition within 12 months prior to the arrest; and

• Specifying that a law enforcement agency that seizes marijua-na plants from a person who claims to be a medical user has no responsibility to maintain the live marijuana plants while the case is pending.

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8 “Bill clarifies medical marijuana guidelines,” Bangor Daily News, March 6, 2002.

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State-By-State Report 2011To address remaining ambiguities in the medical marijuana law, the state attorney

general’s office convened a working group to develop recommendations on how state and local authorities should enforce the law. Issued on December 15, 1999, the recommendations elaborate on the range of defenses provided by the law and when they are applicable and offer cautious policies for seizing and destroying marijuana plants for jurisdictions to consider.

In 2001, with the volume of patients overwhelming the understaffed program, an internal audit revealed numerous problems: The program had a backlog of almost 800 applications, often failed to verify doctor signatures on applications, regularly missed deadlines for processing applications, and had no clear procedure for rejecting incomplete applications. Three registry cards (out of more than 2,000) had been issued to patients who had forged doctors’ signatures. In response, the OMMP dramatically increased its staffing, which allowed it to clear the application backlog and greatly improve oversight.

The program has also adopted stricter rules for physicians, requiring that doctors who sign patients’ applications maintain an up-to-date medical file for each patient, perform a physical, and develop a treatment plan. The state program may also examine a copy of the patient’s file.

In 2003, Oregon avoided passing a bill to further restrict the program. H.B. 2939 would have disqualified any person previously convicted of a drug violation from accessing the medical marijuana program and required medical marijuana patients to complete a “medical marijuana education course.” H.B. 2939 passed the House but died in the Senate Health Policy Committee.

In 2004, in response to concerns that patients who cannot cultivate their own marijuana must turn to the criminal market to obtain it, some activists attempted to pass Measure 33, a ballot initiative that would have created state-regulated nonprofit dispensaries where qualified patients could buy medical marijuana. The measure also proposed increasing the amount of medical marijuana a patient may have on hand to one pound of usable medical marijuana — six pounds if the patient were to choose to grow once a year. Measure 33 lost, 58% to 42%.

In 2005, the Oregon Legislature considered two key medical marijuana bills. S.B. 1085, which was passed in August 2005, increased the amount of marijuana that a patient could possess from seven plants, three of which could be mature, and one ounce of usable marijuana per mature plant to 24 ounces of usable mari-juana, six mature plants, and 18 seedlings. H.B. 2693, which died, would have given employers much more room to discriminate against medical marijuana patients in the workplace.

In 2007, a bill was introduced that would have allowed employers to discriminate against medical marijuana patients. S.B. 465 would have allowed employers to fire patients for using medical marijuana, regardless of when or where patients used their medicine, or if they were medicated while working. Interestingly, Oregon Revised Statute 659.840 requires an employer to have reasonable grounds before administering a Breathalyzer test to an employee they believe to be under the influence of alcohol. S.B. 465 would have actually allowed an employer to test an employee for marijuana with less evidence of wrongdoing than is required for the same employer to test the same employee for alcohol. S.B. 465 passed the Senate, but died in the House Elections, Ethics and Rules Committee.

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Although S.B. 465 was not enacted, the issue has since been taken up by the Oregon Supreme Court in Emerald Steel, Inc. v. Bureau of Labor and Industries, 348 Or. 159, 2010. The Court held that employers can terminate an employee for testing positive for metabolites, which can linger in a person’s system for weeks after their last use of marijuana. Not even a year later, the same court found that county sheriffs are required to issue conceal and carry permits to applicants who qualify under state law, even if they are medical marijuana patients. Willis v. Winters, 350 Or. 299, 2011. The court reasoned that although federal government has decided that the illegal use of drugs prohibits an individual from purchasing a firearm, there is nothing in the state’s conceal and carry law that would prohibit a medical marijuana patient being granted that permit. As of publication, the sheriff in question plans to appeal to the United States Supreme Court.

In 2010, the issue of regulated medical marijuana dispensaries again appeared on the ballot. Like Measure 33, Measure 74 would have created state-regulated nonprofit dispensaries that could be accessed by Oregon medical marijuana patients. The concerns were the same in 2010 as they were in 2004, some patients lacked access to medicine because they either could not grow their own or find anyone to grow for them. Unlike Measure 33, Measure 74 did not seek to increase possession limits. Unfortunately, Measure 74 was defeated 56% to 44%.

In 2011, many bills were introduced in the Oregon Legislature seeking to amend the medical marijuana program; none of them passed. Most of the bills tried to add restrictions on to the program by attempting to reduce the amount of medical marijuana a patient could possess (H.B. 3093) or by prohibiting individuals convicted of felony violations of the Controlled Substances Act from being issued medical marijuana cards (H.B. 2982). One bill sought to regulate and authorize the formation of collectives (H.B. 3046); unfortunately, this bill died in committee as well.

The program has proved a financial boon to the state government. The OMMP is entirely supported by patient fees, which were originally set at $150 per application and renewal. Due to the popularity of the program, the OMMP was able to create significant cash reserves and lower the rate to $100, with a further reduced rate of $20 for those who could demonstrate financial need. In 2005, the legislature shifted $900,000 worth of accumulated funds from the OMMP to an underfunded Department of Health — demonstrating not only that medical marijuana programs need not cost the state, but that they can actually produce revenues.

No substantial law enforcement problems have materialized around the program. A study conducted by the federal General Accounting Office (GAO) in 2002 on Oregon’s and three other states’ medical marijuana programs found that “medical marijuana laws had had little impact on their law enforcement activities.” 9

In early June 2011, operators of Oregon’s unregulated medical marijuana dispensaries received notice from United States Attorney  Dwight C. Holton that selling marijuana for any purpose, including medical use, was against both federal and state law. Although 33 Oregon district attorneys signed the letter, there has been no major enforcement effort to date. In fact, enforcement of federal marijuana laws has so far focused more closely on Oregon’s neighbors in

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9 United States General Accounting Office, Marijuana: Early Experiences with Four States’ Laws That Allow Use for Medical Purposes, Washington: GAO, 2002.

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State-By-State Report 2011California and Washington. Only a handful of Oregon patients have faced federal prosecution in the last 11 years.

In 2005, in the days following the U.S. Supreme Court’s decision in Gonzales v. Raich, Dr. Grant Higginson — the public health officer who oversees the OMMP — said that the OMMP would stop issuing registry cards until the Oregon attorney general issued an opinion on the impact of the Raich decision. After a tremendous public outcry and threats of litigation, the Oregon attorney general issued an opinion on June 17, stating that the Raich decision had no impact on the state’s administration of the OMMP. It immediately resumed issuing cards and cleared the backlogged applications in a matter of weeks.

Physician participation in Oregon has remained strong, with 4,000 physicians having written at least one recommendation. In addition, Kaiser Permanente, one of the nation’s largest health maintenance organizations, developed a standardized recommendation letter for its Oregon physicians to use in conjunction with the registry process.

AlaskaAlaska voters passed a ballot initiative in 1998 to protect seriously ill state

residents from arrest for possessing, using, and cultivating medical marijuana.

In 1999, S.B. 94 made it mandatory for patients to participate in a state registra-tion program. It also significantly reduced patients’ protections by making the law an affirmative defense that must be proven in court, rather than protection from prosecution.

The legislature also limited the amount of marijuana that a patient may legally possess to one ounce and six plants, with no exceptions. Previously, patients who exceeded the numerical limit could argue at trial that a greater amount was medically necessary. Patients now often complain that the plant limit is too low.

Additionally, local advocates believe some patients are unable to maintain a consistent supply of medical marijuana. With the nation’s shortest growing season, Alaskans generally have no choice but to grow indoors, which often presents a financial hardship. Not only does the state not permit medical marijuana distribution, but the Department of Health and Social Services rejected an idea to allow the registry program to provide patients with a list of independent groups that could provide them with the assistance necessary to grow marijuana on their own.

Because of these factors, there are only 339 registered medical marijuana patients in the state, making it the nation’s smallest medical marijuana program. However, in addition to the problems mentioned above, low registration rates may also be due to the fact that Alaska courts have held that the Alaska Constitution’s privacy clause protects the adult possession of limited amounts of marijuana in the home, thereby lessening the need to register with the state for protection for patients who do not possess marijuana outside the home.

Alaska has no breakdown of its registrants’ conditions and symptoms because the physician statement forms do not require the naming of the specific ailments, in order to protect patient confidentiality.

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Although the scope of the law has narrowed since it was first passed, police and prosecutors typically exercise discretion and maintain the spirit of the law when conducting medical marijuana investigations, according to the state attorney general’s office. Unregistered patients often are either not charged or are charged with a lesser crime if they can clearly demonstrate their medical need to the investigating officer.

In one case reported by the Alaska attorney general’s office, an unregistered wife and husband — who possessed plants in excess of the specified limit — were initially charged with felonies. After obtaining evidence that the woman had a qualifying medical need, the charges against her were dropped, and the husband was allowed to plead guilty to a lesser charge. Although not wholly absolved, the couple avoided prosecution for serious charges. At the same time, this example stresses the value of obtaining registry cards. As enforcement practices vary from town to town, patients are not guaranteed the same treatment across Alaska.

District of ColumbiaAlthough 69% of District of Columbia voters approved an initiative removing

district-level criminal penalties for the medical use of marijuana all the way back in 1998, the District’s medical marijuana program is still in its infancy. That’s because a long-standing provision, or “rider,” in Congress’ appropriations to the District prevented the District from using any federal or local funds to imple-ment the act. The author of the “Barr Amendment” rider, Georgia Congressman Bob Barr (R) had a charge of heart, and MPP hired him to lobby to have the provision removed in 2007. The effort succeeded in late 2009.

Immediately after the Barr Amendment was removed and the initiative was transmitted to Congress for review (all legislation passed in the District must be sent to Congress which then has 30 days to nullify the law), the D.C. Council passed amending legislation drastically narrowing the law.

Originally, the initiative would have allowed doctors to recommend marijuana for any condition that the doctor thought could be alleviated by marijuana. Under B18-622, the Council’s amending legislation, marijuana can only be recommended for HIV/AIDS, glaucoma, cancer, and multiple sclerosis, and con-ditions treated by chemotherapy, AZT, protease inhibitors, or radiotherapy. The executive branch can also add additional debilitating conditions. Additionally, the Council removed wording that would have allowed patients to grow their own marijuana or have caregivers grow it for them.

As it stands now, D.C.’s medical marijuana law only allows patients to obtain marijuana from a dispensary licensed by the District’s Health Department. The Health Department is currently in the process of licensing 10 cultivation centers and five dispensaries, which will grow and distribute marijuana to patients. The Department expects cultivation centers to be licensed by January 2012,10 and dispensaries to be licensed shortly thereafter. Until that time, patients will not be able to legally procure — or possess — medical marijuana.

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10 See http://hrla.doh.dc.gov/hrla/frames.asp?doc=/hrla/lib/hrla/pharmacy_control/110803mmptimelinecultivationcenters.pdf

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State-By-State Report 2011Caregivers have a limited role under the District’s law. They are appointed to

pick up marijuana on patients’ behalf from their designated dispensary and to assist in the administration of marijuana. There is an affirmative defense in the law for individuals who are not registered caregivers, but can establish they were only assisting a patient with the administration of medical marijuana because the patient’s caregiver was unavailable.

WashingtonWashington state has one of the country’s weakest medical marijuana laws.

It is one of only two laws that are considered “effective” but that fail to provide protection from arrest or prosecution and instead only provide an affirmative defense. Of the jurisdictions that passed medical marijuana initiatives in 1998, Washington state and Washington D.C. were the only two that did not place a numerical limit on the amount of marijuana that may be possessed or grown by a patient. Instead, the Washington state law allows patients to possess no more than a “sixty-day supply.”

In 2007, the legislature passed SB 6032, which directed the Department of Health to determine what constitutes a “sixty-day supply” by July 1, 2008. In June, about one month before their recommendation was statutorily due, the department suggested that a 60-day supply be defined as 35 ounces and a 100-square-foot canopy; however, Gov. Christine Gregoire (D) felt law enforce-ment and prosecutors were underrepresented and pressured the department to reconsider. Although there were four public hearings held across the state by the department in 2007, and law enforcement did in fact comment, with the DEA even showing up at one point, the department acquiesced, recanted its original recommendation and came back with a recommendation of 24 ounces and 24 plants. Ultimately, in October 2008, the department finalized a presumptive pa-tient limit of 24 ounces of usable marijuana and 15 plants, at any stage of growth. The legislature codified this presumptive limit, which can be overcome at trial by “a preponderance of the evidence, that the qualifying patient’s necessary medical use exceeds” 24 ounces of usable marijuana and 15 plants.

Washington is also the only one of the 17 jurisdictions in the U.S. (including Washington, D.C.) with an effective medical marijuana law without some sort of registry system in place. The number of patients utilizing the state law is estimated to be around 85,600. This estimate is calculated based on Oregon’s mandatory registration system (which shows approximately 1.3% of the entire population using medical marijuana).

Washington law also differs from most medical marijuana state laws by al-lowing for a greater universe of medical professionals to write valid medical marijuana recommendations. In 2010, the legislature passed and the governor signed SB 5798. This new law allows physician’s assistants, osteopathic physician’s assistants, naturopaths, and advanced registered nurse practitioners, in addition to physicians and doctors of osteopathy, to write recommendations for their patients.

Most patients grow their own medical marijuana, either alone or with the help of a designated provider. To assist those patients who cannot grow marijuana, a handful of patient cooperatives exist to verify patients’ credentials, distribute marijuana, and provide related services. Although designated providers are

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limited to serving one patient at a time, until 2011 statutory law was silent as to cooperatives and designated providers growing in groups. While some cooperatives and designated providers operated without interference from law enforcement, others have been targeted by police and sometimes raided. This situation is the result of different law enforcement agencies having different poli-cies, coupled with a lack of statutory guidance.

The legislature attempted to remedy this situation in 2011 when it enacted SB 5073. SB 5073 was the result of numerous focus groups conducted with patients, patient advocates, city leaders, law enforcement, and legislators. The bill would have created a state registered and regulated dispensary system and a voluntary patient registry. Patients who registered would have been granted immunity from arrest and prosecution so long as they were within their possession limits. In addition, the bill allowed for small-scale patient collectives, where no more than 10 patients may collectively cultivate no more than 15 plants per patient or 45 plants total (whatever number is smaller). In addition, it provided that docu-mentation of valid medical marijuana recommendations for all patients must be present at the collective garden at all times.

Unfortunately, SB 5073 did not make it out of Governor Chris Gregoire’s (D) office intact. The governor used her power of the section veto to eviscerate the enacted legislation, leaving it a shell of its original self. Governor Gregoire vetoed sections creating registered and regulated medical marijuana dispensaries. She vetoed the section creating a voluntary patient registry with the accompanying arrest and prosecution protections for those registered. However, Gov. Gregorie left intact a section stating that a caregiver may only be a caregiver for one patient, and if that status is revoked, they must wait 15 days before becoming a caregiver for a new patient. The governor leaving this section intact is important because it closed the previously available legal loophole that arguably allowed pre-existing dispensaries to operate. Thus, instead of recognizing and regulat-ing dispensaries, as the legislature intended, once Gov. Gregorie was done with SB 5073, it undercut the strongest legal argument they had for operating. Gov. Gregoire also signed off on provisions in SB 5073 that protect patients’ parental rights, mandating that use of medical marijuana on its own is not enough to show cause of child neglect.

In addition to problems related to Washington’s supply issue, police complained that it was difficult to determine what is an appropriate doctor’s recommenda-tion. The legislature tried to address this issue in 2010 when they enacted, and Governor Gregoire signed, legislation requiring that all recommendations be signed, dated, and written on “tamper-resistant paper” that includes one or more industry-recognized features designed to prevent counterfeiting or modifica-tion in any way. The patient registry passed by the legislature in 2011, but subsequently vetoed by Gov. Gregoire, would have also provided more clarity to police officers for participating patients. Although the 2010 law signed by Gov. Gregoire adds some clarity, patients are still being arrested and having their marijuana seized because of the ambiguity and weakness of the law.

To assist patients, the Washington Department of Health provides a toll-free phone number (800-525- 0127) where patients can obtain information about the law, maintains a frequently asked questions page on their website, and provides

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State-By-State Report 2011copies of the statute on their website. The department also links to organizations like the ACLU, which can provide further assistance as needed.

Patients who contact the Department of Health most often ask about how they can obtain marijuana, if they can be referred to a physician, and what their status is under federal law. The department does not refer patients to physicians who can provide recommendations, nor does it refer them to patient networks that can provide medical marijuana. With no formal role in the administration of the law, the department’s primary advice for patients is to read the law carefully.

The only state agency with any administrative authority over the law is the Medical Quality Assurance Commission. It can expand the list of terminal or debilitating conditions that may be treated with marijuana under state law. During the law’s first two years of effectiveness, the commission added Crohn’s disease and hepatitis C, as well as diseases that have specific symptoms like nausea, vomiting, wasting, appetite loss, cramping, seizures, muscle spasms, and spasticity, when these symptoms are unrelieved by standard treatments. In 2007, SB 6032 codified these conditions and symptoms as “qualifying conditions” under the medical marijuana statute. In 2010, the commission added chronic renal failure to the list of “qualifying conditions” for which medical marijuana may be recommended. The commission has rejected the inclusion of insomnia, post-traumatic stress disorder, depression, and severe anxiety, but Washington remains one of very few medical marijuana states that has responded favorably to any of the petitions to add qualifying conditions.

CaliforniaCalifornia’s law — which voters approved in November 1996 — was the

first effective medical marijuana law to be enacted. As with all initial efforts, Proposition 215 did not address every aspect of medical marijuana policy. Most notably, the law — called the Compassionate Use Act (CUA) — did not specify the amount of marijuana that may be possessed or grown by a patient, nor did it permit any state agency to establish guidelines for the law.

One major unresolved issue was supply. How much marijuana is sufficient for the “personal medical purposes” of a patient, as defined by the CUA? Without any specified numerical guidelines, law enforcement officials sometimes err on the side of prosecuting — or at least hassling — patients if the quantity seems too large.

Unlike most of the later state medical marijuana laws, the CUA has not been in-terpreted as providing protection from arrest. On July 18, 2002, in a unanimous ruling, the California Supreme Court interpreted the CUA as allowing CUA patients to move to dismiss attempts to prosecute them in a pretrial motion.11 In essence, the CUA allows patients to avoid a jury trial if they are valid medical marijuana users.

Similar to most other effective medical marijuana laws, the CUA did not explicitly permit distribution beyond individual caregivers assisting individual patients. Unfortunately, many patients are not capable of growing their own marijuana, nor do they have capable caregivers. In response to this unmet need,

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11 People v. Mower, (Cal. 2002) 49 P.3d 1067.

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a number of medical marijuana distributors — in earlier years referred to as “cannabis buyers’ cooperatives” or “clubs” (CBCs) and now called “dispensaries” or “collectives” — emerged throughout the state. In fact, some had been in existence before the initiative became law.

The dispensaries initially acted as the “qualified primary caregiver” for the patients they served. However, at least one court held that an organization did not meet the definition, which required that the caregiver be a person who has consistently assumed responsibility for the patient’s housing, health, or safety.12 In a 1997 decision, the San Francisco CBC was successfully targeted by the state attorney general’s office. The California First District Court of Appeals ruled that a commercial enterprise that sells marijuana does not qualify as a primary caregiver. In 2008, the California Supreme Court found that caregivers must consistently provide caregiving for patients independent of medical marijuana, at or before the time they begin assisting with medical marijuana. (People v. Mentch, 45 Cal.4th 274.)

Attempting to address the questions left unanswered by the CUA, then-Cali-fornia Attorney General Bill Lockyer (D) formed a task force in 1999 to develop recommendations for implementing the law.

Co-chaired by state Sen. John Vasconcellos (D) and Santa Clara District Attorney George Kennedy (R), the task force produced a number of recommen-dations that were added to a bill sponsored by Vasconcellos. The bill, S.B. 848, contained four major provisions:

• Establish a registry program within the Department of Health Services;

• Allow the Department of Health Services to determine what constitutes an appropriate medical marijuana supply;

• Permit regulated operation of cooperative cultivation projects; and

• Clarify those instances when medical marijuana may be authorized, and re-quire that a patient’s personal physician make the recommendation.

After years of attempts, a modified version of the legislation was enacted in 2003 and signed into law by Gov. Gray Davis (D). To help resolve the inconsis-tencies among jurisdictions in enforcing the medical marijuana law, S.B. 420 provided that patients and caregivers may possess at least eight ounces of mari-juana and six mature or 12 immature plants per patient. Counties and localities may raise those amounts, but are not permitted to lower them. In addition, a patient can possess a greater amount with a doctor’s recommendation stating that the limit would be insufficient. Further, the new law, called the Medical Marijuana Program (MMP), mandated the creation of a voluntary statewide ID card and registry system, which provided the patients and caregivers who chose to participate with additional protection — protection from arrest. County health departments are required to verify information in the applications, ap-prove and deny the applications, and issue the cards. The California Department of Health Services maintains a website for law enforcement to verify ID cards’ validity.

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12 People ex rel. Lungren v. Peron (App. 1 Dist. 1997) 70 Cal.Rptr.2d 20, 59 Cal.App.4th 1383, review denied.

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State-By-State Report 2011Several counties initially resisted implementing the ID card program. As of

publication, two small counties — Colusa and Sutter — are still not offering ID cards. In addition, neither county is currently scheduled to implement the ID card program.

The most important provision of the MMP is that it made California the first state to expressly allow cooperatives under state law. The provision states, “Qualified patients, persons with valid identification cards, and the designated primary caregivers of qualified patients and persons with identification cards, who associate within the State of California in order collectively or cooperatively to cultivate marijuana for medical purposes, shall not solely on the basis of that fact be subject to state criminal sanctions.” It also provides that caregivers cannot be prosecuted solely for being compensated for their actual expenses and services. The MMP also said that it does not authorize for-profit marijuana distribution.

In a 2005 ruling, People v. Urziceanu, the Third Appellate District Court of Appeal of California found that the MMP provides a defense for distribution by collectives and cooperatives, including for conduct that occurred before the law passed. Although the court found that the CUA did not allow collective medical marijuana distribution, it ruled that S.B. 420’s “specific itemization of marijuana sales indicates it contemplates the formation and operation of medical marijuana cooperatives that would receive reimbursement for marijuana and the services provided in conjunction with the provision of marijuana.”

Although no state agency actually collects the data, estimates on the number of medical marijuana dispensaries serving patients in California range from several hundred to more than a thousand. However, even after the passage of the MMP, many dispensaries have been shut down either by state and local law enforce-ment or by federal legal action.

The Oakland Cannabis Buyers’ Cooperative (OCBC) unsuccessfully fought a January 1998 civil suit brought by the U.S. Department of Justice, which sought to stop the operation of OCBC and five other distribution centers in Northern California. (See Appendix I for detailed information on this case.)

In July 2007, the DEA sent threatening letters to more than 160 landlords who allegedly leased to dispensaries in several areas of the state. The letters notified the landlords that they could face federal prosecution or forfeiture if they con-tinued leasing to medical marijuana collectives.13 In Santa Barbara, these letters were followed up with in-person threats to landlords of fines, forfeiture, and even prosecution if they did not evict the dispensaries.14

Since the enactment of the CUA, federal agents have also raided more than 200 medical marijuana locations, mostly dispensaries, homes related to them, and large gardens. Several dozen people have been federally prosecuted for medical marijuana, usually for involvement in dispensing collectives or large gardens. Shortly after Pres. Barack Obama was sworn into office, the number of raids decreased. However, some federal raids and prosecutions have continued in California under his administration. In October 2011, the four U.S. attorneys

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13 Welch, William, “DEA Targets Landlords in Pot Battle,” USA Today, July 26, 2007.14 “Shakedown From Feds Imperils Medicinal Marijuana,” Santa Barbara Independent, August 12, 2008.

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for California announced a crackdown on medical marijuana dispensaries in the state. As was the case in 2007, threatening letters were sent to dozens of landlords who rented to dispensaries.

The MMP’s provisions allowing for dispensing collectives are vague, and some local officials – such as San Diego County District Attorney Bonnie Dumanis and former Los Angeles County Attorney Steve Cooley – have claimed that storefront dispensaries and sales are not allowed. In San Diego and some other areas, local and federal officials have cooperated to raid dispensaries.15 In one case, a county sheriff requested a federal raid against a city-licensed dispensary. The operator, Charles Lynch, was convicted of five federal charges on August 5, 2008, because perfect compliance with a state’s medical marijuana law is no defense to federal charges.

In 2008, San Diego Assemblymember Lori Saldaña introduced legislation to stop the use of state and local resources to subvert the state’s medical marijuana law. The bill, A.B. 2743, was sponsored by MPP and would have prevented state and local officials from assisting in federal raids. For its first year, the legislation made significant progress. It passed two committees and had more supporters than opponents in the Assembly. However, a majority of all members – not just voting members – is required in California, and the bill was not called to a floor vote.

Another tactic used to subvert the medical marijuana program is enactment of city ordinances prohibiting dispensaries or putting a hold, or moratorium, on new dispensaries. The sheriff ’s office in one county, Butte, has even raided private patient collectives, including forcing the uprooting of 29 of 41 plants for a seven-patient collective. On July 1, 2009, the Third Appellate District ruled against the raid and Butte’s policy in a lawsuit brought by Americans for Safe Access. However, in August 2011, a Superior Court Judge in Orange County ruled that the MMP does not preempt local ordinances that intend to regulate – even ban – the distribution of medical marijuana. Qualified Patients Association, the dispensary that sued Anaheim over the ban, plans on appealing the decision.

Other cities have sought to ensure safe access while making sure dispensaries are good neighbors. More than three dozen cities and counties across California — including San Francisco, Los Angeles, and Sacramento — have passed ordinances regulating medical marijuana dispensaries. These ordinances usually contain security requirements, such as limiting the hours of operation, requiring plenty of outdoor lighting, or requiring security guards. They also may require the dispensaries to prevent loitering. Some of the cities utilized temporary moratoriums, such as Los Angeles, to give themselves time to develop and issue regulations.

California appellate courts have had contradictory rulings on whether federal law preempts a city licensing dispensaries. In August 2010, the Fourth Appellate District ruled that dispensary licensing was not preempted by federal law, in Qualified Patients Association v. City of Anaheim. However, in October 2011, the Second Appellate District ruled that the city of Long Beach issuing dispensary

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15 See Office of the San Diego County District Attorney 2007 Annual Report. “Our prosecutors effectively shut down all of these so-called medical marijuana clinics.”

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State-By-State Report 2011permits based on a lottery system and accepting fees was preempted. The court noted that the state could decriminalize the conduct without issuing permits and noted that many regulations would not be preempted. It also indicated permits would not be preempted if they merely identified those entities the state did not criminalize.

Regardless of how these matters involving distribution centers are resolved, individual patients and their primary caregivers will continue to be allowed to acquire or grow medical marijuana under state law.

In 2007 and 2008, legislation was introduced to address another problem dis-pensaries face. Sen. Carole Migden (D-San Francisco) introduced bills to remove liability for back sales taxes that older medical marijuana dispensaries faced. The dispensaries had little reason to believe they owed sales taxes on prior years, since they were not allowed to obtain seller’s permits until 2005. Most dispensa-ries were only notified that they were liable for any sales taxes in February 2007. The legislation did not make it out of committee either year.

Meanwhile, in January 2006, three of California’s 58 counties — San Diego, San Bernardino, and Merced — refused to issue medical marijuana ID cards and filed a lawsuit claiming that the MMP and parts of the CUA are preempted by federal law. In December 2006, San Diego Superior Court Judge William R. Nevitt Jr., ruled against the counties and upheld California’s medical marijuana laws. Merced County dropped out of the lawsuit and began issuing medical marijuana cards. San Diego and San Bernardino filed an appeal. In 2008, the Fourth District Court of Appeals unanimously found that the counties only had legal standing to challenge the part of the law requiring them to issue ID cards, and it unanimously ruled against the two counties.16 The two counties appealed. Both the Supreme Court of California and the United States Supreme Court denied certiorari, allowing the Court of Appeals decision to stand.

Four other important court decisions also came down in 2007 and 2008. Many California patients have had their medical marijuana seized by state or local offi-cials who refused to return it. On November 28, 2007, the Fourth District Court of Appeals unanimously upheld a ruling requiring the City of Garden Grove to return seized marijuana to patient Felix Kha. The state Supreme Court refused to hear the city’s appeal.

The state Supreme Court ruled on January 24, 2008 that patients can be fired or not hired for testing positive for having marijuana in their systems.17 The 5-2 ruling did note that the legislature could explicitly choose to protect patients from employment discrimination, and Assemblyman Mark Leno introduced A.B. 2279, a bill sponsored by Americans for Safe Access (ASA), that would have done just that. Unfortunately, the bill died. However, now a state Senator, Leno has introduced similar legislation – SB 129 – which, as of publication, is still pending.

The validity of the MMP possession limit guidelines has also been called into question. In California, the state legislature cannot amend initiatives. The CUA did not include any caps on how much marijuana can be possessed, so

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16 County of San Diego et al. v San Diego NORML et al., (CA.App 4th Dist. 2008) 2008 WL 2930117.17 Ross v. Ragingwire Telecommunications, Inc., (Cal. 2008) 179 P.3d 200.

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subsequent legislation cannot do so either. The MMP guidelines sought to create an amount of marijuana a patient could possess knowing that he or she was protected by the law — a safe harbor. The Supreme Court of California ruled that insofar as those limits burden a patient’s right to assert a medical defense – i.e., if a patient were denied the right to assert a medical defense for possession of an amount exceeding the MMP limits – they are unconstitutional. However, unlike the Court of Appeals, the Supreme Court allowed the cap to stand as a safe harbor for patients. People v. Kelly, 47 Cal.4th 1008, 222 P.3d 186 (2010).

As instructed by the MMP and to help clarify the medical marijuana program, then California Attorney General Jerry Brown issued long-awaited medical marijuana guidelines in August 2008.18 The “Guidelines for the Security and Non-Diversion of Marijuana Grown for Medical Use” seek to clarify the state’s medical marijuana law for patients, caregivers, dispensing collectives, and law enforcement personnel. Current Attorney General Kamala Harris – who was heavily supported by the medical marijuana community – has issued a draft of updated guidelines. As of publication, AG Harris’s guidelines are still draft.

Both the current and the draft guidelines note that, under existing law, col-lectives and cooperatives of patients and caregivers are allowed, but that they may not operate for profit. They also include recordkeeping guidelines and provide that marijuana cannot be obtained from sources other than patients and caregivers who are part of the collective. The attorney general also made recommendations that should help prevent the arrest of bona fide patients, including a recommendation that state and local law enforcement officers “not arrest individuals or seize marijuana under federal law,” if they determine that the activity is protected by state law.

In 2010 and 2011, multiple proposals were introduced in the California Legislature that ostensibly sought to further clarify the medical marijuana program by instituting more thorough statewide regulations. Heralded by proponents as a way to more carefully regulate the industry, most proposals failed to state clearly that medical marijuana dispensaries are legal under state law. Without providing for clear legal protections, these bills would do nothing to clear up confusion over what is, and what is not, legally allowed under state law. No such proposal has yet to make it out of the legislature.

Despite the occasional questions and controversies, California’s medical marijuana law has increased in popularity since it was enacted. A statewide Public Policy Institute of California poll released in May of 2010 found that 78% of California voters approved of legal protections for medical marijuana patients, compared to the 56% who approved the CUA when it appeared on the 1996 ballot.19 This figure includes strong majority support across political party affiliation with 82% of Democrats, 68% of Republicans, and 80% of independents supporting medical marijuana. The law is estimated to be protecting more than 470,000 patients, who are allowed to use medical marijuana with the approval of physicians.

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18 The guidelines are available at <http://ag.ca.gov/cms_attachments/press/pdfs/n1601_medicalmarijuanaguidelines.pdf>.

19 Mark Baldassare, Dean Bonner, Sonja Petek, and Nicole Willcoxon. Californians & their government. Public Policy Institute of California public opinion poll, pp. 15-16. May 2010.

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1. Exemption from Arrest and ProsecutionA state may establish that it is no longer a state-level crime for patients to

possess or cultivate marijuana for medicinal purposes. Federal laws would be broken by individual patients, but an “exemption from arrest and pros-ecution” prevents the state from arresting and prosecuting qualified patients. Most exemptions are tied to a state registry program, which allows patients’ credentials to be easily verified.

2. Affirmative DefenseSeveral state medical marijuana laws allow individuals to assert an affirma-

tive defense to charges of unlawful marijuana cultivation and/or possession. To establish the affirmative defense, individuals must prove at trial — often by a preponderance of the evidence — that they are in compliance with the medical marijuana statute.

The affirmative defense is the only defense afforded to individuals by the medical marijuana laws in Alaska, Maryland, and Washington. Although this defense does not prevent patients from being arrested, as a matter of practice, individuals who are clearly in compliance with the law are often not arrested in Washington state. Colorado, Maine, Michigan, Nevada, and Washington state’s laws allow individuals to use an affirmative defense to argue that an amount of marijuana in excess of the specified legal limit is medically neces-sary. California, Colorado, Michigan, Nevada, Oregon, and Rhode Island allow unregistered patients to raise an affirmative defense.1 Delaware’s law includes an affirmative defense that protects qualified patients from convic-tion if they possess marijuana until the registry program is up and running and while they wait for the health department to process their applications.

3. “Choice of Evils” DefenseIn addition to being exempt from prosecution or providing an affirmative

defense, medical marijuana patients may raise a medical necessity defense,2 often referred to as a “choice of evils” defense. This is brought up to show that violation of the law (such as using marijuana) was necessary to prevent a greater evil (such as exacerbation of an illness).

Appendix G: Types of Legal Defenses Afforded by Effective State Medical Marijuana Laws

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1 See Appendix K for more information on the medical necessity defense.2 The language in some of these cases has not been litigated completely, so there are some states where the law

seems to allow unregistered patients to raise a defense or a defense to be raised for additional amounts, but where courts may ultimately interpret the language more narrowly.

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Appendix H: Types of Physician D

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State-By-State Report 2011Appendix H: Types of Physician Documentation Required to Cultivate, Possess, or Use Medical Marijuana

California and Arizona, the first two states to pass medical marijuana initiatives in 1996, used slightly different wording in their enacting statutes:

• California law allows patients to use medical marijuana if they possess a rec-ommendation from a physician.

• Arizona’s 1996 law allowed patients to use medical marijuana if they possessed a prescription from a physician.

The difference seems slight, but its effect is great. Patients in California are protected under state law if they possess valid recommendations for medical marijuana. In Arizona, however, patients did not enjoy state-level legal protection until voters approved a new initiative in 2010 because it is impossible to obtain a prescription for medical marijuana.

Definitions of “prescription” and “recommendation,” as they apply to medical marijuana, explain the difference in legal protections for California and Arizona patients.

Vermont’s medical marijuana law is unique in that it doesn’t require physicians to prescribe or recommend medical marijuana; rather, a physician must simply certify that a patient has a qualifying illness.

• Vermont law allows a person to register with the state as a medical marijuana patient if that patient possesses such a certification from his or her physician.

PrescriptionA prescription is a legal document from a licensed physician, ordering a pharma-

cy to release a controlled substance to a patient. Prescription licenses are granted by the federal government, and it is a violation of federal law to “prescribe” mari-juana, regardless of state law. Furthermore, it is illegal for pharmacies to dispense marijuana (unless as part of a federally sanctioned research program).

In addition to Arizona’s 1996 law, the medical marijuana laws of Connecticut, Louisiana, Virginia, and Wisconsin also use the word “prescribe” and are there-fore ineffective.

RecommendationA recommendation is not a legal document, but a professional opinion provided

by a qualified physician in the context of a bona fide physician-patient relation-ship. The term “recommendation” skillfully circumvents the federal prohibition on marijuana prescriptions, and federal court rulings have affirmed a physician’s right to discuss medical marijuana with patients, as well as to recommend it. A “recommendation” is constitutionally protected speech.1

Whereas patients do not receive meaningful legal protection via marijuana “prescriptions” because they cannot be lawfully obtained, patients who have phy-

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1 See Appendix I for details.

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a sicians’ “recommendations” can meet their state’s legal requirements for medical marijuana use.

The states that have enacted medical marijuana laws since 1996 have gener-ally avoided using the words “prescription” and “recommendation.” Instead, they require physicians to discuss, in the context of a bona fide physician-patient re-lationship, the risks and benefits of medical marijuana use and advise patients that the medical benefits of marijuana would likely outweigh the health risks. Not only does this circumvent the federal prohibition on marijuana, but it minimizes physicians’ concerns that they might face liability related to medical marijuana.

CertificationThe states that have enacted medical marijuana laws since 1996 have generally

avoided using the words “prescription” and “recommendation.” Instead, they gen-erally protect patients who submit written certifications to a health department. Like a “recommendation,” a “certification” is not a legal document. In issuing a “certification,” a physician simply signs a written statement. In most states, the statement must affirm that the physician discussed, in the context of a bona fide physician-patient relationship, the risks and benefits of medical marijuana use and advised the patient that the medical benefits of marijuana would likely outweigh the health risks. The certifications must also verify that the patient has a qualifying condition.

However, in Vermont, the physician needs only to certify that the patient has a medical condition that the state has approved as a qualifying condition for the medical use of marijuana. This circumvents the federal prohibition on marijuana. And because of this, a medical marijuana law based on this type of “certification” should fully eliminate physicians’ concerns that they might face liability related to medical marijuana.

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Appendix I: Federal Litigation Related to Effective State Medical M

arijuana Laws

State-By-State Report 2011Appendix I: Federal Litigation Related to Effective State Medical Marijuana Laws The federal government’s position on medical marijuana

The federal government has not tried to overturn any state medical marijuana law, nor is it planning to do so.

In fact, high-ranking members of the U.S. Department of Justice evaluated the legal prospects of a court challenge to the medical marijuana initiatives and concluded that such a challenge would fail.

This was stated on the record by David Anderson of the U.S. Department of Justice during a hearing in Wayne Turner v. D.C. Board of Elections and Ethics, et al. (Civil Action No. 98-2634 RWR, September 17, 1999).1

Anderson’s comments are supported by Footnote 5 in the federal court’s Turner opinion: “In addition, whatever else Initiative 59 purports to do, it proposes making local penalties for drug possession narrower than the comparable federal ones. Nothing in the Constitution prohibits such an action.”

Testifying at a June 16, 1999 hearing of the U.S. House Government Reform Subcommittee on Criminal Justice, Drug Policy, and Human Resources, then-drug czar Barry McCaffrey also admitted that “these [medical marijuana] statutes were deemed to not be in conflict with federal law.”

Further, McCaffrey said that the federal government has “the problem” because there are not enough Drug Enforcement Administration (DEA) agents to enforce federal laws against personal use, possession, and cultivation in the states that have removed criminal penalties for medical marijuana.

In May 2011, Arizona Governor Jan Brewer filed a federal lawsuit question-ing whether federal law preempts state law and named the U.S. Department of Justice (DOJ) as a defendant. The DOJ filed a motion to dismiss the case, which did not take a position on preemption, but asked the court to dismiss the suit for failing to be a case or controversy.

The federal government cannot force states to have criminal laws that are iden-tical to federal law, nor can the federal government force state and local police to enforce federal laws. However, the U.S. Department of Justice may take legal action against individuals and organizations for violations of federal law. See ap-pendix S for a discussion of the federal government’s statements and practices on enforcing its laws in medical marijuana states.

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1 Turner challenged the constitutionality of U.S. Rep. Bob Barr’s (R-GA) amendment to the fiscal year 1999 budget, which prohibited the District from spending any funds to conduct any initiative that would reduce the penalties for possession, use, or distribution of marijuana. This amendment had the effect of preventing the local Washington, D.C., government from tallying the votes on the local medical marijuana ballot initiative in November 1998. The U.S. District Court for the District of Columbia ruled in Turner’s favor—albeit not on constitutional grounds. The votes were counted, and the medical marijuana initiative was found to have passed; however, Congress subsequently prevented it from taking effect. This occurred only because D.C. is a district, not a state, and therefore is legally subject to greater federal oversight and control.

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s Medical marijuana litigation in federal courtSince 1996, there have been five key federal cases relating to medical marijuana:

Conant v. Walters, U.S. v. Oakland Cannabis Buyers’ Cooperative, County of Santa Cruz v. Ashcroft, Gonzales v. Raich, and Arizona v. Department of Justice.

Dr. Marcus Conant v. John L. Walters (309 F.3d 629)Ruling: A federal district court ruled that the federal government cannot punish

physicians for discussing or recommending medical marijuana. After this ruling was upheld by the Ninth U.S. Circuit Court of Appeals, it was appealed to the U.S. Supreme Court, which declined to take the case, letting the ruling stand.

Background: Shortly after California voters approved Proposition 215 in 1996, the federal government threatened to punish—even criminally prosecute—physicians who recommend medical marijuana. Specifically, the federal government wanted to take away physician authority to write prescriptions for any controlled substances. In response to those threats, a group of California physicians and patients filed suit in federal court on January 14, 1997, claiming that the federal government had violated their constitutional rights.

The lawsuit asserted that physicians and patients have the right—protected by the First Amendment to the U.S. Constitution—to communicate in the context of a bona fide physician-patient relationship, without government interference or threats of punishment, about the potential benefits and risks of the medical use of marijuana.

On April 30, 1997, U.S. District Court Judge Fern Smith issued a preliminary injunction prohibiting federal officials from threatening or punishing physicians for recommending medical marijuana to patients suffering from HIV/AIDS, cancer, glaucoma, and/or seizures or muscle spasms associated with chronic, debilitating conditions. According to Judge Smith, “[t]he First Amendment allows physicians to discuss and advocate medical marijuana, even though use of marijuana itself is illegal.”

The case was finally heard in the U.S. District Court for the Northern District of California in August 2000. Plaintiffs argued that the threats amounted to censorship. The federal government countered that there is a national standard for determining which medicines are accepted and that the use of marijuana should not be decided by individual physicians. In response to that argument, Judge William Alsup stated, “Who better to decide the health of a patient than a doctor?”

Alsup ruled on September 7, 2000 that the federal government cannot penalize California doctors who recommend medical marijuana under state law. Specifically, he said the U.S. Department of Justice is permanently barred from revoking licenses to dispense medication “merely because the doctor recommends medical marijuana to a patient based on a sincere medical judgment and from initiating any investigations solely on that ground.”

The U.S. Department of Justice sought to overturn Alsup’s ruling. In a hearing before the Ninth Circuit on April 8, 2002, judges questioned Justice Department attorneys who were appealing an injunction against sanctioning these doctors.

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State-By-State Report 2011“Why on earth does an administration that’s committed to the concept of

federalism . . . want to go to this length to put doctors in jail for doing something that’s perfectly legal under state law?” asked Judge Alex Kozinski at the hearing.

U.S. Attorney Mark Stern argued that the government should be allowed to investigate doctors whose advice “will make it easier to obtain marijuana.” But he had difficulty convincing judges that there was a distinction between discussing marijuana and recommending it.

On October 29, 2002, the Ninth Circuit upheld the Conant v. McCaffrey ruling, which affirms that doctors may recommend marijuana to their patients, regardless of federal laws prohibiting medical marijuana. The government’s attempt to bar doctors from recommending medical marijuana “does … strike at core First Amendment interests of doctors and patients. … Physicians must be able to speak frankly and openly to patients,” Chief Judge Mary Schroeder wrote in the 3–0 opinion.

On October 14, 2003, medical marijuana patients and doctors achieved a historic victory when the U.S. Supreme Court refused to hear the Justice Department’s appeal of Conant, letting stand the Ninth Circuit ruling from October 2002. This powerful ruling has put a stop to the federal government’s campaign to punish physicians who recommend medical marijuana to patients.

United States of America v. Oakland Cannabis Buyers’ Cooperative (532 U.S. 483)

Ruling: The U.S. Supreme Court ruled that people who are arrested on federal marijuana distribution charges may not raise a “medical necessity” defense in federal court to avoid conviction.

Background: In California, dozens of medical marijuana distribution centers received considerable media attention following the passage of Proposition 215. Yet many of them had been quietly operating for years before the law was enacted. State and local responses ranged from prosecution to uneasy tolerance to hearty endorsement.

In January 1998, the U.S. Department of Justice filed a civil suit to stop the operation of six distribution centers in Northern California, including the Oakland Cannabis Buyers’ Cooperative (OCBC).

The U.S. District Court issued an injunction in May 1998 to stop the distributors’ actions and rejected, in October 1998, OCBC’s motion to modify the injunction to allow medically necessary distributions of marijuana. In September 1999, the Ninth Circuit ruled 3–0 that “medical necessity” is a valid defense against federal marijuana distribution charges, provided that a distributor can prove in a trial court that the patients it serves are seriously ill, face imminent harm without marijuana, and have no effective legal alternatives.

The case then went back to U.S. District Court, where the 1998 injunction was modified, allowing OCBC to distribute marijuana to seriously ill people who meet the Ninth Circuit’s medical necessity criteria. The Justice Department then filed an appeal, asking the U.S. Supreme Court to overturn the Ninth Circuit’s decision establishing a federal “medical necessity defense” for marijuana distribution.

Writing for a unanimous court (8–0), Justice Clarence Thomas affirmed what medical marijuana patients, providers, and advocates have long known: The

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s U.S. Congress has not recognized marijuana’s medical benefits, as evidenced by the drug’s placement in the most restrictive schedule of the federal Controlled Substances Act.

Specifically, Thomas wrote: “In the case of the Controlled Substances Act, the statute reflects a determination that marijuana has no medical benefits worthy of an exception (outside the confines of a Government-approved research project).”

“Unable … to override a legislative determination manifest in statute” that there is no exception at all for any medical use of marijuana, the court held that the “medical necessity defense” is unavailable to medical marijuana distributors like OCBC.

The ruling does not affect the ability of states to remove criminal penalties for medical marijuana. It merely asserts that similar protections do not currently exist at the federal level. Of note, the case did not challenge the viability of Proposition 215, the California law that allows patients to legally use medical marijuana.

This ruling has made large-scale medical marijuana distributors vulnerable to federal prosecution and has resulted in many states having programs that only allow small-scale cultivation by patients and caregivers.

Unclear, however, is whether individual patients can assert a “medical necessity defense” to federal marijuana charges.

Footnote 7 of the opinion says nothing in the court’s analysis “suggests that a distinction should be made between prohibitions on manufacturing and distributing and other prohibitions in the Controlled Substances Act.”

In a concurring opinion, Justice John Paul Stevens criticized Footnote 7, writing that “the Court reaches beyond its holding, and beyond the facts of the case, by suggesting that the defense of necessity is unavailable for anyone under the Controlled Substances Act.”

Given the U.S. Supreme Court’s narrow ruling, OCBC appealed the case again in U.S. District Court, raising constitutional and other issues.

OCBC argued that the federal injunction against it exceeds federal authority over interstate commerce. The organization also argued that barring marijuana distribution would violate its members’ fundamental rights to relieve pain and the life-threatening side effects of some treatments for conditions like AIDS and cancer.

Ruling for the U.S. District Court on May 3, 2002, Judge Charles Breyer said OCBC has no constitutional right to distribute medical marijuana to sick patients. Breyer also said the federal government has the constitutional authority to regulate drug activity, even if it takes place entirely within a state’s boundaries. OCBC appealed the ruling to the Ninth Circuit.

On June 12, 2003, Judge Breyer issued a permanent injunction prohibiting OCBC and two other organizations from distributing medical marijuana. The order, requested by the U.S. Department of Justice, affects OCBC, the Marin Alliance for Medical Marijuana in Fairfax, and a dispensary in Ukiah.

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State-By-State Report 2011Gonzales v. Raich (545 U.S. 1), on remand Raich v. Gonzales (500 F.3d 850)

Ruling: On June 6, 2005, the U.S. Supreme Court ruled 6-3 that the federal government has the power under the Commerce Clause of the U.S. Constitution to prohibit purely intrastate cultivation and possession of marijuana authorized by state medical marijuana laws.

The Supreme Court also sent Raich back to the Ninth Circuit to consider legal issues that had not been argued. On March 14, 2007, the Ninth Circuit ruled that there is not yet a constitutional due process right to use marijuana to preserve one’s life. It also held that the criminal defense “medical necessity” cannot be used in a civil suit to prevent a federal prosecution.

Background: On October 9, 2002, two seriously ill medical marijuana patients sued the federal government for violating the Fifth, Ninth, and Tenth Amendments to the U.S. Constitution in its attacks on patients and providers.

Angel Raich, who suffers from life-threatening wasting syndrome, nausea, a brain tumor, endometriosis, scoliosis, and other disorders that cause her chronic pain and seizures, uses marijuana because of her adverse reaction to most pharmaceutical drugs.

Diane Monson, a medical marijuana patient suffering from severe chronic back pain and spasms, was raided by the Drug Enforcement Administration (DEA) on August 15, 2002. Ms. Monson has tried several pharmaceutical drugs, but none of them allows her to function normally; only medical marijuana does.

The lawsuit sought to prevent the federal government from arresting or prosecuting the plaintiffs for their medical use of marijuana. According to the complaint, U.S. Attorney General John Ashcroft and former DEA Administrator Asa Hutchinson were overstepping their authority by seizing marijuana plants that were grown under the state’s medical marijuana law. The plaintiffs argued that the federal government has no constitutional jurisdiction over their activities, which are entirely noncommercial and do not cross state lines.

On March 5, 2003, the U.S. District Court denied the preliminary injunction, despite finding that “the equitable factors tip in plaintiff ’s favor.”

A week later, on March 12, 2003, Angel Raich and Diane Monson filed an appeal with the Ninth U.S. Circuit Court of Appeals.

The appeals court heard oral arguments on October 7, 2003. On December 16, 2003, the court issued an opinion reversing the U.S. District Court decision and remanding Raich to the district court with instructions to enter a preliminary injunction, as sought by the patients and caregivers. The Ninth Circuit found that “the appellants have demonstrated a strong likelihood of success on their claim that, as applied to them, the CSA [Controlled Substances Act of 1970] is an unconstitutional exercise of Congress’ Commerce Clause authority.”

This decision stated that federal interference in state medical marijuana laws is unconstitutional. This was a huge victory for medical marijuana patients—and for the states that have these laws, establishing clearly that the federal Controlled Substances Act does not apply to noncommercial medical marijuana activities that do not cross state lines.

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s On February 26, 2004, the Ninth Circuit unanimously rejected the U.S. Department of Justice’s petition for an en banc review of the ruling. The Justice Department appealed to the U.S. Supreme Court, which on June 28, 2004, agreed to hear the case.

On June 6, 2005, the U.S. Supreme Court ruled 6-3 that the federal government has the power under the Commerce Clause of the U.S. Constitution to prohibit purely intrastate cultivation and possession of marijuana authorized by state medical marijuana laws. Justices Sandra Day O’Connor and Clarence Thomas and Chief Justice William Rehnquist argued in dissent that prohibiting this activity is beyond the scope of the Commerce Clause. This ruling in no way invalidates existing state medical marijuana laws, nor does it prevent states from enacting medical marijuana laws. It merely upholds the status quo: that federal authorities can continue to arrest medical marijuana users.

The Supreme Court remanded the case to the Ninth Circuit for further proceedings to determine whether an injunction is warranted based on due process, medical necessity, or Tenth Amendment claims. The Ninth Circuit had not addressed these claims in earlier proceedings since the Court of Appeals held that an injunction was warranted based solely on the Commerce Clause argument. On March 27, 2006, the Ninth Circuit heard oral arguments on these issues, with Diane Monson no longer a party to the case.

On March 14, 2007, the three-judge panel unanimously ruled against Raich’s remaining arguments for an injunction to prevent federal prosecution.

The court found that there is not a due process right “to use marijuana to preserve bodily integrity, avoid pain, and preserve [one’s] life.” The majority decision, authored by Judge Harry Pregerson and signed by Judge Richard Paez, suggested that there is a possibility that under emerging standards of fundamental rights the medical use of marijuana could eventually be recognized as a fundamental right. The opinion said, “For now, federal law is blind to the wisdom of a future day when the right to use medical marijuana to alleviate excruciating pain may be deemed fundamental. Although that day has not yet dawned, considering that during the last ten years eleven states have legalized the use of medical marijuana, that day may be upon us sooner than expected.”

The Ninth Circuit also unanimously ruled that Raich could not use a medical necessity defense to obtain a civil injunction barring a federal prosecution. The ruling noted that it did not decide whether Raich could successfully raise the defense if she were criminally prosecuted. The majority evaluated the three prongs that must be proven in a necessity defense and said, “Raich appears to satisfy the threshold requirements for asserting a necessity defense under our case law.” The opinion also said that the issue of whether the Supreme Court’s OCBC ruling and the Controlled Substances Act foreclose the possibility of patients like Raich asserting marijuana necessity defenses is an unanswered question.

The third judge, C. Arlen Beam, issued an opinion that concurred with the decision to uphold the district court’s denial of an injunction. However, he dissented “from the court’s expansive consideration” of whether Raich met the prongs of a necessity defense. He argued that because Gonzales v. Raich was a civil case that followed civil rules of evidence and procedure, the court could not make a determination about whether Raich could meet the requirements for a

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State-By-State Report 2011necessity defense to a criminal prosecution. He did, however, “acknowledge that [Raich] certainly may be eligible to advance such a defense to criminal liability in the context of an actual prosecution.”

Although the Ninth Circuit’s ruling on remand did not provide any immediate protection to Raich, it was not entirely negative. It left open the possibility that the seriously ill might eventually have a due process right to use medical marijuana if states continue enacting effective medical marijuana laws. It also left open the possibility that the seriously ill could avoid criminal liability under federal law by raising the medical necessity defense.

County of Santa Cruz, et al. v. Mukasey, et al. (C-03-1802 JF)Ruling: On April 21, 2004, U.S. District Court Judge Jeremy Fogel issued a historic

preliminary injunction barring the U.S. Department of Justice from raiding or prosecuting Wo/Men’s Alliance for Medical Marijuana (WAMM) in Santa Cruz, California. The Ninth Circuit reversed the injunction following the U.S. Supreme Court decision Gonzales v. Raich, but the case is still alive. The plaintiffs raised additional claims for declaratory relief and an injunction, and Judge Fogel ruled against the defendants’ motion to dismiss the claims based on medical necessity and the Tenth Amendment. As of publication, Judge Fogel has not issued a final decision.

In 2009, after Deputy Attorney General David Ogden issued a memo stat-ing that federal prosecutors should not target those in clear and unambiguous compliance with state medical marijuana laws, the city and county of Santa Cruz agreed to voluntarily dismiss their lawsuit. On May 9, 2011, following letters from several U.S. attorneys that were not consistent with the DOJ policy, the ACLU — which represents plaintiffs in the Santa Cruz case — wrote the DOJ requesting that it stand by the policy articulated in the Ogden memo. The AC-LU’s letter cited the stipulation in the Santa Cruz case that if the DOJ withdrew, modified, or failed to follow the Odgen memo, the case could be reinstated at the same posture, which was immediately preceding discovery (such as subpoenas and depositions of the department).

Background: This suit was prompted by a DEA raid that received national attention in September 2002, when heavily armed federal agents stormed the Wo/Men’s Alliance for Medical Marijuana cooperative. During this raid, they handcuffed several medical marijuana patients while cutting down the plants that Valerie and Michael Corral had been dispensing free of charge.

The lawsuit — which aimed to end the Bush administration’s active interference with state medical marijuana laws — was filed by eight plaintiffs who were patients of the cooperative. At least four of them have passed away. The defendants in the case are the U.S. attorney general, the DEA administrator, the director of the White House Office of National Drug Control Policy, and the DEA agents who conducted the raid. This is a historic lawsuit because it is the first time that a public entity has sued the federal government on behalf of medical marijuana patients.

On September 24, 2002, 20 to 30 DEA agents raided WAMM, a collective of medical marijuana patients and their caregivers. While holding the founders of the collective, Valerie and Mike Corral, at gunpoint, they confiscated 160 plants. The Corrals were taken into custody but have not been charged with a crime. Following the raid, WAMM and the City and County of Santa Cruz jointly sued the federal

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s government, challenging the authority of the federal government to conduct medical marijuana raids. County of Santa Cruz, et al. v. Mukasey initially focused on constitutional issues related to the Commerce Clause; because no interstate trade or commercial activity was involved, plaintiffs argued that the federal raid was unconstitutional in that it went beyond the scope of the Commerce Clause.

On August 28, 2003, Judge Fogel of the U.S. District Court for Northern California denied the plaintiffs’ motion for a preliminary injunction that would have barred the federal government from conducting raids while the case was tried. Later that year, in light of the Ninth Circuit’s landmark decision in Raich — which specifically criticized Judge Fogel’s decision in this case — the plaintiffs asked the judge to reconsider his decision. On April 21, 2004, Judge Fogel issued a historic preliminary injunction barring the U.S. Department of Justice from raiding or prosecuting WAMM in Santa Cruz, California.

On September 20, 2005, after the U.S. Supreme Court decision overturning and remanding the Ninth Circuit’s Raich decision, the Ninth Circuit reversed the order for a preliminary injunction. The County of Santa Cruz, et al. raised additional legal theories requesting declaratory relief and an injunction. Those included claims based on the Tenth Amendment, medical necessity, and due process. On June 23, 2006, the court heard a motion to dismiss, filed by the defendants. The court waited to decide until after the Ninth Circuit ruled on Raich v. Gonzales on remand (Raich II). In the wake of Raich II, both parties filed supplemental briefings, and Judge Fogel heard oral arguments on July 13, 2007. The defendants argued that Raich II controlled and that the claims should be dismissed.

The County of Santa Cruz, et al. argued that the medical necessity claims are distinguishable from those raised in Raich II because they are in the context of part of a criminal prosecution, since charges could still be filed against the members of WAMM. They also maintained that the due process claims are valid because the court in Raich II did not consider the right to control the circumstances of one’s death. The plaintiffs also claimed that the Tenth Amendment claims are distinguishable from those raised in Raich II because they are raised by local governments. They argued that the federal government cannot interfere in the states’ affairs.

On August 20, 2007, Judge Fogel granted federal motion to dismiss all of the claims except medical necessity. He also allowed County of Santa Cruz, et al. to submit an amended complaint on the Tenth Amendment issue. In their amended complaint, County of Santa Cruz, et al. argued that the federal government engaged in a plan to try to force California and other states to repeal their medical marijuana laws. This conduct included threatening to punish doctors who recommend medical marijuana, threatening officials who issue medical marijuana cards, interfering with zoning plans, and raiding and arresting providers who work closely with municipalities.

On August 19, 2008, Fogel ruled against the federal government’s motion to dismiss the Tenth Amendment claims. The court found, “If Plaintiffs can prove that Defendants are enforcing the CSA in the manner alleged … they may be able to show that Defendants deliberately are seeking to frustrate the state’s ability to determine whether an individual’s use of marijuana is permissible under California law. A working system of recommendations, identification cards and medicinal providers is essential to the administration of California’s medical marijuana law.

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State-By-State Report 2011The effect of a concerted effort to disrupt that system at least arguably would be to require state officials to enforce the terms of the CSA.”

Santa Cruz and the other plaintiffs voluntarily dismissed their case against the federal government and DEA agents following the issuance of the Ogden memo in 2009, which detailed a shift in federal enforcement policy to not prioritize those in clear and unambiguous compliance with state laws. However, now that the DOJ has changed its position, it is possible the suit could be reinstated at the same status, which was immediately prior to depositions of the Justice Depart-ment.

Arizona, et al. v. United States, et al. (No. CV-11-01072-PHX-SRB)On May 27, 2011, Arizona Attorney General Tom Horne filed a suit for a

declaratory judgment against the United States, the U.S. Department of Justice, Arizona’s U.S. attorney, and U.S. Attorney General Eric Holder asking whether state employees and others had safe harbor against federal prosecution or wheth-er Arizona’s state medical marijuana law is preempted by federal law. Arizona also invented hypothetical defendants, DOES I-XX, that it claimed were on either side of the issue and invited interested parties to volunteer as defendants. Only supporters of the law, such as patients, voters, and members of the dispen-sary interest volunteered to be defendants.

The Department of Justice and the other defendants filed motions to dismiss. At the time of this publication, there has been no ruling on the case, including on the motions to dismiss.

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Appendix J: Therapeutic Research Programs

State-By-State Report 2011Appendix J: Therapeutic Research Programs

The federal government allows one exception to its prohibition of the cultivation, distribution, and use of Schedule I controlled substances: research. Doctors who wish to conduct research on Schedule I substances such as marijuana must obtain a special license from the DEA to handle the substance, FDA approval of the research protocol (if experimenting with human subjects), and a legal supply of the substance from the only federally approved source — the National Institute on Drug Abuse (NIDA).

An individual doctor may conduct research if all of the necessary permissions have been granted. In addition, a state may run a program involving multiple doctor-patient teams if the state secures the necessary permission for the researchers from the federal government.

Beginning in the late 1970s, a number of state governments sought to give large numbers of patients legal access to medical marijuana through federally approved research programs.

While 26 states passed laws creating therapeutic research programs, only seven obtained all of the necessary federal permissions, received marijuana and/or THC (tetrahydrocannabinol, the primary active ingredient in marijuana) from the federal government, and distributed the substances to approved patients through approved pharmacies. Those seven states were California, Georgia, Michigan, New Mexico, New York, Tennessee, and Washington.

Typically, patients were referred to the program by their personal physicians. These patients, who had not been responding well to conventional treatments, underwent medical and psychological screening processes. Then, the patients applied to their state patient qualification review board, which resided within the state health department. If granted permission, they would receive marijuana from approved pharmacies. Patients were required to monitor their usage and marijuana’s effects, which the state used to prepare reports for the FDA.

(Interestingly, former Vice President Al Gore’s sister received medical marijuana through the Tennessee program while undergoing chemotherapy for cancer in the early 1980s.)

These programs were designed to enable patients to use marijuana. The research was not intended to generate data that could lead to FDA approval of marijuana as a prescription medicine. For example, the protocols did not involve double-blind assignment to research and control groups, nor did they involve the use of placebos.

Since the programs ceased operating in the mid-1980s, the federal government has made it more difficult to obtain marijuana for research, preferring to approve only those studies that are well-controlled clinical trials designed to yield essential scientific data.

Outlining its position on medical marijuana research, the U.S. Department of Health and Human Services — in which NIDA resides — issued new research guidelines, which became effective on December 1, 1999. The guidelines were widely criticized as being too cumbersome to enable research to move forward as expeditiously as possible.

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s These new obstacles are not surprising, given NIDA’s institutional mission: to sponsor research into the understanding and treatment of the harmful consequences of the use of illegal drugs and to conduct educational activities to reduce the demand for and use of these illegal drugs. This mission makes NIDA singularly inappropriate for expediting scientific research into the potential medical uses of marijuana.

Three cases further demonstrate the federal barricade to medical marijuana research:

• Lyle Craker, Ph.D., a researcher at the University of Massachusetts at Amherst, was denied permission to cultivate research-grade medical marijuana to be used in government-approved medical studies by himself and other scientists. Prof. Craker was given elusive and contradictory information several times by the DEA, which finally denied the permission to conduct research. He ar-gued that researchers were not adequately served by NIDA’s marijuana. NIDA produces marijuana at only one location, the University of Mississippi. The DEA has not prohibited other Schedule I drugs — even cocaine — from being produced by DEA-licensed private labs for research. Six years into Craker’s efforts, Drug Enforcement Administration Administrative Law Judge Mary Ellen Bittner issued a ruling in his favor, concluding “that there is currently an inadequate supply of marijuana available for research purposes.” Scientists tes-tified in his favor that NIDA denied their requests for marijuana to be used in FDA-approved research protocol. However, the decision is non-binding, and the DEA rejected the recommendation on January 14, 2009.

• Donald Abrams, M.D., a researcher at the University of California at San Francisco (UCSF), tried for five years to gain approval to conduct a study on marijuana’s benefits for AIDS patients with wasting syndrome. Despite ap-proval by the FDA and UCSF’s Institutional Review Board, Abrams’ proposal was turned down twice by NIDA, in an experience he described as “an endless labyrinth of closed doors.” He was able to gain approval only after redesigning the study so that it focused on the potential risks of marijuana in AIDS pa-tients rather than its benefits. “The science,” Abrams said at the time, “is barely surviving the politics.” 1

• Neurologist Ethan Russo, M.D., finally gave up trying to secure approval for a study of marijuana to treat migraine headaches — a condition afflicting 35 million Americans, nearly one-third of whom do not respond to “gold stan-dard” treatments. When the National Institutes of Health (NIH) rejected his first proposal, he sought guidance from his “program official” as to how to re-vise the design, but the official failed to respond and later denied receiving his emails. Russo rewrote the protocol according to recommendations made by the 1997 NIH Consensus Panel on Medical Marijuana. The second rejection complained that the evidence for marijuana’s efficacy was only “anecdotal” — but failed to address how better evidence could be obtained if formal trials are not approved. Only after this second rejection did Russo learn that not a single headache specialist was included on the 20-member review panel. 2

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1 Bruce Mirken, “Medical Marijuana: The State of the Research,” AIDS Treatment News, no. 257, October 18, 1996.

2 Ethan Russo, “Marijuana for migraine study rejected by NIH, Revisited,” posted on www.maps.org, March 1999.

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Appendix J: Therapeutic Research Programs

State-By-State Report 2011California is the only state where clinical research on marijuana’s medical ef-

ficacy has taken place in recent years, thanks to a $9 million appropriation granted by the California Legislature. The funding authorized about a dozen clinical trials on humans that were carefully controlled and not designed to provide patients with access. They were conducted by the Center for Medicinal Cannabis Research (CMCR). (The funding also included support for some animal studies.) The CMCR trials were nothing like the therapeutic research programs in the 1970s and 1980s that provided access. They were highly controlled, in-patient studies that involved no more than one week’s worth of marijuana and enrolled a total of fewer than 250 patients. Six of the planned trials had to be discontinued because of difficulty recruiting patients, probably because California patients have state-legal, regular access to higher quality medical marijuana without mandatory wash-out periods, extremely short time-periods with access, in-patient stays, and placebo controls.

Because of these excessively strict federal guidelines for research, the limited supply of NIDA marijuana, and the high cost of conducting clinical trials, it is extremely unlikely that the therapeutic-research laws will again distribute mari-juana to patients on a meaningful scale. In addition, all recent trials have been short-term, and there is no reason to think the federal government would approve any therapeutic research program for a long-term trial.

Given these obstacles, states have been unwilling to devote their limited resourc-es to the long and likely fruitless research application process, but several have allowed these inactive therapeutic-research program laws to remain on the books. Meanwhile, since 1996, 16 states and the District of Columbia have enacted laws that provide access to marijuana without depending on federal approval.

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State-By-State Report 2011Appendix K: Medical Necessity Defense

The necessity defense, long recognized in common law, gives defendants the chance to prove in court that their violation of the law was necessary to avert a greater evil. It is often referred to as the “choice of evils defense.”

If allowed in a medical marijuana case, the medical necessity defense may lead to an acquittal, even if the evidence proves that the patient did indeed possess or cultivate marijuana. This defense generally holds that the act committed (mari-juana cultivation or possession, in this case) was an emergency measure to avoid imminent harm.

Unlike “exemption from prosecution,” a patient is still arrested and prosecuted for the crime, because a judge and/or jury may decide that the evidence was insuf-ficient to establish medical necessity.

The necessity defense is not allowed as a defense to any and all charges. Typically, courts look to prior court decisions or legislative actions that indicate circumstances where a necessity defense may be applicable. Regarding medical marijuana, for example, a court’s decision on whether to permit the defense may depend on whether the legislature has enacted a law that recognizes marijuana’s medical benefits.

This defense is typically established by decisions in state courts of appeals. Additionally, a state legislature may codify a medical necessity defense into law. Several state medical marijuana laws — including Michigan’s and Oregon’s — per-mit a variation of this defense for unregistered patients whose doctors recommend medical marijuana, in addition to an exemption from prosecution for registered patients.

The first successful use of the medical necessity defense in a marijuana culti-vation case led to the 1976 acquittal of Robert Randall, a glaucoma patient in Washington, D.C.

In the Randall case, the court determined that the defense is available if (1) the defendant did not cause the compelling circumstances leading to the violation of the law, (2) a less offensive alternative was not available, and (3) the harm avoided (loss of vision) was more serious than the harm that was caused (such as cultivat-ing marijuana).

In two non-medical marijuana states, Florida and Idaho, a medical marijuana necessity defense based in common law has been allowed by an appellate court in limited circumstances.

In a 1991 Florida case, Jenks v. State, the First District Court of Appeals al-lowed two seriously ill HIV/AIDS patients to raise a medical necessity defense to marijuana cultivation and drug paraphernalia charges.1 The court found that the defendants had met the burden of establishing the defense at trial, and thus reversed the trial court’s judgment and acquitted the defendants. Since the Florida Supreme Court denied review later that year, all trial courts in Florida are bound

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1 Jenks v. State, 582 So. 2d 676 (Fla. 1st Dist. Ct. App. 1991).

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by this decision unless another District Court of Appeals issues a contradictory decision.2

The same First District Court of Appeals upheld the medical necessity defense again in the 1998 case, Sowell v. State, allowing a seriously ill patient to assert the defense to marijuana cultivation charges. The court noted the defense was still ap-propriate, again grounding it in the common law, even after the legislature made a slight change to its Schedule I statutory language that was unfriendly to the use of medical marijuana.3 The Florida Supreme Court let the decision stand as well.

In a 1990 case, State v. Hastings, the Idaho Supreme Court allowed a rheumatoid arthritis patient to present a necessity defense to marijuana possession charges at trial, though it declined to create a special defense of “medical necessity.”4 It based its reasoning on the common law necessity defense, which the legislature had adopted in the Idaho Code. The court vacated the trial court’s decision, and remanded the case back to trial, so that the defendant could present evidence of how medical marijuana helped her control her pain and muscle spasms. This decision remains binding precedent in all Idaho courts. The defense was further clarified by the Court of Appeals of Idaho (an intermediate court) in the 2001 case, State v. Tadlock, which restricted the defense only to a simple marijuana possession charge and disallowed it for a possession with intent to deliver charge.5

It is also possible for a judge to allow an individual to raise a medical necessity defense based on the state having a symbolic medical marijuana law. For example, an Iowa judge ruled (in Iowa v. Allen Douglas Helmers) that a medical marijuana user’s probation could not be revoked for using marijuana because the Iowa Legislature has defined marijuana as a Schedule II drug with a “current accepted medical use.” (It remains a Schedule I drug when used for non-medical purposes.)

While federal law prevents Iowa patients from getting legal prescriptions for marijuana, the Iowa judge ruled that the legislature’s recognition of marijuana’s medical value protected Allen Helmers from being sent to prison for a probation violation for using marijuana.

Of note, Iowa moved marijuana used for medical purposes into Schedule II in 1979, when it enacted a therapeutic research program. The research program ex-pired in 1981, but marijuana’s dual scheduling remains in place, even after the Iowa Board of Pharmacy concluded in February 2010 that marijuana has medi-cal value and recommended that the legislature reschedule marijuana solely to Schedule II.

A different judge could have ruled that the Iowa Legislature intended for mari-juana to be used solely in connection with the research program and, without the program, the medical necessity defense should not be available. In fact, some state courts — in Alabama and Minnesota, for example — have made similar interpre-tations and have refused to allow this defense.

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2 Florida District Courts of Appeals do not bind each other; however, in Florida, a trial court is obligated to follow the decisions of other District Courts of Appeals in absence of conflicting authority if the appellate court in its own district has not decided the issue. See Pimm v. Pimm, 568 So. 2d 1299 (Fla. 2d Dist. App. 1990).

3 Sowell v. State, 738 So. 2d 333 (Fla. 1st Dist. Ct. App. 1998). 4 State v. Hastings, 801 P.2d 563 (Idaho 1990). 5 State v. Tadlock, 34 P.3d 1096 (Idaho Ct. App. 2001).

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State-By-State Report 2011These cases demonstrate that although it is up to the courts to decide whether to

allow the medical necessity defense, the activities of a state legislature may signifi-cantly impact this decision.

Some states have statutes that authorize a necessity defense generally and have specified the elements of proof needed to succeed. But this does not guarantee that the courts will recognize a medical necessity defense for marijuana. It depends on how the courts interpret the legislature’s intent. If the defense is not recognized, the case proceeds as if the defendant possessed marijuana for recreational use or distribution. If found guilty, the offender is subject to prison time in most states.

The medical necessity defense is a very limited measure. Though a legislature may codify the defense into law, this is not the best course of action for a state legislature to pursue.

Preferably, a state would have a law that (1) exempts from prosecution qualified patients who cultivate and/or possess medical marijuana, and (2) allows patients to use an affirmative defense if they are arrested and prosecuted anyway. An ideal statute would allow the defense for personal-use cultivation, as well as possession.

Other than states that also provide patients with protection from arrest, MPP has identified only three states whose legislatures have passed bills to establish the medical necessity defense for medical marijuana offenses — Maryland, Massachusetts, and Ohio. Ultimately, all of these efforts but Maryland’s were short-lived, if not unsuccessful.

An Ohio bill that included a medical necessity defense provision became law in 1996, only to be repealed a year later. Massachusetts enacted a law in 1996 to allow patients to use the defense, but only if they are “certified to participate” in the state’s therapeutic research program. Unfortunately, the state never opened its research program, and thus, Massachusetts’s patients are likely to be denied the necessity defense, similar to patients in Alabama and Minnesota, as noted above.

Maryland enacted a medical necessity law in 2003 that did not prevent a convic-tion, but instead could be raised at sentencing to reduce the penalty to a fine of up to $100. After determining that this law was insufficient and underused, the Maryland Legislature passed a much more detailed, full affirmative defense law in 2011. Maryland patients who have been diagnosed with debilitating medical conditions by their doctors may assert the defense in court to prevent a conviction for possession of up to an ounce of marijuana or paraphernalia.

At the federal level, the U.S. Supreme Court ruled in May 2001 that people who are arrested on federal marijuana distribution charges may not raise a medical necessity defense in federal court to avoid conviction.

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ense States Without Effective Medical Marijuana Laws Where Courts Have

Allowed the Medical Necessity Defense in Marijuana Cases

Florida State v. Mussika, 14 F.L.W. 1 (Fla. 17th Cir. Ct. Dec. 28, 1988).

Florida Jenks v. State, 582 So. 2d 676 (Fla. 1st Dist. Ct. App. 1991).

Florida Sowell v. State, 738 So. 2d 333 (Fla. 1st Dist. Ct. App. 1998).

Idaho State v. Hastings, 801 P.2d 563 (Idaho 1990).

Idaho State v. Tadlock, 34 P.3d 1096 (Idaho Ct. App. 2001).

Iowa Iowa v. Allen Douglas Helmers (Order No. FECR047575).

Texas Texas v. Stevens, unpublished (2008): A Potter County jury acquit-ted an HIV patient charged with possessing four grams of marijuana based on a medical necessity defense.

States With Effective Medical Marijuana Laws Where Courts Have Allowed the Medical Necessity Defense in Marijuana Cases

District of Columbia United States v. Randall, 104 Wash. Daily L. Rep. 2249 (D.C. Super. Ct. 1976).

Hawaii State v. Bachman, 595 P. 2d 287 (Haw. 1979).

Vermont Addison County District Court acquitted Steven Bryant of possession of marijuana in May 2005 based on medical necessity. See: Flowers, John, “Bryant Claims Marijuana Was Medically Necessary,” Addison County Independent, May 2, 2005.

Washington State v. Diana, 604 P.2d 1312 (Ct. App. Wash 1979).

Washington State v. Cole, 874 P.2d 878 (Ct. App. Wash. 1994).

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State-By-State Report 2011States Where Courts Have Refused to Allow the Medical Necessity Defense in Marijuana Cases

Alabama Kauffman v. Alabama, 620 So. 2d 90 (1993)

The state Court of Appeals refused to allow a patient to use the medical necessity defense because the legislature had already expressed its intent by plac-ing marijuana in Schedule I — and by establishing a therapeutic research program, thereby defining the very limited circumstances under which marijuana may be used.

Georgia Spillers v. Georgia, 245 S.E. 2d 54, 55 (1978)

The state Court of Appeals ruled that the lack of any recognition of marijuana’s medical uses by the state legislature precluded the court from allowing the medical necessity defense.

Massachusetts Massachusetts v. Hutchins, 575 N.E. 2d 741, 742 (1991)

The state Supreme Judicial Court ruled that the societal harm of allowing the medical necessity defense would be greater than the harm done to a patient denied the opportunity to offer the medical necessity defense.

Minnesota Minnesota v. Hanson, 468 N.W. 2d 77, 78 (1991)

The state Court of Appeals refused to allow a patient to use the medical necessity defense because the legislature had already expressed its intent by plac-ing marijuana in Schedule I — and by establishing a therapeutic research program, thereby defining the very limited circumstances under which marijuana may be used.

Missouri Missouri v. Cox, 248 S.W.3d 1 (2008)

The state Court of Appeals affirmed a lower court’s rejection of a patient’s medical necessity defense because the legislature had already expressed its intent by placing marijuana in Schedule 1, even though statute allowed the dispensing of Schedule I substances by certain professionals.

New Jersey New Jersey v. Tate, 505 A. 2d 941 (1986)

The state Supreme Court ruled that the legislature — by placing marijuana in Schedule I — had already indicated its legislative intent to prohibit the medical use of marijuana. In addition, the court claimed that the criteria of “necessity” could not be met because there were research program options that could have been pursued instead.

South Dakota South Dakota v. Matthew Ducheneaux, SD 131 (2003)

The state Supreme Court ruled that Mr. Ducheneaux — who was convicted of marijuana possession in 2000 — could not rely on a state necessity defense law that allows illegal conduct when a person is being threatened by unlawful force. The court stated that it would strain the language of the law if it could be used to show that a health problem amounts to unlawful force against a person.

Virginia Murphy v. Com. 31 Va. App. 70, 521 S.E. 2d 301 Va. App., 1999

The Court of Appeals ruled that the necessity de-fense was unavailable to a migraine sufferer because the legislature limited the medical use of marijuana (symbolically only) to patients whose doctors pre-scribe it to relieve cancer or glaucoma.

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arijuana Legislation Considered in 2011

State-By-State Report 2011Appendix L: State Medical Marijuana Legislation Considered in 2011State medical marijuana legislation considered in 2011 *

State Bill Number

Intent Good or Bad

Outcome

Alabama HB 386 Remove criminal penalties and threat of arrest for patients who grow, possess, and use medical marijuana

Good Died in the House Committee on Health

Arizona HB 2541 Expand an employer’s ability to fire medical marijuana patients

Bad Passed House (56-3) and Senate (25-4); signed by Gov. Jan Brewer

Arizona HB 2557 Tax medical marijuana at 300% rate Bad Died in House Ways and Means Committee

Arizona HB 2585 Add medical marijuana ID card information to the Controlled Substances Prescription Monitoring Database

Bad Passed House (51-6) and Senate (27-2); signed by Gov. Jan Brewer

Arizona HB 2598 Prohibit a locality from imposing a tax on medical marijuana that exceeds 10% of gross proceeds of sales

Good Died in the House Health and Human Services Committee

Arizona SB 1358 Establish residency requirements for all involved in medical marijuana program

Bad Failed, 1-5, in Senate Government Relations Committee

Arizona SB 1421 Classify marijuana as a luxury item for tax purposes, which raises tax burden

Bad Failed, 2-5, in Senate Finance Committee

California (2011-2012 session)

AB 1300 Clarify that localities may dictate when, where, and how collectives can operate

Flawed Passed both chambers and signed by the governor; effective January 1, 2012

California (2011-2012 session)

SB 847 Prohibit collectives and cooperatives with a storefront from opening within 600 feet of an area zoned or used for residential purposes

Bad Passed both chambers; vetoed Sept. 21, 2011

California (2011-2012 session)

SB 129 Grant employment protection for medical marijuana patients who use their medicine off-site, after hours. Grants no employment protection for using medical marijuana at work or being actually impaired at work.

Good Currently placed on inactive file; will carry over to 2012 session

California (2011-2012 session)

SB 626 Ask the Board of Equalization to study how best to tax marijuana and marijuana products

Both Currently in Senate Appropriations; will carry over to 2012

California (2011-2012 session)

AB 223 Establish a comprehensive and multidisciplinary commission that would be empowered to address issues regarding the legality and implementation of the Compassionate Use Act of 1996 and the state’s medical marijuana law

Good Currently in Assembly Public Safety; will carry over to 2012

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Intent Good or Bad

Outcome

Colorado HB 1043 Clarify provisions in the medical marijuana code – require primary caregivers who grow medical marijuana to register their cultivation sites and the registry number for every patient associated with them

Both Passed both chambers and signed by governor; effective July 1, 2011

Colorado HB 1250 Require all marijuana infused products to be packaged in child-proof packaging and labeled “Medical Product – keep out of reach of children”

Good Passed both chambers and signed by governor; effective July 1, 2011

Connecticut HB 5139 Remove state-level criminal penalties and the threat of arrest for patients with serious illnesses who use marijuana for medical purposes

Good Died in Judiciary Committee

Connecticut HB 5900 Remove state-level criminal penalties and the threat of arrest for patients with serious illnesses who use marijuana for medical purposes, and establish a licensing and regulatory structure for alternative treatment centers that would provide marijuana to patients

Good Died in Judiciary Committee

Connecticut HB 6566 Remove state-level criminal penalties and the threat of arrest for patients with serious illnesses who use marijuana for medical purposes, and establish a licensing and regulatory structure for licensed producers that would provide marijuana to patients

Good Died in Judiciary Committee

Connecticut SB 329 Permit the palliative use of marijuana for individuals with debilitating medical conditions

Good Died in Judiciary Committee

Connecticut SB 345 Allow the prescriptive use of marijuana for the relief of pain and suffering related to serious medical conditions

Good Died in Judiciary Committee

Connecticut SB 1015 Remove state-level criminal penalties and the threat of arrest for patients with serious illnesses who use marijuana for medical purposes

Good Passed Judiciary, Health, and Finance Committees, but never received a vote on Senate floor

Delaware SB 17 Remove criminal penalties and threat of arrest for patients who possess and use medical marijuana and includes civil discrimination protections

Good Passed House (27-14) and Senate (17-4); Gov. Jack Markell (D) signed it into law on May 13

Florida HJR 1407 Place a medical marijuana question on the general election ballot of 2012

Good Died in Criminal Justice Subcommittee

Hawaii (2011-2012 session)

HB 923 Create three classes of medical marijuana licenses to allow regulated larger-scale cultivation, dispensing, and infused products manufacture; includes tax on sales of medical marijuana

Good Referred to House committees; will carry over to 2012

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arijuana Legislation Considered in 2011

State-By-State Report 2011State medical marijuana legislation considered in 2011 *

State Bill Number

Intent Good or Bad

Outcome

Hawaii (2011-2012 session)

HB 1169 Increase penalties for fraudulent medical marijuana application to make consistent with penalties for other controlled substances

Both Referred to House committees; will carry over to 2012

Hawaii (2011-2012 session)

HB 1624 Establish a three-year pilot medical marijuana research program

Good Referred to House committees; will carry over to 2012

Hawaii (2011-2012 session)

SB 58 Increase amount of medical marijuana considered an adequate supply; make identification of the site where cannabis is grown confidential; prohibit the department of public safety from requiring that a certifying physician be the patient’s primary care physician; prohibit certifying physicians from naming or describing a patient’s particular debilitating condition; increase the permissible ratio of patients to caregivers by allowing a caregiver to grow cannabis for no more than three patients at any given time; allow transfer to another qualified patient and transport of medical marijuana without prosecution.

Good Unanimously passed Senate, referred to House committees; will carry over to 2012

Hawaii (2011-2012 session)

SB 113 Establish a three-year pilot medical cannabis research program

Good Passed Senate, referred to House committees; will carry over to 2012

Hawaii (2011-2012 session)

SB 174 Move marijuana from Schedule I to Schedule III

Good Passed Senate Committee on Health, referred to Senate Committee on Judiciary and Labor, no hearings held; will carry over to 2012

Hawaii (2011-2012 session)

SB 175 Transfer medical marijuana program from the department of public safety to the department of health

Good Passed Senate and referred to committee in House; will carry over to 2012

Hawaii (2011-2012 session)

SB 1458 Create a dispensary program in Hawaii (as introduced); create a comprehensive five-year medical marijuana distribution pilot program (as amended)

Both Passed both chambers in different forms; currently in conference committee; will carry over to 2012

Hawaii (2011-2012 session)

SB 1459 Establish licensure of producers, processors, and dispensers of medical marijuana; require secure registration system

Good Referred to Senate committees; will carry over to 2012

Idaho H 19 Remove criminal penalties and threat of arrest for qualified patients who possess and use medical marijuana; create a dispensary program

Good Informational hearing in House Health and Wellness Committee; died in committee without a vote

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Outcome

Illinois (2011-2012 session)

HB 30 Establish a three-year pilot program allowing patients with debilitating conditions whose doctors recommend marijuana to use it for medical purposes and obtain marijuana from dispensaries regulated by the Department of Health

Good Pending on House floor

Illinois (2011-2012 session)

SB 1548 Establish a three-year pilot program allowing patients with debilitating conditions whose doctors recommend marijuana to use it for medical purposes and obtain marijuana from dispensaries regulated by the Department of Health

Good Will carry over to 2012

Indiana SB 192 Require Criminal Law and Sentencing Policy Committee to study medical marijuana program

Good Passed Senate (28-21), but died in the House without a vote

Indiana SR 70 Urge Legislative Council to direct Criminal Law and Sentencing Policy Committee to study the effects of potential changes to Indiana’s marijuana laws

Good Senate adopted the resolution by voice vote on April 18

Iowa (2011-2012 session)

H.F. 183 Remove marijuana from Schedule II and solely schedule it in Schedule I

Bad Died in Public Safety Committee

Iowa (2011-2012 session)

S.F. 266 Remove criminal penalties and threat of arrest for patients who grow, possess, and use medical marijuana

Good Passed out of subcommittee but died in Senate Human Services Committee

Iowa (2011-2012 session)

S.S.B. 1016 Remove marijuana from Schedule I and solely schedule it in Schedule II

Good Died in House Human Resources Committee

Kansas (2011-2012 session)

HB 5139 Remove state-level criminal penalties and the threat of arrest for patients with serious illnesses who use marijuana for medical purposes, and establish a licensing and regulatory structure for compassion centers that would provide marijuana to patients

Good Pending in Health and Human Services Committee

Maine (2011-2012 session)

LD 1296 Amend the medical marijuana law to, among other things, make registration optional for patients, provide an affirmative defense for possession of excess marijuana for medical purposes, and prohibit cultivation “collectives”

Mostly Good

Passed the House and Senate by voice vote on June 16; signed by Governor Paul LePage on June 24

Maine (2011-2012 session)

LD 887 Include medical marijuana patients in the state’s Controlled Substances Prescription Monitoring Program

Bad Died on June 10 when the House accepted the Health and Human Services Committee’s “Ought not to pass” report

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State-By-State Report 2011State medical marijuana legislation considered in 2011 *

State Bill Number

Intent Good or Bad

Outcome

Maine (2011-2012 session)

LD 1159 Require registry cardholders to carry a Maine driver’s license or other state-issued photo ID

Bad Passed the House and Senate by voice vote on June 8; signed by Gov. Paul LePage on June 20

Maryland HB 291/SB 308

Originally intended to put in place a full medical marijuana program; amended to establish a work group and provide an affirmative defense for possession of up to one ounce of marijuana for patients with qualifying medical conditions who prove the defense

Good SB 308 passed the House (83-50) and Senate (38-6); signed by Gov. O’Malley on May 10

Massachusetts (2011-2012 session)

HB 625; SB 1161

Remove criminal penalties and threat of arrest for qualified patients who possess, grow and use medical marijuana; create a dispensary program

Good Pending in Joint Public Health Committee, hearing held

Massachusetts (2011-2012 session)

SB 818 Remove criminal penalties and threat of arrest for qualified patients who possess, grow, and use medical marijuana

Good Pending in Joint Committee on Judiciary

Michigan (2011-2012 session)

HB 4463; SB 505

Prohibit anyone with any felony conviction from becoming a caregiver

Bad Pending in the House Judiciary Committee

Michigan (2011-2012 session)

HB 4661 Prohibits any cultivation of marijuana within 500 feet of a church, school, or daycare center

Bad Pending in the House Judiciary Committee

Michigan (2011-2012 session)

HB 4834 Require photograph on registry cards and require disclosure of patient identification information to law enforcement agencies

Bad Pending in the House Judiciary Committee

Michigan (2011-2012 session)

HB 4850 Prohibit patients from providing marijuana to other patients

Bad Pending in the House Judiciary Committee

Michigan (2011-2012 session)

HB 4851 Define and require a “bona fide physician-patient relationship” before a doctor can recommend marijuana to a patient

Bad Pending in House Judiciary Committee

Michigan (2011-2012 session)

HB 4852 Allow municipalities to prohibit cultivation of marijuana by zoning ordinance

Bad Pending in House Judiciary Committee

Michigan (2011-2012 session)

HB 4853 Provide for a felony for selling marijuana in violation of registry ID card restrictions

Bad Pending in House Judiciary Committee

Michigan (2011-2012 session)

HB 4854 Prohibit advertising of caregiver services or offers to sell, provide, or make available marijuana

Bad Pending in House Judiciary Committee

Michigan (2011-2012 session)

HB 4856 Require marijuana transferred by vehicle to be carried in the trunk or otherwise inaccessible from the passenger compartment

Good Pending in House Judiciary Committee

Michigan (2011-2012 session)

SB 321 Prohibit marijuana from being covered by personal health insurance policies

Bad Pending in Senate Judiciary Committee

Michigan (2011-2012 session)

SB 377 Require patient identification information to be sent to law enforcement agencies upon issuance of registry ID card

Bad Pending in the Committee of the Whole

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Michigan (2011-2012 session)

SB 418 Prohibit lawsuits challenging municipal ordinances regarding medical marijuana

Bad Pending in the Committee of the Whole

Michigan (2011-2012 session)

SB 504 Prohibit transfers of marijuana within 1,000 feet of a school or church, except to registered patients within a residence

Good Pending in the Committee of the Whole

Michigan (2011-2012 session)

SB 506 Define and require an extensive and ongoing relationship between patients and doctors who recommend marijuana for them (similar to HB 4851)

Bad Pending in the Committee on Health Policy

Minnesota (2011-2012 session)

HF 662 Allow the production of medical marijuana for export

Good Referred to Agriculture and Rural Policy Development Committee; will carry over to 2012

Mississippi SB 2672 Remove criminal penalties and threat of arrest for patients who grow, possess, and use medical marijuana

Good Died in Senate Drug Policy Committee

Missouri HB 698 Remove state-level criminal penalties and the threat of arrest for patients with serious illnesses who use marijuana for medical purposes, and establish a licensing and regulatory structure for registered organizations that would provide marijuana to patients

Good Died in Crime Prevention and Public Safety Committee

Montana HB 19 Apply Montana Clean Indoor Air Act to medical marijuana

Good Passed Senate (50-0) and House (97-3); Gov. Brian Schweitzer signed into law on March 16

Montana HB 43 Allow employers to more easily discriminate against medical marijuana patients

Bad Passed House (99-0) and Senate (34-16); Gov. Brian Schweitzer signed it into law on May 6

Montana HB 82 Require annual reporting of complaints on physician practices relating to medical marijuana by Board of Medicine

Good Passed Senate (43-6) and House (80-15); Gov. Brian Schweitzer signed it into law on April 7

Montana HB 161, SB 334, HB 175

Repeal medical marijuana program completely (HB 161 & SB 334); submit repeal to the 2012 ballot

Bad HB 161 passed House (62-37) and Senate (28-22), and Gov. Brian Schweitzer vetoed it on April 13; SB 334 and HB 175 died

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State-By-State Report 2011State medical marijuana legislation considered in 2011 *

State Bill Number

Intent Good or Bad

Outcome

Montana SB 423 Dramatically reduce number of registered medical marijuana patients by adding onerous restrictions, particularly to chronic pain patients, and virtually eliminate safe access by limiting caregivers to three patients and prohibiting any reimbursement

Bad Legislature approved the bill, and Gov. Schweitzer announced veto if changes were not made; legislature rejected most of his amendments; revised bill passed House (88-12) and Senate (33-16), and became law without Gov. Schweitzer’s signature on May 13; part of SB 423 is on hold, pending a state court case; a referendum has been filed on SB 423

Montana HB 68, HB 389

Create regulated dispensary system (HB 68) and require warning label on marijuana sold for medical use (HB 389)

Good HB 68 died in the House Human Services Committee; HB 389 died in the House after passing the House Human Services Committee

Montana HB 33, HB 429, HB 488

Add a zero tolerance DUID provision to current DUI law, with no exception for metabolites (HB 33); gut the medical marijuana law and force patients to get certified in court (HB 429); mandate that qualified patients can only smoke medical marijuana in their residences (HB 488)

Bad HB 33 died in the House Judiciary Committee; HB 429 and HB 488 died in the House Human Services Committee

Montana SB 154, SB 193, SB 336

Medical marijuana dispensary regulation bill that included an overabundance of public hearings (SB 154); add further regulations to medical marijuana law that are featured in MPP’s model bill (SB 193); add PTSD as a qualifying condition for medical marijuana (SB 336)

Good Died in the Senate Judiciary Committee

Montana SB 170 Revise law for chronic pain patients, making it more difficult for them to get a recommendation

Bad Died in the Senate Judiciary Committee

Nevada AB 528 Allow Department of Health and Human Services to transfer medical marijuana program funds to the Department of Mental Health Services, depleting program-specific reserves

Bad Passed Assembly (42-0) and Senate (20-1); Gov. Brian Sandoval signed it into law on June 16

Nevada AB 235 Make ID cards optional and allow collective cultivation sites

Good Died in the Assembly Health and Human Services Committee

Nevada AB 438 Create a system of regulated dispensaries

Good Died in the Assembly Health and Human Services Committee

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Nevada SB 256 Raise penalties for cultivation, and make it more difficult to become a registered caregiver or qualifying patient

Bad Passed Senate (21-0), but died in Assembly without a vote

Nevada SB 336 Reschedule marijuana to Schedule III and create pilot medical marijuana distribution system using compound pharmacies, cultivation sites, and testing laboratories

Good Died in Senate Committee on Finance

New Hampshire HB 442 Remove criminal penalties and threat of arrest for patients who grow, possess, and use medical marijuana

Good Passed the House (221-96) and Senate Health and Human Services Committee; tabled by full Senate after veto threat by Gov. John Lynch

New Jersey SCR 140 Determine that Board of Medical Examiner proposed medicinal marijuana program rules are inconsistent with legislative intent

Good Passed Senate Health, Human Services, and Senior Citizens Committee (6-2); awaits action

New Jersey SCR 151, ACR 188

Formally prohibit adoption of several of the proposed medical marijuana rules

Good Introduced in both chambers and awaiting action

New Mexico HB 593 Repeal the state’s medical marijuana law

Bad Retracted by sponsor

New Mexico HM 53 Resolution requesting that the Health Department study the impact of the state’s medical marijuana law

Good Passed House (62-5); memorials need only pass one chamber and need not be signed by the governor

New York A. 7347, S. 2774

Remove criminal penalties and threat of arrest for patients who grow, possess, and use medical marijuana

Good A. 7347 passed Assembly Health, Codes, and Ways and Means Committees; both bills awaiting action

North Carolina (2011-2012 session)

H 577 Remove criminal penalties and threat of arrest for qualified patients who possess, grow, and use medical marijuana; create a dispensary program

Good Referred to House committees; will carry over to 2012

Ohio (2011-2012 session)

HB 214 Remove state-level criminal penalties and the threat of arrest for patients with serious illnesses who use marijuana; allow patients, or their caregivers, to cultivate marijuana

Good Pending in Health and Aging Committee

Oklahoma (2011-2012 session)

SB 573 Remove state-level criminal penalties and the threat of arrest for patients with serious illnesses who use marijuana; allow patients, or their caregivers, to cultivate marijuana

Good Pending in Health and Human Services Committee

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Appendix L: State Medical M

arijuana Legislation Considered in 2011

State-By-State Report 2011State medical marijuana legislation considered in 2011 *

State Bill Number

Intent Good or Bad

Outcome

Oregon HB 2982 Require Oregon Health Authority to deny application for medical marijuana registry identification card if applicant has been convicted of felony involving controlled substance; prohibit person convicted of felony involving controlled substance from using medical marijuana registry identification card

Bad Died in Judiciary Committee upon adjournment of session

Oregon HB 2994 Prohibit operation of marijuana grow site within 2,500 feet of school or place of worship

Bad Died in Judiciary Committee upon adjournment of session

Oregon HB 3046 Direct Oregon Health Authority to register marijuana cooperatives to operate marijuana grow sites and sell marijuana to registry identification cardholders

Good Died in Health Care Committee upon adjournment

Oregon HB 3077 Require medical marijuana registry identification cardholder to be Oregon resident

Bad Died in Judiciary Committee upon adjournment

Oregon HB 3093 Reduce amount of usable medical marijuana that a person may possess to one ounce

Bad Died in Health Care Committee upon adjournment

Oregon HB 3103 Prohibit issuance of registry identification cards for medical marijuana to persons under 18 years of age

Bad Died in Health Care Committee upon adjournment

Oregon HB 3129 Strengthen provisions relating to release of information from Oregon Medical Marijuana Program to Oregon Health Authority and law enforcement

Good Died in Judiciary Committee upon adjournment

Oregon HB 3132 Provide that Oregon Health Authority shall revoke registry identification card if cardholder is convicted of drug crime

Bad Died in Health Care Committee upon adjournment

Oregon HB 3202 Modify multiple provisions in the Oregon Medical Marijuana Act

Both Died in Health Care Committee upon adjournment

Oregon HB 3423 Require Oregon Health Authority to adopt rules that establish standards and procedures for registration of manufacture and delivery of medical marijuana

Good Died in Judiciary Committee upon adjournment

Oregon HB 3426 Require applicant for marijuana grow site registration to notify Oregon Health Authority if premises of marijuana grow site are rented or leased and provide name and address of owner; require authority to notify owner of premises that authority has registered marijuana grow site at premises

Both Died in Judiciary Committee upon adjournment

Oregon HB 3664 Make various changes to the current Oregon Medical Marijuana Act

Both Public Hearing held in Rules Committee; died in committee upon adjournment

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State Bill Number

Intent Good or Bad

Outcome

Oregon SB 646 Expand ability of employer to prohibit use of medical marijuana in workplace

Bad Died in Judiciary Committee upon adjournment

Oregon SB 708 Direct Oregon Health Authority to develop system by which certain law enforcement employees may determine whether a person is medical marijuana registry identification cardholder or designated primary caregiver of cardholder or whether location is authorized marijuana grow site

Both Died in Judiciary Committee upon adjournment

Oregon SB 777 Pare down the list of debilitating medical conditions for which medical marijuana is available and remove power of Oregon Health Authority to add other debilitating medical conditions; require registry identification cardholder to provide updated documentation from physician every six months

Bad Hearing in Health Care, Human Services, and Rural Health Policy Committee; died upon adjournment

Oregon SB 847 Direct State Department of Agriculture to establish registration system for marijuana farms; direct State Board of Pharmacy to adopt rules allowing pharmacy or pharmacist to purchase marijuana from marijuana farms and dispense marijuana to cardholders

Both Hearing and work session held in Judiciary Committee; died upon adjournment

Pennsylvania (2011-2012 session)

HB 1653 Remove criminal penalties and threat of arrest for qualified patients who possess, grow, and use medical marijuana; create a dispensary program

Good Pending in Human Services Committee; will carry over to 2012

Pennsylvania (2011-2012 session)

SB 1003 Remove criminal penalties and threat of arrest for qualified patients who possess, grow, and use medical marijuana; create a dispensary program

Good Pending in the Senate Health and Public Welfare Committee; will carry over to 2012

Rhode Island H 5032 Provide for indemnification of landlords of tenants engaged in cultivating medical marijuana for any claims arising out of the medical marijuana cultivation

Neither Withdrawn after introduction at sponsor’s request

Rhode Island H 5040 Provide that a landlord does not have to lease a dwelling to persons who either cultivate or intend to cultivate medical marijuana on leased premises

Bad Died in House Judiciary Committee without a vote

Rhode Island H 5290 Permit a landlord to refuse to rent to a medical marijuana cardholder who intends to grow marijuana on the leased premises

Bad Died in House Judiciary Committee without a vote

Rhode Island H 5401 Make various changes to the medical marijuana law, including ending personal cultivation by patients and caregivers

Bad Died in House Health, Education and Welfare Committee without a vote

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Appendix L: State Medical M

arijuana Legislation Considered in 2011

State-By-State Report 2011State medical marijuana legislation considered in 2011 *

State Bill Number

Intent Good or Bad

Outcome

Rhode Island H 5601 Apply appropriate state taxes to all compassion center revenue exceeding the amount of five hundred thousand dollars ($500,000)

Bad Died in House Finance Committee without a vote

Rhode Island H 5603 Require medical marijuana compassion centers to supply evidence of federal tax-exempt status prior to receiving a registration certificate

Bad Died in House Finance Committee without a vote

Rhode Island S 204 Make various changes to the medical marijuana act, including requiring that the cultivation and dispensing of medical marijuana would only be authorized by compassion centers

Bad Died in Senate Health and Human Services Committee without a vote

Tennessee (2011-2012 session)

HB 294, SB 251

Remove state-level criminal penalties and the threat of arrest for patients with serious illnesses who use marijuana for medical purposes, and establish a licensing and regulatory structure for licensed producers and distributors that would provide marijuana to patients

Good Pending in the General Subcommittee of the Health and Human Resources Committee

Texas HB 1491 Provide an affirmative defense to patients charged with possession of small amounts of marijuana on the grounds that his or her physician has recommended marijuana to treat the patient’s medical condition

Good Died in Public Health Committee

Vermont S. 17 Allow for the establishment of up to four dispensaries, regulated by the Department of Public Safety, that can provide medical marijuana to registered patients

Good Passed the Senate (25-4) and House (99-44); signed by Gov. Peter Shumlin on June 2

Washington (2011-2012 session)

HB 1100 Provide arrest and prosecution protection for medical marijuana patients, and establish a medical marijuana dispensary program

Good Referred to the House Committee on Healthcare and Wellness; will carry over to 2012

Washington (2011-2012 session)

HB 2118 Modify the current medical marijuana law by providing for medical marijuana dispensaries and collectives

Good Referred to House Committee on Healthcare and Wellness; will carry over to 2012

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Washington (2011-2012 session)

SB 5073 Modify the current medical marijuana program to set up a voluntary patient registry, provide for arrest and prosecution protection to registered patients, set up a system of regulated dispensaries, and provide civil protections

Good, until sectional veto

Passed both chambers intact; Gov. Gregoire vetoed key sections, including the registry, arrest protection, and allowing regulated dispensaries; provisions that became law include civil protections and eliminating a provision that arguably allowed some dispensaries; the remaining sections became effective July 22, 2011

Washington (2011-2012 session)

SB 5955 Require the department of health to adopt rules to create, implement, administer, and maintain a medical cannabis registry as a secure and confidential registration system for qualifying patients, designated providers, collective gardens, and nonprofit patient cooperatives; provide sales and use tax exemptions

Good Public hearing held in Senate Committee on Ways and Means; motion to move out of committee failed

Washington (2011-2012 session)

SB 5957 Reclassify marijuana from Schedule I to Schedule II

Good Referred to Senate Committee on Ways and Means; will carry over to 2012

West Virginia HB 3251 Remove criminal penalties and threat of arrest for patients who grow, possess, and use medical marijuana

Good Died in House Judiciary Committee

Wyoming HB 69 Invalidate any prescription or order from a physician for marijuana, THC, or synthetic THC (with the exception of dronabinol); NOTE: Medical marijuana was already not allowed in Wyoming

Bad Passed both chambers and signed by governor; effective July 1, 2011

*In some states that have two-year legislative cycles, bills that are not passed or defeated in the first year can be considered in the second year. In other states with two-year cycles, bills that are not passed or defeated do not carry over to the following year.

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Appendix M: Resolution of Support

State-By-State Report 2011Appendix M: Model Resolution of Support

Resolution to Protect Seriously Ill People from Arrest and Imprisonment for Using Medical Marijuana

Whereas, the National Academy of Sciences’ Institute of  Medicine concluded after reviewing the relevant scientific literature — including dozens of works doc-umenting marijuana’s therapeutic value — that “nausea, appetite loss, pain, and anxiety are all afflictions of wasting, and all can be mitigated by marijuana” and that “there will likely always be a subpopulation of patients who do not respond well to other medications”;1 and,

Whereas, subsequent studies since the 1999 Institute of Medicine report continue to show the therapeutic value of marijuana in treating a wide array of debilitating medical conditions, including relieving medication side effects and thus improv-ing the likelihood that patients will adhere to life-prolonging treatments for HIV/AIDS and hepatitis C and alleviating HIV/AIDS neuropathy, a painful condition for which there are no FDA-approved treatments;2 and,

Whereas, a scientific survey conducted in 1990 by Harvard University researchers found that 54% of oncologists with an opinion favored the controlled medical availability of marijuana, and 44% had already suggested at least once that a pa-tient obtain marijuana illegally;3 and,

Whereas, in 2008 and 2009, respectively, the American College of Physicians and the American Medical Association called for the federal government to review the evidence and consider reclassifying marijuana from a Schedule I drug; and,

Whereas, on September 6, 1988, after reviewing all available medical data, the Drug Enforcement Administration’s chief  administrative law judge, Francis L. Young, recommended that marijuana be rescheduled and available by prescrip-tion, declaring that marijuana is “one of the safest therapeutically active substances known”;4 and,

Whereas, medical marijuana laws have been enacted in 16 states and the District of Columbia and are protecting thousands of suffering patients from being ar-rested for using medical marijuana according to their doctors’ recommendations; and,

__________________________________________________________________________________________

1 J. Joy, S. Watson, and J. Benson, “Marijuana and Medicine: Assessing the Science Base, Institute of Medicine,” Washington: National Academy Press, 1999; Chapter 4, “The Medical Value of Marijuana and Related Substances,” lists 198 references in its analysis of marijuana’s medical uses.

2 B.C. deJong, et al, “Marijuana Use and its Association With Adherence to Antiretroviral Therapy Among HIV-Infected Persons With Moderate to Severe Nausea,” Journal of Acquired Immune Deficiency Syndromes, January 1, 2005; D.L. Sylvestre, B.J. Clements, and Y. Malibu, “Cannabis Use Improves Retention and Virological Outcomes in Patients Treated for Hepatitis C,” European Journal of Gastroenterology and Hepatology, September 2006. In February 2010, the state-funded University of California’s Center for Medicinal Cannabis Research released a report documenting marijuana’s medical value in 15 rigorous clinical studies, including seven trials. Center for Medicinal Cannabis Research, available at http://www.cmcr.ucsd.edu/index.php?option=com_content&view=category&id=41&Itemid=135.

3 R. Doblin and M. Kleiman, “Marijuana as Antiemetic Medicine,” Journal of Clinical Oncology 9 (1991): 1314-1319.

4 U.S. Department of Justice, Drug Enforcement Administration, “In The Matter Of Marijuana Rescheduling Petition, Docket No. 86-22, Opinion and Recommended Ruling, Findings of Fact, Conclusions of Law and Decision of Administrative Law Judge,” Francis L. Young, Administrative Law Judge, September 6, 1988.

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Whereas, hundreds of thousands of patients nationwide — people with AIDS, cancer, glaucoma, chronic pain, and multiple sclerosis — have found marijuana in its natural form to be therapeutically beneficial and are already using it with their doctors’ approval; and, 

Whereas, numerous organizations have endorsed medical  access to mari-juana, including the American  Academy of HIV Medicine; the American Bar Association; the American Nurses  Association; the American Public Health Association; the Lymphoma Foundation of America; the Leukemia & Lymphoma Society; numerous state nurses associations; several state hospice, public health, and medical associations; the Presbyterian Church (USA); the Episcopal Church; the Union of Reform Judaism; the Progressive National Baptist Convention; the Unitarian  Universalist Association; the United Church of Christ; and the United Methodist Church; and, 

Whereas, a January 2010 ABC News/Washington Post poll found that 81% of Americans think “doctors should be able to prescribe marijuana for medical pur-poses to treat their patients”; and, 

Whereas, the present federal classification of marijuana5 and the resulting bureaucratic controls impede additional scientific research into marijuana’s ther-apeutic potential,6 thereby making it nearly impossible for the Food and Drug Administration to evaluate and approve marijuana through standard procedural channels; and,

Whereas, the Ninth U.S. Circuit Court of Appeals, in the case of Conant v. Walters, upheld the right of physicians to recommend medical marijuana to pa-tients without federal government interference, and the United States Supreme Court declined to hear the federal government’s appeal of this ruling; and,

Whereas, the U.S. Department of Justice issued a memo in June 2011 specifying that “individuals with cancer or other serious illnesses who use marijuana as part of a recommended treatment regimen consistent with applicable state law” should not be targeted for federal law enforcement;7 and, 

Whereas, state medical marijuana laws do not require anyone to violate federal law and are thus are not preempted by federal law, according to two California cases that the U.S. Supreme Court declined to review; 8 and,

Whereas, seriously ill people should not be punished for acting in accordance with the opinion of their physicians in a bona fide attempt to relieve suffering; therefore,

__________________________________________________________________________________________5 Section 812(c) of Title 21, United States Code.6 The U.S. Department of Health and Human Services (HHS) issued written guidelines for medical marijuana

research, effective December 1, 1999. The guidelines drew criticism from a coalition of medical groups, scientists, members of Congress, celebrities, and concerned citizens. The coalition called the guidelines “too cumbersome” and urged their modification in a letter to HHS Secretary Donna Shalala, dated November 29, 1999. Signatories of the letter included 33 members of Congress, former Surgeon General Joycelyn Elders, and hundreds of patients, doctors, and medical organizations. In addition, Drug Enforcement Administration (DEA) Administrative Law Judge Mary Ellen Bittner issued a February 2007 ruling concluding “that there is currently an inadequate supply of marijuana available for research purposes” and recommending that the DEA grant Dr. Lyle Craker a license to cultivate research-grade marijuana, but the DEA has failed to do so.

7 http://www.mpp.org/assets/pdfs/library/Cole-memo.pdf8 See County of San Diego v. San Diego NORML, 165 Cal.App.4th 798 (Cal.App. 4th Dist. 2008), review denied

(Cal. 2008), cert denied, 129 S.Ct. 2380 (2009); City of Garden Grove v. Superior Court 68 157 Cal.App.4th 355 (Cal.App. 4 th Dist. 2007), review denied (Cal. 2008), cert denied 129 S.Ct 623 (2008).

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Appendix M: Resolution of Support

State-By-State Report 2011Be It Resolved, that licensed medical doctors should not be punished for rec-ommending the medical use of marijuana to seriously ill people, and seriously ill people should not be subject to criminal sanctions for using marijuana if their physician has told them that such use is likely to be beneficial; and be it further

Resolved that state and federal law should be changed so that no seriously ill patient will be subject to criminal or civil sanction for the doctor-advised med-ical use of marijuana, and so that qualifying seriously ill patients can safely obtain medical marijuana from well-regulated entities.

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Appendix N: States That H

ave the Initiative Process

State-By-State Report 2011Appendix N: States That Have the Initiative Process

The initiative process allows citizens to vote on proposed laws, as well as amendments, to the state constitution. There is no national initiative pro-cess, but 23 states and the District of Columbia have the initiative process in some form.

Some states allow citizens to propose laws that are placed directly on a ballot for voters to decide. The legislature has no role in this process, known as the “direct initiative process.”

Other states have an “indirect initiative process,” where laws or con-stitutional amendments proposed by the people must first be submitted to the state legislature. If the legislature fails to approve the law or constitution-al amendment, the proposal appears on the ballot for voters to decide. Maine’s medical marijuana law and the 2009 addition of dispensaries to the law were both enacted via an indirect ini-tiative process; all other state medical marijuana initiatives have been direct.

Colorado’s and Nevada’s medical marijuana initiatives amended their state constitutions, while the medi-cal marijuana initiatives in Arizona, California, the District of Columbia, Maine, Michigan, Montana, Oregon, and Washington enacted statutory laws.

The initiative process is not a panacea, however. Twenty-seven states do not have it, which means voters in these states cannot themselves propose and enact medical marijuana laws; rather, they must rely on their elected representatives to enact such laws. Moreover, passing legislation is much more cost-effective than passing ballot initiatives, which can be very expensive endeavors.

In contrast to initiatives, referenda deal with matters not originated by the voters. There are two types of referenda. A popular referendum is the power of the people to refer to the ballot, through a petition, specific legislation that was enacted by the

23* States and D.C. Have the Initiative Process

Statutory Law Constitutional Amendment

State Direct Indirect Direct IndirectAlaska N Y N NArizona Y N Y NArkansas Y N Y NCalifornia Y N Y NColorado Y N Y NDistrict of Co-lumbia

Y N N N

Florida N N Y NIdaho Y N N NMaine N Y N NMassachusetts N Y N YMichigan N Y Y NMississippi N N N YMissouri Y N Y NMontana Y N Y NNebraska Y N Y NNevada N Y Y NNorth Dakota Y N Y NOhio N Y Y NOklahoma Y N Y NOregon Y N Y NSouth Dakota Y N Y NUtah Y Y N NWashington Y Y N NWyoming Y N N N

Y – has the process; N – does not have the process

* MPP does not consider Illinois to be an initiative state because voters cannot place marijuana-related questions on the ballot. Rather, only initiatives that change the structure or function of government can be placed on the ballot.

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legislature, for the voters’ approval or rejection. A legislative referendum is when a state legislature places a proposed constitutional amendment or statute on the ballot for voter approval or rejection.

There are two states that have a popular referendum process but not an initiative process — Maryland and New Mexico. In addition, in 49 states, the legislature must put a proposed constitutional amendment on the ballot for voter approval. (A listing of the states with the referendum process is not provided in the chart in this section.)

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State-By-State Report 2011

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Appendix O: Effective Arguments for Medical Marijuana Advocates

INTRODUCTIONMedical marijuana advocates are frequently confronted with challenging questions

and arguments. Media interviews, debates, and correspondence with government of-ficials require meticulous preparation. Reformers’ responses to these challenges will significantly affect the future of the medical marijuana movement.Since its inception in January 1995, the Marijuana Policy Project (MPP) has devoted substantial time and energy to changing the medical marijuana laws. Whether lobbying Congress or state legislatures, campaigning for ballot initiatives, networking with health and medical associations, attending drug warriors’ conferences, or talking to reporters, reformers continue to encounter the same questions and arguments.MPP’s responses to these challenges have been developed through experience, advice from colleagues, observations of debates and news coverage, and an extensive review of poll results and publications by prohibitionists and reformers alike.This paper provides medical mari-juana advocates with responses to the 34 most common challenges.MPP encourages all reform advocates to read this paper. Keep it handy when giving media interviews, writing to elected officials, testifying before legislative committees, or debating the medical marijuana issue. Feel free to copy responses verbatim or to use this paper to prepare materials for other activists. Additions or suggestions should be sent to MPP for inclusion in future editions.

OVERARCHING RESPONSE TO MEDICAL MARIJUANA QUESTIONS AND CHALLENGES

Always stress that the core issue is protecting seriously ill patients from arrest and jail. It is crucial to avoid getting lost in side arguments. Whenever possible, remind your audience that federal and most state laws subject seriously ill patients to arrest and imprisonment for using marijuana. Most of the following responses can be en-hanced by ending with the question, “Should seriously ill patients be arrested and sent to prison for using marijuana with their doctors’ approval?”The key issue is not that patients and advocates are trying to make a “new drug” available. Rather, the goal is to protect from arrest and imprisonment the hundreds of thousands of patients who are already using marijuana, as well as the doctors who are recommending such use. Always bring the discussion back to the issue of arrest and imprisonment.Remember: Patients for whom the standard, legal drugs are not safe or effective are left with two terrible choices: (1) continue to suffer, or (2) obtain marijuana illegally and risk suf-fering such consequences as:

• an insufficient supply of marijuana due to prohibition-inflated prices or scarcity;

• impure, low-quality, contaminated, or chemically adulterated marijuana pur-chased from the criminal market, as well as the risk of violence associated with that market; and

• arrests, fines, court costs, property forfeiture, loss of child custody, incarceration, probation, and criminal records.

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CHALLENGE #1: “There is no reliable evidence that marijuana has medical value. Existing evidence is either anecdotal, unscientific, or not replicated.”

Response A: There is abundant scientific evidence that marijuana is a safe, effective medicine for some people. In 1999, the National Academy of Sciences’ Institute of Medicine (IOM) reported, “Nausea, appetite loss, pain, and anxiety are all afflictions of wasting, and all can be mitigated by marijuana.”1

Since then, extensive new research has confirmed marijuana’s medical benefits. Three University of California studies published since February 2007 have found that marijuana relieved neuropathic pain (pain caused by damage to nerves), a type of pain that commonly afflicts patients with multiple sclerosis, HIV/AIDS, diabetes, and a variety of other conditions, and for which conventional pain drugs are notoriously inadequate — and did so with only minor side effects.2,3,4 An observational study re-ported in the European Journal of Gastroenterology & Hepatology found that hepatitis C patients using marijuana had three times the cure rate of those not using marijuana, apparently because marijuana successfully relieved the noxious side effects of anti-hepatitis C drugs, allowing patients to successfully complete treatment.5

Response B: On September 6, 1988, after hearing two years of testimony, the Drug Enforcement Administration’s chief administrative law judge, Francis Young, ruled: “Marijuana, in its natural form, is one of the safest therapeutically active substances known … It would be unreasonable, arbitrary, and capricious for DEA to continue to stand between those sufferers and the benefits of this substance.”6 Newer research (see Response A above) has confirmed that finding many times over.

Response C: Numerous medical organizations have examined the evidence and concluded that marijuana can be a safe, effective medicine for some patients. These include the American College of Physicians, American Public Health Association, American Nurses Association, and many others (for a full list, see Challenge #28). For example, the American College of Physicians has stated, “Evidence not only sup-ports the use of medical marijuana in certain conditions, but also suggests numerous indications for cannabinoids.”7 In its 2009 call for the federal government to recon-sider marijuana’s classification under federal law, the AMA also took note of clinical trials showing marijuana’s medical efficacy.

CHALLENGE #2: “Medical marijuana is unnecessary. We already have drugs that work better than marijuana for the conditions it’s used to treat.”

Response A: That’s not true. For example, neuropathic pain — pain caused by dam-age to the nerves — often is not helped by existing drugs, but marijuana has been shown to provide effective relief, even in patients for whom conventional drugs have failed. (See Challenge #1, Response A.) This is a type of pain that affects millions of Americans with multiple sclerosis, diabetes, HIV/AIDS, and other illnesses.

Response B: Different people respond differently to different medicines. The most effective drug for one person might not work at all for another person. That is why there are different drugs on the market to treat the same ailment. Treatment deci-sions should be made in doctors’ offices, not by federal bureaucrats. Doctors need to have numerous substances available in their therapeutic arsenals in order to meet

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State-By-State Report 2011the needs of a variety of patients. That’s why the Physicians’ Desk Reference comprises 3,000 pages of prescription drugs, rather than just one drug per symptom.

Response C: Consider all of the over-the-counter pain medications: aspirin, acet-aminophen, ibuprofen, etc. We do not just determine which is “best” and then ban all of the rest. Because patients are different, doctors must have the freedom to choose what works best for a particular patient. Why use a double standard for marijuana?

Response D: The 1999 Institute of Medicine report explained:

• “Although some medications are more effective than marijuana for these prob-lems, they are not equally effective in all patients.”8

• “[T]here will likely always be a subpopulation of patients who do not respond well to other medications. The combination of cannabinoid drug effects (anxiety reduction, appetite stimulation, nausea reduction, and pain relief) suggests that cannabinoids would be moderately well suited for certain conditions, such as chemotherapy-induced nausea and vomiting and AIDS wasting.”9

• “The critical issue is not whether marijuana or cannabinoid drugs might be supe-rior to the new drugs, but whether some group of patients might obtain added or better relief from marijuana or cannabinoid drugs.”10

CHALLENGE #3: “Why is marijuana needed when it is already available in pill form?”

Response A: Marijuana is not available in pill form. THC, the component respon-sible for marijuana’s “high,” is sold as the prescription pill Marinol (with the generic name “dronabinol”). But people who use the pill find that it commonly takes an hour or more to work, while vaporized or smoked marijuana takes effect almost instanta-neously. They also find that the dose of THC they have absorbed (in the pill form) is often either too much or too little. Because slow and uneven absorption makes oral dosing of THC so difficult, The Lancet Neurology wrote in May 2003, “Oral admin-istration is probably the least satisfactory route for cannabis.”11 In its 2008 position paper on medical marijuana, the American College of Physicians noted, “Oral THC is slow in onset of action but produces more pronounced, and often unfavorable, psy-choactive effects than those experienced with smoking.”7

Response B: As Mark Kris, M.D., one member of an expert panel convened by the National Institutes of Health in 1997 to review the scientific data on medical mari-juana, explained during the group’s discussion on February 20, 1997: “[T]he last thing that [patients] want is a pill when they are already nauseated or are in the act of throw-ing up.”12

Response C: Marijuana contains about 80 active cannabinoids in addition to THC.13 Research has shown that these other compounds contribute significantly to marijuana’s therapeutic effects. For example, cannabidiol (CBD) has been shown to have anti-nausea, anti-anxiety, and anti-inflammatory actions, as well as the ability to protect nerve cells from many kinds of damage.14 CBD also moderates THC’s ef-fects so patients are less likely to get excessively “high.” Other cannabinoids naturally contained in marijuana have also shown significant therapeutic promise.

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Response D: Thousands of patients continue to break the law to obtain marijuana, even though they could legally use the THC pill. Why would they risk arrest and prison to use something that doesn’t work?

CHALLENGE #4: “Why not isolate the other useful cannabinoids and make them available in a pure, synthetic form?”

Response A: Marijuana contains about 80 naturally occurring cannabinoids. While spending time and money testing and producing pharmaceutical versions of these chemicals may someday produce useful drugs, it does nothing to help patients now. The Institute of Medicine urged such research in 1999, but added, “In the meantime there are patients with debilitating symptoms for whom smoked marijuana might provide relief.”15

Response B: Marijuana naturally contains at least 66 cannabinoids in a combination that is safe and effective, and which has already given relief to millions of people. Given the current state of research, it will be years before any new cannabinoid drugs reach pharmacy shelves. Why should seriously ill patients have to risk arrest and jail for years while awaiting new pharmaceuticals which may or may not ever be available?

Response C: If spending time and money isolating the different cannabinoids would help patients, then we support such research. But such research should not be a stall tactic to keep medical marijuana illegal. Patients should be allowed to use a drug they and their doctors know works in the meantime — in many cases, that drug is marijuana.

Response D: Many of the cannabinoids in marijuana interact with each other and other chemicals within the plant, creating a combined effect that is not present in isolated compounds. These combined effects have been found to be helpful in certain cases, such as allowing for a strong palliative effect while decreasing the psychoactive effects of THC.

CHALLENGE #5: “Why not make THC and other cannabinoids available in inhalers, suppositories, and so forth?”

Response A: If these delivery systems would help patients, then they should be made available. However, the development of these systems should not substitute for the research into marijuana that is necessary for FDA approval of this natural medi-cine. A safe, effective delivery system for whole marijuana already exists: vaporization (discussed in Response A to Challenge #27).

Response B: The availability of such delivery systems should not be used as an ex-cuse to maintain the prohibition of the use of natural marijuana. As long as there are patients and doctors who prefer the natural substance, they should not be criminal-ized for using or recommending it, no matter what alternatives are available. Doctors and patients should be able to choose the form that’s best for their particular situation.

Response C: [Use Responses A and B to Challenge #4. See also Challenge #6.]

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State-By-State Report 2011CHALLENGE #6: “Doesn’t Sativex, the new marijuana-based spray, make use of the crude plant unnecessary?”

Response A: In fact, Sativex, a liquid extract of natural marijuana, proves that mari-juana is a medicine. Sativex is to marijuana as a cup of coffee is to coffee beans. If Sativex is safe and effective, marijuana is safe and effective. But for now, Sativex is legally available only in Canada, Spain, and the United Kingdom. The company that makes it, GW Pharmaceuticals, only recently started the process of seeking U.S. ap-proval, which is likely to take years.

Response B: Natural marijuana has significant advantages over Sativex. For one thing, Sativex acts much more slowly than marijuana that is vaporized or smoked. Peak blood levels are reached in one and a half to four hours, as opposed to a mat-ter of minutes with inhalation.16 Because patients have found that different strains of marijuana provide the best relief for different conditions, Sativex is unlikely to help every patient who benefits (or could benefit) from whole marijuana. It’s simply an-other form of medical marijuana, and patients and doctors should be able to choose what works best for each individual.

CHALLENGE #7: “The FDA says that marijuana is not a medicine and that medical marijuana laws subvert the FDA drug approval process.”

Response A: The FDA issued its April 2006 statement without conducting any stud-ies or even reviewing studies done by others, under political pressure from rabidly anti-medical marijuana politicians such as Congressman Mark Souder(R-Ind.). The FDA simply ignored evidence that contradicts federal policy, such as the 1999 Institute of Medicine report. That’s why IOM co-author Dr. John A. Benson told The New York Times that the government “loves to ignore our report ... They would rather it never happened.”17 The FDA statement was immediately denounced by health experts and newspaper editorial boards around the country as being political and unscientific.

Response B: State medical marijuana laws have absolutely nothing to do with the FDA drug approval process. The FDA does not arrest people for using unapproved treatments. The FDA does not bar Americans from growing, using, and possessing a wide variety of medical herbs that it has not approved as prescription drugs, including echinacea, ginseng, St. John’s Wort, and many others. State medical marijuana laws don’t conflict with the FDA in the slightest. They simply protect medical marijuana patients from arrest and jail under state law.

Response C: There is already substantial evidence that marijuana is safe and effective for some patients, including new studies published after the FDA’s statement. (See re-sponses to Challenge #1.) However, the federal government has blocked researchers from doing the specific types of studies that would be required for licensing, labeling, and marketing marijuana as a prescription drug. They’ve created a perfect Catch-22: Federal officials say “Marijuana isn’t a medicine because the FDA hasn’t approved it,” while making sure that the studies needed for FDA approval never happen. (See also Response C to Challenge #25.)

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Response D: Marijuana was already on the market (in some two dozen preparations, many marketed by well-known pharmaceutical companies) before the 1938 Food, Drug, and Cosmetics Act was passed, creating the FDA. Under the terms of the Act, marijuana should not be considered a “new” drug, subject to the FDA drug-approval requirements that new drugs must meet. Many older drugs, including aspirin and morphine, were “grandfathered in” under this provision, without ever being submit-ted for new-drug approval by the FDA.

Response E: Half of current prescriptions have never been declared safe and effective by the FDA. Between 40-60% of all drug prescriptions in this country are “off-label” — i.e. for drugs not approved by the FDA for the condition they’re being prescribed for. We know much more about marijuana’s safety and efficacy in cancer, AIDS, MS, and many other conditions than we know about most off-label prescriptions.

Response F: The FDA is not infallible. For instance, FDA-approved Vioxx is estimat-ed to have caused between 26,000 and 55,000 needless deaths before it was taken off the market. And David Graham, associate director of the FDA’s Office of Drug Safety, has told Congress that the FDA is “virtually defenseless” against another Vioxx-type disaster. In contrast, 5,000 years of real world experience with marijuana show that it is safe and effective for many patients.

CHALLENGE #8: “Doesn’t medical marijuana send the wrong message to children?”

Response A: Experience in states with medical marijuana laws shows that they do not increase teen marijuana use. For example, the state-sponsored California Student Survey (CSS) documented that marijuana use by California teens rose markedly until 1996 — the year California’s medical marijuana law, Proposition 215, passed — and then dropped dramatically afterwards.18

State surveys of students in the other medical marijuana states have consistently reported declines in teen marijuana use since those laws were passed. (See Appendix T for more comprehensive information on Teen Marijuana Use in Medical Marijuana States.)

A winter 2011 article in the California Pediatrician compared current marijuana us-age rates among the oldest high school grade surveyed and concluded, “the data are very reassuring that in almost all cases medical marijuana legalized for adults does not lead to an increase in recreational use of marijuana by adolescents.”19

The state of California commissioned an independent study examining the effects of Proposition 215, as part of the 1997-98 CSS. Researchers concluded, “There is no evidence supporting that the passage of Proposition 215 increased marijuana use dur-ing this period.”20

Response B: Harsh, uncompassionate laws — like those which criminalize patients for using their medicine — send the wrong message to children. Dishonesty sends the wrong message to children. Arguing that sick people should continue to suffer in order to protect children sends the wrong message to children. Valuing politics over science sends the wrong message to children.

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State-By-State Report 2011Response C: Children can and should be taught the difference between medicine

and drug abuse. There are no substances in the entire Physicians’ Desk Reference that children should use for fun. In fact, doctors can prescribe cocaine, morphine, and methamphetamine. Children are not taught that these drugs are good to use recre-ationally just because they are used as medicines.

Response D: It is absurd to think that children will want to be as “cool” as a dying cancer patient. If anything, the use of marijuana by seriously ill patients might de-glamorize it for children. The message is, “Marijuana is for sick people.”

CHALLENGE #9: “It’s dangerous to allow patients to grow marijuana, especially when children might be around. Not only does it expose kids to an illegal drug, it puts them in danger of criminal activity: Patients may sell their marijuana on the illicit market or thieves could break into the home to rob them of it.”

Response A: There are already laws against drug dealing. If someone is selling mari-juana to non-patients, they’re breaking the law and subject to arrest. And state and county child protective services agencies already have the power to protect children whose parents are engaged in criminal activity. A medical marijuana law changes none of this.

Response B: What do you think is more dangerous: a bottle of liquid morphine sit-ting next to a dying patient’s bed (or a bottle of OxyContin in the medicine cabinet), or a marijuana plant growing in the basement? All medicines need to be handled with appropriate care and kept out of easy reach of children. Marijuana is no different.

Response C: Criminals break into homes every day to steal valuable items — jewelry, high-end electronics, and even prescription drugs. We don’t ban possession of these items because the owners might be victims of crime. By this logic, parents shouldn’t be allowed to drive 1994 Honda Civics (the most-stolen vehicle in 2009, according to the National Crime Bureau).

CHALLENGE #10: “Marijuana is too dangerous to be used as a medicine. More than 10,000 scientific studies have shown that marijuana is harmful and addictive.”

Response A: A large and growing body of scientific evidence demonstrates that the health risks associated with marijuana are actually relatively minor. The 1999 Institute of Medicine report noted, “[E]xcept for the harms associated with smok-ing, the adverse effects of marijuana use are within the range of effects tolerated for other medications. “(See Challenge #26 for a discussion of smoking.)21 In 2008, the American College of Physicians agreed, citing marijuana’s “relatively low toxicity.”7

A government-funded study, conducted by researchers at the Kaiser Permanente HMO, found no association between marijuana use and premature death in other-wise healthy people.22

Response B: Doctors are allowed to prescribe cocaine, morphine, and methamphet-amine. Can anyone say with a straight face that marijuana is more dangerous than these substances?

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Response C: All medicines have some negative side effects. For example, Tylenol (acetaminophen) has been estimated to kill nearly 500 Americans per year by caus-ing acute liver failure,23 while no one has ever died from marijuana poisoning. But no one would seriously suggest banning Tylenol because it’s too dangerous. In con-trast, recent medical marijuana studies have found no significant side effects. (See responses to Challenge #1.) The question is this: Do the benefits outweigh the risks for an individual patient? Such decisions should be made by doctors and patients, not the criminal justice system. Patients should not be criminalized if their doctors believe that the benefits of using medical marijuana outweigh the risks. In addition, there has never been a single recorded case of marijuana overdose resulting in death.

Response D: The “10,000 studies” claim is simply not true. The University of Mississippi Research Institute of Pharmaceutical Sciences maintains a 12,000-citation bibliography on the entire body of marijuana literature. The institute notes: “Many of the studies cited in the bibliography are clinical, but the total number also includes papers on the chemistry and botany of the Cannabis plant, cultivation, epidemiologi-cal surveys, legal aspects, eradication studies, detection, storage, economic aspects and a whole spectrum of others that do not mention positive or negative effects … However, we have never broken down that figure into positive/negative papers, and I would not even venture a guess as to what that number would be.”24 You cannot provide a list of 10,000 negative studies, so please stop making this false statement.

CHALLENGE #11: “Isn’t marijuana bad for the immune system?”

Response A: Scientific studies have not demonstrated any meaningful harm to the immune system from marijuana. The Institute of Medicine reported, “Despite the many claims that marijuana suppresses the human immune system, the health effects of marijuana-induced immunomodulation are still unclear.”25

The IOM also noted, “The short-term immunosuppressive effects [of marijuana] are not well established; if they exist at all, they are probably not great enough to preclude a legitimate medical use.”26

Response B: Extensive research in HIV/AIDS patients — whose immune systems are particularly vulnerable — shows no sign of marijuana-related harm. University of California at San Francisco researcher Donald Abrams, M.D., has studied marijuana and Marinol in AIDS patients taking anti-HIV combination therapy. Not only was there no sign of immune system damage, but the patients gained T-lymphocytes, the critical immune system cells lost in AIDS, and also gained more weight than those taking a placebo. Patients using marijuana also showed greater reductions in the amount of HIV in their bloodstream.27 Long-term studies of HIV/AIDS patients have shown that marijuana use (including social or recreational use) does not worsen the course of their disease. For example, in a six-year study of HIV patients conducted by Harvard University researchers, marijuana users showed no increased risk of devel-oping AIDS-related illness.28 In her book Nutrition and HIV, internationally known AIDS specialist Mary Romeyn, M.D., noted, “The early, well-publicized studies on marijuana in the 1970s, which purported to show a negative effect on immune status, used amounts far in excess of what recreational smokers, or wasting patients with prescribed medication, would actually use … Looking at marijuana medically rather than sociopolitically, this is a good drug for people with HIV.”29

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State-By-State Report 2011CHALLENGE #12: “Marijuana contains over 400 chemicals, including most of the harmful compounds found in tobacco smoke.”

Response A: Coffee, mother’s milk, broccoli, and most foods also contain hundreds of different chemical compounds. This number doesn’t mean anything. Marijuana is a relatively safe medicine, regardless of the number of chemical compounds found therein.

Response B: [Use Response A, B, or C to Challenge #10.]

Response C: [Use Response A, B, or C to Challenge #27.]

CHALLENGE #13: “Marijuana’s side effects — for instance, increased blood pressure — negate its effectiveness in fighting glaucoma.”

Response A: Paul Palmberg, M.D., one member of an expert panel convened by the National Institutes of Health in 1997 to review the scientific data on medical mari-juana, explained during the group’s discussion on February 20, 1997, “I don’t think there’s any doubt about its effectiveness, at least in some people with glaucoma.”30

Response B: The federal government has given marijuana to at least three patients with glaucoma, and it preserved their vision for years after they were expected to go blind.

Response C: So should someone who uses marijuana to treat glaucoma be arrested? Shouldn’t we trust a patient and a doctor to make the right decision regarding that patient’s circumstances?

CHALLENGE #14: “How exactly do state medical marijuana laws help patients?”

Response: The laws of Alaska, Arizona, California, Colorado, Delaware, the District of Columbia, Hawaii, Maine, Michigan, Montana, Nevada, New Jersey, New Mexico, Oregon, Rhode Island, Vermont, and Washington remove state-level criminal penal-ties for using, obtaining, or cultivating marijuana strictly for medical purposes. To verify a legitimate medical need, a doctor’s recommendation is required. Doctors may not be punished by the state for making such recommendations.

Maryland’s law, enacted in 2003 and improved in 2011, gives patients an affirmative defense against conviction for possession of marijuana if they can show they have been diagnosed with a debilitating medical condition. Unfortunately, Maryland’s law does not protect patients from arrest or allow a safe means of access.

Federal laws still apply to patients, but the government has recently become less draconian in its approach. Federal authorities have never aggressively pursued indi-vidual patients, but they have raided some large-scale medical marijuana distributors in California. However, in 2009, the Department of Justice announced that it would not prosecute medical marijuana activities that are clearly permitted by state law. And even without such a policy, it’s important to remember that 99 out of every 100 mari-

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juana arrests are made at the state or local level, so even in the worst-case scenario, state medical marijuana laws give patients 99% protection.

CHALLENGE #15: “Don’t medical marijuana laws put the states in violation of federal law?”

Response: No. There is no federal law that mandates that states must enforce fed-eral laws against marijuana possession or cultivation. States are free to determine their own penalties — or lack thereof — for drug offenses. State governments cannot directly violate federal law by giving marijuana to patients, but states can refuse to arrest patients who possess or grow their own. The 2005 Supreme Court decision in Gonzales v. Raich (discussed in detail under Challenge #33) did not overturn state medical marijuana laws or block other states from adopting similar measures.

CHALLENGE #16: “Aren’t these medical marijuana bills and initiatives full of loopholes?”

Response A: The medical marijuana laws adopted from 1998 on in Alaska, Arizona, Colorado, Delaware, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, New Jersey, Oregon, Rhode Island, Vermont, and Washington were all drafted very care-fully to make sure that there are no loopholes, real or imagined. These laws are not at all like the comparatively open-ended law in California (see Response B). Read them carefully and you’ll see. Medical marijuana advocates have nothing to gain and ev-erything to lose by wording the initiatives so as to enable recreational marijuana use.

Response B: The first successful medical marijuana initiative, California’s Proposition 215, did contain some vague wording, which has resulted in some reported abuse. However, California courts, the state legislature, and many cities and counties have been working to eliminate ambiguities through legislation, court rulings, and local ordinances. In 2008, California Attorney General Jerry Brown issued guidelines that have also helped provide clarity. Despite the concerns, California voters still strongly support their state’s medical marijuana law. For example, in Los Angeles – where most reports of abuse have come from – a Mason-Dixon poll in October 2009 found 74 percent support for the law, including patients’ right to purchase medical mari-juana from dispensaries, with only 16 percent opposed. Newer medical marijuana laws in other states have been drafted much more precisely, eliminating many of the concerns raised by Proposition 215.

Response C: If the bills and initiatives are not perfect, they are the best attempt to protect patients and physicians from punishment for using or recommending medical marijuana. The real problem is that the federal government’s overriding prohibition of medical marijuana leaves state bills and initiatives as the only option to help patients at this point. As soon as federal law changes, this process will no longer be needed.

CHALLENGE #17: “These bills and initiatives basically legalize marijuana for everyone.”

Response: That is simply not true. A person must have an ailment that a licensed medical doctor believes is best treated with marijuana. The General Accounting Office (the investigative arm of Congress, renamed the Government Accountability Office) interviewed officials from 37 law enforcement agencies in four states with

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State-By-State Report 2011medical marijuana laws. A key issue they examined was whether medical marijuana laws had interfered with enforcement of laws regarding non-medical use. According to the GAO’s November 2002 report, the majority of these officials “indicated that medical marijuana laws had had little impact on their law enforcement activities.”31 In California, where the most reports of alleged abuse have occurred, the number of marijuana arrests has increased since passage of Prop. 215, totaling over 74,000 in 2007.32 That hardly sounds like legalization, does it?

CHALLENGE #18: “Didn’t these medical marijuana initiatives pass because of well-funded campaigns that hoodwinked the voters?”

Response A: Actually, the public has never needed to be persuaded — much less “hoodwinked” — to support legal protection for medical marijuana patients.

State, local, and national public opinion polls have consistently shown overwhelming public support. A CNN/Time magazine national poll, published November 4, 2002, found 80% support for legal access to medical marijuana. During the 1996 campaign for California’s Proposition 215, independent polls showed the measure ahead months before any ads ran. Just as important, polling in states that have had medical mari-juana laws for years shows support just as high as or — in most cases — higher than when they were on the ballot,33 so voters clearly don’t think they were hoodwinked.

Response B: The medical marijuana initiative drives have actually been low-budget campaigns by modern standards. In California, where statewide campaign expendi-tures commonly run into the tens of millions of dollars, the Proposition 215 campaign spent slightly more than $2 million.

In contrast, federal officials, including the last two White House drug czars, have used their offices and budgets to oppose medical marijuana initiatives, campaigning with a virtually unlimited supply of taxpayer dollars. The Office of National Drug Control Policy spends nearly as much money on its anti-drug ads (many of which demonize marijuana) in three weeks as Proposition 215 supporters spent during the entire campaign!

CHALLENGE #19: “This bill/initiative doesn’t even require a doctor’s ‘prescription,’ just a ‘recommendation’!”

Response A: The federal government prohibits doctors from “prescribing” mari-juana for any reason. A prescription is a legal document ordering a pharmacy to release a controlled substance. Currently, the federal government does not allow this for marijuana.

However, there needs to be some way for state criminal justice systems to determine which marijuana users have a legitimate medical need. So state medical marijuana laws require doctors’ recommendations. Doctors recommend many things: exercise, rest, chicken soup, vitamins, cranberry juice for bladder infections, and so on. The right of physicians to recommend marijuana when appropriate for a patient’s condi-tion has been upheld by the federal courts.

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Nothing in these laws requires the courts or law enforcement to simply take it on faith that a person has a legitimate physician’s recommendation for marijuana. They can and do ask for documentation. The vast majority of doctors who are willing to write such a recommendation do not do so lightly or casually, but state medical boards do investigate and discipline physicians who fail to follow appropriate standards of care.

Response B: If you would trust a doctor to write a prescription for marijuana, why not trust a doctor to write a professional opinion on his or her letterhead instead? Admit it: You simply do not want patients to use medical marijuana, and you’re just nit-picking for an excuse to attack the bill/initiative. What advantage would there be to a prescription instead of a written, signed recommendation on a physician’s let-terhead? Please explain the big difference in practical terms.

Response C: [Best for a live debate format:] Oh, so you agree that doctors should be allowed to prescribe marijuana?

CHALLENGE #20: “These bills and initiatives are confusing to law enforcement officials.”

Response A: What’s so confusing? If a person is growing or using marijuana and has a written recommendation from a physician, do not arrest the patient or caregiver. If the person does not have suitable documentation, either call the person’s doctor or arrest the person and let the courts decide.It should be no more confusing than determining if someone drinking alcohol is underage or on probation, if someone is the legal owner of a piece of property, or if a person is a legal immigrant or not.

Response B: [Use the GAO statement in the response to Challenge #17.]

CHALLENGE #21: “Medical marijuana dispensaries – ‘pot shops’ – are totally out of control!”

Response A: That’s sometimes been true in parts of California, whose medical mari-juana law was the first and most loosely worded, but the much tighter wording in the other states has effectively prevented such problems. More and more states, such as New Mexico, Rhode Island, and Maine, are now moving to strict state licensing and regulation of medical marijuana providers to ensure proper controls.

Response B: Many cities have developed or are in the process of developing regula-tions to ensure that medical marijuana dispensaries operate in a safe, healthful, and law-abiding manner, and California’s attorney general recently issued guidelines to assist in that process. In cities such as San Francisco, successful regulations have made medical marijuana dispensaries a respected and uncontroversial part of the local health care system, shutting down any who don’t follow the law. As then San Francisco District Attorney Terence Hallinan explained: “Nonprofit medical mari-juana dispensaries have become an important part of this system, providing a safe, quality-controlled supply of medicinal cannabis to seriously ill people and working closely with local law enforcement and public health officials.”34

The biggest obstacle to effective local regulation of dispensaries is federal law that irrationally treats anyone providing medical marijuana to a cancer or AIDS patient as a common drug dealer, making no distinction between good guys and bad guys.

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State-By-State Report 2011States and cities have no trouble effectively regulating dispensaries when the federal government lets them.

Response C: Any problems with dispensaries could be eliminated if Congress passed federal legislation allowing states to create a system whereby medical marijuana is sold through licensed pharmacies. Such a system is already in place in the Netherlands.

CHALLENGE #22: “Isn’t the medical marijuana issue just a sneaky step toward legalization?”

Response A: How? Exactly how does allowing seriously ill patients to use mari-juana lead to the end of the prohibition of marijuana for recreational use? Doctors are allowed to prescribe cocaine and morphine, and these drugs are not even close to becoming legal for recreational use.

Response B: Each law should be judged on its own merits. Should seriously ill pa-tients be subject to arrest and imprisonment for using marijuana with their doctors’ approval? If not, then support medical marijuana access. Should healthy people be sent to prison for using marijuana for fun? If so, then keep all non-medical uses il-legal. There’s no magic tunnel between the two.

Response C: Supporters of medical marijuana include some of the most respect-ed medical and public-health organizations, including the American College of Physicians, American Public Health Association, American Nurses Association, American Academy of HIV Medicine, and the state medical societies of New York, California, and Rhode Island. Do you really think these organizations are part of a conspiracy to legalize drugs?

Response D: While many who support medical marijuana also support taxing and regulating it like alcohol for recreational use, these are two distinct policies and not part of a single strategy. Medical marijuana laws can be looked at as a way to remove the sick and dying from the battlefield of the war on marijuana.

CHALLENGE #23: “Are people really arrested for medical marijuana?”

Response A: Yes. There were dozens of known medical marijuana patients arrested in California in the 1990s, which is what prompted people to launch the medical mar-ijuana initiative there. There have been many other publicized and not-so-publicized cases across the United States. (For examples, see Response B to Challenge #24.)

Response B: Roughly 19 million marijuana users have been arrested since 1970.35

Unfortunately, the government does not keep track of how many were medical users. However, even if only 1% of those arrestees used marijuana for medical purposes, that is approximately 190,000 patients arrested!

Response C: You insist that patients don’t really get arrested for using medical mari-juana. If that is the case, then the bill/initiative doesn’t change anything. Why are you so strongly opposed to it?

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Response D: The possibility of arrest is itself a terrible punishment for seriously ill patients. Imagine the stress of knowing that you can be arrested and taken to jail at any moment. Stress and anxiety are proven detriments to health and the immune system. Should patients have to jump out of bed every time they hear a bump in the night, worrying that the police are finally coming to take them away?

CHALLENGE #24: “Do people really go to prison for medical marijuana offenses?”

Response A: Federal law and the laws of 34 states do not make any exceptions for medical marijuana. Federally, possession of even one joint carries a penalty of up to one year in prison. Cultivation of even one plant is a felony, with a maximum sentence of five years. Most states’ laws are in this same ballpark. With no medical necessity defense available, medical marijuana users are treated the same as recreational users. Many are sent to prison.

Response B: There are too many examples to list. Here are just a few: In December 2009, New Jersey multiple sclerosis patient John Wilson was convicted of “operating a drug manufacturing facility” for growing the marijuana he used to treat his multiple sclerosis, and faced a sentence of from 5 to 10 years in state prison. Rancher and Vietnam veteran Larry Rathbun was arrested in December 1999 for cultivating medi-cal marijuana to relieve his degenerative multiple sclerosis. When he was arrested in 1999, he could still walk, which he attributes to the medical use of marijuana. After serving 19 months, Rathbun came out of Montana State Prison confined to a wheel-chair. Byron Stamate spent three months in a California jail for growing marijuana for his disabled girlfriend (who killed herself so that she would not have to testify against Byron). Gordon Farrell Ethridge spent 60 days in an Oregon jail for growing marijuana to treat the pain from his terminal cancer. Quadriplegic Jonathan Magbie, who used marijuana to ease the constant pain from the childhood injury that left him paralyzed, died in a Washington, D.C., jail in September 2004 while serving a 10-day sentence for marijuana possession.

Response C: Estimates vary, but all sources agree that there are at minimum tens of thousands of marijuana offenders in prisons and jails at any given time. Even if only 1% of them are medical marijuana users, that is hundreds of patients behind bars right now!

Response D: Even if a patient is not sent to prison, consider the trauma of the arrest. A door kicked in, a house ransacked by police, a patient handcuffed and put into a po-lice car. Perhaps a night or two in jail. Court costs and attorney fees paid by the patient and the taxpayers. Probation — which means urine tests for a couple of years, which means that the patient must go without his or her medical marijuana. Huge fines and possible loss of employment —which hurt the patient’s ability to pay insurance, medi-cal bills, rent, food, home-care expenses, and so on. Then there’s the stigma of being a “druggie.” Doctors might be too afraid to prescribe pain medication to someone whom the system considers a “drug addict.” Should any of this happen to seriously ill people for using what they and their doctors believe is a beneficial medicine?

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State-By-State Report 2011CHALLENGE #25: “Isn’t the government making it easier to do medical marijuana research? Since they are becoming more flexible, shouldn’t we wait for that research before we proceed?

Response A: As a Schedule I drug, marijuana can be researched as a medicine only with federal approval. Until California voters passed Proposition 215 in 1996, federal authorities blocked all efforts to study marijuana’s medical benefits. Since then, fed-eral restrictions have been loosened somewhat, and a small number of studies have gone forward, but that happened because the passage of ballot initiatives forced the government to acknowledge the need for research. The federal government remains intensely hostile to medical marijuana, and if the political pressure created by ballot initiatives and legislative proposals subsides, the feds will surely go back to their old, obstructionist ways. The federal government has been supplying medical marijuana to a small group of patients for over 25 years, in what is officially deemed a research program, but has refused to study even its own patients!

Response B: Some studies have indeed been completed, and they’ve all shown medi-cal marijuana to be safe and effective. More research is always desirable, but we know enough right now to know that there is no justification for arresting patients using medical marijuana under their doctors care.

Response C: The studies approved by the federal government thus far are small, pilot studies that are providing useful data, but are not large enough to bring about FDA approval of marijuana as a prescription drug. And all medical marijuana re-search must be done with marijuana supplied by the National Institute on Drug Abuse. NIDA’s product is poor-quality, low-grade marijuana that is likely to show less efficacy and greater side effects than the marijuana available through medical marijuana dispensaries in California and elsewhere — but it remains illegal to use this higher-quality marijuana for research! Scientists and activists have appealed to the Drug Enforcement Administration to allow other sources of marijuana to be used, and in 2007, DEA Administrative Law Judge Mary Ellen Bittner ruled that a proposed University of Massachusetts project to grow and study marijuana for medical purpos-es should be allowed to proceed. But the DEA does not have to obey Bittner’s ruling and has given no indication that it intends to do so. The U.S. government remains the largest single obstacle to medical marijuana research.

CHALLENGE #26: “Modern medicine no longer uses crude plant products like marijuana, so this would be a return to the dark ages. Aspirin is made from willow bark, but we take it in pill form, not by chewing — or smoking — willow bark. You can’t control the dosage of a crude plant product.”

Response A: If you’re suggesting that medical marijuana be treated just like willow bark, then you’re endorsing our position. Yes, most people prefer their aspirin in pill form, but we don’t arrest and jail patients for possession of willow bark. And in this case, there is plenty of evidence that the whole plant works better than the pharma-ceutical alternatives now available. (See responses to Challenges #3 and 4.)

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Response B: Marijuana is so safe that patients can easily find the proper dose themselves with no danger of overdose. As University of Washington researcher Dr. Gregory Carter and colleagues noted in a recent journal article, “THC (and other cannabinoids) has relatively low toxicity and lethal doses in humans have not been described ... It has been estimated that approximately 628 kilograms of cannabis would have to be smoked in 15 minutes to induce a lethal effect.”36

Response C: In his book, Understanding Marijuana, State University of New York psychology professor Mitch Earleywine explains, “Smoked marijuana may also have fewer side effects than oral THC and other drugs. Patients can smoke a small amount, notice effects in a few minutes, and alter their dosages to keep adverse reactions to a minimum.”37

Response D: The Canadian government-approved prescribing information for Sativex, the natural marijuana extract now sold by prescription in Canada (discussed in Challenge #6), gives patients complete freedom to adjust their dose as needed. The official pamphlet provided to patients specifies: “The dose you require is determined by you. You can determine the dose that best suits you according to the pain relief you experience.”38 Patients using whole marijuana can do just the same — and more easily, because the action of vaporized or smoked marijuana is much faster than Sativex.

CHALLENGE #27: “How can you call something a medicine when you have to smoke it? Smoke is not a medicine, and marijuana smoke contains more carcinogens than tobacco smoke.”

Response A: Patients don’t need to smoke marijuana. Marijuana can be vaporized, eaten, or made into extracts and tinctures. (Such products were sold in pharmacies prior to marijuana prohibition in 1937.) The tars and other unwanted irritants in smoke have nothing to do with marijuana’s therapeutically active components, called cannabinoids. Vaporizers are simple devices that give users the fast action of inhaled cannabinoids without most of those unwanted irritants.39, 40 Research on vaporizers has proceeded more slowly than it should have because of federal obstructionism, and they cannot be marketed openly because the government considers them illegal “drug paraphernalia.”

Response B: While heavy marijuana smokers do face some health risks associated with smoke — for example, an increased risk of bronchitis — those risks do not in-clude higher rates of lung cancer. The Institute of Medicine reported, “There is no conclusive evidence that marijuana causes cancer in humans, including cancers usu-ally related to tobacco use.”41

In a huge study that followed 65,000 California HMO patients for 10 years, tobacco use, as expected, resulted in rates of lung cancer as much as 11 times that of nonsmok-ers. But marijuana smokers who did not use tobacco actually had a slightly lower rate of lung cancer than nonsmokers.42 A major, federally-funded study conducted at UCLA also found no lung cancer risk connected to marijuana smoking — and even suggestions of a “possible protective effect of marijuana” against lung cancer.43

Response C: All medicines have risks and side effects, and part of a physician’s job is to evaluate those risks in relation to the potential benefits for the individual patient. Doctors are allowed to prescribe morphine, cocaine, OxyContin, and methamphet-amine. Do you really think marijuana is more dangerous than those drugs?

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State-By-State Report 2011CHALLENGE #28: “Medical marijuana is opposed by the American Medical Association, the American Cancer Society, and all other major health and medical organizations.”

Response A: Most of these organizations simply do not have positions in support of medical access to marijuana, but neither do they advocate arresting and jailing patients who use medical marijuana, which is what our current laws do. And many, including both the AMA and ACS, have acknowledged that marijuana contains medi-cally useful components. In fact, in 2009 the AMA recommended that the federal government consider removing marijuana from Schedule I so that more research could be conducted on it. At the same meeting, the AMA voted down a resolution that said “smoked marijuana should not be recommended for medical use.” Such large professional associations often avoid taking what they perceive as controversial posi-tions early in the debate, even though many of them have chapters and journals that have endorsed medical marijuana. And a huge number of medical organizations sup-port medical marijuana. (See Response C below.)44

Response B: It’s true that some medical organizations don’t have a position on medi-cal marijuana, but neutrality shouldn’t be confused with supporting the arrest and imprisonment of patients. As former U.S. Surgeon General Dr. Joycelyn Elders put it in a 2004 newspaper column, “I know of no medical group that believes that jailing sick and dying people is good for them.”45

Response C: Numerous health and medical organizations and other prominent asso-ciations have favorable medical marijuana positions, including: AIDS Action Council; AIDS Foundation of Chicago; AIDS Project Rhode Island; American Academy of HIV Medicine (AAHIVM); American Anthropological Association; American Association for Social Psychiatry; American Bar Association; American College of Physicians; American Nurses Association; American Public Health Association; Americans for Democratic Action; Associated Medical Schools of New York; Being Alive: People With HIV/AIDS Action Committee (San Diego); California Democratic Council; California Legislative Council for Older Americans; California Nurses Association; California Pharmacists Association; California Society of Addiction Medicine; California-Pacific Annual Conference of the United Methodist Church; Colorado Nurses Association; Consumer Reports magazine; Episcopal Church; Gray Panthers; Hawaii Nurses Association; Iowa Democratic Party; Leukemia & Lymphoma Society; Life Extension Foundation; Lymphoma Foundation of America; Medical Society of the State of New York; Medical Student Section of the American Medical Association; National Association of People With AIDS; New Mexico Nurses Association; New York County Medical Society; New York State AIDS Advisory Council; New York State Association of County Health Officials; New York State Hospice and Palliative Care Association; New York State Nurses Association; New York StateWide Senior Action Council, Inc.; Ninth District of the New York State Medical Society (Westchester; Rockland; Orange; Putnam; Dutchess; and Ulster counties); Presbyterian Church (USA); Progressive National Baptist Convention; Project Inform (national HIV/AIDS treatment education advocacy organization); Rhode Island Medical Society; Rhode Island State Nurses Association; Society for the Study of Social Problems; Test Positive Aware Network (Illinois); Texas Democratic Party; Union of Reform Judaism (formerly Union of American Hebrew Congregations); Unitarian Universalist Association; United Church of Christ; United Methodist Church; United Nurses and

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Allied Professionals (Rhode Island); Wisconsin Nurses Association; Wisconsin Public Health Association; and numerous other health and medical groups.46

Response D: Surveys of physicians also show strong support for medical marijuana. For example, a 2005 national survey of physicians conducted by HCD Research and the Muhlenberg College Institute of Public Opinion found that 73% of doctors sup-ported use of marijuana to treat nausea, pain, and other symptoms associated with AIDS, cancer, and glaucoma. 56% would recommend medical marijuana to patients if permitted by state law, even if it remained illegal under federal law.47

CHALLENGE #29: “Medical marijuana is advocated by the same people who support drug legalization!”

Response A: Many health and medical associations support medical access to mar-ijuana but do not advocate broader reform of the drug laws. (See Challenge #28, Response C.) In fact, poll results consistently show that half of the people who sup-port medical marijuana actually oppose the full legalization of marijuana.

Response B: Some organizations believe that nobody, sick or not, should be sent to prison simply for growing or using their own marijuana. Why is it surprising or scan-dalous that those organizations think that patients should not go to prison? Should those organizations take the position that healthy marijuana users should not go to prison but medical marijuana users should?

Response C: Surely you’re not suggesting that patients should be punished just to spite me for believing that healthy people shouldn’t go to prison for using marijuana.

Response D: [Use Responses B & C to Challenge #22.]

Response E: Many people who advocate for taxing and regulating marijuana for recreational purposes simply see medical marijuana laws as a way to get the sick and dying off the battlefield of the war on marijuana. This does not detract from the sen-sibility of such laws, or the need for them.

CHALLENGE #30: “In 1994, the U.S. Court of Appeals overruled DEA Administrative Law Judge Francis Young’s decision, so his ruling is irrelevant.”

Response: The U.S. Court of Appeals simply ruled that the DEA has the authority to ignore the administrative law judge’s ruling— in effect, that the DEA can substitute its own prejudices for the facts established by the administrative law judge’s investiga-tion. This bolsters the argument that medical marijuana laws should be changed by legislation or ballot initiatives. The DEA has proven itself to be completely intransi-gent, and the courts are willing to allow this tyrannical behavior.

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State-By-State Report 2011CHALLENGE #31: “Isn’t marijuana already available for some people?”

Response A: Four patients in the United States legally receive marijuana from the federal government. These patients are in an experimental program that was closed to all new applicants in 1992. Thousands of Americans used marijuana through experi-mental state programs in the late 1970s and early 1980s, but none of these programs are presently operating.

Sixteen states and the District of Columbia allow qualifying patients to use medical marijuana, but the federal government can still arrest patients there.

Response B: For many people, the only availability exists within the criminal market, which can expose them to danger and possibly tainted medicine. State-level medical marijuana laws remove that danger, as would federal regulation allowing states to determine their own marijuana policies.

CHALLENGE #32: “The Supreme Court ruled that marijuana is not medicine and that states can’t legalize medical marijuana.”

Response A: That is not true. In fact, the majority opinion in the Supreme Court’s June 2005 decision in Gonzales v. Raich stated unequivocally that “marijuana does have valid therapeutic purposes.” The ruling did not overturn state medical marijuana laws or prevent states from enacting new ones. It simply preserved the status quo as it has been since California passed Proposition 215 in 1996: States can stop arresting medical marijuana patients under state law, but these laws don’t create immunity from federal prosecution (however, the Obama administration indicated in October 2009 that it generally would not prosecute medical marijuana activities that are permitted by state laws).

Response B: The Supreme Court’s other ruling related to medical marijuana — in a 2001 case involving a California medical marijuana dispensary — also did not over-turn state medical marijuana laws. It simply declared that under federal law, those distributing medical marijuana cannot use a “medical necessity” defense in federal court. This extremely narrow ruling did not in any way curb the rights of states to protect patients under state law. Indeed, the U.S. Department of Justice has never even tried to challenge the rights of states to enact such laws. Notably, in both cases the court went out of its way to leave open the possibility that individual patients could successfully present a “medical necessity” claim.

CHALLENGE #33: “Marijuana use can increase the risk of serious mental illness, including schizophrenia.”

Response: There remains no convincing evidence that marijuana causes psychosis in otherwise healthy individuals. Overall, the evidence suggests that marijuana can precipitate schizophrenia in vulnerable individuals but is unlikely to cause the illness in otherwise normal persons.48 Epidemiological data show no correlation between rates of marijuana use and rates of psychosis or schizophrenia: Countries with high rates of marijuana use don’t have higher rates of these illnesses than countries where

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marijuana use is rarer, and research has consistency failed to find a connection be-tween increases in marijuana use and increased rates of psychosis.49, 50 As with all medications, the physician needs to consider what is an appropriate medication in light of the individual patient’s situation, and may well suggest avoiding marijuana or cannabinoids in patients with a family or personal history of psychosis. This is the sort of risk/benefit assessment that physicians are trained to make.

CHALLENGE #34: “Aren’t medical marijuana dispensaries and distributors just fronts for illegal drug dealers? If they are only providing medicine, why are they making so much money?”

Response A: Illegal drug dealers don’t pay taxes. In 2010, California’s medical mari-juana industry reported $1.5 billion in revenue and paid more than $150 million in state, local, and federal taxes.

Response B: Well-run businesses tend to make money. That does not make them criminals. The pharmaceutical industry reports record profits nearly every year, but they are not punished for it.

Response C: A regulated medical marijuana industry is the only thing keeping pa-tients away from the illicit market. In the absence of dispensaries, patients are forced to procure medicine from criminals who may not provide the quality of medicine that they require. A regulated distribution system allows safe access to medicine for patients, and allows the industry to best serve those patients while under the protec-tion of the law.

OTHER USEFUL SOUND BITES

• Which is worse for seriously ill people: marijuana or prison?• Saying that the THC pill is medicine but marijuana must stay illegal is like saying, “You can have a vitamin C pill, but we’ll throw you in jail for eating an orange.”

• I’m very concerned about the message that’s sent to children when government of-ficials deny marijuana’s medicinal value. They’re destroying the credibility of drug education.

• The central issue is not research, and it’s not the FDA. The issue is arresting patients.

• How many more studies do we need to determine that seriously ill people should not be arrested for using their medicine?

• Hundreds of thousands of patients are already using medical marijuana. Should they be arrested and sent to prison? If so, then the laws should remain exactly as they are.

• Arrest suffering, not patients.

• As long as we have a war on drugs, let’s remove the sick and wounded from the battlefield.

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State-By-State Report 2011FOR FURTHER INFORMATION

Please refer reporters and elected officials to MPP for information. MPP will provide further documentation upon request for any of the points made in this paper.

ACKNOWLEDGMENTSThis paper is based on an original document written by MPP co-founder Chuck Thomas,

with assistance from the following people, who provided peer-review and numerous suggestions: Rick Doblin, Ph.D., Multidisciplinary Association for Psychedelic Studies; Dave Fratello, Americans for Medical Rights; Dale Gieringer, Ph.D., California NORML; Eric Sterling, Criminal Justice Policy Foundation; Ty Trippet, The Lindesmith Center (now known as the Drug Policy Alliance); and Kendra Wright. Valuable assistance has also been provided by Ethan Russo, editor of Journal of Cannabis Therapeutics; Mitch Earleywine, Ph.D., University at Albany, State University of New York; Stephen Sidney, M.D., Kaiser Permanente Division of Research; and Leslie Iversen, Ph.D., University of Oxford, Division of Pharmacology.

FOOTNOTES1 Institute of Medicine, Marijuana and Medicine: Assessing the Science Base (Washington, D.C.: National Academy Press,

1999), 159.2 Abrams, D., Jay, C., Shade, S., Vizoso, H., Reda, H., Press S., Kelly M., Rowbotham M., and Petersen, K., “Cannabis in

painful HIV-associated sensory neuropathy: A randomized placebo-controlled trial,” Neurology. 68: 515-521.3 Wilsey, B. et al., “A randomized, placebo-controlled, crossover trial of cannabis cigarettes in neuropathic pain.” The

Journal of Pain. 9(6):506-521.4 Ellis, R.J. et al., “Smoked medicinal cannabis for neuropathic pain in HIV: a randomized, crossover clinical trial.”

Neuropsychopharmacology. Published online ahead of print, Aug. 6, 2008.5 Sylvestre D., Clements B.,Malibu Y, “Cannabis use improves retention and virological outcomes in patients treated for

hepatitis C,” European Journal of Gastroenterology & Hepatology 2006, 18:1057-1063.6 “In the Matter of Marijuana Rescheduling Petition,” DEA Docket No. 86-22, September 6, 1988.7 American College of Physicians, “Supporting Research into the Therapeutic Role of Marijuana,” 2008.8 Institute of Medicine, 159.9 Institute of Medicine, 3-4.10 Institute of Medicine, 153.11 Baker, David, et al., “The Therapeutic Potential of Cannabis,” The Lancet Neurology 2: May 2003, 291-298.12 “Report on the Possible Medical Uses of Marijuana,” NIH medicinal marijuana expert group, Rockville, MD, National

Institutes of Health, August 8, 1997; note 8, 89.13 Izzo A.A. et al. “Non-Psychotropic Plant Cannabinoids: New Therapeutic Opportunities From an Ancient Herb,” Trends

in Pharmacological Sciences, 30(10): 515-527. 2009.14 Mechoulam R., et al., “Cannabidiol — Recent Advances, ”Chemistry and Biodiversity 4: 1678-1692, 2007.15 Institute of Medicine, 7.16 GW Pharmaceuticals, “Product Monograph: Sativex,” April 13, 2005, 27.17 Harris, Gardiner, “FDA Dismisses Medical Benefit From Marijuana,” New York Times, April 21, 2006.18 “Report to Attorney General Bill Lockyer, 11th Biennial California Student Survey, Grades 7, 9 and 11,” WestEd, 2006.19 Ammerman, Seth, M.D. “Medical Marijuana: Update for the Pediatrician,” California Pediatrician, Vol. 27, No. 1 (Winter

2011): 11-13.20 Skager, Rodney; Austin, Greg; and Wong, Mamie, “Marijuana Use and the Response to Proposition 215 Among California

Youth, a Special Study From the California Student Substance Use Survey (Grades 7, 9, and 11) 1997-98.” 8.21 Institute of Medicine, 5.22 Sidney S. et al., “Marijuana Use and Mortality,” American Journal of Public Health 87(4), April 1997, 585-590.23 Lee, William, “Acetaminophen and the U.S. Acute Liver Failure Study Group: Lowering the Risk of Hepatic Failure,”

Hepatology, 40 (1)(2004), 6-9.24 Letter from Beverly Urbanek, Research Associate of the University of Mississippi Research Institute of Pharmaceutical

Sciences (601-232-5914), to Dr. G. Alan Robison, Drug Policy Forum of Texas, June 13, 1996.25 Institute of Medicine, 109.26 Institute of Medicine, 126.27 Abrams D., et al., “Short-Term Effects of Cannabinoids in Patients With HIV-1Infection,” Annals of Internal Medicine,

2003;139:258-266.

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128 Di Franco M.J., et al., “The Lack of Association of Marijuana and Other Recreational Drugs With Progression to AIDS in

the San Francisco Men’s Health Study,” Annals of Epidemiology, 6 (4) (1996), 283-289.29 Romeyn, Mary, Nutrition and HIV: A New Model for Treatment, second edition (San Francisco: Jossey-Bass, 1998), 117-

118.30 “Transcripts of Open Discussions Held on February 20, 1997, Book Two, Tab C, Pp. 96-97; Washington, D.C.: ACE-

Federal Reporters, Inc.31 General Accounting Office, “Report to the Chairman, Subcommittee on Criminal Justice, Drug Policy and Human

Resources, Committee on Government Reform, U.S. House of Representatives. Marijuana: Early Experiences With Four States’ Laws that Allow Use for Medical Purposes” (Washington, D.C.: GAO, 2002), 32.

32 Office of the Attorney General, Arrests by City and County. Data downloaded from http://ag.ca.gov/cjsc/datatabs.php. Accessed 12-23-09.

33 Marijuana Policy Project, “Proposition 215 Ten Years Later: Medical Marijuana Goes Mainstream,” November 2006.34 Hallinan, Terence, “Medical Marijuana: Feds Should Stop Their Attack,” Desert Post Weekly, June 6, 2002.35 Crime in the United States, FBI division of Uniform Crime Reports; Washington, D.C.: U.S. Government Printing Office,

annual series from 1970 to 2008.36 Carter, Gregory T. et al., “Medicinal Cannabis: Rational Guidelines for Dosing,” IDrugs 2004 7(5). P. 464-470.37 Earleywine, Mitch, Understanding Marijuana. Oxford University Press, 2002, 171.38 GW Pharmaceuticals, 37.39 Abrams, D.I. et al., “Vaporization as a Smokeless Cannabis Delivery System: A Pilot Study,” Clinical Pharmacology and

Therapeutics, April 11, 2007,; [Epub ahead of print].40 Earleywine, M., Barnwell, S.S., “Decreased Respiratory Symptoms in Cannabis Users Who Vaporize,” Harm Reduction

Journal, 2007, 4:11.41 Institute of Medicine, 119.42 Sidney, Stephen, et al., “Marijuana use and cancer incidence (California, United States),” Cancer Causes and Control 8,

1997, 722-728.43 Hashibe, Mia et al., “Marijuana Use and the Risk of Lung and Upper Aerodigestive Tract Cancers: Results of a Population-

Based Case-Control Study,” Cancer Epidemiology, Biomarkers and Prevention, 2006;15(10). pp. 1829-1834.44 Hoeffel, John, “Medical Marijuana Gets a Boost From Major Doctors Group,” Los Angeles Times, Nov. 11, 2009.45 Elders, Joycelyn, “Myths About Medical Marijuana,” Providence Journal, March 26, 2004.46 “Partial List of Organizations with Favorable Medicinal Marijuana Positions,” State-By-State Report, Marijuana Policy

Project, 2008.47 HCD Research, “Physicians and Consumers Approve of Medical Marijuana Use,” June 9, 2005.48 Hall W., Degenhardt L., “What are the policy implications of the evidence on cannabis and psychosis?” Canadian Journal

of Psychiatry, 2006 Aug; 51(9):566-574.49 Hall W. “Is Cannabis Use Psychotogenic?” The Lancet, vol. 367, Jan. 22, 2006.50 Frisher M. et al. “Assessing the Impact of Cannabis Use on Trends in Diagnosed Schizophrenia in the United Kingdom

from 1996 to 2005,” Schizophrenia Research, vol. 113, September 2009.

9/11

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State-By-State Report 2011Appendix P: Partial List of Organizations with Favorable Positions on Medical MarijuanaDefinitions

Legal/prescriptive access: This category encompasses the strongest of all favorable medical marijuana positions. Although the exact wording varies, or-ganizations advocating “legal/prescriptive access” assert that marijuana should be legally available upon a doctor’s official approval. Some groups say that marijuana should be “rescheduled” and/or moved into a specified schedule (e.g., Schedule II) of the federal Controlled Substances Act; others say that doc-tors should be allowed to “prescribe” marijuana or that it should be available “under medical supervision.” These organizations support changing the law so that marijuana would be as available through pharmacies as other tightly con-trolled prescription drugs, like morphine or cocaine. This category also includes endorsements of specific efforts to remove state-level criminal penalties for medi-cal marijuana use with a doctor’s approval.

Compassionate access: Organizations with positions in this category assert that patients should have the opportunity to apply to the government for special per-mission to use medical marijuana on a case-by-case basis. Most groups in this category explicitly urge the federal government to re-open the compassionate ac-cess program that operated from 1978 until 1992, when it was closed to all new applicants. (Only four patients still receive free marijuana from the federal govern-ment.) “Compassionate access” is a fairly strong position, as it acknowledges that at least some patients should be allowed to administer natural, whole marijuana right now. However, access to marijuana would be more restrictive than access to legally available prescription drugs, as patients would have to jump through vari-ous bureaucratic hoops to receive special permission.

Research: This category includes positions urging the government to make it easier for scientists to conduct research into the medical efficacy of natural mari-juana that can be vaporized or smoked. Many of these groups have recognized that the federal government’s current medical marijuana research guidelines are un-necessarily burdensome. Modifying the guidelines would increase the likelihood that the FDA could eventually approve natural, whole marijuana as a prescrip-tion medicine. These groups want patients to be allowed to administer marijuana as research subjects and — if the results are favorable — to eventually qualify marijuana as an FDA-approved prescription drug. Groups listed with “research” positions differ from the White House Office of National Drug Control Policy and numerous other drug war hawks who claim to support research. Such groups are not listed if they (1) oppose research that has a realistic chance of leading to FDA approval of natural marijuana, or (2) actively support the laws that criminalize patients currently using medical marijuana. (At worst, some of the groups listed as supporting research are silent on the issue of criminal penalties — but many, in fact, concurrently endorse legal/prescriptive access and/or compassionate access.)

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ape

Cod

8/20

093

“The

AID

S Su

ppor

t Gro

up o

f Cap

e Cod

… u

rges

the

Mas

-sa

chus

etts

Gen

eral

Cou

rt to

pas

s leg

islat

ion

that

ens

ures

th

at li

cens

ed m

edic

al d

octo

rs w

ill n

ot b

e cr

imin

ally

pu

nish

ed fo

r rec

omm

endi

ng th

e m

edic

al u

se o

f mar

ijuan

a to

serio

usly

ill p

eopl

e, an

d se

rious

ly il

l peo

ple

will

not

be

subj

ect t

o cr

imin

al sa

nctio

ns fo

r usin

g m

ariju

ana

if th

e pa

tient

’s ph

ysic

ian

has t

old

the

patie

nt th

at su

ch u

se is

lik

ely

to b

e be

nefic

ial.

Fur

ther

, suc

h pa

tient

s sho

uld

not

be fo

rced

to se

ek th

eir m

edic

ine

on th

e cr

imin

al m

arke

t, bu

t rat

her t

hrou

gh sa

fe, s

tate

-rec

ogni

zed

disp

ensa

ries.”

Lette

r to

Mat

thew

Alle

n, E

xecu

tive

Dire

ctor

of M

assa

chus

etts

Pat

ient

s A

dvoc

acy

Alli

ance

Ala

ska

Nur

ses A

ssoc

iatio

n9/

1998

3A

cces

s und

er a

phy

sicia

n’s su

perv

ision

AN

A R

esol

utio

n: S

epte

mbe

r 199

8A

lban

y (N

Y) C

omm

on C

ounc

il6/

2/20

033

“Be

it re

solv

ed, t

hat t

he A

lban

y C

omm

on C

ounc

il ca

lls

on th

e N

ew Y

ork

Stat

e Le

gisla

ture

to a

dopt

A. 5

796

whi

ch

wou

ld le

galiz

e th

e po

sses

sion,

man

ufac

ture

, sal

e, ad

min

is-tr

atio

n, d

eliv

ery,

disp

ensin

g, a

nd d

istrib

utio

n of

mar

ijuan

a in

conn

ectio

n w

ith m

edic

al u

se fo

r cer

tifie

d pa

tient

s.”

Reso

lutio

n N

umbe

r 61.

52.0

3R in

sup-

port

of A

. 579

6, N

ew Y

ork

med

ical

m

ariju

ana

bill

Am

eric

an A

cade

my

of F

amily

Ph

ysic

ians

1995

3“T

he A

mer

ican

Aca

dem

y of

Fam

ily P

hysic

ians

[doe

s not

op

pose

] the

use

of m

ariju

ana

... u

nder

med

ical

supe

rvi-

sion

and

cont

rol f

or sp

ecifi

c med

ical

indi

catio

ns.”

1996

-199

7 A

AFP

Ref

eren

ce M

anua

l -

Sele

cted

Pol

icie

s on

Hea

lth Is

sues

Am

eric

an A

cade

my

of H

IV

Med

icin

e (A

AH

IVM

) 11

/11/

2003

33

3“W

e su

ppor

t sta

te a

nd fe

dera

l leg

islat

ion

not o

nly

to

rem

ove

crim

inal

pen

altie

s ass

ocia

ted

with

med

ical

mar

i-ju

ana,

but

furt

her t

o ex

clud

e m

ariju

ana/

cann

abis

from

cl

assif

icat

ion

as a

Sch

edul

e I d

rug.”

Oth

er: s

uppo

rt in

corp

orat

ing

a m

edic

al m

ariju

ana

dist

ri-bu

tion

prog

ram

into

stat

e an

d lo

cal d

eliv

ery

syst

ems o

f ca

re

Lette

r to

New

Yor

k A

ssem

blym

an R

ich-

ard

Got

tfrie

d, C

hair

of th

e A

ssem

bly

Hea

lth C

omm

ittee

, in

supp

ort o

f the

N

ew Y

ork

Ass

embl

y m

edic

al m

ariju

ana

bill,

A.5

796

Am

eric

an A

nthr

opol

ogic

al

Ass

ocia

tion

9/20

033

33

“We

seek

to re

peal

law

s whi

ch p

enal

ize

or p

rohi

bit t

he

peac

eful

, per

sona

l, re

ligio

us, s

cien

tific

, med

ical

, agr

icul

-tu

ral,

spiri

tual

, art

istic

, hist

oric

al, a

nd/o

r ind

ustr

ial u

ses o

f C

anna

bis,

Mar

ijuan

a, H

emp.

We

favo

r law

s whi

ch p

erm

it su

ch b

enef

icia

l use

s.”

Reso

lutio

n fr

om 2

003

Ann

ual M

eetin

g

Am

eric

an B

ar A

ssoc

iatio

n2/

1984

; 5/

4/19

983

3Re

solu

tion;

lette

r to

U.S

. Hou

se Ju

dici

a-ry

Com

mitt

ee o

ppos

ing

an a

nti-m

edic

al

mar

ijuan

a re

solu

tion

Page 162: State by State Laws Report 2011

P-4

Stat

e-By

-Sta

te R

epor

t 201

1

Appe

ndix

P: P

artia

l List

of O

rgan

izat

ions

with

Fav

orab

le P

ositi

ons o

n M

edic

al M

ariju

ana

Part

ial L

ist o

f Org

aniz

atio

ns F

avor

ing

Lega

l/Pre

scri

ptiv

e A

cces

s to

Med

ical

Mar

ijuan

a

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

R

esea

rch

O

ther

Com

men

tsR

efer

ence

AFS

CM

E (A

mer

ican

Fed

erat

ion

of S

tate

, Cou

nty

& M

unic

ipal

Em

ploy

ees)

8/20

063

“AFS

CM

E en

dors

es a

nd su

ppor

ts le

galiz

atio

n of

med

ical

m

ariju

ana

for a

ppro

pria

te m

edic

ally

indi

cate

d ai

lmen

ts

incl

udin

g bu

t not

lim

ited

to H

IV/A

IDS,

can

cer,

glau

com

a,

epile

psy,

arth

ritis,

and

the

othe

r med

ical

cond

ition

s list

ed

here

in.”

Reso

lutio

n N

o: 9

3, 3

7th A

nnua

l Int

er-

natio

nal C

onve

ntio

n, C

hica

go, I

llino

is,

Augu

st 7

-11,

200

6

Am

eric

an M

edic

al S

tude

nt

Ass

ocia

tion

3/19

933

AM

SA H

ouse

of D

eleg

ates

Res

olut

ion

#12

Am

eric

an N

urse

s Ass

ocia

tion

(AN

A)

3/20

043

33

Lega

l/pre

scrip

tive

acce

ss, c

ompa

ssio

nate

acc

ess:

“Sup

port

th

e rig

ht o

f pat

ient

s to

have

safe

acc

ess t

o …

mar

ijuan

a un

der a

ppro

pria

te p

resc

riber

supe

rvisi

on …

Sup

port

the

abili

ty o

f hea

lth c

are

prov

ider

s to

disc

uss a

nd/o

r rec

om-

men

d th

e med

icin

al u

se o

f mar

ijuan

a w

ithou

t the

thre

at o

f in

timid

atio

n or

pen

aliz

atio

n.” A

lso su

ppor

ts re

sche

dulin

g “t

o ex

clud

e m

ariju

ana

from

clas

sific

atio

n as

a S

ched

ule

I dr

ug.”

Posit

ion

Stat

emen

t, “P

rovi

ding

Pat

ient

s Sa

fe A

cces

s to

Ther

apeu

tic M

ariju

ana/

Can

nabi

s,” A

NA

Boa

rd o

f Dire

ctor

s, M

arch

19,

200

4

Am

eric

an P

reve

ntiv

e M

edic

al

Ass

ocia

tion

(now

“Am

eric

an

Ass

ocia

tion

for H

ealth

Fr

eedo

m”)

12/8

/199

7;

12/2

000

33

“Med

icin

al U

se o

f Mar

ijuan

a” p

olic

y st

atem

ent;

signa

tory

of 2

000

lette

r to

U.S

. Dep

t. of

Hea

lth a

nd H

uman

Se

rvic

esA

mer

ican

Pub

lic H

ealth

A

ssoc

iatio

n19

95; 1

2/20

003

33

Pres

crip

tive

acce

ss: “

mar

ijuan

a w

as w

rong

fully

pla

ced

in S

ched

ule

I of t

he C

ontr

olle

d Su

bsta

nces

Act

”; “g

reat

er

harm

is c

ause

d by

the

lega

l con

sequ

ence

s of i

ts p

rohi

bi-

tion

than

pos

sible

risk

s of m

edic

inal

use

Posit

ion

#951

3: A

cces

s to

Ther

apeu

tic

Mar

ijuan

a/C

anna

bis;

signa

tory

of 2

000

lette

r to

U.S

. Dep

t. of

Hea

lth a

nd H

u-m

an S

ervi

ces

Am

eric

ans f

or D

emoc

ratic

A

ctio

n1/

1997

; 12

/200

03

33

Reso

lutio

n ap

prov

ed at

ann

ual m

eetin

g,

Jan.

19-

20, 1

997;

sign

ator

y of

200

0 le

t-te

r to

U.S

. Dep

t. of

Hea

lth a

nd H

uman

Se

rvic

esA

ssoc

iate

d M

edic

al S

choo

ls of

N

ew Y

ork

4/14

/200

43

“Sup

port

s Ass

embl

y Bi

ll A

. 579

6”Le

tter t

o N

ew Y

ork

Ass

embl

yman

Ri

char

d G

ottfr

ied,

chai

r of t

he A

ssem

bly

Hea

lth C

omm

ittee

, in

supp

ort o

f the

N

ew Y

ork

Ass

embl

y m

edic

al m

ariju

ana

bill,

A. 5

796

Ass

ocia

tion

of th

e Ba

r of t

he

City

of N

ew Y

ork,

com

mitt

ee20

073

The

Com

mitt

ee o

n D

rugs

and

the

Law

of t

he A

ssoc

iatio

n of

the

Bar o

f the

City

of N

ew Y

ork

supp

orts

Ass

embl

y Bi

ll A

0486

7. T

he B

ill w

ould

per

mit

the

man

ufac

ture

, del

iver

y, po

sses

sion,

and

use

of m

arih

uana

for m

edic

al p

urpo

ses.”

Repo

rt co

mm

entin

g on

A.4

867,

whi

ch

wou

ld p

erm

it th

e m

anuf

actu

re, d

eliv

ery,

poss

essio

n, a

nd u

se o

f mar

ijuan

a fo

r m

edic

al p

urpo

ses i

n N

ew Y

ork

Page 163: State by State Laws Report 2011

P-5

Appendix P: Partial List of Organizations w

ith Favorable Positions on Medical M

arijuana

State-By-State Report 2011Pa

rtia

l Lis

t of O

rgan

izat

ions

Fav

orin

g Le

gal/P

resc

ript

ive

Acc

ess t

o M

edic

al M

ariju

ana

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

R

esea

rch

O

ther

Com

men

tsR

efer

ence

Buffa

lo (N

Y) C

omm

on C

ounc

il2/

17/2

004

3“T

he C

omm

on C

ounc

il of

the

City

of B

uffa

lo d

oes h

ereb

y su

ppor

t the

ado

ptio

n of

A. 5

796

by th

e N

ew Y

ork

Stat

e Le

gisla

ture

whi

ch w

ould

lega

lize

the

poss

essio

n, m

anu-

fact

ure,

sale

, adm

inist

ratio

n, d

eliv

ery,

disp

ensin

g, a

nd

dist

ribut

ion

of m

ariju

ana

in co

nnec

tion

with

med

ical

use

of

cert

ified

pat

ient

s.”

Reso

lutio

n in

supp

ort o

f A. 5

796,

New

Yo

rk m

edic

al m

ariju

ana

bill

Cam

brid

ge C

ares

Abo

ut A

IDS

10/2

009

3“C

ambr

idge

Car

es …

urg

es th

e M

assa

chus

etts

Gen

eral

C

ourt

to p

ass l

egisl

atio

n th

at en

sure

s tha

t lic

ense

d m

edic

al

doct

ors w

ill n

ot b

e cr

imin

ally

pun

ished

for r

ecom

men

d-in

g th

e m

edic

al u

se o

f mar

ijuan

a to

serio

usly

ill p

eopl

e, an

d se

rious

ly il

l peo

ple

will

not

be

subj

ect t

o cr

imin

al

sanc

tions

for u

sing

mar

ijuan

a if

the

patie

nt’s

phys

icia

n ha

s tol

d th

e pa

tient

that

such

use

is li

kely

to b

e be

nefic

ial.

Fu

rthe

r, su

ch p

atie

nts s

houl

d no

t be

forc

ed to

seek

thei

r m

edic

ine

on th

e cr

imin

al m

arke

t, bu

t rat

her t

hrou

gh sa

fe,

stat

e-re

cogn

ized

disp

ensa

ries.”

Lette

r to

Mas

sach

uset

ts S

tate

Rep

rese

n-ta

tive

Fran

k Sm

izik

Bein

g A

live:

Peo

ple

With

HIV

/A

IDS

Act

ion

Com

mitt

ee

(San

Die

go)

1/3/

1996

; 1/

1997

; 12

/200

0

33

3Le

gal a

cces

s und

er a

phy

sicia

n’s su

perv

ision

and

pre

scrip

-tiv

e ac

cess

Oth

er: e

ndor

sem

ent o

f a p

hysic

ian’s

righ

t to

disc

uss m

ari-

juan

a th

erap

y w

ith a

pat

ient

Lette

r fro

m e

xecu

tive

dire

ctor

sup-

port

ing

the

effo

rts o

f Cal

iforn

ians

for

Com

pass

iona

te U

se; p

lain

tiff i

n C

onan

t v.

McC

affr

ey; s

igna

tory

of 2

000

lette

r to

U.S

. Dep

t. of

Hea

lth a

nd H

uman

Se

rvic

esC

alifo

rnia

Aca

dem

y of

Fa

mily

Phy

sicia

ns19

94; 1

996

3“S

uppo

rt e

ffort

s to

expe

dite

acc

ess t

o ca

nnab

oids

[sic

] for

us

e un

der t

he d

irect

ion

of a

phy

sicia

n”; e

ndor

sed

1996

C

alifo

rnia

Bal

lot P

ropo

sitio

n 21

5

Febr

uary

199

4 st

atem

ent a

dopt

ed b

y A

cade

my’s

Con

gres

s of D

eleg

ates

; 199

6 en

dors

emen

t, re

port

ed v

ia th

e Bu

sines

s W

ire S

ervi

ce, O

ct. 2

9, 1

996

Cal

iforn

ia D

emoc

ratic

Cou

ncil

8/3/

2003

33

“We

call

upon

our

elec

ted

offic

ials

to …

[r]e

form

fede

ral

law

s to

allo

w fo

r the

lega

l cul

tivat

ion

of m

edic

al c

anna

bis

and

its p

rovi

sion

in a

safe

and

ord

erly

man

ner.”

Reso

lutio

n ap

prov

ed at

ann

ual m

eetin

g

Cal

iforn

ia L

egisl

ativ

e C

ounc

il fo

r Old

er A

mer

ican

s12

/1/1

993;

11

/29/

1999

; 12

/200

0

33

3Pr

escr

iptiv

e ac

cess

: urg

es re

sche

dulin

gA

dopt

ed at

23r

d A

nnua

l Act

ion

Con

fer-

ence

; sig

nato

ry o

f 199

9 an

d 20

00 le

tters

to

U.S

. Dep

t. of

Hea

lth a

nd H

uman

Se

rvic

es

Page 164: State by State Laws Report 2011

P-6

Stat

e-By

-Sta

te R

epor

t 201

1

Appe

ndix

P: P

artia

l List

of O

rgan

izat

ions

with

Fav

orab

le P

ositi

ons o

n M

edic

al M

ariju

ana

Part

ial L

ist o

f Org

aniz

atio

ns F

avor

ing

Lega

l/Pre

scri

ptiv

e A

cces

s to

Med

ical

Mar

ijuan

a

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

R

esea

rch

O

ther

Com

men

tsR

efer

ence

Cal

iforn

ia M

edic

al A

ssoc

iatio

n19

97;

1/11

/200

03

33

Oth

er: l

ette

r opp

oses

fede

ral t

hrea

ts a

gain

st d

octo

rs fo

r di

scus

sing

risks

and

ben

efits

of m

ariju

ana

Mar

ch 1

4, 1

997,

lette

r; M

ay 2

1, 1

997,

en

dors

emen

t of C

A re

sear

ch b

ill; a

mic

us

curia

e brie

f sup

port

ing

right

to d

istrib

-ut

e m

edic

al m

ariju

ana

in C

alifo

rnia

(U

.S. v

. Oak

land

Can

nabi

s Buy

ers’

Coo

pera

tive)

Cal

iforn

ia N

urse

s Ass

ocia

tion

9/21

/199

5;

12/2

000

33

Pres

crip

tive

acce

ss: s

uppo

rted

Cal

iforn

ia b

ill A

.B. 1

529

to

rem

ove

pena

lties

for m

edic

al u

seLe

tter t

o C

alifo

rnia

Gov

. Pet

e W

ilson

; sig

nato

ry o

f 200

0 le

tter t

o U

.S. D

ept.

of

Hea

lth a

nd H

uman

Ser

vice

sC

alifo

rnia

Pha

rmac

ists

Ass

ocia

tion

2/19

97;

11/2

9/19

99;

12/2

000

33

3Pr

escr

iptiv

e ac

cess

: acc

ordi

ng to

Ass

ocia

ted

Pres

s, th

e C

PA “p

asse

d a

reso

lutio

n su

ppor

ting

phar

mac

y pa

rtic

ipa-

tion

in th

e le

gal d

istrib

utio

n of

med

ical

mar

ijuan

a”

AP

Fina

ncia

l New

s, 5/

26/9

7; si

gnat

ory

of 1

999

and

2000

lette

rs to

U.S

. Dep

t. of

H

ealth

and

Hum

an S

ervi

ces

Cal

iforn

ia S

ocie

ty o

f Add

ictio

n M

edic

ine

5/19

973

Pres

crip

tive

acce

ss: u

rges

resc

hedu

ling

Cal

iforn

ia S

ocie

ty o

f Add

ictio

n M

edi-

cine

New

s, Sp

ring

1997

Cal

iforn

ia-P

acifi

c Ann

ual

Con

fere

nce

of th

e U

nite

d M

etho

dist

Chu

rch

6/19

963

Pres

crip

tive

acce

ss: v

ia re

solu

tion

(also

end

orse

d C

alifo

r-ni

a 19

96 b

allo

t Pro

posit

ion

215)

Reso

lutio

n 10

4 of

the

Cal

iforn

ia-P

acifi

c A

nnua

l Con

fere

nce

of th

e U

nite

d M

eth-

odist

Chu

rch,

June

12-

16, 1

996

Col

orad

o N

urse

s Ass

ocia

tion

1995

3Pr

escr

iptiv

e ac

cess

: urg

es re

sche

dulin

gC

olor

ado

Nur

ses A

ssoc

iatio

n 19

95 C

on-

vent

ion

Dire

ctor

y an

d Bo

ok o

f Rep

orts

, p.

28

Com

mun

ity H

IV/A

IDS

Mob

iliza

tion

Proj

ect (

CH

AM

P)10

/ 200

73

3Su

ppor

ts le

gal/p

resc

riptiv

e ac

cess

, allo

win

g ph

arm

acy-

like

dist

ribut

ion,

and

rese

arch

, inc

ludi

ng p

rivat

e pr

oduc

tion

of

mar

ijuan

a fo

r res

earc

h; “L

icen

sed

med

ical

doc

tors

shou

ld

not b

e pu

nish

ed fo

r rec

omm

endi

ng m

edic

al u

se o

f mar

i-ju

ana

to se

rious

ly il

l peo

ple,

who

shou

ld n

ot b

e su

bjec

t to

crim

inal

sanc

tions

for u

sing

mar

ijuan

a if

the

patie

nts’

phys

icia

ns h

ave

told

the

patie

nts t

hat s

uch

use

is lik

ely

to

be b

enef

icia

l”

Lette

r fro

m e

xecu

tive

dire

ctor

, Jul

ie

Dav

ids

Con

sum

er R

epor

ts m

agaz

ine

5/19

973

Pres

crip

tive

acce

ss: “

Fede

ral l

aws s

houl

d be

rela

xed

in

favo

r of s

tate

s’ rig

hts t

o al

low

phy

sicia

ns to

adm

inist

er

mar

ijuan

a to

thei

r pat

ient

s on

a ca

ring

and

com

pass

iona

te

basis

.”

May

199

7 C

onsu

mer

Rep

orts

artic

le,

“Mar

ijuan

a as

med

icin

e: H

ow st

rong

is

the

scie

nce?

” Pp.

62-

63

Page 165: State by State Laws Report 2011

P-7

Appendix P: Partial List of Organizations w

ith Favorable Positions on Medical M

arijuana

State-By-State Report 2011Pa

rtia

l Lis

t of O

rgan

izat

ions

Fav

orin

g Le

gal/P

resc

ript

ive

Acc

ess t

o M

edic

al M

ariju

ana

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

R

esea

rch

O

ther

Com

men

tsR

efer

ence

DC

-37

(New

Yor

k C

ity la

bor

unio

n)11

/17/

2009

3“O

n be

half

of th

e 12

5,00

0 m

embe

rs a

nd 5

0,00

0 re

tiree

s, D

istric

t Cou

ncil

37 st

rong

ly su

ppor

ts th

is le

gisla

tion

[A.

9016

] and

urg

es it

pas

sage

.”

Legi

slativ

e m

emo

in su

ppor

t of N

ew

York

med

ical

mar

ijuan

a bi

ll

Episc

opal

Chu

rch

1982

3“T

he E

pisc

opal

Chu

rch

urge

s the

ado

ptio

n by

Con

gres

s an

d al

l sta

tes o

f sta

tute

s pro

vidi

ng th

at th

e us

e of

mar

i-ju

ana

be p

erm

itted

whe

n de

emed

med

ical

ly ap

prop

riate

by

dul

y lic

ense

d m

edic

al p

ract

ition

ers.”

67th

Con

vent

ion

of th

e Ep

iscop

al

Chu

rch

(B-0

04)a

Expo

nent

s, In

c.2/

23/2

004

3“I

am

her

e to

day

to u

rge

the

city

coun

cil t

o pa

ss R

eso-

lutio

n #0

756

that

cal

ls on

the

stat

e le

gisla

ture

to e

nact

m

edic

al m

ariju

ana

legi

slatio

n, A

. 579

6, a

lso k

now

n as

the

Got

tfrie

d bi

ll.”

Test

imon

y by

How

ard

Jose

pher

, CSW

, Ex

ecut

ive

Dire

ctor

, Exp

onen

ts, I

nc. t

o th

e N

ew Y

ork

City

Cou

ncil

Fam

ily S

ervi

ce o

f Rho

de Is

land

10/2

008

33

“Fam

ily S

ervi

ce o

f RI u

rges

that

serio

usly

ill p

atie

nts

who

se d

octo

rs h

ave

told

them

that

the

med

ical

use

of

mar

ijuan

a is

likel

y to

be

bene

ficia

l sho

uld

not b

e ar

rest

ed

for i

ts u

se a

nd sh

ould

hav

e sa

fe a

cces

s to

med

ical

mar

i-ju

ana

from

pha

rmac

y-lik

e no

n-pr

ofit

esta

blish

men

ts.”

Reso

lutio

n ap

prov

ed O

ctob

er 2

008

Gay

Men

’s H

ealth

Cris

is20

053

“GM

HC

will

cont

inue

to su

ppor

t pas

sage

of l

egisl

atio

n th

at w

ould

allo

w p

atie

nts s

uffe

ring

from

serio

us il

lnes

ses

to h

ave

lega

l acc

ess t

o m

ariju

ana

unde

r med

ical

supe

rvi-

sion.”

2005

NYS

Leg

islat

ive

Age

nda

Gra

y Pa

nthe

rs12

/200

03

3Le

gal a

cces

s: “w

e st

rong

ly su

ppor

t … e

ffort

s to

refo

rm

stat

e an

d fe

dera

l law

so th

at p

atie

nts m

ay u

se m

ariju

ana

whe

n th

eir d

octo

rs b

elie

ve it

wou

ld b

e be

nefic

ial t

o th

em”;

urge

s res

ched

ulin

g

Sign

ator

y of

200

0 le

tter t

o U

.S. D

ept.

of

Hea

lth a

nd H

uman

Ser

vice

s

Haw

aii N

urse

s Ass

ocia

tion

10/2

1/19

99;

12/2

000

33

“Sup

port

legi

slatio

n to

rem

ove

stat

e le

vel c

rimin

al p

enal

-tie

s for

bot

h bo

na fi

de m

edic

al m

ariju

ana

patie

nts a

nd

thei

r hea

lthca

re p

rovi

ders

Reso

lutio

n; si

gnat

ory

of 2

000

lette

r to

U.S

. Dep

t. of

Hea

lth a

nd H

uman

Se

rvic

esIll

inoi

s Nur

ses A

ssoc

iatio

n12

/200

4 4/

30/2

007

33

33

“The

Illin

ois N

urse

s Ass

ocia

tion

supp

orts

the

posit

ion

of

the

AN

A a

nd w

ill b

e co

unte

d am

ong

the

orga

niza

tions

th

at su

ppor

t the

righ

t of p

atie

nts t

o ac

cess

lega

lly a

nd

safe

ly th

erap

eutic

can

nabi

s, an

d th

e rig

ht o

f pro

vide

rs to

pr

escr

ibe,

with

out r

ecrim

inat

ion,

ther

apeu

tic c

anna

bis f

or

thei

r pat

ient

s.”

“Pos

ition

Pap

er o

n Pr

ovid

ing

Patie

nts

Safe

Acc

ess t

o Th

erap

eutic

Mar

ijuan

a/C

anna

bis,”

Dec

embe

r 200

4; si

gnat

ory

of

2000

lette

r to

U.S

. Dep

t. of

Hea

lth a

nd

Hum

an S

ervi

ces

Page 166: State by State Laws Report 2011

P-8

Stat

e-By

-Sta

te R

epor

t 201

1

Appe

ndix

P: P

artia

l List

of O

rgan

izat

ions

with

Fav

orab

le P

ositi

ons o

n M

edic

al M

ariju

ana

Part

ial L

ist o

f Org

aniz

atio

ns F

avor

ing

Lega

l/Pre

scri

ptiv

e A

cces

s to

Med

ical

Mar

ijuan

a

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

R

esea

rch

O

ther

Com

men

tsR

efer

ence

Inte

rnat

iona

l Nur

ses S

ocie

ty o

n A

ddic

tions

5/1/

1995

33

Has

sinc

e m

odifi

ed it

s sup

port

of p

resc

riptiv

e ac

cess

“Pos

ition

Pap

er: A

cces

s to

Ther

apeu

tic

Can

nabi

s,” ap

prov

ed b

y In

tNSA

Boa

rd

of D

irect

ors

Iow

a Bo

ard

of P

harm

acy

2/17

/ 201

03

The

Iow

a Bo

ard

of P

harm

acy

toda

y iss

ued

a re

com

-m

enda

tion

that

the

Iow

a Le

gisla

ture

recl

assif

y m

ariju

ana

from

Sch

edul

e I o

f the

Iow

a C

ontr

olle

d Su

bsta

nces

Act

in

to S

ched

ule

II o

f the

Act

. . .

. In

add

ition

, the

Boa

rd o

f Ph

arm

acy

is re

com

men

ding

the

Legi

slatu

re co

nven

e a

task

forc

e or

stud

y co

mm

ittee

for t

he p

urpo

se o

f mak

-in

g re

com

men

datio

ns b

ack

to th

e Le

gisla

ture

rega

rdin

g th

e ad

min

istra

tion

of a

med

ical

mar

ijuan

a pr

ogra

m .

. .

Resc

hedu

ling

of m

ariju

ana

is th

e fir

st st

ep o

f a p

roce

ss

that

coul

d ul

timat

ely

resu

lt in

lega

lizat

ion

for m

edic

al

purp

oses

.”

“Iow

a Bo

ard

of P

harm

acy

Issu

es R

ecom

-m

enda

tion”

, Iow

a D

epar

tmen

t of P

ublic

H

ealth

New

s Rel

ease

, Feb

ruar

y 17

, 201

0

Iow

a D

emoc

ratic

Par

ty20

033

Con

sum

er P

rote

ctio

n: “W

e su

ppor

t leg

aliz

ing

the

med

ical

us

e of

mar

ijuan

a …

”20

03 P

arty

Pla

nk 5

9

Leuk

emia

& L

ymph

oma

Soci

ety

July

200

73

“Sup

port

s leg

islat

ion

to re

mov

e cr

imin

al a

nd ci

vil s

anc-

tions

for t

he d

octo

r-ad

vise

d, m

edic

al u

se o

f mar

ijuan

a by

pa

tient

s with

serio

us p

hysic

al m

edic

al co

nditi

ons”

Reso

lutio

n ap

prov

ed Ju

ly 2

007

Life

Ext

ensio

n Fo

unda

tion

3/19

97;

12/2

000

33

Com

plai

nt fo

r dec

lara

tory

judg

men

t an

d in

junc

tive

relie

f, Pe

arso

n an

d Sh

ow

v. M

cCaf

frey

; sig

nato

ry o

f 200

0 le

tter

to U

.S. D

ept.

of H

ealth

and

Hum

an

Serv

ices

Lym

phom

a Fo

unda

tion

of

Am

eric

a 1/

1997

; 11

/29/

1999

33

3Pr

escr

iptiv

e ac

cess

: urg

es re

sche

dulin

gRe

solu

tion;

sign

ator

y of

199

9 le

tter

to U

.S. D

ept.

of H

ealth

and

Hum

an

Serv

ices

Mar

ylan

d Bo

ard

of P

harm

acy

3/8/

2010

33

3“T

he B

oard

supp

orts

the

conc

ept o

f allo

win

g m

edic

al

mar

ijuan

a to

be

pres

crib

ed a

nd d

ispen

sed

in M

aryl

and.”

Lette

r to

Pete

r Ham

men

, Cha

ir, M

ary-

land

Hou

se H

ealth

& G

over

nmen

t O

pera

tions

Com

mitt

eeM

aryl

and

Nur

ses A

ssoc

iatio

n2/

26/2

010

33

33

“Res

earc

h ha

s sho

wn

the

valu

e of

the

med

ical

use

of m

ari-

juan

a in

alle

viat

ing

pain

and

miti

gatin

g na

usea

. The

re is

no

reas

on to

den

y th

is us

eful

med

ical

tool

to p

hysic

ians

an

d th

eir p

atie

nts.

Our

pat

ient

s are

suffe

ring

beca

use

of

the

arbi

trar

y di

stin

ctio

n be

twee

n m

edic

al m

ariju

ana

and

othe

r pre

scrib

ed m

edic

atio

ns.”

Test

imon

y to

the

Mar

ylan

d H

ouse

Judi

-ci

ary

and

Hea

lth &

Gov

ernm

ent O

pera

-tio

ns C

omm

ittee

s, Fe

brua

ry 2

6, 2

010

Page 167: State by State Laws Report 2011

P-9

Appendix P: Partial List of Organizations w

ith Favorable Positions on Medical M

arijuana

State-By-State Report 2011Pa

rtia

l Lis

t of O

rgan

izat

ions

Fav

orin

g Le

gal/P

resc

ript

ive

Acc

ess t

o M

edic

al M

ariju

ana

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

R

esea

rch

O

ther

Com

men

tsR

efer

ence

Mar

ylan

d Ph

arm

acist

s A

ssoc

iatio

n2/

25/2

010

33

3Th

e M

aryl

and

Phar

mac

ists A

ssoc

iatio

n su

ppor

ts [m

edic

al

mar

ijuan

a le

gisla

tion]

. Stu

dies

hav

e sh

own

that

mar

ijuan

a ca

n be

use

ful i

n al

levi

atin

g pa

in a

nd su

fferin

g.

Test

imon

y to

the

Mar

ylan

d H

ouse

Judi

-ci

ary

and

Hea

lth &

Gov

ernm

ent O

pera

-tio

ns C

omm

ittee

s, Fe

brua

ry 2

5, 2

010

Mas

sach

uset

ts C

hapt

er o

f Le

ukem

ia &

Lym

phom

a So

ciet

y9/

2009

3“T

he L

euke

mia

and

Lym

phom

a So

ciet

y …

urg

es th

e M

as-

sach

uset

ts G

ener

al C

ourt

to p

ass l

egisl

atio

n th

at e

nsur

es

that

lice

nsed

med

ical

doc

tors

will

not

be

crim

inal

ly

puni

shed

for r

ecom

men

ding

the

med

ical

use

of m

ariju

ana

to se

rious

ly il

l peo

ple,

and

serio

usly

ill p

eopl

e w

ill n

ot b

e su

bjec

t to

crim

inal

sanc

tions

for u

sing

mar

ijuan

a if

the

patie

nt’s

phys

icia

n ha

s tol

d th

e pa

tient

that

such

use

is

likel

y to

be

bene

ficia

l. F

urth

er, s

uch

patie

nts s

houl

d no

t be

forc

ed to

seek

thei

r med

icin

e on

the

crim

inal

mar

ket,

but r

athe

r thr

ough

safe

, sta

te-r

ecog

nize

d di

spen

sarie

s.”

Lette

r to

Mat

thew

Alle

n, E

xecu

tive

Dire

ctor

of M

assa

chus

etts

Pat

ient

s A

dvoc

acy

Alli

ance

Mas

sach

uset

ts H

epat

itis

Empo

wer

men

t Pro

ject

12/2

009

3“T

he M

assa

chus

etts

Hep

atiti

s Pat

ient

Em

pow

erm

ent P

roj-

ect,

a pa

tient

com

mun

ity-b

ased

adv

ocac

y or

gani

zatio

n fo

r peo

ple

livin

g w

ith v

iral h

epat

itis,

exte

nds i

ts su

ppor

t to

the

Mas

sach

uset

ts P

atie

nt A

dvoc

acy

Alli

ance

cam

paig

n fo

r leg

aliz

ed m

edic

al m

ariju

ana.”

Lette

r to

Mas

sach

uset

ts S

tate

Rep

rese

n-ta

tive

Fran

k Sm

izik

Mas

sach

uset

ts B

reas

t Can

cer

Coa

litio

n8/

2009

3“T

he M

assa

chus

etts

Bre

ast C

ance

r Coa

litio

n …

urg

es th

e M

assa

chus

etts

Gen

eral

Cou

rt to

pas

s leg

islat

ion

that

en-

sure

s tha

t lic

ense

d m

edic

al d

octo

rs w

ill n

ot b

e cr

imin

ally

pu

nish

ed fo

r rec

omm

endi

ng th

e m

edic

al u

se o

f mar

ijuan

a to

serio

usly

ill p

eopl

e, an

d se

rious

ly il

l peo

ple

will

not

be

subj

ect t

o cr

imin

al sa

nctio

ns fo

r usin

g m

ariju

ana

if th

e pa

tient

’s ph

ysic

ian

has t

old

the

patie

nt th

at su

ch u

se is

lik

ely

to b

e be

nefic

ial.

Fur

ther

, suc

h pa

tient

s sho

uld

not

be fo

rced

to se

ek th

eir m

edic

ine

on th

e cr

imin

al m

arke

t, bu

t rat

her t

hrou

gh sa

fe, s

tate

-rec

ogni

zed

disp

ensa

ries.”

Lette

r to

Mat

thew

Alle

n, E

xecu

tive

Dire

ctor

of M

assa

chus

etts

Pat

ient

s A

dvoc

acy

Alli

ance

Page 168: State by State Laws Report 2011

P-10

Stat

e-By

-Sta

te R

epor

t 201

1

Appe

ndix

P: P

artia

l List

of O

rgan

izat

ions

with

Fav

orab

le P

ositi

ons o

n M

edic

al M

ariju

ana

Part

ial L

ist o

f Org

aniz

atio

ns F

avor

ing

Lega

l/Pre

scri

ptiv

e A

cces

s to

Med

ical

Mar

ijuan

a

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

R

esea

rch

O

ther

Com

men

tsR

efer

ence

Mas

sach

uset

ts N

urse

s A

ssoc

iatio

n4/

2010

3 “T

he M

assa

chus

etts

Nur

se A

ssoc

iatio

n th

eref

ore

urge

s th

e M

assa

chus

etts

Gen

eral

Cou

rt to

pas

s leg

islat

ion

that

en

sure

s tha

t lic

ense

d m

edic

al d

octo

rs w

ill n

ot b

e crim

inal

-ly

pun

ished

for r

ecom

men

ding

the

med

ical

use

of m

ari-

juan

a to

serio

usly

ill p

eopl

e, an

d se

rious

ly il

l peo

ple

will

no

t be

subj

ect t

o cr

imin

al sa

nctio

ns fo

r usin

g m

ariju

ana

if th

eir p

hysic

ian

has t

old

them

that

such

use

is li

kely

to

be b

enef

icia

l. F

urth

er, s

uch

patie

nts s

houl

d no

t be

forc

ed

to se

ek th

eir m

edic

ine

on th

e cr

imin

al m

arke

t, bu

t rat

her

thro

ugh

safe

, sta

te-r

ecog

nize

d tr

eatm

ent c

ente

rs.”

Lette

r to

Mas

sach

uset

ts S

tate

Rep

rese

n-ta

tive

Fran

k Sm

izik

Med

Chi

: The

Mar

ylan

d St

ate

Med

ical

Soc

iety

9/26

/201

03

33

“[M

]edi

cal m

ariju

ana

can

relie

ve su

fferin

g an

d he

lp

patie

nts c

ope

with

serio

us m

edic

al co

nditi

ons w

hen

conv

entio

nal t

reat

men

ts h

ave

faile

d. [C

]urr

ent e

vide

nce

sugg

ests

that

med

ical

mar

ijuan

a ca

n re

lieve

intr

acta

ble

naus

ea, m

uscl

e sp

asm

s, an

d im

prov

e ap

petit

e in

pat

ient

s w

ith d

ebili

tatin

g ch

roni

c illn

esse

s inc

ludi

ng c

ance

r, m

ul-

tiple

scle

rosis

, and

AID

S.”

Reso

lutio

n 12

-10;

ado

pted

by

boar

d of

de

lega

tes,

Sept

embe

r 26,

201

0

Med

ical

Soc

iety

of t

he S

tate

of

New

Yor

k5/

3/20

04;

12/1

4/20

103

3“R

esol

ved,

that

the

use

of m

ariju

ana

may

be

appr

opria

te

whe

n pr

escr

ibed

or c

ertif

ied

by a

lice

nsed

phy

sicia

n so

lely

fo

r use

in a

llevi

atin

g pa

in a

nd/o

r nau

sea

in p

atie

nts w

ho

have

bee

n di

agno

sed

as ch

roni

cally

ill w

ith li

fe th

reat

en-

ing

dise

ases

, whe

n al

l oth

er tr

eatm

ents

hav

e fa

iled,

that

th

e ph

ysic

ians

who

pre

scrib

e m

ariju

ana

for p

atie

nt u

se,

subj

ect t

o th

e co

nditi

ons s

et fo

rth

abov

e, sh

ould

not

be

held

crim

inal

ly, ci

villy

, or p

rofe

ssio

nally

liab

le a

nd th

at it

su

ppor

ts co

ntin

ued

clin

ical

tria

ls on

the

use

of m

ariju

ana

for m

edic

al p

urpo

ses,

and

be it

furt

her r

esol

ved

that

the

Med

ical

Soc

iety

of t

he S

tate

of N

ew Y

ork

reco

mm

end

to

the

spon

sors

of t

his l

egisl

atio

n th

at th

e us

e of

med

ical

m

ariju

ana

shou

ld n

ot b

e ut

ilize

d in

pat

ient

s who

suffe

r so

lely

from

psy

chia

tric

cond

ition

s.”

Dec

embe

r 14,

201

0 le

tter t

o N

ew Y

ork

Ass

embl

yman

Ric

hard

Got

tfrie

d, ch

air

of th

e A

ssem

bly

Hea

lth C

omm

ittee

, in

supp

ort o

f a N

ew Y

ork

med

ical

mar

i-ju

ana

bill

Mic

higa

n D

emoc

ratic

Par

ty2/

27/2

007

3“L

icen

sed

med

ical

doc

tors

shou

ld n

ot b

e cr

imin

ally

pu

nish

ed fo

r rec

omm

endi

ng th

e m

edic

al u

se o

f mar

ijuan

a to

serio

usly

ill p

eopl

e, an

d se

rious

ly il

l peo

ple

shou

ld n

ot

be su

bjec

t to

crim

inal

sanc

tions

for u

sing

mar

ijuan

a if

the

patie

nt’s

phys

icia

n ha

s tol

d th

e pa

tient

that

such

use

is

likel

y to

be

bene

ficia

l”

Reso

lutio

n ap

prov

ed b

y an

nual

stat

e co

nven

tion

in D

etro

it, F

ebru

ary

2007

Page 169: State by State Laws Report 2011

P-11

Appendix P: Partial List of Organizations w

ith Favorable Positions on Medical M

arijuana

State-By-State Report 2011Pa

rtia

l Lis

t of O

rgan

izat

ions

Fav

orin

g Le

gal/P

resc

ript

ive

Acc

ess t

o M

edic

al M

ariju

ana

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

R

esea

rch

O

ther

Com

men

tsR

efer

ence

Mic

higa

n N

urse

s Ass

ocia

tion

10/2

/200

83

“Med

ical

mar

ijuan

a ha

s pro

ven

to b

e an

effe

ctiv

e tr

eat-

men

t for

man

y pa

tient

s suf

ferin

g fr

om il

lnes

ses l

ike

can-

cer,

HIV

/AID

S, m

ultip

le sc

lero

sis a

nd o

ther

cond

ition

s, an

d th

at’s

why

the

Mic

higa

n N

urse

s Ass

ocia

tion

endo

rses

Pr

opos

al 1

.”

10/2

/08

pres

s rel

ease

, “M

ichi

gan

Nur

ses

Ass

ocia

tion

endo

rses

med

ical

mar

ijuan

a ba

llot p

ropo

sal”

Min

neso

ta A

IDS

Proj

ect

4/1/

2005

3“S

uppo

rts t

he p

assa

ge o

f S.F.

197

3 an

d H

.F. 2

151,”

MPP

’s m

odel

med

ical

mar

ijuan

a bi

llLe

tter t

o M

inne

sota

Sta

te S

en. S

teve

Kel

-le

y, m

edic

al m

ariju

ana

bill

spon

sor

Min

neso

ta N

urse

s Ass

ocia

tion

2/20

02;

2/7/

2006

3Re

gard

ing

pres

crip

tive

acce

ss: “

Alo

ng w

ith o

ur n

atio

nal

asso

ciat

ion

and

man

y ot

her s

tate

nur

ses a

ssoc

iatio

ns, t

he

Min

neso

ta N

urse

s Ass

ocia

tion

wan

ts to

offe

r our

supp

ort

for t

he p

assa

ge o

f S.F.

197

3 an

d H

.F. 2

151,”

MPP

’s m

odel

m

edic

al m

ariju

ana

bill

Sign

ator

y of

lette

r to

Pres

iden

t Bus

h; le

t-te

r to

Min

neso

ta S

tate

Sen

. Ste

ve K

elle

y, m

edic

al m

ariju

ana

bill

spon

sor

Min

neso

ta P

ublic

Hea

lth

Ass

ocia

tion

2/28

/200

63

“Sup

port

s the

pas

sage

of S

.F. 1

973

and

H.F.

215

1,” M

PP’s

mod

el m

edic

al m

ariju

ana

bill

Lette

r to

Min

neso

ta S

tate

Sen

. Ste

ve K

el-

ley,

med

ical

mar

ijuan

a bi

ll sp

onso

rM

inne

sota

Sen

ior F

ound

atio

n3/

1/20

063

“Sup

port

s the

pas

sage

of S

.F. 1

973

and

H.F.

215

1,” M

PP’s

mod

el m

edic

al m

ariju

ana

bill

Lette

r to

Min

neso

ta S

tate

Sen

. Ste

ve K

el-

ley,

med

ical

mar

ijuan

a bi

ll sp

onso

rM

ultip

le S

cler

osis

Cal

iforn

ia

Act

ion

Net

wor

k19

963

Pres

crip

tive

acce

ss: “

the

deci

sion

as to

whe

ther

or n

ot

mar

ijuan

a co

nstit

utes

an

appr

opria

te tr

eatm

ent i

s one

bes

t le

ft to

phy

sicia

n an

d pa

tient

on

a ca

se-b

y-ca

se b

asis”

Gov

ernm

ent I

ssue

s Act

ion

(GIA

) Re-

port

, pag

e 2,

Janu

ary/

Febr

uary

199

6

Nat

iona

l Ass

ocia

tion

of

Peop

le W

ith A

IDS

1992

; 11

/29/

1999

; 12

/200

0

33

3Si

gnat

ory

of 1

999

and

2000

lette

rs

to U

.S. D

ept.

of H

ealth

and

Hum

an

Serv

ices

Nat

iona

l Nur

ses S

ocie

ty o

n

Add

ictio

ns (N

NSA

)5/

1995

33

“The

NN

SA u

rges

the

fede

ral g

over

nmen

t to

rem

ove

mar

ijuan

a fr

om th

e Sc

hedu

le I

cate

gory

imm

edia

tely,

and

m

ake

it av

aila

ble

for p

hysic

ians

to p

resc

ribe.

NN

SA u

rges

th

e A

mer

ican

Nur

ses’

Ass

ocia

tion

and

othe

r hea

lth c

are

prof

essio

nal o

rgan

izat

ions

to su

ppor

t pat

ient

acc

ess t

o th

is m

edic

ine.”

“Pos

ition

Pap

er: A

cces

s to

Ther

apeu

-tic

Can

nabi

s,” ap

prov

ed b

y th

e N

NSA

Bo

ard

of D

irect

ors,

May

1, 1

995

The N

ew E

ngla

nd Jo

urna

l of

Med

icin

e1/

30/1

997

33

Pres

crip

tive

acce

ss: u

rges

resc

hedu

ling

“[A

] fed

eral

pol

icy

that

pro

hibi

ts p

hysic

ians

from

alle

viat

-in

g su

fferin

g by

pre

scrib

ing

mar

ijuan

a fo

r ser

ious

ly il

l pa

tient

s is m

isgui

ded,

hea

vy-h

ande

d, a

nd in

hum

ane.”

Edito

rial,

Dr.

Jero

me

P. K

assir

er, V

olum

e 33

6, N

umbe

r 5, J

an. 3

0, 1

997

Page 170: State by State Laws Report 2011

P-12

Stat

e-By

-Sta

te R

epor

t 201

1

Appe

ndix

P: P

artia

l List

of O

rgan

izat

ions

with

Fav

orab

le P

ositi

ons o

n M

edic

al M

ariju

ana

Part

ial L

ist o

f Org

aniz

atio

ns F

avor

ing

Lega

l/Pre

scri

ptiv

e A

cces

s to

Med

ical

Mar

ijuan

a

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

R

esea

rch

O

ther

Com

men

tsR

efer

ence

New

Jers

ey N

atio

nal L

eagu

e fo

r N

ursin

g5/

2008

3“I

n M

ay 2

008,

the

New

Jers

ey L

eagu

e fo

r Nur

sing

test

ified

in

supp

ort o

f med

ical

mar

ijuan

a at

the

New

Jers

ey

Ass

embl

y H

ealth

Com

mitt

ee’s

info

rmat

iona

l hea

ring

on

the

med

ical

mar

ijuan

a ac

t.”

“Nur

ses F

ight

for V

iabl

e M

edic

al

Mar

ijuan

a Pr

ogra

m,”

Jani

ce P

etre

lla

Lync

h, R

N, M

SN, N

urse

s.com

, Jan

uary

24

, 201

1N

ew Je

rsey

Sta

te N

urse

s A

ssoc

iatio

n3/

20/1

999

3“R

ecog

nize

s the

ther

apeu

tic v

alue

and

safe

ty o

f med

i-ca

lly re

com

men

ded

mar

ijuan

a; re

cogn

izes

the

effe

ct o

f se

cond

hand

smok

e on

thos

e in

the

imm

edia

te th

erap

eutic

en

viro

nmen

t; su

ppor

ts le

gal a

cces

s to

med

ical

ly re

com

-m

ende

d m

ariju

ana

for p

atie

nts i

n N

ew Je

rsey

who

are

un

der t

he c

are

of a

lice

nsed

hea

lth c

are

prov

ider

; and

ur

ges t

he G

over

nor o

f New

Jers

ey a

nd th

e N

ew Je

rsey

St

ate

Legi

slatu

re to

mov

e ex

pedi

tious

ly to

mak

e m

edic

al

mar

ijuan

a le

gally

avai

labl

e to

New

Jers

ey re

siden

ts w

ho

can

bene

fits f

rom

it”

Reso

lutio

n C

once

rnin

g Th

erap

eutic

M

ariju

ana,

200

2 N

ew Je

rsey

Nur

sing

Con

vent

ion

New

Mex

ico

Nur

ses A

ssoc

iatio

n7/

28/1

997;

12

/200

03

3“E

ndor

se th

e co

ncep

t of a

llow

ing

for t

he th

erap

eutic

use

of

mar

ijuan

a in

a v

arie

ty o

f dise

ase s

tate

s … w

hen

conv

en-

tiona

l tre

atm

ents

are

inef

fect

ive”

Lette

r to

Brya

n A

. Kru

mm

, RN

, BSN

; sig

nato

ry o

f 200

0 le

tter t

o U

.S. D

ept.

of

Hea

lth a

nd H

uman

Ser

vice

sN

ew Y

ork

AID

S C

oalit

ion

12/1

8/20

023

“Leg

aliz

ing

med

ical

mar

ijuan

a is

both

the

com

pass

iona

te

and

logi

cal c

ours

e of

act

ion.

Its u

se is

ben

efic

ial t

o pe

ople

with

man

y ty

pes o

f illn

esse

s. In

the

case

of A

IDS,

nu

mer

ous s

tudi

es h

ave

prov

en th

at it

can

redu

ce n

ause

a an

d vo

miti

ng, s

timul

ate

appe

tite

and

redu

ce th

e ef

fect

s of

was

ting.

Am

ong

phys

icia

ns sp

ecia

lizin

g in

AID

S/H

IV,

ther

e is

wid

espr

ead

ackn

owle

dgm

ent t

hat m

ariju

ana

repr

esen

ts a

sign

ifica

nt tr

eatm

ent c

ompo

nent

for t

hose

w

ho h

ave

adva

nced

-sta

ge H

IV sy

mpt

oms,

as w

ell a

s fo

r tho

se w

ith sy

mpt

oms c

ause

d by

the

mul

tiple

-dru

g th

erap

ies u

sed

to co

ntro

l HIV

.”

Stat

emen

t

New

Yor

k C

ity C

ounc

il6/

12/2

006

3“T

he C

ounc

il of

the

City

of N

ew Y

ork

calls

upo

n th

e N

ew

York

Sta

te L

egisl

atur

e to

ado

pt A

. 579

6-A

and

S. 4

805,

w

hich

wou

ld le

galiz

e th

e po

sses

sion,

man

ufac

ture

, sal

e, ad

min

istra

tion,

del

iver

y, di

spen

sing

and

dist

ribut

ion

of

mar

ijuan

a in

conn

ectio

n w

ith m

edic

al u

se fo

r cer

tifie

d pa

tient

s.”

Reso

lutio

n 71

-A

Page 171: State by State Laws Report 2011

P-13

Appendix P: Partial List of Organizations w

ith Favorable Positions on Medical M

arijuana

State-By-State Report 2011Pa

rtia

l Lis

t of O

rgan

izat

ions

Fav

orin

g Le

gal/P

resc

ript

ive

Acc

ess t

o M

edic

al M

ariju

ana

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

R

esea

rch

O

ther

Com

men

tsR

efer

ence

New

Yor

k C

ount

y M

edic

al

Soci

ety

10/2

9/20

033

“Ado

pt a

pos

ition

of s

uppo

rt”

Lette

r to

New

Yor

k A

ssem

blym

an

Rich

ard

Got

tfrie

d, ch

air o

f the

Ass

embl

y H

ealth

Com

mitt

ee, i

n su

ppor

t of t

he

New

Yor

k A

ssem

bly

med

ical

mar

ijuan

a bi

ll, A

. 579

6N

ew Y

ork

Stat

e A

IDS

A

dviso

ry C

ounc

il12

/16/

2003

3“S

uppo

rts A

. 579

6, ‘A

n ac

t to

amen

d th

e pu

blic

hea

lth la

w,

in re

latio

n to

med

ical

use

of m

ariju

ana.’

”Le

tter t

o N

ew Y

ork

Ass

embl

yman

Ri

char

d G

ottfr

ied,

chai

r of t

he A

ssem

bly

Hea

lth C

omm

ittee

, in

supp

ort o

f the

N

ew Y

ork

Ass

embl

y m

edic

al m

ariju

ana

bill,

A. 5

796

New

Yor

k St

ate

Hos

pice

and

Pa

lliat

ive

Car

e A

ssoc

iatio

n20

033

“Sup

port

s A. 5

796/

S. 4

805”

“Mem

oran

dum

of S

uppo

rt: M

edic

al U

se

of M

ariju

ana”

New

Yor

k St

ate

Nur

ses

Ass

ocia

tion

6/29

/199

5;

11/2

9/19

99;

12/2

000;

2/

2004

33

3Si

gnat

ory

of 1

999

and

2000

lette

rs to

U

.S. D

ept.

of H

ealth

and

Hum

an S

er-

vice

s; re

solu

tion

in su

ppor

t of t

he N

ew

York

Ass

embl

y’s m

edic

al m

ariju

ana

bill,

A

. 579

6N

ew Y

ork

Stat

eWid

e Se

nior

A

ctio

n C

ounc

il, In

c.6/

17/2

003

3Su

ppor

ts A

. 579

6 an

d S.

480

5, to

“aut

horiz

e m

edic

al

trea

tmen

t with

inha

led

mar

ijuan

a fo

r pat

ient

s with

cond

i-tio

ns w

here

oth

er tr

eatm

ents

hav

e pr

oven

inef

fect

ive

and

mar

ijuan

a is

effe

ctiv

e. Th

e bi

ll co

ntai

ns sa

fegu

ards

aga

inst

di

vers

ion

of m

ariju

ana

into

ille

gal u

se.”

Mem

oran

dum

in su

ppor

t of m

edic

al

mar

ijuan

a bi

lls, A

. 579

6 an

d S.

480

5

Nin

th D

istric

t of t

he N

ew

York

Sta

te M

edic

al S

ocie

ty

(Wes

tche

ster

, Roc

klan

d, O

rang

e, Pu

tnam

, Dut

ches

s, an

d U

lster

co

untie

s)

1/20

043

“Sup

port

s bill

s in

the

New

Yor

k St

ate

Legi

slatu

re to

allo

w

the

med

ical

use

of m

ariju

ana”

Reso

lutio

n w

ith th

e N

ew Y

ork

Cou

nty

Med

ical

Soc

iety

200

4

Nor

th C

arol

ina

Dem

ocra

tic

Part

y O

ctob

er 2

009

3“T

he N

orth

Car

olin

a D

emoc

ratic

Par

ty p

ropo

ses t

hat s

ale

and

use

of M

edic

al M

ariju

ana

be d

ecrim

inal

ized

.”Re

solu

tion

pass

ed at

the

2009

Nor

th

Car

olin

a D

emoc

ratic

Con

vent

ion

Page 172: State by State Laws Report 2011

P-14

Stat

e-By

-Sta

te R

epor

t 201

1

Appe

ndix

P: P

artia

l List

of O

rgan

izat

ions

with

Fav

orab

le P

ositi

ons o

n M

edic

al M

ariju

ana

Part

ial L

ist o

f Org

aniz

atio

ns F

avor

ing

Lega

l/Pre

scri

ptiv

e A

cces

s to

Med

ical

Mar

ijuan

a

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

R

esea

rch

O

ther

Com

men

tsR

efer

ence

Nor

th C

arol

ina

Nur

ses

Ass

ocia

tion

10/1

5/19

963

3“N

CN

A u

rges

the

Adm

inist

ratio

n an

d C

ongr

ess t

o m

ake

cann

abis

avai

labl

e as

a le

gal m

edic

ine

whe

re sh

own

to

be sa

fe a

nd e

ffect

ive

and

to im

med

iate

ly a

llow

acc

ess t

o th

erap

eutic

can

nabi

s thr

ough

the

Inve

stig

atio

nal N

ew

Dru

g Pr

ogra

m. N

CN

A a

lso su

ppor

ts re

sear

ch o

f the

th

erap

eutic

pro

pert

ies a

nd co

mbi

natio

ns o

f the

var

ious

ca

nnab

inoi

ds a

nd a

ltern

ativ

e m

etho

ds o

f adm

inist

ratio

n to

dec

reas

e th

e ha

rmfu

l effe

cts r

elat

ed to

smok

ing.”

“Pos

ition

Sta

tem

ent o

f The

rape

utic

Use

of

Can

nabi

s”

Oce

an S

tate

Act

ion

unkn

own

3“L

icen

sed

med

ical

doc

tors

shou

ld n

ot b

e pu

nish

ed fo

r re

com

men

ding

the

med

ical

use

of m

ariju

ana

to se

rious

ly

ill p

eopl

e, an

d se

rious

ly il

l peo

ple

shou

ld n

ot b

e su

bjec

t to

crim

inal

sanc

tions

for u

sing

mar

ijuan

a if

the

patie

nts’

phys

icia

ns h

ave

told

the

patie

nts t

hat s

uch

use

is lik

ely

to

be b

enef

icia

l. Fu

rthe

r, su

ch p

atie

nts s

houl

d no

t be

forc

ed

to se

ek th

eir m

edic

ine

on th

e cr

imin

al m

arke

t, bu

t rat

her

thro

ugh

safe

, sta

te-r

ecog

nize

d co

mpa

ssio

n ce

nter

s.”

Reso

lutio

n to

Pro

tect

Ser

ious

ly Il

l Peo

ple

from

Arr

est a

nd Im

priso

nmen

t for

U

sing

Med

ical

Mar

ijuan

a

Old

er Io

wan

s Leg

islat

ure

9/30

/200

93

“Be

it en

acte

d by

the

Old

er Io

wan

s Leg

islat

ure

that

the

Gen

eral

Ass

embl

y of

the

Stat

e of

Iow

a en

act l

egisl

atio

n al

low

ing

phys

icia

ns li

cens

ed to

pra

ctic

e m

edic

ine

in Io

wa

to p

resc

ribe

mar

ijuan

a fo

r chr

onic

ally

ill o

r ter

min

al

patie

nts.”

OIL

Bill

09-

29A

Phar

mac

ists S

ocie

ty o

f the

Sta

te

of N

ew Y

ork

6/20

103

“Afte

r car

eful

revi

ew a

nd d

iscus

sion,

the

Phar

mac

ists

Soci

ety

of th

e St

ate

of N

ew Y

ork

supp

orts

this

bill

beca

use

it es

tabl

ishes

a co

mpr

ehen

sive

prog

ram

to d

istrib

ute

mar

ijuan

a fo

r med

icin

al u

se in

this

stat

e w

ith ap

prop

riate

co

ntro

ls th

at fa

r exc

eed

thos

e in

oth

er st

ates

. Pha

rmac

ists

belie

ve in

pal

liativ

e ca

re. W

e su

ppor

t thi

s ini

tiativ

e to

pr

ovid

e ac

cess

to a

pro

duct

that

can

relie

ve su

fferin

g in

in

divi

dual

s with

intr

acta

ble

pain

whe

n it

is re

com

men

ded

by th

eir p

hysic

ians

in th

e co

ntex

t of t

he p

rogr

am h

erei

n.”

Mem

oran

dum

of s

uppo

rt, J

une

2010

Pres

byte

rian

Chur

ch U

SA20

063

3“T

his r

esol

utio

n de

clar

es su

ppor

t for

the

med

icin

al u

se o

f ca

nnab

is sa

tiva

(also

kno

wn

as m

ariju

ana)

, and

dire

cts t

he

Pres

byte

rian

Chu

rch

(U.S

.A.)

to a

ctiv

ely

urge

the

Fede

ral

gove

rnm

ent t

o am

end

and

adop

t suc

h la

ws a

s will

allo

w

the

bene

fits o

f mar

ijuan

a tr

eatm

ent f

or su

ch d

iseas

es a

s ca

ncer

, AID

S, a

nd m

uscu

lar d

ystr

ophy

.”

Min

utes

from

the

217th

Gen

eral

A

ssem

bly,

2006

Page 173: State by State Laws Report 2011

P-15

Appendix P: Partial List of Organizations w

ith Favorable Positions on Medical M

arijuana

State-By-State Report 2011Pa

rtia

l Lis

t of O

rgan

izat

ions

Fav

orin

g Le

gal/P

resc

ript

ive

Acc

ess t

o M

edic

al M

ariju

ana

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

R

esea

rch

O

ther

Com

men

tsR

efer

ence

Prog

ress

ive

Nat

iona

l Bap

tist

Con

vent

ion

5/20

043

“Lic

ense

d m

edic

al d

octo

rs sh

ould

not

be

puni

shed

for

reco

mm

endi

ng th

e m

edic

al u

se o

f mar

ijuan

a to

serio

usly

ill

peo

ple,

and

serio

usly

ill p

eopl

e sh

ould

not

be

subj

ect t

o sa

nctio

ns fo

r usin

g m

ariju

ana

if th

e pa

tient

’s ph

ysic

ian

has

told

the

patie

nt th

at su

ch u

se is

like

ly to

be

bene

ficia

l.”

Sign

ed st

atem

ent o

f prin

cipl

e

Prot

esta

nts f

or th

e C

omm

on

Goo

d4/

16/2

010

33

3“P

assin

g [m

edic

al m

ariju

ana]

legi

slatio

n w

ould

be

an a

ct

of co

mpa

ssio

n an

d m

ercy

. Vic

tims o

f can

cer,

mul

tiple

sc

lero

sis, e

pile

psy

and

othe

r ser

ious

hea

lth p

robl

ems h

ave

give

n co

mpe

lling

test

imon

y th

at c

anna

bis (

the

tech

nica

l te

rm fo

r mar

ijuan

a) p

rovi

des r

elie

f fro

m p

ain

and

suffe

ring.

Thi

s rel

ief o

ften

can

com

e in

no

othe

r way

.”

“It’s

tim

e to

pas

s med

ical

pot

law

in

Illin

ois H

ouse

,” C

hica

go S

un-T

imes

, Ap

ril 1

6, 2

010

Proj

ect I

nfor

m (n

atio

nal H

IV/

AID

S tr

eatm

ent e

duca

tion

advo

cacy

org

aniz

atio

n)

6/19

/200

43

“Lic

ense

d m

edic

al d

octo

rs sh

ould

not

be

puni

shed

for

reco

mm

endi

ng th

e m

edic

al u

se o

f mar

ijuan

a to

serio

usly

ill

peo

ple,

and

serio

usly

ill p

eopl

e sh

ould

not

be

subj

ect t

o sa

nctio

ns fo

r usin

g m

ariju

ana

if th

e pa

tient

’s ph

ysic

ian

has

told

the

patie

nt th

at su

ch u

se is

like

ly to

be

bene

ficia

l.”

Reso

lutio

n in

supp

ort o

f the

Hin

chey

-Ro

hrab

ache

r Am

endm

ent t

o th

e C

omm

erce

-Sta

te-J

ustic

e Ap

prop

riatio

ns

bill

in U

.S. C

ongr

ess,

whi

ch w

ould

pre

-ve

nt fe

dera

l rai

ds o

n m

edic

al m

ariju

ana

patie

nts a

nd p

rovi

ders

who

are

in co

m-

plia

nce

with

stat

e la

wRh

ode

Isla

nd ch

apte

r of t

he

Leuk

emia

& L

ymph

oma

Soci

ety

2/20

083

3Su

ppor

ts le

gal/p

resc

riptiv

e ac

cess

, allo

win

g ph

arm

acy-

like

dist

ribut

ion,

and

rese

arch

, inc

ludi

ng p

rivat

e pr

oduc

tion

of

mar

ijuan

a fo

r res

earc

h

Reso

lutio

n, M

edic

al M

ariju

ana

Use

and

Re

sear

ch

Rhod

e Is

land

Med

ical

Soc

iety

3/15

/200

43

Supp

orts

Rho

de Is

land

’s m

edic

al m

ariju

ana

law

(bas

ed

on M

PP’s

mod

el b

ill) a

nd te

stifi

ed in

favo

r of i

t; “[

T]he

RI

Med

ical

Soc

iety

supp

orts

this

legi

slatio

n pe

rtai

ning

to th

e m

edic

al u

se o

f mar

ijuan

a.”

Lette

r to

Rep.

Tho

mas

Sla

ter,

Mar

ch 1

5,

2004

Rhod

e Is

land

Offi

ce o

f the

Pu

blic

Def

ende

r4/

2008

3Su

ppor

ts le

gal/p

resc

riptiv

e ac

cess

and

allo

win

g ph

arm

acy-

like

dist

ribut

ion,

“ser

ious

ly il

l pat

ient

s who

se d

octo

rs h

ave

told

them

that

the

med

ical

use

of m

ariju

ana

is lik

ely

to b

e be

nefic

ial s

houl

d no

t be

arre

sted

for i

ts u

se a

nd sh

ould

ha

ve sa

fe a

cces

s to

med

ical

mar

ijuan

a fr

om a

non

-pro

fit

dist

ribut

ion

faci

lity”

Reso

lutio

n sig

ned

by e

xecu

tive

dire

ctor

Jo

hn H

arrim

an, “

Med

ical

Mar

ijuan

a U

se

& A

cces

s,” 4

/200

8

Page 174: State by State Laws Report 2011

P-16

Stat

e-By

-Sta

te R

epor

t 201

1

Appe

ndix

P: P

artia

l List

of O

rgan

izat

ions

with

Fav

orab

le P

ositi

ons o

n M

edic

al M

ariju

ana

Part

ial L

ist o

f Org

aniz

atio

ns F

avor

ing

Lega

l/Pre

scri

ptiv

e A

cces

s to

Med

ical

Mar

ijuan

a

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

R

esea

rch

O

ther

Com

men

tsR

efer

ence

Rhod

e Is

land

Pub

lic H

ealth

A

ssoc

iatio

n4/

2008

3“S

erio

usly

ill p

atie

nts w

hose

doc

tors

hav

e to

ld th

em th

at

the

med

ical

use

of m

ariju

ana

is lik

ely

to b

e be

nefic

ial

shou

ld n

ot b

e ar

rest

ed fo

r its

use

and

shou

ld h

ave

safe

ac-

cess

to m

edic

al m

ariju

ana

from

pha

rmac

y-lik

e no

n-pr

ofit

esta

blish

men

ts”

“Res

olut

ion

Supp

ortin

g Rh

ode

Isla

nd’s

Med

ical

Mar

ijuan

a La

w A

nd E

ffort

s to

Impr

ove

Lega

l Acc

ess t

o M

edic

al

Mar

ijuan

a”

Rhod

e Is

land

Sta

te C

ounc

il of

C

hurc

hes

3/20

083

“Ser

ious

ly il

l pat

ient

s who

se d

octo

rs h

ave

told

them

that

th

e m

edic

al u

se o

f mar

ijuan

a is

likel

y to

be

bene

ficia

l sh

ould

not

be

arre

sted

for i

ts u

se a

nd sh

ould

hav

e sa

fe a

c-ce

ss to

med

ical

mar

ijuan

a fr

om a

non

-pro

fit C

ompa

ssio

n C

ente

r”

Reso

lutio

n, “M

edic

al M

ariju

ana

Use

&

Acc

ess”

Rhod

e Is

land

Sta

te N

urse

s A

ssoc

iatio

n3/

29/2

004

33

33

“The

Rho

de Is

land

Sta

te N

urse

s Ass

ocia

tion

is su

ppor

tive

of p

rovi

ding

pat

ient

s saf

e ac

cess

to th

erap

eutic

Mar

ijuan

a/C

anna

bis.

Our

pos

ition

is co

nsist

ent w

ith th

e A

mer

ican

N

urse

s Ass

ocia

tion

(AN

A).”

Lette

r to

Tom

Ang

ell,

Mar

ch 2

9, 2

004

San

Fran

cisc

o M

edic

al S

ocie

ty8/

8/19

96;

2/19

973

33

“The

SFM

S ta

kes a

supp

ort p

ositi

on o

n th

e C

alifo

rnia

M

edic

al M

ariju

ana

Initi

ativ

e” (P

ropo

sitio

n 21

5)

Oth

er: e

ndor

sem

ent o

f a p

hysic

ian’s

righ

t to

disc

uss m

ari-

juan

a th

erap

y w

ith a

pat

ient

Mot

ion

pass

ed b

y SF

MS

Boar

d of

Dire

c-to

rs; “

Med

ical

Mar

ijuan

a: A

Ple

a fo

r Sc

ienc

e an

d C

ompa

ssio

n,” is

sued

join

tly

by G

ay a

nd L

esbi

an M

edic

al A

ssoc

iatio

n an

d Sa

n Fr

anci

sco

Med

ical

Soc

iety

Seni

or A

gend

a C

oalit

ion

Mar

ch 2

007

33

“Sup

port

s mak

ing

Rhod

e Is

land

’s m

edic

al m

ariju

ana

law

pe

rman

ent,

so th

at n

o se

rious

ly il

l pat

ient

will

be

subj

ect

to cr

imin

al o

r civ

il sa

nctio

n un

der [

the]

stat

e’s la

ws f

or th

e do

ctor

-adv

ised,

med

ical

use

of m

ariju

ana”

and

reso

lved

th

at st

ate-

appr

oved

med

ical

mar

ijuan

a pa

tient

s “sh

ould

no

t be

subj

ect t

o fe

dera

l crim

inal

pen

altie

s for

such

med

i-ca

l use

Dire

ctor

issu

ed re

solu

tion,

Mar

ch 2

007

Test

Pos

itive

Aw

are

Net

wor

k (I

llino

is)1/

26/2

004

3En

dors

es le

gisla

tion

“… to

pro

tect

the

right

of m

edic

al

mar

ijuan

a us

e fo

r peo

ple

with

AID

S/H

IV a

nd o

ther

life

th

reat

enin

g an

d lo

ng-t

erm

chro

nic h

ealth

cond

ition

s”

Lette

r fro

m M

att S

harp

, dire

ctor

of t

reat

-m

ent e

duca

tion

Page 175: State by State Laws Report 2011

P-17

Appendix P: Partial List of Organizations w

ith Favorable Positions on Medical M

arijuana

State-By-State Report 2011Pa

rtia

l Lis

t of O

rgan

izat

ions

Fav

orin

g Le

gal/P

resc

ript

ive

Acc

ess t

o M

edic

al M

ariju

ana

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

R

esea

rch

O

ther

Com

men

tsR

efer

ence

Texa

s Dem

ocra

tic P

arty

6/20

043

33

3“R

ESO

LVED

that

the

Dem

ocra

tic P

arty

supp

orts

and

/or

enc

oura

ges t

he fo

llow

ing:

... R

esea

rch

in co

ntro

lled

inve

stig

atio

nal t

rials

... T

he ri

ght o

f pat

ient

s to

have

safe

ac

cess

to th

erap

eutic

mar

ijuan

a/ca

nnab

is un

der a

ppro

-pr

iate

med

ical

supe

rvisi

on ..

. The

abi

lity

of h

ealth

car

e pr

ovid

ers t

o di

scus

s and

/or r

ecom

men

d th

e m

edic

inal

use

of

mar

ijuan

a ...

Leg

islat

ion

to re

mov

e cr

imin

al p

enal

ties

incl

udin

g ar

rest

and

impr

isonm

ent f

or b

ona

fide

patie

nts

and

prov

ider

s ...

Fede

ral a

nd st

ate

legi

slatio

n to

exc

lude

m

ariju

ana/

cann

abis

from

clas

sific

atio

n as

a S

ched

ule

I dr

ug ..

. The

edu

catio

n of

med

ical

pro

fess

iona

ls re

gard

ing

curr

ent,

evid

ence

-bas

ed th

erap

eutic

use

of m

ariju

ana/

cann

abis.

Ado

pted

at 2

004

Texa

s Dem

ocra

tic

Con

vent

ion

Texa

s Lea

gue

of W

omen

Vot

ers

1/20

063

“Law

s reg

ardi

ng d

rug

abus

e an

d dr

ug a

ddic

tion

shou

ld

incl

ude

no cr

imin

al p

enal

ties f

or c

anna

bis (

mar

ihua

na)

poss

essio

n w

hen

reco

mm

ende

d by

a p

hysic

ian.”

Posit

ion

adop

ted

by T

LWV

stat

e bo

ard

at Ja

nuar

y 20

06 m

eetin

g

Texa

s Nur

ses A

ssoc

iatio

n1/

2005

3“L

icen

sed

heal

th c

are

prov

ider

s sho

uld

not b

e pu

nish

ed

for r

ecom

men

ding

the

med

ical

use

of m

ariju

ana

to se

ri-ou

sly il

l peo

ple,

and

serio

usly

ill p

eopl

e sh

ould

not

be

sub-

ject

ed to

crim

inal

sanc

tions

for u

sing

med

ical

mar

ijuan

a if

thei

r hea

lth c

are

prov

ider

has

told

the

patie

nt th

at su

ch

use

is lik

ely

to b

e be

nefic

ial.”

Stat

emen

t of p

rinci

ple

adop

ted

by T

NA

st

ate

boar

d at

Janu

ary

2005

mee

ting

Uni

on o

f Ref

orm

Juda

ism

(form

erly

Uni

on o

f Am

eric

an

Heb

rew

Con

greg

atio

ns)

11/2

003;

6/

2004

33

3Re

solv

es to

“sup

port

fede

ral l

egisl

atio

n an

d re

gula

tion

to

allo

w th

e m

edic

inal

use

of m

ariju

ana

... u

rge

the

Food

and

D

rug

Adm

inist

ratio

n to

exp

and

the

scop

e of

allo

wab

le

Inve

stig

atio

nal N

ew D

rug

appl

icat

ions

... c

all f

or fu

rthe

r m

edic

al re

sear

ch ..

. adv

ocat

e fo

r the

nec

essa

ry ch

ange

s in

loca

l, st

ate

and

fede

ral l

aw to

per

mit

the

med

icin

al u

se o

f m

ariju

ana

and

ensu

re it

s acc

essib

ility

for t

hat p

urpo

se”;

“Lic

ense

d m

edic

al d

octo

rs sh

ould

not

be

puni

shed

for

reco

mm

endi

ng th

e m

edic

al u

se o

f mar

ijuan

a to

serio

usly

ill

peo

ple,

and

serio

usly

ill p

eopl

e sh

ould

not

be

subj

ect t

o sa

nctio

ns fo

r usin

g m

ariju

ana

if th

e pa

tient

’s ph

ysic

ian

has

told

the

patie

nt th

at su

ch u

se is

like

ly to

be

bene

ficia

l.”

Reso

lutio

n ad

opte

d at

the

67th

Gen

eral

A

ssem

bly;

sign

ed st

atem

ent o

f prin

cipl

e

Page 176: State by State Laws Report 2011

P-18

Stat

e-By

-Sta

te R

epor

t 201

1

Appe

ndix

P: P

artia

l List

of O

rgan

izat

ions

with

Fav

orab

le P

ositi

ons o

n M

edic

al M

ariju

ana

Part

ial L

ist o

f Org

aniz

atio

ns F

avor

ing

Lega

l/Pre

scri

ptiv

e A

cces

s to

Med

ical

Mar

ijuan

a

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

R

esea

rch

O

ther

Com

men

tsR

efer

ence

Uni

taria

n U

nive

rsal

ist

Ass

ocia

tion

6/22

/200

23

3“M

ake

all d

rugs

lega

lly av

aila

ble

with

a p

resc

riptio

n by

a

licen

sed

phys

icia

n, su

bjec

t to

prof

essio

nal o

vers

ight

. End

th

e pr

actic

e of

pun

ishin

g an

indi

vidu

al fo

r obt

aini

ng, p

os-

sess

ing,

or u

sing

an o

ther

wise

ille

gal s

ubst

ance

to tr

eat a

m

edic

al co

nditi

on.”

From

“Alte

rnat

ives

to th

e W

ar o

n D

rugs

: St

atem

ent o

f Con

scie

nce”

reso

lutio

n,

pass

ed b

y th

e G

ener

al A

ssem

bly

with

a

two-

third

s maj

ority

of d

eleg

ates

Uni

ted

Chu

rch

of C

hrist

2002

3“W

e be

lieve

that

serio

usly

ill p

eopl

e sh

ould

not

be

subj

ect

to a

rres

t and

impr

isonm

ent f

or u

sing

med

ical

mar

ijuan

a w

ith th

eir d

octo

rs’ a

ppro

val.”

Min

istry

for C

rimin

al Ju

stic

e &

Hum

an

Righ

ts si

gned

on

to M

PP’s

Coa

litio

n fo

r C

ompa

ssio

nate

Acc

ess i

n 20

02U

nite

d M

etho

dist

Chu

rch

5/20

043

“Lic

ense

d m

edic

al d

octo

rs sh

ould

not

be

puni

shed

for

reco

mm

endi

ng th

e m

edic

al u

se o

f mar

ijuan

a to

serio

usly

ill

peo

ple,

and

serio

usly

ill p

eopl

e sh

ould

not

be

subj

ect t

o sa

nctio

ns fo

r usin

g m

ariju

ana

if th

e pa

tient

’s ph

ysic

ian

has

told

the

patie

nt th

at su

ch u

se is

like

ly to

be

bene

ficia

l.”

stat

emen

t of p

rinci

ple

signe

d by

Uni

ted

Met

hodi

st C

hurc

h G

ener

al B

oard

of

Chu

rch

and

Soci

ety

afte

r qua

dren

nial

co

nven

tion

Uni

ted

Nur

ses a

nd A

llied

Pr

ofes

siona

ls (R

hode

Isla

nd)

5/20

043

Sent

legi

slativ

e al

erts

to it

s mem

bers

end

orsin

g M

PP’s

mod

el b

ills

May

200

4 le

tters

to R

hode

Isla

nd R

ep.

Thom

as S

late

r and

Rho

de Is

land

Sen

. Rh

oda

Perr

yU

nite

d Se

nior

s of M

aryl

and

2/25

/201

03

33

3“I

f a v

ery

dang

erou

s con

trol

led

subs

tanc

e, lik

e m

orph

ine,

can

be u

sed

for m

edic

al p

urpo

ses b

ecau

se o

f the

ben

efits

de

rived

from

its u

se, …

mar

ijuan

a sh

ould

be

mov

ed to

th

e ca

tego

ry o

f a co

ntro

lled

subs

tanc

e so

that

its b

enef

its

mig

ht b

e m

ade

use

of. I

n ot

her w

ords

, … m

ariju

ana

shou

ld b

e tr

eate

d lik

e an

y ot

her d

rug

that

can

be

lega

lly

pres

crib

ed b

y a

phys

icia

n.”

Test

imon

y to

the

Mar

ylan

d H

ouse

Ju

dici

ary

and

Hea

lth &

Gov

ernm

ent

Ope

ratio

ns C

omm

ittee

s, Fe

brua

ry 2

6,

2010

Vete

rans

for P

eace

8/18

/200

73

33

“Sup

port

s leg

islat

ion

that

elim

inat

es cr

imin

al a

nd ci

vil

pena

lties

for t

he d

octo

r-ad

vise

d, m

edic

al u

se o

f mar

ijuan

a by

pat

ient

s with

serio

us p

hysic

al m

edic

al co

nditi

ons”

and

“u

rges

the

Vete

rans

Adm

inist

ratio

n an

d its

doc

tors

not

to

with

hold

trea

tmen

ts fr

om a

pat

ient

und

er th

eir c

are

simpl

y be

caus

e th

ey te

st p

ositi

ve fo

r mar

ijuan

a”

Reso

lutio

n ap

prov

ed at

ann

ual m

eetin

g,

Augu

st 2

007

Virg

inia

Nur

ses A

ssoc

iatio

n10

/7/1

994;

12

/200

03

3Re

solu

tion;

sign

ator

y of

200

0 le

tter

to U

.S. D

ept.

of H

ealth

and

Hum

an

Serv

ices

Page 177: State by State Laws Report 2011

P-19

Appendix P: Partial List of Organizations w

ith Favorable Positions on Medical M

arijuana

State-By-State Report 2011Pa

rtia

l Lis

t of O

rgan

izat

ions

Fav

orin

g Le

gal/P

resc

ript

ive

Acc

ess t

o M

edic

al M

ariju

ana

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

R

esea

rch

O

ther

Com

men

tsR

efer

ence

Wisc

onsin

Nur

ses A

ssoc

iatio

n10

/29/

1999

; 12

/200

03

3“U

rges

the

Gov

erno

r of W

iscon

sin a

nd th

e W

iscon

sin

Legi

slatu

re to

mov

e ex

pedi

tious

ly to

mak

e ca

nnab

is av

ail-

able

as a

lega

lly p

resc

ribed

med

icin

e w

here

show

n to

be

safe

and

effe

ctiv

e”

reso

lutio

n ad

opte

d by

WN

A; o

ne o

f the

17

org

aniz

atio

ns th

at si

gned

lette

r to

form

er O

ffice

of N

atio

nal D

rug

Con

trol

Po

licy

Dire

ctor

Bar

ry M

cCaf

frey

Wisc

onsin

Pub

lic H

ealth

A

ssoc

iatio

n6/

1999

3“U

rges

the

Gov

erno

r of W

iscon

sin a

nd th

e W

iscon

sin

Legi

slatu

re to

mov

e ex

pedi

tious

ly to

mak

e ca

nnab

is av

ail-

able

as a

lega

lly p

resc

ribed

med

icin

e w

here

show

n to

be

safe

and

effe

ctiv

e”

WPH

A re

solu

tion

from

its J

une

1999

m

eetin

g

Wom

en o

f Ref

orm

Juda

ism12

/199

9;

12/2

000

33

3H

ealth

Issu

es R

esol

utio

n, a

dopt

ed at

the

1999

Orla

ndo

Ass

embl

y; si

gnat

ory

of

2000

lette

r to

U.S

. Dep

t. of

Hea

lth a

nd

Hum

an S

ervi

ces

Part

ial L

ist o

f Org

aniz

atio

ns F

avor

ing

Com

pass

iona

te A

cces

s to

Med

ical

Mar

ijuan

a

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

Res

earc

h

Oth

erC

omm

ents

Ref

eren

ceA

IDS

Nat

iona

l Int

erfa

ith N

et-

wor

k2/

17/1

999

3O

ne o

f 17

orga

niza

tions

that

sign

ed le

tter t

o fo

rmer

O

ffice

of N

atio

nal D

rug

Con

trol

Pol

icy

Dire

ctor

Ba

rry

McC

affr

eyA

IDS

Proj

ect A

rizon

a2/

17/1

999

3O

ne o

f 17

orga

niza

tions

that

sign

ed le

tter t

o fo

rmer

O

ffice

of N

atio

nal D

rug

Con

trol

Pol

icy

Dire

ctor

Ba

rry

McC

affr

eyA

IDS

Proj

ect L

os A

ngel

es2/

17/1

999

3O

ne o

f 17

orga

niza

tions

that

sign

ed le

tter t

o fo

rmer

O

ffice

of N

atio

nal D

rug

Con

trol

Pol

icy

Dire

ctor

Ba

rry

McC

affr

eyA

IDS

Surv

ival

Pro

ject

(Atla

nta)

2/20

023

Sign

ator

y of

lette

r to

Pres

iden

t Bus

h

AID

S Tr

eatm

ent I

nitia

tives

(A

tlant

a)12

/200

03

Sign

ator

y of

200

0 le

tter t

o U

.S. D

ept.

of H

ealth

and

H

uman

Ser

vice

s

Page 178: State by State Laws Report 2011

P-20

Stat

e-By

-Sta

te R

epor

t 201

1

Appe

ndix

P: P

artia

l List

of O

rgan

izat

ions

with

Fav

orab

le P

ositi

ons o

n M

edic

al M

ariju

ana

Part

ial L

ist o

f Org

aniz

atio

ns F

avor

ing

Com

pass

iona

te A

cces

s to

Med

ical

Mar

ijuan

a

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

Res

earc

h

Oth

erC

omm

ents

Ref

eren

ceA

IDS

Trea

tmen

t New

s2/

2002

3Si

gnat

ory

of le

tter t

o Pr

esid

ent B

ush

Am

eric

an C

ivil

Libe

rtie

s Uni

on2/

2002

3Si

gnat

ory

of le

tter t

o Pr

esid

ent B

ush

Bay

Are

a Ph

ysic

ians

for H

uman

Ri

ghts

1/19

97;

12/2

000

33

Oth

er: e

ndor

sem

ent o

f a p

hysic

ian’s

righ

t to

disc

uss m

ariju

ana

ther

apy

with

a p

atie

ntPl

aint

iff in

Con

ant v

. McC

affr

ey; s

igna

tory

of 2

000

lette

r to

U.S

. Dep

t. of

Hea

lth a

nd H

uman

Ser

vice

sBo

ulde

r Cou

nty

AID

S Pr

ojec

t (C

olor

ado)

2/17

/199

9;

12/2

000

3O

ne o

f 17

orga

niza

tions

that

sign

ed le

tter t

o fo

rmer

O

ffice

of N

atio

nal D

rug

Con

trol

Pol

icy

Dire

ctor

Ba

rry

McC

affr

ey; s

igna

tory

of 2

000

lette

r to

U.S

. D

ept.

of H

ealth

and

Hum

an S

ervi

ces

Cen

ter f

or A

IDS

Serv

ices

(Oak

-la

nd)

2/17

/199

93

One

of 1

7 or

gani

zatio

ns th

at si

gned

lette

r to

form

er

Offi

ce o

f Nat

iona

l Dru

g C

ontr

ol P

olic

y D

irect

or

Barr

y M

cCaf

frey

Cen

ter f

or W

omen

Pol

icy

Stud

-ie

s2/

2002

3sig

nato

ry o

f let

ter t

o Pr

esid

ent B

ush

Col

orad

o A

IDS

Proj

ect

2/17

/199

93

One

of 1

7 or

gani

zatio

ns th

at si

gned

lette

r to

form

er

Offi

ce o

f Nat

iona

l Dru

g C

ontr

ol P

olic

y D

irect

or

Barr

y M

cCaf

frey

Com

miss

ion

on S

ocia

l Act

ion

of

Refo

rm Ju

daism

2/20

023

Sign

ator

y of

lette

r to

Pres

iden

t Bus

h

Con

nect

icut

Pea

ce C

oalit

ion/

New

Hav

en2/

2002

3Si

gnat

ory

of le

tter t

o Pr

esid

ent B

ush

Con

tigo-

Con

mig

o12

/200

03

Sign

ator

y of

200

0 le

tter t

o U

.S. D

ept.

of H

ealth

and

H

uman

Ser

vice

sEm

brac

e Li

fe (S

anta

Cru

z)12

/200

03

Sign

ator

y of

200

0 le

tter t

o U

.S. D

ept.

of H

ealth

and

H

uman

Ser

vice

sFl

orid

a M

edic

al A

ssoc

iatio

n 6/

1/19

973

3Re

solu

tion

#97-

61

Page 179: State by State Laws Report 2011

P-21

Appendix P: Partial List of Organizations w

ith Favorable Positions on Medical M

arijuana

State-By-State Report 2011Pa

rtia

l Lis

t of O

rgan

izat

ions

Fav

orin

g C

ompa

ssio

nate

Acc

ess t

o M

edic

al M

ariju

ana

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

Res

earc

h

Oth

erC

omm

ents

Ref

eren

ceG

ay a

nd L

esbi

an M

edic

al A

s-so

ciat

ion

5/19

95;

2/19

97;

11/2

9/19

99;

12/2

000

33

3O

ther

: end

orse

men

t of a

phy

sicia

n’s ri

ght t

o di

scus

s mar

ijuan

a th

erap

y w

ith a

pat

ient

GLM

A P

olic

y St

atem

ent #

066-

95-1

04; “

Med

ical

Mar

i-ju

ana:

A P

lea

for S

cien

ce a

nd C

ompa

ssio

n,” is

sued

jo

intly

by

GLM

A a

nd S

an F

ranc

isco

Med

ical

Soc

iety

in

199

7; si

gnat

ory

of 1

999

and

2000

lette

rs to

U.S

. D

ept.

of H

ealth

and

Hum

an S

ervi

ces

Har

m R

educ

tion

Coa

litio

n12

/200

03

Sign

ator

y of

200

0 le

tter t

o U

.S. D

ept.

of H

ealth

and

H

uman

Ser

vice

sH

epat

itis C

Act

ion

& A

dvoc

acy

Coa

litio

n1/

2001

3Si

gnat

ory

of le

tter t

o Pr

esid

ent B

ush

Inst

itute

for P

olic

y St

udie

s, D

rug

Polic

y Pr

ojec

t2/

2002

3Si

gnat

ory

of le

tter t

o Pr

esid

ent B

ush

Just

ice

Polic

y In

stitu

te2/

2002

3Si

gnat

ory

of le

tter t

o Pr

esid

ent B

ush

Latin

o C

omm

issio

n on

AID

S2/

17/1

999

3O

ne o

f 17

orga

niza

tions

that

sign

ed le

tter t

o fo

rmer

O

ffice

of N

atio

nal D

rug

Con

trol

Pol

icy

Dire

ctor

Ba

rry

McC

affr

eyLi

bert

aria

n Pa

rty

2/20

023

Sign

ator

y of

lette

r to

Pres

iden

t Bus

h

Life

Fou

ndat

ion

12/2

000

3Si

gnat

ory

of 2

000

lette

r to

U.S

. Dep

t. of

Hea

lth a

nd

Hum

an S

ervi

ces

Mai

ne A

IDS

Alli

ance

12/2

000

3Si

gnat

ory

of 2

000

lette

r to

U.S

. Dep

t. of

Hea

lth a

nd

Hum

an S

ervi

ces

Miss

issip

pi N

urse

s Ass

ocia

tion

12/2

000

3Si

gnat

ory

of 2

000

lette

r to

U.S

. Dep

t. of

Hea

lth a

nd

Hum

an S

ervi

ces

Mob

iliza

tion

Aga

inst

AID

S

(San

Fra

ncisc

o)2/

17/1

999

3O

ne o

f 17

orga

niza

tions

that

sign

ed le

tter t

o fo

rmer

O

ffice

of N

atio

nal D

rug

Con

trol

Pol

icy

Dire

ctor

Ba

rry

McC

affr

eyM

oder

atio

n M

anag

emen

t1/

2001

3Si

gnat

ory

of le

tter t

o Pr

esid

ent B

ush

Mot

hers

Aga

inst

Misu

se a

nd

Abu

se12

/200

03

Sign

ator

y of

200

0 le

tter t

o U

.S. D

ept.

of H

ealth

and

H

uman

Ser

vice

s

Page 180: State by State Laws Report 2011

P-22

Stat

e-By

-Sta

te R

epor

t 201

1

Appe

ndix

P: P

artia

l List

of O

rgan

izat

ions

with

Fav

orab

le P

ositi

ons o

n M

edic

al M

ariju

ana

Part

ial L

ist o

f Org

aniz

atio

ns F

avor

ing

Com

pass

iona

te A

cces

s to

Med

ical

Mar

ijuan

a

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

Res

earc

h

Oth

erC

omm

ents

Ref

eren

ceM

othe

rs’ V

oice

s to

End

AID

S2/

17/1

999

3O

ne o

f 17

orga

niza

tions

that

sign

ed le

tter t

o fo

rmer

O

ffice

of N

atio

nal D

rug

Con

trol

Pol

icy

Dire

ctor

Ba

rry

McC

affr

eyN

atio

nal A

cade

my

of S

cien

ces’

Inst

itute

of M

edic

ine

3/17

/199

93

3M

ariju

ana

and

Med

icin

e: A

sses

sing

the S

cien

ce B

ase;

see

ww

w.m

pp.o

rg/s

cien

ce.h

tml

Nat

iona

l Ass

ocia

tion

for P

ublic

H

ealth

Pol

icy

11/2

9/19

99;

12/2

000

33

Sign

ator

y of

199

9 an

d 20

00 le

tters

to U

.S. D

ept.

of

Hea

lth a

nd H

uman

Ser

vice

sN

atio

nal B

lack

Pol

ice

Ass

ocia

-tio

n11

/29/

1999

; 12

/200

03

3Si

gnat

ory

of 1

999

and

2000

lette

rs to

U.S

. Dep

t. of

H

ealth

and

Hum

an S

ervi

ces

Nat

iona

l Cen

ter o

n In

stitu

tions

an

d A

ltern

ativ

es2/

2002

3Si

gnat

ory

of le

tter t

o Pr

esid

ent B

ush

Nat

iona

l Lat

ina/

o Le

sbia

n,

Gay

, Bise

xual

and

Tra

nsge

nder

O

rgan

izat

ion

2/17

/199

93

One

of 1

7 or

gani

zatio

ns th

at si

gned

lette

r to

form

er

Offi

ce o

f Nat

iona

l Dru

g C

ontr

ol P

olic

y D

irect

or

Barr

y M

cCaf

frey

Nat

iona

l Nat

ive

Am

eric

an A

IDS

Prev

entio

n C

ente

r2/

17/1

999

3O

ne o

f 17

orga

niza

tions

that

sign

ed le

tter t

o fo

rmer

O

ffice

of N

atio

nal D

rug

Con

trol

Pol

icy

Dire

ctor

Ba

rry

McC

affr

eyN

atio

nal W

omen

’s H

ealth

N

etw

ork

12/2

000

3Si

gnat

ory

of 2

000

lette

r to

U.S

. Dep

t. of

Hea

lth a

nd

Hum

an S

ervi

ces

Neb

rask

a A

IDS

Proj

ect

2/20

023

Sign

ator

y of

lette

r to

Pres

iden

t Bus

h

New

Yor

k C

ity A

IDS

Hou

sing

Net

wor

k2/

2002

3Si

gnat

ory

of le

tter t

o Pr

esid

ent B

ush

Nor

thw

est A

IDS

Foun

datio

n (S

eattl

e)2/

17/1

999

3O

ne o

f 17

orga

niza

tions

that

sign

ed le

tter t

o fo

rmer

O

ffice

of N

atio

nal D

rug

Con

trol

Pol

icy

Dire

ctor

Ba

rry

McC

affr

eyO

kalo

osa

AID

S Su

ppor

t and

In

form

atio

n Se

rvic

es (F

t. W

alto

n Be

ach,

Flo

rida)

12/2

000

3Si

gnat

ory

of 2

000

lette

r to

U.S

. Dep

t. of

Hea

lth a

nd

Hum

an S

ervi

ces

Peop

le o

f Col

or A

gain

st A

IDS

Net

wor

k (S

eattl

e)2/

17/1

999

3O

ne o

f 17

orga

niza

tions

that

sign

ed le

tter t

o fo

rmer

O

ffice

of N

atio

nal D

rug

Con

trol

Pol

icy

Dire

ctor

Ba

rry

McC

affr

ey

Page 181: State by State Laws Report 2011

P-23

Appendix P: Partial List of Organizations w

ith Favorable Positions on Medical M

arijuana

State-By-State Report 2011

Part

ial L

ist o

f Org

aniz

atio

ns F

avor

ing

Com

pass

iona

te A

cces

s to

Med

ical

Mar

ijuan

a

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

Res

earc

h

Oth

erC

omm

ents

Ref

eren

cePh

ysic

ians

for S

ocia

l Res

pons

i-bi

lity

(Ore

gon)

2/20

023

Sign

ator

y of

lette

r to

Pres

iden

t Bus

h

POZ

mag

azin

e2/

2002

3Si

gnat

ory

of le

tter t

o Pr

esid

ent B

ush

Proj

ect S

afe

1/20

013

Sign

ator

y of

lette

r to

Pres

iden

t Bus

h

Publ

ic C

itize

n12

/200

03

Sign

ator

y of

200

0 le

tter t

o U

.S. D

ept.

of H

ealth

and

H

uman

Ser

vice

sRa

dio

Bilin

gue

2/20

023

Sign

ator

y of

lette

r to

Pres

iden

t Bus

h

San

Fran

cisc

o A

IDS

Foun

datio

n2/

17/1

999;

12

/200

03

One

of 1

7 or

gani

zatio

ns th

at si

gned

lette

r to

form

er

Offi

ce o

f Nat

iona

l Dru

g C

ontr

ol P

olic

y D

irect

or

Barr

y M

cCaf

frey

; sig

nato

ry o

f 200

0 le

tter t

o U

.S.

Dep

t. of

Hea

lth a

nd H

uman

Ser

vice

sTh

e Re

gas I

nstit

ute

2/20

023

Sign

ator

y of

lette

r to

Pres

iden

t Bus

h

The

Vill

age

Wel

l: Le

sbia

n, G

ay,

Bise

xual

, and

Tra

nsge

nder

In

itiat

ive

of th

e H

arle

m C

om-

mun

ity A

IDS

Cen

ter

2/20

023

Sign

ator

y of

lette

r to

Pres

iden

t Bus

h

Tri-C

ount

y A

IDS

Con

sort

ium

(P

rovi

ncet

own,

MA

)2/

2002

3Si

gnat

ory

of le

tter t

o Pr

esid

ent B

ush

Whi

tman

-Wal

ker C

linic

(Was

h-in

gton

, D.C

.)2/

17/1

999;

11

/29/

1999

; 12

/200

0

33

One

of 1

7 or

gani

zatio

ns th

at si

gned

lette

r to

form

er

Offi

ce o

f Nat

iona

l Dru

g C

ontr

ol P

olic

y D

irect

or

Barr

y M

cCaf

frey

; sig

nato

ry o

f 199

9 an

d 20

00 le

tters

to

U.S

. Dep

t. of

Hea

lth a

nd H

uman

Ser

vice

sW

iscon

sin N

urse

s Ass

ocia

tion

12/2

000

3Si

gnat

ory

of 2

000

lette

r to

U.S

. Dep

t. of

Hea

lth a

nd

Hum

an S

ervi

ces

Wom

en a

nd M

en A

gain

st A

IDS

(Bro

nx, N

Y)2/

17/1

999

3O

ne o

f 17

orga

niza

tions

that

sign

ed le

tter t

o fo

rmer

O

ffice

of N

atio

nal D

rug

Con

trol

Pol

icy

Dire

ctor

Ba

rry

McC

affr

ey

Page 182: State by State Laws Report 2011

P-24

Stat

e-By

-Sta

te R

epor

t 201

1

Appe

ndix

P: P

artia

l List

of O

rgan

izat

ions

with

Fav

orab

le P

ositi

ons o

n M

edic

al M

ariju

ana

Part

ial L

ist o

f Org

aniz

atio

ns W

ith F

avor

able

Pos

ition

s on

Res

earc

h an

d/or

Oth

er U

ses o

f Med

ical

Mar

ijuan

a

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

Res

earc

h

Oth

erC

omm

ents

Ref

eren

ceA

mer

ican

Can

cer S

ocie

ty7/

24/1

997

3Su

ppor

ted

Cal

iforn

ia re

sear

ch b

ill S

.B. 5

35Le

tter t

o C

alifo

rnia

Sta

te S

en. J

ohn

Vasc

once

l-lo

sA

mer

ican

Col

lege

of P

hysic

ians

2/20

083

3Th

e A

CP

“urg

es a

n ev

iden

ce-b

ased

revi

ew o

f mar

i-ju

ana’s

stat

us a

s a S

ched

ule

I con

trol

led

subs

tanc

e to

det

erm

ine

whe

ther

it sh

ould

be

recl

assif

ied

to a

di

ffere

nt sc

hedu

le.”

It al

so “s

tron

gly

urge

s pro

tec-

tion

from

crim

inal

or c

ivil

pena

lties

for p

atie

nts

who

use

med

ical

mar

ijuan

a as

per

mitt

ed u

nder

st

ate

law

s.”

Febr

uary

200

8 po

sitio

n pa

per,

with

July

200

8 ad

dend

um

Am

eric

an M

edic

al A

ssoc

iatio

n11

/200

93

3“O

ur A

mer

ican

Med

ical

Ass

ocia

tion

(AM

A)

urge

s tha

t mar

ijuan

a’s st

atus

as a

fede

ral S

ched

ule

I con

trol

led

subs

tanc

e be

revi

ewed

with

the

goal

of

faci

litat

ing

the

cond

uct o

f clin

ical

rese

arch

and

de

velo

pmen

t of c

anna

bino

id-b

ased

med

icin

es. T

his

shou

ld n

ot b

e vi

ewed

as a

n en

dors

emen

t of s

tate

-ba

sed

med

ical

can

nabi

s pro

gram

s, th

e le

galiz

atio

n of

mar

ijuan

a, o

r tha

t sci

entif

ic e

vide

nce

on th

e th

erap

eutic

use

of c

anna

bis m

eets

the

curr

ent

stan

dard

s for

a p

resc

riptio

n dr

ug p

rodu

ct.”

Cou

ncil

on S

cien

ce a

nd P

ublic

Hea

lth R

epor

t #3

: Use

of C

anna

bis f

or M

edic

inal

Pur

pose

s

Am

eric

an P

sych

iatr

ic A

ssoc

iatio

n19

983

Oth

er: “

effe

ctiv

e pa

tient

car

e re

quire

s the

free

and

un

fette

red

exch

ange

of i

nfor

mat

ion

on tr

eat-

men

t alte

rnat

ives

; disc

ussio

n of

thes

e al

tern

ativ

es

betw

een

phys

icia

ns a

nd p

atie

nts s

houl

d no

t sub

ject

ei

ther

par

ty to

any

crim

inal

pen

altie

s”

Appr

oved

by

the

APA

Boa

rd o

f Tru

stee

s in

re-

spon

se to

fede

ral t

hrea

ts a

gain

st p

hysic

ians

fol-

low

ing

the

pass

age

of C

alif.

Pro

p. 2

15, r

epor

ted

in P

sych

iatr

ic N

ews,

9/4/

1998

Am

eric

an S

ocie

ty o

f Hea

lth-

Syst

em P

harm

acist

s (A

SHP)

6/20

113

“To

enco

urag

e th

e D

rug

Enfo

rcem

ent

Adm

inist

ratio

n to

elim

inat

e ba

rrie

rs to

med

ical

m

ariju

ana

rese

arch

, inc

ludi

ng re

view

of m

edic

al

mar

ijuan

a’s st

atus

as a

Sch

edul

e I c

ontr

olle

d su

bsta

nce,

and

its re

clas

sific

atio

n, if

nec

essa

ry to

fa

cilit

ate

rese

arch

…”

Hou

se o

f Del

egat

es o

f the

Am

eric

an S

ocie

ty

of H

ealth

-Sys

tem

Pha

rmac

ists (

ASH

P), 6

3rd

annu

al se

ssio

n, Ju

ne 1

2-14

, 201

1

Page 183: State by State Laws Report 2011

P-25

Appendix P: Partial List of Organizations w

ith Favorable Positions on Medical M

arijuana

State-By-State Report 2011Pa

rtia

l Lis

t of O

rgan

izat

ions

With

Fav

orab

le P

ositi

ons o

n R

esea

rch

and/

or O

ther

Use

s of M

edic

al M

ariju

ana

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

Res

earc

h

Oth

erC

omm

ents

Ref

eren

ceA

ssoc

iatio

n of

Nur

ses i

n A

IDS

Car

e (A

NA

C)

1/20

083

3A

NA

C b

elie

ves t

hat “

fund

ing

for r

esea

rch

thro

ugh

fede

ral f

undi

ng so

urce

s is r

equi

red

to d

eter

min

e th

e sa

fety

and

effi

cacy

of m

ariju

ana

as a

ther

apeu

tic

inte

rven

tion

for a

var

iety

of s

ympt

oms i

n H

IV/

AID

S an

d ot

her d

iseas

es; h

ealth

care

per

sonn

el

(HC

P) sh

ould

not

be

thre

aten

ed, p

enal

ized

, or

othe

rwise

intim

idat

ed fo

r disc

ussin

g an

d/or

re

com

men

ding

the

med

icin

al u

se o

f mar

ijuan

a;

indi

vidu

als s

houl

d no

t be

pros

ecut

ed fo

r med

ical

us

e of

mar

ijuan

a.”

Med

ical

Use

of M

ariju

ana,

Pos

ition

Sta

tem

ent,

Ado

pted

by

AN

AC

Boa

rd o

f Dire

ctor

s, Se

ptem

ber 1

3, 1

998,

Rev

iew

ed a

nd R

evise

d by

th

e A

NA

C B

oard

: Aug

ust 1

4, 1

999;

Nov

embe

r 1,

200

0; A

pril

15, 2

001;

Janu

ary

2003

; Aug

ust

2005

; and

Janu

ary

2008

Briti

sh M

edic

al A

ssoc

iatio

n11

/18/

1997

33

Rese

arch

to d

evel

op c

anna

bino

id p

harm

aceu

tical

s; ot

her:

leni

ency

for m

edic

al m

ariju

ana-

usin

g pa

-tie

nts i

n th

e m

eant

ime

(“th

erap

eutic

use

shou

ld n

ot

be co

nfus

ed w

ith re

crea

tiona

l misu

se”)

BMA

repo

rt: “

Ther

apeu

tic U

ses o

f Can

nabi

s,”

1997

Con

gres

s of N

ursin

g Pr

actic

e5/

31/1

996

33

Oth

er: i

nstr

uctin

g RN

s on

med

ical

mar

ijuan

aM

otio

n pa

ssed

by

CN

P

Fede

ratio

n of

Am

eric

an S

cien

tists

11/1

994

3FA

S Pe

titio

n on

Med

ical

Mar

ijuan

a

HIV

Med

icin

e A

ssoc

iatio

n of

the

Infe

ctio

us D

iseas

es S

ocie

ty o

f A

mer

ica

10/2

004

3“[

I]t c

anno

t ser

ious

ly b

e co

ntes

ted

that

ther

e ex

ists

a sm

all b

ut si

gnifi

cant

clas

s of i

ndiv

idua

ls w

ho

suffe

r fro

m p

ainf

ul ch

roni

c, de

gene

rativ

e, an

d te

rmin

al co

nditi

ons,

for w

hom

mar

ijuan

a pr

ovid

es

uniq

uely

effe

ctiv

e re

lief.”

HIV

Med

icin

e A

ssoc

iatio

n of

the

Infe

ctio

us

Dise

ases

Soc

iety

of A

mer

ica,

alo

ng w

ith

Am

eric

an M

edic

al S

tude

nts A

ssoc

iatio

n,

Lym

phom

a Fo

unda

tion

of A

mer

ica,

Dr.

Barb

ara

Robe

rts,

and

Irvi

n Ro

senf

eld,

Am

icus

Cu

riae

brie

f file

d in

the

U.S

. Sup

rem

e C

ourt

(in

the

case

of G

onza

les v.

Rai

ch),

Oct

ober

200

4 H

uman

Rig

hts C

ampa

ign

1/15

/199

73

Reso

lutio

n

Iow

a M

edic

al S

ocie

ty4/

18/2

010

3“R

esol

ved:

Tha

t the

Iow

a M

edic

al S

ocie

ty su

ppor

t th

e Io

wa

Boar

d of

Pha

rmac

y’s re

clas

sific

atio

n of

m

ariju

ana

as a

Sch

edul

e II

cont

rolle

d su

bsta

nce

with

the

goal

of f

acili

tatin

g fu

rthe

r stu

dy in

to

pote

ntia

l med

ical

use

s.”

Subs

titut

e Re

solu

tion

10-0

3

Page 184: State by State Laws Report 2011

P-26

Stat

e-By

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te R

epor

t 201

1

Appe

ndix

P: P

artia

l List

of O

rgan

izat

ions

with

Fav

orab

le P

ositi

ons o

n M

edic

al M

ariju

ana

Part

ial L

ist o

f Org

aniz

atio

ns W

ith F

avor

able

Pos

ition

s on

Res

earc

h an

d/or

Oth

er U

ses o

f Med

ical

Mar

ijuan

a

Nam

e of

Gro

upD

ate

Lega

l /

Pres

crip

tive

Acc

ess

Com

pass

iona

te

Acc

ess

Res

earc

h

Oth

erC

omm

ents

Ref

eren

ceK

aise

r Per

man

ente

1997

3O

ther

: May

/June

199

7 ed

ition

of t

heir

Hea

lth

Educ

atio

n Se

rvic

es’ “

HIV

New

slette

r” in

clud

es

mar

ijuan

a as

a tr

eatm

ent o

ptio

n fo

r AID

S w

astin

g sy

ndro

me;

dev

elop

ed fo

rm le

tter f

or C

alifo

rnia

an

d W

ashi

ngto

n do

ctor

s to

ackn

owle

dge

patie

nts’

med

ical

mar

ijuan

a us

e

On

file

The L

ance

t Neu

rolo

gy5/

1/03

3O

ther

: Mar

ijuan

a ca

n “i

nhib

it pa

in in

virt

ually

ev

ery

expe

rimen

tal p

ain

para

digm

.” A

lso su

g-ge

sted

that

mar

ijuan

a co

uld

be “t

he a

spiri

n of

the

21st

cent

ury.”

“The

ther

apeu

tic p

oten

tial o

f can

nabi

s,” T

he

Lanc

et N

euro

logy

, Vol

. 2, N

o. 5

, May

1, 2

003

Nat

iona

l Epi

leps

y Fo

unda

tion

6/20

053

“Stu

dyin

g th

e ef

fect

s of m

ariju

ana

on se

izur

es in

an

appr

opria

te le

gal a

nd sc

ient

ific e

nviro

nmen

t is

the

optim

al w

ay to

det

erm

ine

whe

ther

this

curr

ently

ille

gal d

rug

has a

ny ap

prop

riate

use

for

the

trea

tmen

t of e

pile

psy.

The

Epile

psy

Foun

datio

n ca

lls fo

r fur

ther

stud

y of

the

role

of T

HC

in a

nim

al

mod

els a

nd fo

r ran

dom

ized

pla

cebo

cont

rolle

d st

udie

s of t

his p

oten

tial t

reat

men

t of s

eizu

res.”

Reso

lutio

n

Nat

iona

l Mul

tiple

Scl

eros

is So

ciet

y7/

2011

3“B

ecau

se in

hale

d sm

oked

can

nabi

s has

mor

e fa

vora

ble

phar

mac

okin

etic

s tha

n ad

min

istra

tion

via

oral

or o

ther

rout

es, r

esea

rch

shou

ld fo

cus

on th

e de

velo

pmen

t of a

n in

hale

d m

ode

of

adm

inist

ratio

n th

at g

ives

resu

lts a

s clo

se to

smok

ed

cann

abis

as p

ossib

le. …

The

re a

re su

ffici

ent d

ata

avai

labl

e to

sugg

est t

hat c

anna

bino

ids m

ay h

ave

neur

opro

tect

ive

effe

cts t

hat s

tudi

es in

this

area

sh

ould

be

aggr

essiv

ely

purs

ued.”

“Rec

omm

enda

tions

Reg

ardi

ng th

e U

se o

f C

anna

bis i

n M

ultip

le S

cler

osis,

” Exp

ert

Opi

nion

Pap

er, J

uly

2011

Texa

s Med

ical

Ass

ocia

tion

5/14

/200

43

3“T

he T

exas

Med

ical

Ass

ocia

tion

supp

orts

(1) t

he

phys

icia

n’s ri

ght t

o di

scus

s with

his/

her p

atie

nts a

ny

and

all p

ossib

le tr

eatm

ent o

ptio

ns re

late

d to

the

patie

nts’

heal

th a

nd cl

inic

al c

are,

incl

udin

g th

e us

e of

mar

ijuan

a, w

ithou

t the

thre

at to

the

phys

icia

n or

pat

ient

of r

egul

ator

y, di

scip

linar

y, or

crim

inal

sa

nctio

ns; a

nd (2

) fur

ther

wel

l-con

trol

led

stud

ies o

f th

e us

e of

mar

ijuan

a w

ith se

rious

ly il

l pat

ient

s who

m

ay b

enef

it fr

om su

ch a

ltern

ativ

e tr

eatm

ent.”

Ado

pted

as a

ssoc

iatio

n po

licy

at th

e

May

200

4 an

nual

conv

entio

n

Page 185: State by State Laws Report 2011

Q-1

Appendix Q: M

PP’s Model State M

edical Marijuana Bill

State-By-State Report 2011Appendix Q: MPP’s Model State Medical Marijuana Bill

Be it enacted by the people of the state of ____________________:

Section 1. Title.Sections 1 through 27 of this chapter shall be known as the _____________ Medical Marijuana Act.

Section 2. Findings.(a) Marijuana’s recorded use as a medicine goes back nearly 5,000 years. Modern medical research has confirmed the beneficial uses for marijuana in treating or alleviating the pain, nausea, and other symptoms associated with a variety of debilitating medical conditions, including cancer, multiple sclerosis, and HIV/AIDS, as found by the National Academy of Sciences’ Institute of Medicine in March 1999.

(b) Studies published since the 1999 Institute of Medicine report have continued to show the therapeutic value of marijuana in treating a wide array of debilitat-ing medical conditions. These include relief of the neuropathic pain caused by multiple sclerosis, HIV/AIDS, and other illnesses and injuries that often fails to respond to conventional treatments and relief of nausea, vomiting, and other side effects of drugs used to treat HIV/AIDS and hepatitis C, increasing the chances of patients continuing on life-saving treatment regimens.

(c) Marijuana has many currently accepted medical uses in the United States, hav-ing been recommended by thousands of licensed physicians to more than 500,000 patients in states with medical marijuana laws. Marijuana’s medical utility has been recognized by a wide range of medical and public health organizations, including the American Academy of HIV Medicine, the American College of Physicians, the American Nurses Association, the American Public Health Association, the Leukemia & Lymphoma Society, and many others.

(d) Data from the Federal Bureau of Investigation’s Uniform Crime Reports and the Compendium of Federal Justice Statistics show that approximately 99 out of every 100 marijuana arrests in the U.S. are made under state law, rather than un-der federal law. Consequently, changing state law will have the practical effect of protecting from arrest the vast majority of seriously ill patients who have a medi-cal need to use marijuana.

(e) Alaska, Arizona, California, Colorado, Delaware, the District of Columbia, Hawaii, Maine, Michigan, Montana, Nevada, New Mexico, New Jersey, Oregon, Vermont, Rhode Island, and Washington have removed state- or district-level criminal penalties from the medical use and cultivation of marijuana. _____ joins in this effort for the health and welfare of its citizens.

(f) States are not required to enforce federal law or prosecute people for engaging in activities prohibited by federal law. Therefore, compliance with this act does not put the state of _____ in violation of federal law.

(g) State law should make a distinction between the medical and non-medical uses of marijuana. Hence, the purpose of this act is to protect patients with debilitating

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medical conditions, as well as their practitioners and providers, from arrest and prosecution, criminal and other penalties, and property forfeiture, if such patients engage in the medical use of marijuana.

Section 3. Definitions.For purposes of this chapter, unless the context otherwise requires:

(a) “Bona fide practitioner-patient relationship” means:

(1) A practitioner and patient have a treatment or consulting relationship, during the course of which the physician has completed a full assessment of the patient’s medical history and current medical condition, including an appropriate personal physical examination;

(2) The practitioner has consulted with the patient with respect to the patient’s debilitating medical condition; and

(3) The physician is available to or offers to provide follow-up care and treatment to the patient, including but not limited to patient examinations.

(b) “Cardholder” means a qualifying patient or a designated caregiver who has been issued and possesses a valid registry identification card.

(c) “Compassion center agent” means a principal officer, board member, employ-ee, or agent of a registered compassion center who is 21 years of age or older and has not been convicted of a disqualifying felony offense.

(d) “Debilitating medical condition” means:

(1) cancer, glaucoma, positive status for human immunodeficiency virus, acquired immune deficiency syndrome, hepatitis C, amyotrophic lateral sclerosis, Crohn’s disease, agitation of Alzheimer’s disease, post-traumatic stress disorder, or the treatment of these conditions;

(2) a chronic or debilitating disease or medical condition or its treatment that produces one or more of the following: cachexia or wasting syndrome; severe, debilitating pain; severe nausea; seizures; or severe and persistent muscle spasms, including but not limited to those characteristic of multiple sclerosis; or

(3) any other medical condition or its treatment added by the department, as pro-vided for in section 7.

(e) “Department” means the _____ Department of Health or its successor agency.

(f) “Designated caregiver” means a person who:

(1) is at least 21 years of age;

(2) has agreed to assist with a patient’s medical use of marijuana;

(3) has not been convicted of a disqualifying felony offense; and

(4) assists no more than five qualifying patients with their medical use of marijuana.

(g) “Disqualifying felony offense” means:

(1) a violent crime defined in section ____, that was classified as a felony in the jurisdiction where the person was convicted; or

(2) a violation of a state or federal controlled substance law that was classified as a felony in the jurisdiction where the person was convicted, not including:

Page 187: State by State Laws Report 2011

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Appendix Q: M

PP’s Model State M

edical Marijuana Bill

State-By-State Report 2011(A) an offense for which the sentence, including any term of probation, incarcera-tion, or supervised release, was completed 10 or more years earlier; or

(B) an offense that consisted of conduct for which this chapter would likely have prevented a conviction, but the conduct either occurred prior to the enactment of this chapter or was prosecuted by an authority other than the state of ________ .

(h) “Enclosed, locked facility” means a closet, room, greenhouse, building, or other enclosed area that is equipped with locks or other security devices that per-mit access only by the cardholder allowed to cultivate the plants or, in the case of a registered compassion center, the compassion center agents working for the registered compassion center. Two or more registered qualifying patients and/or registered designated caregivers who reside in the same dwelling and have a regis-try identification card that removes state penalties for marijuana cultivation may share one enclosed, locked facility for cultivation.

(i) “Marijuana” has the meaning given that term in _____.

(j) “Mature marijuana plant” means a marijuana plant that with one or more of the following characteristics:

(1) the plant has flowers;

(2) the plant is 12 or more inches in height; or

(3) the plant is 12 inches or greater in diameter.

(k) “Medical use” includes the acquisition, administration, cultivation, or manu-facture in an enclosed, locked facility; delivery, possession, transfer, transportation, or use of marijuana or paraphernalia relating to the administration of marijuana to treat or alleviate a registered qualifying patient’s debilitating medical condition or symptoms associated with the patient’s debilitating medical condition. It does not include cultivation by a visiting qualifying patient or cultivation by a regis-tered designated caregiver or registered qualifying patient who is not designated as being allowed to cultivate.

(l) “Practitioner” means a person who is licensed with authority to prescribe drugs to humans under section _____ except as otherwise provided in this subsection. If the qualifying patient’s debilitating medical condition is post-traumatic stress disorder, the practitioner must be a licensed psychiatrist. In relation to a visiting qualifying patient, “practitioner” means a person who is licensed with authority to prescribe drugs to humans in the state of the patient’s residence.

(m) “Qualifying patient” means a person who has been diagnosed by a practitio-ner as having a debilitating medical condition.

(n) “Registered compassion center” means a not-for-profit entity registered pur-suant to section 15 that acquires, possesses, cultivates, manufactures, delivers, transfers, transports, sells, supplies, or dispenses marijuana, paraphernalia, or related supplies and educational materials to registered qualifying patients.

(o) “Registry identification card” means a document issued by the department that identifies a person as a registered qualifying patient or registered designated caregiver.

(p) “Registered safety compliance facility” means an entity registered under sec-tion 16 by the department to provide one or more of the following services:

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testing marijuana produced for medical use, including for potency and contami-nants; and training cardholders and compassion center agents. The training may include, but need not be limited to, information related to one or more of the following:

(A) the safe and efficient cultivation, harvesting, packaging, labeling, and distribu-tion of marijuana;

(B) security and inventory accountability procedures; and up-to-date scientific and medical research findings related to medical marijuana.

(q) “Safety compliance facility agent” means a principal officer, board member, employee, or agent of a registered safety compliance facility who is 21 years of age or older and has not been convicted of a disqualifying felony offense.

(r) “Seedling” means a marijuana plant that has no flowers, is less than 12 inches in height, and is less than 12 inches in diameter.

(s) “Usable marijuana” means the flowers of the marijuana plant and any mixture or preparation thereof, but does not include the seeds, stalks, and roots of the plant. It does not include the weight of any non-marijuana ingredients combined with marijuana, including ingredients added to prepare a topical administration, food, or drink.

(t) “Verification system” means a phone or Web-based system established and maintained by the department that is available to law enforcement personnel and compassion center agents on a twenty-four-hour basis for verification of registry identification cards.

(u) “Visiting qualifying patient” means a person who:

(1) has been diagnosed with a debilitating medical condition;

(2) possesses a valid registry identification card, or its equivalent, that was issued pursuant to the laws of another state, district, territory, commonwealth, insular possession of the United States or country recognized by the United States that allows the person to use marijuana for medical purposes in the jurisdiction of issuance; and

(3) is not a resident of ____ or who has been a resident of _____ for less than 30 days.

(v) “Written certification” means a document dated and signed by a practitioner, stating that in the practitioner’s professional opinion the patient is likely to receive therapeutic or palliative benefit from the medical use of marijuana to treat or alle-viate the patient’s debilitating medical condition or symptoms associated with the debilitating medical condition. A written certification shall affirm that it is made in the course of a bona fide practitioner-patient relationship and shall specify the qualifying patient’s debilitating medical condition.

Section 4. Protections for the Medical Use of Marijuana.(a) A registered qualifying patient shall not be subject to arrest, prosecution, or denial of any right or privilege, including but not limited to civil penalty or disciplinary action by a court or occupational or professional licensing board or bureau, for the medical use of marijuana pursuant to this chapter, if the registered qualifying patient does not possess more than:

Page 189: State by State Laws Report 2011

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Appendix Q: M

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edical Marijuana Bill

State-By-State Report 2011(1) Six ounces of usable marijuana; and

(2) 12 mature marijuana plants and 12 seedlings, if the qualifying patient has not specified that a designated caregiver will be allowed under state law to cultivate marijuana for the qualifying patient.

(b) A registered designated caregiver shall not be subject to arrest, prosecution, or denial of any right or privilege, including but not limited to civil penalty or disciplinary action by a court or occupational or professional licensing board or bureau:

(1) for assisting a registered qualifying patient to whom he or she is connected through the department’s registration process with the medical use of marijuana if the designated caregiver does not possess more than:

(A) Six ounces of usable marijuana for each qualifying patient to whom the reg-istered caregiver is connected through the department’s registration process; and

(B) 12 mature marijuana plants and 12 seedlings for each registered qualifying patient who has specified that the designated caregiver will be allowed under state law to cultivate marijuana for the qualifying patient.

(2) for receiving compensation for costs associated with assisting a registered qualifying patient’s medical use of marijuana if the registered designated caregiver is connected to the registered qualifying patient through the department’s regis-tration process.

(c) All mature marijuana plants and seedlings possessed pursuant to this section must be kept in an enclosed, locked facility, unless they are being transported to a permissible location, including because the cardholder is moving, the registered qualifying patient has changed his or her designation of who can cultivate, or the plants are being given to someone allowed to possess them pursuant to this chapter.

(d) A visiting qualifying patient shall not be subject to arrest, prosecution, or denial of any right or privilege, including but not limited to civil penalty or disciplinary action by a court or occupational or professional licensing board or bureau, for the medical use of marijuana pursuant to this chapter if the visiting qualifying patient does not possess more than six ounces of usable marijuana.

(e) A registered qualifying patient, visiting qualifying patient, or registered des-ignated caregiver shall not be subject to arrest, prosecution, or denial of any right or privilege, including but not limited to civil penalty or disciplinary action by a court or occupational or professional licensing board or bureau for:

(1) possession of marijuana that is incidental to medical use, but is not mature marijuana plants, seedlings, or usable marijuana as defined in this chapter;

(2) selling, transferring, or delivering marijuana seeds produced by the registered qualifying patient, visiting qualifying patient, or registered designated caregiver to a registered compassion center;

(3) transferring marijuana to a registered safety compliance facility for testing; or

(4) giving marijuana to a registered qualifying patient, a registered compassion center, or a registered designated caregiver for a registered qualifying patient’s medical use where nothing of value is transferred in return, or for offering to do

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the same, if the person giving the marijuana does not knowingly cause the recipi-ent to possess more marijuana than is permitted by this section.

(f) (1) There shall be a presumption that a qualifying patient is engaged in, or a designated caregiver is assisting with, the medical use of marijuana in accordance with this chapter if the qualifying patient or designated caregiver:

(A) is in possession of a valid registry identification card, or, in the case of a visit-ing qualifying patient, its equivalent; and

(B) is in possession of an amount of marijuana that does not exceed the amount allowed under section 4(a)-(c).

(2) The presumption may be rebutted by evidence that conduct related to mari-juana was not for the purpose of treating or alleviating the qualifying patient’s debilitating medical condition or symptoms associated with the debilitating med-ical condition in compliance with this chapter.

(g) A practitioner shall not be subject to arrest, prosecution, or penalty in any manner, or denied any right or privilege, including but not limited to civil penalty or disciplinary action by the ______ Medical Board or by any other occupational or professional licensing board or bureau, solely for providing written certifica-tions or for otherwise stating that, in the practitioner’s professional opinion, a patient is likely to receive therapeutic or palliative benefit from the medical use of marijuana to treat or alleviate the patient’s serious or debilitating medical condi-tion or symptoms associated with the serious or debilitating medical condition, provided that nothing in this chapter shall prevent a practitioner from being sanc-tioned for:

(1) issuing a written certification to a patient with whom the practitioner does not have a bona fide practitioner-patient relationship, or

(2) failing to properly evaluate a patient’s medical condition or otherwise violating the standard of care.

(h) No person may be subject to arrest, prosecution, or denial of any right or privi-lege, including but not limited to civil penalty or disciplinary action by a court or occupational or professional licensing board or bureau, for:

(1) selling marijuana paraphernalia to a cardholder upon presentation of a registry identification card in the recipient’s name that has not expired or to a compassion center agent or registered safety compliance facility agent upon presentation of an unexpired copy of the entity’s registration certificate;

(2) being in the presence or vicinity of the medical use of marijuana as allowed under this chapter; or

(3) assisting a registered qualifying patient with using or administering marijuana. For purposes of illustration and not limitation, this includes preparing a vaporizer for a registered qualifying patient’s use or brewing tea for a registered qualifying patient. It does not include providing marijuana to a patient that the patient did not already possess.

(i) A registered compassion center shall not be subject to prosecution under state or municipal law; search or inspection, except by the department pursuant to sec-tion 20 (u); seizure; or penalty in any manner, or be denied any right or privilege, including but not limited to civil penalty or disciplinary action by a court or busi-

Page 191: State by State Laws Report 2011

Q-7

Appendix Q: M

PP’s Model State M

edical Marijuana Bill

State-By-State Report 2011ness licensing board or entity, for acting pursuant to this chapter and department regulations to: sell marijuana seeds to similar entities that are registered to dis-pense marijuana for medical use in other jurisdictions; acquire, possess, cultivate, manufacture, deliver, transfer, transport, supply, sell, or dispense marijuana or related supplies and educational materials to registered qualifying patients and visiting qualifying patients who have designated the compassion center to provide for them, to registered designated caregivers on behalf of the registered qualify-ing patients who have designated the registered compassion center, or to other registered compassion centers.

(j) A registered compassion center agent shall not be subject to prosecution, search, or penalty in any manner, or be denied any right or privilege, including but not limited to civil penalty or disciplinary action by a court or business licensing board or entity, for working for a registered compassion center pursuant to this chapter and department regulations to acquire, possess, cultivate, manufacture, deliver, transfer, transport, supply, sell, or dispense marijuana or related supplies and educational materials to registered qualifying patients who have designated the registered compassion center to provide for them, to registered designated caregivers on behalf of the registered qualifying patients who have designated the registered compassion center, or to other registered compassion centers.

(k) A registered safety compliance facility and registered safety compliance facil-ity agents acting on behalf of a registered safety compliance facility shall not be subject to prosecution; search, except by the department pursuant to section 20 (u); seizure; or penalty in any manner, or be denied any right or privilege, includ-ing but not limited to civil penalty or disciplinary action by a court or business licensing board or entity, solely for acting in accordance with this chapter and department regulations to provide the following services:

(1) acquiring or possessing marijuana obtained from registered cardholders or registered compassion centers;

(2) returning the marijuana to registered cardholders or registered compassion centers;

(3) transporting marijuana that was produced by registered cardholders and reg-istered compassion centers to or from those registered cardholders and registered compassion centers;

(4) the production or sale of educational materials related to medical marijuana;

(5) the production, sale, or transportation of equipment or materials other than marijuana to registered compassion centers or cardholders, including lab equip-ment and packaging materials, that are used by registered compassion centers and cardholders;

(6) testing of medical marijuana samples, including for potency, pesticides, mold, and contamination; and

(7) providing training to cardholders and prospective compassion center agents, provided that only cardholders may be allowed to possess or cultivate marijuana and any possession or cultivation of marijuana must occur on the location regis-tered with the department; and receiving compensation for actions allowed under this section.

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(l) Any marijuana, marijuana paraphernalia, licit property, or interest in licit property that is possessed, owned, or used in connection with the medical use of marijuana as allowed under this chapter, or acts incidental to such use, shall not be seized or forfeited. This chapter shall not prevent the seizure or forfeiture of marijuana exceeding the amounts allowed under this chapter, nor shall it prevent seizure or forfeiture if the basis for the action is unrelated to the marijuana that is possessed, manufactured, transferred, or used pursuant to this chapter.

(m) Mere possession of, or application for, a registry identification card or reg-istration certificate shall not constitute probable cause or reasonable suspicion, nor shall it be used to support the search of the person, property, or home of the person possessing or applying for the registry identification card. The possession of, or application for, a registry identification card shall not preclude the existence of probable cause if probable cause exists on other grounds.

(n) For the purposes of ______ state law, the medical use of marijuana by a card-holder or registered compassion center shall be considered lawful as long as it is in accordance with this chapter.

(o) No law enforcement officer employed by an agency which receives state or local government funds shall expend any state or local resources, including the officer’s time, to effect any arrest or seizure of marijuana, or conduct any investi-gation, on the sole basis of activity the officer believes to constitute a violation of the federal Controlled Substances Act if the officer has reason to believe that such activity is in compliance with state medical marijuana laws, nor shall any such officer expend any state or local resources, including the officer’s time, to provide any information or logistical support related to such activity to any federal law enforcement authority or prosecuting entity.

(p) An attorney may not be subject to disciplinary action by the state bar asso-ciation or other professional licensing association for providing legal assistance to prospective or registered compassion centers, prospective or registered safety compliance facilities, or others related to activity that is no longer subject to crimi-nal penalties under state law pursuant to this chapter.

Section 5. Limitations.(a) This chapter does not authorize any person to engage in, and does not prevent the imposition of any civil, criminal, or other penalties for engaging in, the fol-lowing conduct:

(1) Undertaking any task under the influence of marijuana, when doing so would constitute negligence or professional malpractice;

(2) Possessing marijuana, or otherwise engaging in the medical use of marijuana:

(A) in a school bus;

(B) on the grounds of any preschool or primary or secondary school; or

(C) in any correctional facility.

(3) Smoking marijuana:

(A) on any form of public transportation; or

(B) in any public place.

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(5) Using marijuana, if that person does not have a serious or debilitating medical condition.

Section 6. Discrimination Prohibited. (a) Except as provided in this chapter, a registered qualifying patient who uses marijuana for medical purposes shall be afforded all the same rights under state and local law, including those guaranteed under ______ [the state’s disability rights law], as the individual would have been afforded if he or she were solely prescribed pharmaceutical medications, as it pertains to:

(1) any interaction with a person’s employer;

(2) drug testing by one’s employer; or

(3) drug testing required by any state or local law, agency, or government official.

(b) (1) The rights provided by this section do not apply to the extent that they conflict with an employer’s obligations under federal law or regulations or to the extent that they would disqualify an employer from a monetary or licensing-relat-ed benefit under federal law or regulations.

(2) No employer is required to allow the ingestion of marijuana in any work-place or to allow any employee to work while under the influence of marijuana. A registered qualifying patient shall not be considered to be under the influence of marijuana solely because of the presence of metabolites or components of mari-juana that appear in insufficient concentration to cause impairment.

(c) No school or landlord may refuse to enroll or lease to, or otherwise penalize, a person solely for his or her status as a registered qualifying patient or a regis-tered designated caregiver, unless failing to do so would violate federal law or regulations or cause the school or landlord to lose a monetary or licensing-related benefit under federal law or regulations.

(d)  For the purposes of medical care, including organ transplants,  a registered qualifying patient’s authorized use of marijuana in accordance with this chapter is the equivalent of the authorized use of any other medication used at the direction of a physician, and shall not constitute the use of an illicit substance or otherwise disqualify a qualifying patient from needed medical care.

(e) A person otherwise entitled to custody of or visitation or parenting time with a minor shall not be denied such a right, and there shall be no presumption of neglect or child endangerment, for conduct allowed under this chapter, unless the person’s actions in relation to marijuana were such that they created an unrea-sonable danger to the safety of the minor as established by clear and convincing evidence.

(f) No school, landlord, or employer may be penalized or denied any benefit un-der state law for enrolling, leasing to, or employing a cardholder.

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Bill Section 7. Addition of Debilitating Medical Conditions.

Any citizen may petition the department to add conditions or treatments to the list of debilitating medical conditions listed in section 3(d). The department shall consider petitions in the manner required by department regulation, including public notice and hearing. The department shall approve or deny a petition within 180 days of its submission. The approval or denial of any petition is a final decision of the department subject to judicial review. Jurisdiction and venue are vested in the _____ Court.

Section 8. Acts Not Required, Acts Not Prohibited.(a) Nothing in this chapter requires:

(1) a government medical assistance program or private insurer to reimburse a person for costs associated with the medical use of marijuana, or

(2) any person or establishment in lawful possession of property to allow a guest, client, customer, or other visitor to smoke marijuana on or in that property.

(b) Nothing in this chapter prohibits an employer from disciplining an employee for ingesting marijuana in the workplace or working while under the influence of marijuana.

Section 9. Registration of Qualifying Patients and Designated Caregivers.(a) The department shall issue registry identification cards to qualifying patients who submit the following, in accordance with the department’s regulations:

(1) a written certification issued by a practitioner within 90 days immediately pre-ceding the date of an application;

(2) if the patient is not a visiting qualifying patient, documentation required by department regulations to reasonably establish proof of residency in _____ state;

(3) if the patient is a visiting qualifying patient, a copy of his or her registry identification card or its equivalent that was issued pursuant to the laws of the jurisdiction of the person’s residence;

(4) the application or renewal fee;

(5) the name, address, and date of birth of the qualifying patient, except that if the applicant is homeless no address is required;

(6) the name, address, and telephone number of the qualifying patient’s practitioner;

(7) the name, address, and date of birth of the designated caregiver, if any, chosen by the qualifying patient, except that a visiting qualifying patient may not have a designated caregiver;

(8) the name of the registered compassion center the qualifying patient desig-nates, if any;

(9) if the qualifying patient designates a designated caregiver, a designation as to whether the qualifying patient or designated caregiver will be allowed under state law to possess and cultivate marijuana plants for the qualifying patient’s medical use;

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State-By-State Report 2011(10) a statement signed by the qualifying patient, pledging not to divert marijuana to anyone who is not allowed to possess marijuana pursuant to this chapter; and

(11) a signed statement from the designated caregiver, if any, agreeing to be desig-nated as the patient’s designated caregiver and pledging not to divert marijuana to anyone who is not allowed to possess marijuana pursuant to this chapter.

(b) The application for qualifying patients’ registry identification cards shall ask whether the patient would like the department to notify him or her of any clinical studies needing human subjects for research on the medical use of marijuana. The department shall notify interested patients if it is notified of studies that will be conducted in the United States.

Section 10. Issuance of Registry Identification Cards.(a) Except as provided in subsection (b), the department shall:

(1) verify the information contained in an application or renewal submitted pur-suant to this chapter, and approve or deny an application or renewal, within 15 days of receiving a completed application or renewal application;

(2) issue registry identification cards to a qualifying patient and his or her desig-nated caregiver, if any, within five days of approving the application or renewal. A designated caregiver must have a registry identification card for each of his qualifying patients; and

(3) enter the registry identification number of the registered compassion center the patient designates into the verification system.

(b) The department shall not issue a registry identification card to a qualifying patient who is younger than 18 years of age unless:

(1) the qualifying patient’s practitioner has explained the potential risks and ben-efits of the medical use of marijuana to the custodial parent or legal guardian with responsibility for health care decisions for the qualifying patient; and

(2) the custodial parent or legal guardian with responsibility for health care deci-sions for the qualifying patient consents in writing to:

(A) allow the qualifying patient’s medical use of marijuana;

(B) serve as the qualifying patient’s designated caregiver; and

(C) control the acquisition of the marijuana, the dosage, and the frequency of the medical use of marijuana by the qualifying patient.

Section 11. Denial of Registry Identification Cards.(a) The department may deny an application or renewal of a qualifying patient’s registry identification card only if the applicant:

(1) did not provide the required information or materials;

(2) previously had a registry identification card revoked; or

(3) provided false or falsified information.

(b) The department may deny an application or renewal for a designated care-giver chosen by a qualifying patient whose registry identification card was granted only if:

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(1) the designated caregiver does not meet the requirements of section 3(f);

(2) the applicant did not provide the information required;

(3) the designated caregiver previously had a registry identification card revoked; or

(4) the applicant or the designated caregiver provides false or falsified information.

(c) The department may conduct a background check of the prospective desig-nated caregiver in order to carry out this provision.

(d) The department shall notify the qualifying patient who has designated some-one to serve as his or her designated caregiver if a registry identification card will not be issued to the designated caregiver.

(e) Denial of an application or renewal is considered a final department action, subject to judicial review. Jurisdiction and venue for judicial review are vested in the _____ Court.

Section 12. Registry Identification Cards. (a) Registry identification cards shall contain all of the following:

(1) The name of the cardholder;

(2) A designation of whether the cardholder is a designated caregiver or qualify-ing patient;

(3) The date of issuance and expiration date of the registry identification card;

(4) A random 10-digit alphanumeric identification number, containing at least four numbers and at least four letters, that is unique to the cardholder;

(5) If the cardholder is a designated caregiver, the random 10-digit alphanumeric identification number of the qualifying patient the designated caregiver is receiv-ing the registry identification card to assist;

(6) A clear designation as to whether the cardholder will be allowed under state law to possess the marijuana plants for the qualifying patient’s medical use, which shall be determined based solely on the qualifying patient’s preference;

(7) A photograph of the cardholder, if the department’s regulations require one; and

(8) The phone number or Web address for the verification system.

(b) (1) Except as provided in this subsection, the expiration date shall be one year after the date of issuance.

(2) If the practitioner stated in the written certification that the qualifying patient would benefit from marijuana until a specified earlier date, then the registry iden-tification card shall expire on that date.

(c) The department may, at its discretion, electronically store in the card all of the information listed in subsection (a), along with the address and date of birth of the cardholder, to allow it to be read by law enforcement agents.

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State-By-State Report 2011Section 13. Notifications to Department and Responses; Civil Penalty.(a) The following notifications and department responses are required:

(1) A registered qualifying patient shall notify the department of any change in his or her name or address, or if the registered qualifying patient ceases to have his or her debilitating medical condition, within 10 days of the change.

(2) A registered designated caregiver shall notify the department of any change in his or her name or address, or if the designated caregiver becomes aware the qualifying patient passed away, within 10 days of the change.

(3) Before a registered qualifying patient changes his or her designated caregiver, the qualifying patient must notify the department.

(4) When a registered qualifying patient changes his or her preference as to who may cultivate marijuana for the qualifying patient, the qualifying patient must notify the department.

(5) If a cardholder loses his or her registry identification card, he or she shall notify the department within 10 days of becoming aware the card has been lost.

(b) When a cardholder notifies the department of items listed in subsection (a), but remains eligible under this chapter, the department shall issue the cardholder a new registry identification card with a new random 10-digit alphanumeric iden-tification number within 10 days of receiving the updated information and a $20 fee. If the person notifying the department is a registered qualifying patient, the department shall also issue his or her registered designated caregiver, if any, a new registry identification card within 10 days of receiving the updated information.

(c) If a registered qualifying patient ceases to be a registered qualifying patient or changes his or her registered designated caregiver, the department shall promptly notify the designated caregiver. The registered designated caregiver’s protections under this chapter as to that qualifying patient shall expire 15 days after notifica-tion by the department.

(d) A cardholder who fails to make a notification to the department that is re-quired by this section is subject to a civil infraction, punishable by a penalty of no more than $150.

(e) A registered qualifying patient shall notify the department before changing his or her designated registered compassion center and pay a $20 fee. The department must, within five business days of receiving the notification, update the registered qualifying patient’s entry in the identification registry system to reflect the change in designation and notify the patient that the change has been processed.

(f) If the registered qualifying patient’s certifying practitioner notifies the depart-ment in writing that either the registered qualifying patient has ceased to suffer from a debilitating medical condition or that the practitioner no longer believes the patient would receive therapeutic or palliative benefit from the medical use of marijuana, the card shall become null and void. However, the registered qualify-ing patient shall have 15 days to dispose of or give away his or her marijuana.

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Bill Section 14. Affirmative Defense and Dismissal for Medical Marijuana.

(a) Except as provided in section 5 and this section, an individual may assert a medical purpose for using marijuana as a defense to any prosecution of an offense involving marijuana intended for the patient’s medical use, and this defense shall be presumed valid and the prosecution shall be dismissed where the evidence shows that:

(1) A practitioner states that, in the practitioner’s professional opinion, after hav-ing completed a full assessment of the individual’s medical history and current medical condition made in the course of a bona fide practitioner-patient relation-ship, the patient is likely to receive therapeutic or palliative benefit from marijuana to treat or alleviate the individual’s serious or debilitating medical condition or symptoms associated with the individual’s serious or debilitating medical condi-tion; and

(2) The individual and the individual’s designated caregiver, if any, were collective-ly in possession of a quantity of marijuana that was not more than was reasonably necessary to ensure the uninterrupted availability of marijuana for the purpose of treating or alleviating the individual’s serious or debilitating medical condition or symptoms associated with the individual’s serious or debilitating medical condi-tion; and

(3) The individual was engaged in the acquisition, possession, cultivation, manu-facture, use, or transportation of marijuana, paraphernalia, or both marijuana and paraphernalia, relating to the administration of marijuana to treat or alleviate the individual’s serious or debilitating medical condition or symptoms associated with the individual’s serious or debilitating medical condition; and

(4) any cultivation of marijuana occurred in an enclosed, locked area that only the person asserting the defense could access.

(b) The defense and motion to dismiss shall not prevail if either of the following are proven:

(1) the individual had a registry identification card revoked for misconduct; or

(2) the purposes for the possession or cultivation of marijuana were not solely for palliative or therapeutic use by the individual with a serious or debilitating medi-cal condition who raised the defense.

(c) An individual is not required to possess a registry identification card to raise the affirmative defense set forth in this section.

(d) If an individual demonstrates the individual’s medical purpose for using mari-juana pursuant to this section, except as provided in section 5, the individual shall not be subject to the following for the individual’s use of marijuana for medical purposes:

(1) disciplinary action by an occupational or professional licensing board or bu-reau; or

(2) forfeiture of any interest in or right to non-marijuana, licit property.

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State-By-State Report 2011Section 15. Registration of Compassion Centers.(a) Compassion centers may only operate if they have been issued a valid regis-tration certificate from the department. When applying for a compassion center registration certificate, the applicant shall submit the following in accordance with department regulations:

(1) A non-refundable application fee in an amount determined by the depart-ment’s regulations, not to exceed $4,000.

(2) The proposed legal name of the compassion center.

(3) The proposed physical address of the compassion center and the proposed physical address of any additional locations, if any, where marijuana will be culti-vated, harvested, packaged, labeled, or otherwise prepared for distribution by the compassion center.

(4) The name, address, and date of birth of each principal officer and board mem-ber of the compassion center, provided that all such individuals shall be at least 21 years of age.

(5) Any instances in which a business or not-for-profit that any of the prospective board members managed or served on the board of was convicted, fined, cen-sured, or had a registration or license suspended or revoked in any administrative or judicial proceeding.

(6) Any information required by the department to evaluate the applicant pursu-ant to the competitive bidding process described in subsection (b).

(b) The department shall evaluate applications for compassion center registra-tion certificates using an impartial and numerically scored competitive bidding process developed by the department in accordance with this chapter. The regis-tration considerations shall consist of the following criteria:

(1) The suitability of the proposed location or locations, including compliance with any local zoning laws and the geographic convenience to patients from through-out the state of ______ to compassion centers if the applicant were approved.

(2) The principal officer and board members’ character and relevant experience, including any training or professional licensing related to medicine, pharmaceu-ticals, natural treatments, botany, or marijuana cultivation and preparation and their experience running businesses or not-for-profits.

(3) The proposed compassion center’s plan for operations and services, includ-ing its staffing and training plans, whether it has sufficient capital to operate, and its ability to provide an adequate supply of medical marijuana to the registered patients in the state.

(4) The sufficiency of the applicant’s plans for record keeping.

(5) The sufficiency of the applicant’s plans for safety, security, and the prevention of diversion, including proposed locations and security devices employed.

(6) The applicant’s plan for making medical marijuana available on an afford-able basis to registered qualifying patients enrolled in Medicaid or receiving Supplemental Security Income or Social Security Disability Insurance.

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(7) The applicant’s plan for safe and accurate packaging and labeling of medical marijuana, including the applicant’s plan for ensuring that all medical marijuana is free of contaminants.

(c) No later than one year after the effective date of this chapter, provided that at least five applications have been submitted, the department shall issue compas-sion center registration certificates to the five highest-scoring applicants, except that the department may divide the state into geographical areas and grant a reg-istration to the highest scoring applicant in each geographical area.

(d) No later than two years after the effective date of this chapter, the department shall issue registration certifications to at least [one compassion center registration certificate for each 200,000 residents of the state] of the highest scoring applicants not already awarded a registration certificate, provided a sufficient number of additional applications have been submitted. The need to ensure an adequate geo-graphic distribution may supersede the requirement that the approved applicants be granted registration certificates based solely on which applicants receive the highest scores. If the department determines, after reviewing the report issued pursuant to section 23, that additional compassion centers are needed to meet the needs of registered qualifying patients throughout the state, the department shall issue registration certificates to the corresponding number of applicants who score the highest.

(e) (1) At any time after two years after the effective date of this chapter that the number of outstanding and valid registered compassion center certificates is lower than the number of registration certificates the department is required to issue pursuant to subsections (c) and (d), the department shall accept applications for compassion centers and issue registration certificates to the corresponding number of additional applicants who score the highest, or that score the highest in given geographic areas.

(2) Notwithstanding subsections (c), (d), and (e), an application for a compassion center registration certificate must be denied if any of the following conditions are met:

(A) the applicant failed to submit the materials required by this section, includ-ing if the applicant’s plans do not satisfy the security, oversight, or recordkeeping regulations issued by the department;

(B) the applicant would not be in compliance with local zoning regulations issued in accordance with section 18;

(C) the applicant does not meet the requirements of section 20;

(D) one or more of the prospective principal officers or board members has been convicted of a disqualifying felony offense;

(E) one or more of the prospective principal officers or board members has served as a principal officer or board member for a registered compassion center that has had its registration certificate revoked; and

(F) one or more of the principal officers or board members is younger than 21 years of age.

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State-By-State Report 2011(f) After a compassion center is approved, but before it begins operations, it shall submit a registration fee to the department in the amount determined by the de-partment’s regulations and, if a physical address had not been finalized when it applied, it shall submit a complete listing of all its physical addresses.

(g) The department shall issue each compassion center one copy of its registra-tion certificate for each compassion center location. Registration certificates must include the compassion center’s identification number. The department shall also provide each registered compassion center with the contact information for the verification system.

Section 16. Registration and Certification of Safety Compliance Facilities. (a) Safety compliance facilities may only operate if they have been issued a valid registration certificate from the department. When applying for a safety compli-ance facility registration certificate, the applicant shall submit the following in accordance with department regulations:

(1) a non-refundable application fee in an amount determined by the department’s regulations, not to exceed $4,000;

(2) the proposed legal name of the safety compliance facility;

(3) the proposed physical address of the safety compliance facility;

(4) the name, address, and date of birth of each principal officer and board mem-ber of the safety compliance facility, provided that all such individuals shall be at least 21 years of age;

(5) any instances in which a business or not-for-profit that any of the prospective board members managed or served on the board of was convicted, fined, cen-sured, or had a registration or license suspended or revoked in any administrative or judicial proceeding; and

(6) any information required by the department to evaluate the applicant pursu-ant to the competitive bidding process described in subsection (b).

(b) The department shall evaluate applications for safety compliance facility regis-tration certificates using an impartial and numerically scored competitive bidding process developed by the department in accordance with this chapter. The regis-tration considerations shall consist of the following criteria:

(1) The proposed principal officers’ and board members’ relevant experience, in-cluding any training or professional licensing related to analytical testing, medicine, pharmaceuticals, natural treatments, botany, or marijuana cultivation, prepara-tion, and testing and their experience running businesses or not-for-profits;

(2) The suitability of the proposed location, including compliance with any lo-cal zoning laws and the geographic convenience to cardholders and registered compassion centers from throughout the state of ______ to registered safety com-pliance facilities if the applicant were approved;

(3) The sufficiency of the applicant’s plans for safety, security, and the prevention of diversion, including proposed locations and security devices employed; and

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(4) The proposed safety compliance facility’s plan for operations and services, including its staffing and training plans, and whether it has sufficient capital to operate.

(c) The department shall issue at least one safety compliance facility registration certificate to the highest scoring applicant within one year of the effective date of this chapter.

(d) (1) The department may issue additional safety compliance facility registra-tion certificates to the highest scoring applicant or applicants, or to the highest applicant or applicants in a given geographic area. If the department determines, after reviewing the report issued pursuant to section 23, that additional safety compliance facilities are needed to meet the needs of cardholders and registered compassion centers throughout the state, the department shall issue registration certificates to the corresponding number of applicants who score the highest over-all or in a geographic area.

(2) Notwithstanding subsections (c) and (d), an application for a safety compliance facility registration certificate must be denied if any of the following conditions are met:

(A) the applicant failed to submit the materials required by this section, including if the plans do not satisfy the security, oversight, or recordkeeping regulations issued by the department;

(B) the applicant would not be in compliance with local zoning regulations issued in accordance with section 18;

(C) the applicant does not meet the requirements of section 20;

(D) one or more of the prospective principal officers or board members has been convicted of a disqualifying felony offense;

(E) one or more of the prospective principal officers or board members has served as a principal officer or board member for a registered safety compliance facility or registered compassion center that has had its registration certificate revoked; and

(F) One or more of the principal officers or board members is younger than 21 years of age.

(e) After a safety compliance facility is approved, but before it begins operations, it shall submit a registration fee paid to the department in the amount determined by department regulation and, if a physical address had not been finalized when it applied, its physical address.

(f) The department shall issue each safety compliance facility a registration cer-tificate, which must include an identification number for the safety compliance facility. The department shall also provide the registered safety compliance facility with the contact information for the verification system.

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State-By-State Report 2011Section 17. Compassion Center and Safety Compliance Facilities Suspension and Revocation.(a) The department may on its own motion or on complaint, after investigation and opportunity for a public hearing at which the compassion center or safety compliance facility has been afforded an opportunity to be heard, suspend or re-voke a registration certificate for multiple or serious violations by the registrant or any of its agents of this chapter or any rules promulgated pursuant to it.

(b) The department shall provide notice of suspension, revocation, fine, or other sanction, as well as the required notice of the hearing, by mailing the same in writ-ing to the registration at the address on the registration certificate. A suspension shall not be for a longer period than six months.

(c) A registered compassion center may continue to cultivate and possess marijua-na plants during a suspension, but it may not dispense, transfer, or sell marijuana.

Section 18. Local Ordinances. Nothing shall prohibit local governments from enacting ordinances or regulations not in conflict with this chapter or with department regulations regulating the time, place, and manner of registered compassion center operations and registered safe-ty compliance facilities, provided that no local government may prohibit registered compassion center operation altogether, either expressly or though the enactment of ordinances or regulations which make registered compassion center and registered safety compliance facility operation unreasonably impracticable in the jurisdiction.

Section 19. Compassion Center and Safety Compliance Facility Agents.(a) Registered compassion centers and registered safety compliance facilities shall conduct a background check into the criminal history of every person seeking to become a principal officer, board member, agent, volunteer, or employee be-fore the person begins working at the registered compassion centers or registered safety compliance facility. A registered compassion center may not employ any person who:

(1) was convicted of a disqualifying felony offense; or

(2) is under 21 years of age.

(b) A registered compassion center or safety compliance facility agent must have documentation when transporting marijuana on behalf of the registered safety compliance facility or registered compassion center that specifies the amount of marijuana being transported, the date the marijuana is being transported, the reg-istry ID certificate number of the registered compassion center or registered safety compliance facility, and a contact number to verify that the marijuana is being transported on behalf of the registered compassion center or registered safety com-pliance facility.

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Bill Section 20. Requirements, Prohibitions, Penalties.

(a) A registered compassion center shall be operated on a not-for-profit basis. The by-laws of a registered compassion center shall contain such provisions relative to the disposition of revenues to establish and maintain its not-for-profit charac-ter. A registered compassion center need not be recognized as tax-exempt by the Internal Revenue Service and is not required to incorporate pursuant to ____.

(b) The operating documents of a registered compassion center shall include pro-cedures for the oversight of the registered compassion center and procedures to ensure accurate recordkeeping.

(c) A registered compassion center and a registered safety compliance facility shall implement appropriate security measures to deter and prevent the theft of mari-juana and unauthorized entrance into areas containing marijuana.

(d) A registered compassion center and a registered safety compliance facility may not be located within 500 feet of the property line of a preexisting public or private school.

(e) A registered compassion center is prohibited from acquiring, possessing, cultivating, manufacturing, delivering, transferring, transporting, supplying, or dispensing marijuana for the purposes of distributing marijuana to any person ex-cept registered qualifying patients directly or through their designated caregivers.

(f) All cultivation of marijuana for registered compassion centers must take place in an enclosed, locked location at the physical address or addresses provided to the department during the registration process, which can only be accessed by compassion center agents working on behalf of the registered compassion center.

(g) A registered compassion center may not acquire usable marijuana or mature marijuana plants from any person other than another registered compassion center, a registered qualifying patient, or a registered designated caregiver. A reg-istered compassion center is only allowed to acquire usable marijuana or mature marijuana plants from a registered qualifying patient or a registered designated caregiver if the registered qualifying patient or registered designated caregiver receives no compensation for the marijuana.

(h) Before marijuana may be dispensed to a designated caregiver or a registered qualifying patient, a registered compassion center agent must make a diligent ef-fort to verify each of the following:

(1) that the registry identification card presented to the registered compassion center is valid, including by checking the verification system if it is operational;

(2) that the person presenting the card is the person identified on the registry identification card presented to the registered compassion center agent, including by examining government-issued photo identification; and

(3) that the registered compassion center the compassion center agent is working for is the designated compassion center for the registered qualifying patient who is obtaining the marijuana directly or via his or her designated caregiver.

(i) A registered compassion center shall not dispense more than three ounces of marijuana to a registered qualifying patient, directly or via a designated caregiver, in any 14-day period. Registered compassion centers shall ensure compliance with this limitation by maintaining internal, confidential records that include records

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(j) A registered compassion center or registered compassion center agent may only dispense marijuana to a visiting qualifying patient if he or she possesses a valid ______ registry identification card and if the procedures in sections (h) and (i) are followed.

(k) No person may advertise medical marijuana sales in printed materials, on radio or television, or by paid in-person solicitation of customers. This shall not prevent appropriate signs on the property of the registered compassion center, list-ings in business directories including phone books, listings in marijuana-related or medical publications, or the sponsorship of health or not-for-profit charity or advocacy events.

(l) A registered compassion center shall not share office space with nor refer pa-tients to a practitioner.

(m) A practitioner shall not refer patients to a registered compassion center or registered designated caregiver, advertise in a registered compassion center, or, if the practitioner issues written certifications, hold any financial interest in a regis-tered compassion center.

(n) No person who has been convicted of a disqualifying felony offense may be a registered compassion center agent.

(o) Registered compassion centers and registered safety compliance facilities must display their registration certificates on the premises at all times.

(p) The department may issue a civil fine of up to $3,000 for violations of this section.

(q) The suspension or revocation of a certificate is a final department action, sub-ject to judicial review. Jurisdiction and venue for judicial review are vested in the _____ Court.

(r) Any cardholder who sells marijuana to a person who is not allowed to possess marijuana for medical purposes under this chapter shall have his or her registry identification card revoked and shall be subject to other penalties for the unau-thorized sale of marijuana.

(s) The department may revoke the registry identification card of any cardholder who knowingly commits multiple or serious violations of this chapter.

(t) Registered compassion centers are subject to reasonable inspection by depart-ment regulations. The department shall give at reasonable notice of an inspection under this paragraph.

Section 21. Confidentiality. (a) The following information received and records kept by department regula-tions for purposes of administering this chapter are confidential and exempt from the _____ Freedom of Information Act, and not subject to disclosure to any indi-vidual or public or private entity, except as necessary for authorized employees of the department to perform official duties pursuant to this chapter:

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(1) Applications and renewals, their contents, and supporting information sub-mitted by qualifying patients and designated caregivers, including information regarding their designated caregivers and practitioners.

(2) Applications and renewals, their contents, and supporting information sub-mitted by or on behalf of compassion centers and safety compliance facilities in compliance with this chapter, including their physical addressees.

(3) The individual names and other information identifying persons to whom the department has issued registry identification cards.

(4) Any dispensing information required to be kept under section 20 or depart-ment regulation shall identify cardholders and registered compassion centers by their registry identification numbers and shall not contain names or other per-sonal identifying information.

(5) Any department hard drives or other data-recording media that are no longer in use and that contain cardholder information must be destroyed.

(6) Data subject to this section shall not be combined or linked in any manner with any other list or database and it shall not be used for any purpose not pro-vided for in this chapter.

(b) Nothing in this section precludes the following:

(1) Department employees may notify state or local law enforcement about falsi-fied or fraudulent information submitted to the department or of other apparently criminal violations of this chapter if the employee who suspects that falsified or fraudulent information has been submitted conferred with his or her supervisor and both agree that circumstances exist that warrant reporting.

(2) Department employees may notify the _______ Medical Board if the de-partment has reasonable suspicion to believe a practitioner did not have a bona fide practitioner-patient relationship with a patient for whom he or she signed a written certification, if the department has reasonable suspicion to believe the practitioner violated the standard of care, or for other suspected violations of this act by a practitioner.

(3) Compassion center agents may notify the department of a suspected violation or attempted violation of this chapter or the regulations issued pursuant to it. 

(4) The department may verify registry identification cards pursuant to section 22.

(5) The submission of the section 23 report to the legislature.

(c) It shall be a misdemeanor punishable by up to 180 days in jail and a $1,000 fine for any person, including an employee or official of the department or another state agency or local government, to breach the confidentiality of information obtained pursuant to this chapter.

Section 22. Registry Identification and Registration Certificate Verification. (a) The department shall maintain a confidential list of the persons to whom the department has issued registry identification cards and their addresses, phone numbers, and registry identification numbers. This confidential list shall not be

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State-By-State Report 2011combined or linked in any manner with any other list or database, nor shall it be used for any purpose not provided for in this chapter.

(b) Within 120 days of the effective date of this chapter, the department shall establish a verification system. The verification system must allow law enforce-ment personnel, compassion center agents, and safety compliance facility agents to enter a registry identification number to determine whether or not the number corresponds with a current, valid registry identification card. The system shall only disclose whether the identification card is valid; whether the cardholder is a registered qualifying patient or a registered designated caregiver; whether the cardholder is permitted to cultivate under this act; and the registry identification number of the registered compassion center designated to serve the registered qualifying patient who holds the card or the registry identification number of the patient who is assisted by the registered designated caregiver who holds the card.

(c) The department shall, at a cardholder’s request, confirm his or her status as a registered qualifying patient or registered designated caregiver to a third party, such as a landlord, employer, school, medical professional, or court.

(d) The department shall disclose the fact that a registry identification card was revoked to a prosecutor or court personnel in any case where the prosecutor or court personnel inquires about a specific person who is seeking to assert the protections of section 14. The prosecutor or court personnel must provide the department with the person’s name and date of birth.

Section 23. Annual Reports. (a)(1) The legislature shall appoint a nine-member oversight committee com-prised of: one member of the House of Representatives; one representative of the department; one member of the Senate; one physician with experience in medical marijuana issues; one nurse; one board member or principal officer of a registered safety compliance facility; one individual with experience in policy development or implementation in the field of medical marijuana; and three registered patients.

(2) The oversight committee shall meet at least two times per year for the pur-pose of evaluating and making recommendations to the general assembly and the health department regarding:

(A) The ability of qualifying patients in all areas of the state to obtain timely access to high-quality medical marijuana.

(B) The effectiveness of the registered compassion centers, individually and to-gether, in serving the needs of qualifying patients, including the provision of educational and support services, the reasonableness of their fees, whether they are generating any complaints or security problems, and the sufficiency of the number operating to serve the registered qualifying patients of _____.

(C) The effectiveness of the registered safety compliance facility or facilities, in-cluding whether a sufficient number are operating.

(D) The sufficiency of the regulatory and security safeguards contained in this chapter and adopted by the department to ensure that access to and use of mari-juana cultivated is provided only to cardholders.

(E) Any recommended additions or revisions to the department regulations or this chapter, including relating to security, safe handling, labeling, and nomenclature.

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(F) Any research studies regarding health effects of medical marijuana for patients.

(b) The department shall submit to the legislature an annual report that does not disclose any identifying information about cardholders, registered compassion centers, or practitioners, but does contain, at a minimum, all of the following information:

(1) the number of applications and renewals filed for registry identification cards;

(2) the number of registered qualifying patients who are residents of ____ state at the time of the report;

(3) the number of registry identification cards that were issued to visiting qualify-ing patients at the time of the report;

(4) the nature of the debilitating medical conditions of the qualifying patients;

(5) the number of registry identification cards revoked for misconduct;

(6) the number of practitioners providing written certifications for qualifying pa-tients; and

(7) the number of registered compassion centers.

Section 24. Department to Issue Regulations.(a) Not later than 120 days after the effective date of this chapter, the department shall promulgate regulations:

(1) governing the manner in which the department shall consider petitions from the public to add debilitating medical conditions or treatments to the list of debili-tating medical conditions set forth in section 3(d) of this chapter, including public notice of and an opportunity to comment in public hearings on the petitions;

(2) establishing the form and content of registration and renewal applications sub-mitted under this chapter;

(3) governing the manner in which it shall consider applications for and renewals of registry identification cards, which may include creating a standardized written certification form; and

(4) governing the following matters related to registered compassion centers, with the goal of protecting against diversion and theft, without imposing an undue burden on the registered compassion centers or compromising the confidentiality of cardholders:

(A) oversight requirements for registered compassion centers;

(B) recordkeeping requirements for registered compassion centers;

(C) security requirements for registered compassion centers, which shall include, at a minimum, lighting, video security, alarm requirements, on-site parking, and measures to prevent loitering;

(D) electrical safety requirements;

(E) the competitive scoring process addressed in section 15(b);

(F) procedures for suspending or terminating the registration certificates or registry identification cards of cardholders, registered compassion centers, and registered safety compliance facilities that commit multiple or serious violations

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(G) labeling requirements for marijuana and marijuana products sold by compas-sion centers.

(5) application and renewal fees for registry identification cards, and application and registration fees for compassion center and safety compliance facility certifi-cates, according to the following:

(A) the total fees collected must generate revenues sufficient to offset all expenses of implementing and administering this chapter, except that fee revenue may be offset or supplemented by private donations;

(B) the department may establish a sliding scale of patient application and renewal fees based upon a qualifying patient’s household income; and

(C) the department may accept donations from private sources to reduce applica-tion and renewal fees.

Section 25. Enforcement of this Chapter.(a) If the department fails to adopt regulations to implement this chapter within the times provided for in this chapter, any citizen may commence an action in ____ court to compel the department to perform the actions mandated pursuant to the provisions of this chapter.

(b) If the department fails to issue a valid registry identification card in response to a valid application or renewal submitted pursuant to this chapter within 20 days of its submission, the registry identification card shall be deemed granted, and a copy of the registry identification application or renewal and proof of receipt of the mailing shall be deemed a valid registry identification card.

(c) If at any time after the 140 days following the effective date of this chapter the department has not established a process for accepting and approving or denying applications, a notarized statement by a qualifying patient containing the infor-mation required in an application pursuant to section 9(a)(1-9), together with a written certification issued by a practitioner within 90 days immediately preced-ing the notarized statement, shall be deemed a valid registry identification card for all purposes under this chapter.

Section 26. Severability.Any section of this chapter being held invalid as to any person or circumstance shall not affect the application of any other section of this chapter that can be given full effect without the invalid section or application.

Section 27. Date of Effect.This chapter shall take effect upon its approval.

[In addition, drafters should consider whether to reschedule marijuana under state law to Schedule II or lower. They should also consider whether changes should be made to the provisions of state law with penalties for marijuana offenses.]

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State-By-State Report 2011Appendix R: Overview and Explanation of MPP’s Model Bill

The relationship of the model bill and state law to federal lawAlthough the U.S. Supreme Court ruled on June 6, 2005 (Gonzales v. Raich) that

the federal government can prosecute patients in states that removed their crimi-nal penalties for the medical use of marijuana, the court did not question a state’s ability to allow patients to grow, possess, and use medical marijuana under state law.

Indeed, the medical marijuana laws passed by voter initiatives in ten states and by six legislatures since 1996 continue to provide effective legal protection for patients and their primary caregivers because they are carefully worded. MPP’s model bill is based on those laws — primarily the Rhode Island law, because it is one of the more recent and most comprehensive medical marijuana laws that received majority support among state legislators.

Of course, the model bill only provides protection against arrest and prosecution by state or local authorities. State laws cannot offer protection against the possibil-ity of arrest and prosecution by federal authorities. Even so, because 99% of all marijuana arrests are made by state and local — not federal — officials, properly worded state laws can effectively protect 99 out of every 100 medical marijuana users who would otherwise face prosecution at the state level.

In truth, changing state law is the key to protecting medical marijuana patients from arrest, as there has not been one documented case where a patient has been convicted in a federal court for a small quantity of marijuana in the 16 states that have effective medical marijuana laws. In addition, in June 2011, the U.S. Deputy Attorney General James Cole wrote a memo to U.S. prosecutors advising against targeting “individuals with cancer or other serious illnesses who use marijuana as part of a recommended treatment regimen consistent with applicable state law.”

__________________________________________________________

Four key principles for effective state medical marijuana lawsIn order for a state law to provide effective protection for seriously ill people who

engage in the medical use of marijuana, a state law must:

1. define what is a legitimate medical use of marijuana by requiring a person who seeks legal protection to (1) have a medical condition that is sufficiently serious or debilitating, and (2) have the approval of his or her medical practitioner;

2. avoid provisions that would require physicians or government employees to violate federal law in order for patients to legally use medical marijuana;

3. provide at least one of the following means of obtaining marijuana, preferably all three: (1) permit patients to cultivate their own marijuana; (2) permit pri-mary caregivers to cultivate marijuana on behalf of patients; and (3) authorize nongovernmental organizations to cultivate and distribute marijuana to pa-tients and their primary caregivers. In addition, it should permit patients or

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primary caregivers to purchase marijuana from the criminal market (which patients already do illegally);

4. implement a series of sensible restrictions, such as prohibiting patients and providers from possessing large quantities of marijuana, prohibiting driving while under the influence of marijuana, and so forth.

The importance of precisely worded state lawsBecause federal law prohibits the medical use of marijuana, state medical marijua-

na legislation must be worded precisely in order to provide patients and providers with legal protection under state law. Even changing just one or two words in the model bill can make it symbolic, rather than truly effective. For example, it is essential to avoid use of the word “prescribe,” since federal law prohibits doctors from prescribing marijuana. Doctors risk losing their federally controlled license to prescribe all medications if they “prescribe” marijuana — which would be use-less anyway because pharmacies are governed by the same regulations and cannot fill marijuana prescriptions. Physicians are, however, permitted under federal law to evaluate the relative risks and benefits of the medical use of marijuana. Thus, to establish a patient’s legitimate medical marijuana use, the state law must con-tain language accepting a physician’s statement that says, “the patient is likely to receive therapeutic or palliative benefit from the medical use of marijuana,” or something similar.

The importance of this seemingly trivial distinction is made clear by the case of Arizona, which passed a ballot initiative (Proposition 200) by 65% of the vote in November 1996. Arizona’s original law was dependent upon patients possessing marijuana “prescriptions.” As a result, the initiative provided no legal protection to patients, and a new measure had to be voted on in 2010 to create an effective law.

There are numerous other important technical nuances that are impossible to anticipate without having spent several years working on medical marijuana bills and initiatives nationwide. Consequently, it is crucial to discuss ideas and con-cerns with MPP before changing even one word of the model bill.

Summary of MPP’s Model Medical Marijuana LegislationThe Marijuana Policy Project’s model medical marijuana legislation would create

a limited exception to a state’s criminal and civil laws to permit the doctor-advised medical use of marijuana by patients with serious medical conditions.

A patient would be protected from arrest if his or her physician certifies, in writ-ing, that the patient has a specified debilitating medical condition and that the patient would receive therapeutic benefit from medical marijuana. The patient would send a copy of the written certification to the state department of health, and the department would issue an ID card after verifying the information. Police officers could verify an ID card’s validity with the department. As long as the pa-tient is in compliance with the law, there would be no arrest.

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State-By-State Report 2011Patients would be allowed to possess up to six ounces of marijuana and to

cultivate up to 12 plants for their medical use. Six ounces is less than the fed-eral government has determined is a one-month supply for patients in the Compassionate Investigational New Drug Program.1 Twelve plants mirrors the limits of two of the most recent medical marijuana laws — those passed in Rhode Island and Michigan — which are designed to ensure that the patient has an adequate supply of dried usable marijuana. Both limits are conservative and are significantly less than the 24 ounces and 15 plants that the Washington State Department of Health determined constituted an adequate 60-day supply in October 2008. All cultivation would have to occur in an enclosed, locked facility. Many patients are unable to cultivate their own supply, so the legisla-tion allows them to designate a caregiver who would also receive an ID card. Each caregiver may assist no more than five qualifying patients.

The legislation would also allow for the state-regulated, non-profit distribu-tion of medical marijuana. The department of health would issue registration certificates to qualified applicants, who would have to abide by the rules on security, recordkeeping, and oversight provided for by the model medical marijuana legislation, in addition to any additional rules that the department may develop. All dispensaries would be subject to inspection. It is important that the law provide for both caregivers and dispensaries, since patients in rural areas are unlikely to have access to dispensaries, and because many low-income patients would not be able to afford medical marijuana at dispensaries. In addition, very ill patients would need a caregiver to pick up their medicine for them.

The bill would also provide a medical necessity affirmative defense that patients can raise in court if they can prove they needed more marijuana to maintain a steady supply or if they did not have ID cards at the time of their arrest. This is an important provision, as some legitimate patients will not register because their doctors will not sign a written certification due to an unwarranted fear of federal repercussions.

The bill maintains commonsense restrictions on the medical use of mari-juana, including prohibitions on public use of marijuana and driving under the influence of marijuana. Employers are not required to allow patients to be impaired at work or to allow the possession of marijuana at a workplace. Insurance providers would not have to cover medical marijuana.

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1 Ethan Russo, et al, “Chronic Cannabis Use in the Compassionate Investigational New Drug Program: An Examination of Benefits and Adverse Effects of Legal Clinical Marijuana,” Journal of Cannabis Therapeutics 2:1 (2002).

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State-By-State Report 2011Appendix S: Federal Law Enforcement and State Medical Marijuana Laws

On June 29, 2011, U.S. Deputy Attorney General James Cole released a memo-randum to U.S. attorneys purporting to clarify an October 2009 memo released by then-Deputy Attorney General David Ogden. The 2009 Ogden memo said that the Justice Department “should not focus federal resources . . . on individuals whose actions are in clear and unambiguous compliance with existing state laws provid-ing for the medical use of marijuana ….”1 With the release of the Cole memo, it appears that patients and caregivers will not be targeted and that state employees should not be at risk if they implement programs, but that commercial growers and dispensaries — particularly large ones — could be targeted, if the individual federal prosecutor determines it to be the best use of resources.

Patients and Caregivers: Federal Enforcement Should not Target ThemThe Cole memo says “it is likely not an efficient use of federal resources to focus

enforcement efforts on individuals with cancer or other serious illnesses who use marijuana … consistent with applicable state law, or their caregivers.”2 It defines caregivers as “individuals providing care to individuals” with serious illnesses, “not commercial operations cultivating, selling or distributing marijuana.”

State Employees: No Indication They are at Risk Despite inquiries about state employees from Gov. Chris Christie and others,

the Cole memo makes no mention of them. The only U.S. attorneys who have ad-dressed questions about state employees involved in medical marijuana programs are the two U.S. attorneys for Washington state and the U.S. attorney for Arizona. Collectively, these statements indicate that state employees would only be at risk if they actually handle marijuana, but that they would not be targeted if they do not do so. No state medical marijuana law requires state employees to handle mari-juana, and no state employee has ever been federally prosecuted for working on a medical marijuana program.

A letter from the two U.S. attorneys in Washington state to Gov. Chris Gregoire was the only U.S. attorney letter to mention state employees. It said employees would not be “immune” from liability for carrying out the tasks laid out under a bill that was under consideration.3 One of the authors of the letter, U.S. Attorney Michael Ormsby, was interviewed by an Arizona paper and distinguished the Washington bill from Arizona’s law, specifying that the reason employees were listed in his letter was because they would have to grade marijuana, and thus, handle it.4 After Arizona Gov. Jan Brewer announced a federal lawsuit premised largely on the idea that state employees were at risk, then-U.S. Attorney for Arizona Dennis Burke called the claim “disingenuous.”5 He explained that he would not target state employees, and that he would have listed them in the letter if they were at risk. Additionally, the Department of Justice stressed in their motion to dismiss Gov. Brewer’s suit that there is no “genuine threat that any state employee will face imminent prosecution under federal law.”6

Without a clear and explicit warning, it is inconceivable that the federal gov-ernment would prosecute a state employee for carrying out a medical marijuana program, particularly one that does not involve handling marijuana. This is par-

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providers and regulating dispensaries is not a federal crime.7

Dispensaries: Individual Federal Prosecutors can Choose Whether to Target

In May 2010, Attorney General Holder testified to Congress and made it clear that the DOJ’s de-prioritization policy applied to “entities,” as well as to patients and caregivers.8 Yet, the Cole memo says the Ogden memo was “never intended to shield” large-scale, commercial cultivation and distribution of marijuana. It men-tions facilities that project millions of dollars of revenue, with tens of thousands of plants. It continues by telling the U.S. attorneys that “persons who are in the busi-ness of cultivating, selling or distributing marijuana” are violating federal law and that “[c]onsistent with resource constraints and the discretion you may exercise in your district, such persons are subject to federal enforcement action, including potential prosecution.”

The Cole memo leaves open the possibility of prosecutorial discretion in de-termining whether to target dispensaries. This discretion should be exercised in compliance with the factors laid out in the Ogden memo. The Cole memo notes, “The Ogden Memorandum provides guidance to you in deploying your resources to enforce the CSA as part of the exercise of the broad discretion you are given to address federal criminal matters within your districts.” Department of Justice spokesmen have said the Ogden memo is not overruled and that this is not new policy. They refused to say whether some dispensaries should not be targeted.9

The Ogden memo listed types of activity that “may indicate illegal drug traf-ficking activity of potential federal interest.” These include the unlawful use of firearms, violence, sales to minors, financial or marketing activities inconsistent with state law or its purposes, excessive amounts of cash, possession or sale of other drugs, and ties to other criminal enterprises.

It is notable that, in practice, in states with clear and unambiguous laws that include strict statewide dispensary registration requirements and regulations, no medical marijuana dispensary or producer has been shut down or federally pros-ecuted. Twenty-five licensed producers are operating in New Mexico, the first of which opened in spring 2009, following Attorney General Holder’s statement that they would not be a federal enforcement priority.10 Hundreds of medical mari-juana centers operate in Colorado, none of which have been targeted on the basis of state-legal activity.11 Finally, regulated non-profit dispensaries began to open in Maine in early 2011. The only known raids with a primary focus on state-legal medical marijuana activities have been in states where dispensaries are not clearly registered with the state and regulated. 

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State-By-State Report 2011Conclusion

States should continue to implement duly enacted medical marijuana programs and to enact new programs. Well-regulated programs, including those with dis-pensaries, are successfully providing seriously ill patients with access to their medicine and preventing them from having to support the criminal market. There is no real possibility that state employees would be targeted for implementing a program. While it is possible that federal agents could target a dispensary, there is no requirement that any federal prosecutor target dispensaries. It is up to each prospective operator to weigh the risks and decide whether to move forward. If past practices continue, only those operating without a state registration, or those not complying with state law, would be targeted.

1 David W. Ogden, Deputy Attorney General, “Memorandum for Selected United States Attorneys on Investigations and Prosecutions in States Authorizing the Medical Use of Marijuana,” October 19, 2009. http://blogs.usdoj.gov/blog/archives/192

2 James M. Cole, Deputy Attorney General, “Memorandum for United States Attorneys: Guidance Regarding the Ogden Memo in Jurisdictions Seeking to Authorize Marijuana for Medical Use,” June 29, 2011. http://www.mpp.org/assets/pdfs/library/Cole-memo.pdf

3 Letter to Governor Christine Gregoire from Washington state U.S. Attorneys, Jenny A. Durkan and Michael C. Ormsby, April 14, 2011. http://seattletimes.nwsource.com/ABPub/2011/04/14/2014778917.pdf

4 Fischer, Howard, “Federal Prosecutor: Brewer, Horne Twisting Medical Marijuana Memo,” East Valley Tribune, May 26, 2011. http://www.eastvalleytribune.com/arizona/politics/article_62e3877a-87ee-11e0-95eb-001cc4c03286.html

5 Wyloge, Evan, “U.S. attorney: Brewer and Horne’s lawsuit logic ‘disingenuous’,” Arizona Capitol Times, May 27, 2011. Available at: http://azcapitoltimes.com/news/2011/05/27/us-attorney-brewer-and-horne%E2%80%99s-lawsuit-logic-%E2%80%98disingenuous%E2%80%99/

6 Assistant Attorney General Tony West, DOJ Assistant Branch Manager Arthur R. Goldberg, Trial Attorney with the United States Department of Justice Scott Risner, Federal Defendant’s Motion to Dismiss and Memorandum of Law in Support Thereof, United States District Court, District of Arizona case No. 2:11-cv-01072-SRB, p. 2, August 1, 2011.

7 County of San Diego v. San Diego NORML 165 Cal.App.4th 798 (2008) cert. denied, 129 S. Ct. 2380 (2009), Qualified Patients Association v. City of Anaheim, 187 Cal.App.4th 734 (2010).

8 Attorney General Holder testified, “Well, again, if the entity is, in fact, operating consistent with state law, and is not—does not have any of those factors involved that are contained in that deputy attorney general memo, and given, again, the limited resources that we have and our determination to focus on major traffickers, that would be inconsistent with ... the policy as we have set it out.” http://www.youtube.com/watch?v=_OlY4-nWK2Y&feature=player_embedded

9 Hoeffel, John, “Justice Department shoots down commercial marijuana cultivation,” LA Times, July 2, 2011. http://www.latimes.com/news/local/la-me-medical-marijuana-20110702,0,1515449.story

10 KOB-TV, “Feds: Medical marijuana producers not a target,” June 5, 2009.11 In October 2011, federal agents seized marijuana from a Colorado dispensary, but it appears as if the federal

authorities may have been targeting an individual for activities that were outside of or unrelated to the state’s law. Michael Roberts, “Marijuana raid: Cherry Top Farms compliant with state, but feds still seize plants, medicine,” Westword, Oct. 14, 2011.

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State-By-State Report 2011Appendix T: Teen Marijuana Use in Medical Marijuana States

The debate over medical marijuana laws has included extensive discussion of whether such laws “send the wrong message to young people,” and thereby increase teen marijuana use. In order to assess the validity of such claims, the Marijuana Policy Project and Professor Mitch Earleywine created a report in September 2005 (and updated in June 2011) analyzing teen use data in states with medical mari-juana laws from dates before and after those laws were enacted. Researchers used data collected or commissioned by government agencies, such as the Youth Risk Behavior Surveillance System (YRBSS) survey conducted by states, in conjunction with the Centers for Disease Control, and the National Survey on Drug Use and Health (NSDUH) conducted by the Research Triangle Institute and sponsored by the U.S. Substance Abuse and Mental Health Services Administration.

The results showed that of the 13 states with effective medical marijuana laws with before-and-after data on teen marijuana use, only the two with the most recently enacted laws (Michigan and New Mexico) have indicated possible in-creases, both of which were modest and within the confidence intervals. The other 11 states showed either static use rates, modest decreases, or, in many cases, a statistically significant decrease in teen marijuana use following enactment of a medial marijuana law. Most notably:

In California, the first state to pass a medical marijuana law and the state most often held up as an example of having a poorly crafted and easily abused law, life-time marijuana use by 7th graders dropped from 10.9% to 9.4%, among 9th graders from 35% to 24.6%, and among 11th graders from 46.9% to 41.6%.

In Colorado, the state with the most robust dispensary system in the country, the NSDUH indicates past month marijuana use by 12- to 17-year-olds decreased modestly between 1999 and 2007-2008, from 10.3% to 9.1%.

And in Rhode Island and Vermont, the two states with the highest overall mari-juana use rates among adults in the country, current use by high school seniors has actually gone down since passage of their respective medical marijuana laws: from 34.3% to 31.7% in Rhode Island, and from 37.2% to 32.9% in Vermont.

In short, no state with an overall change outside of the confidence intervals saw an increase in teens’ marijuana use, strongly suggesting that enactment of state medical marijuana laws does not increase teen marijuana use. These findings are consistent with the results of similar report prepared by Dr. Seth Ammerman for the winter 2011 edition of California Pediatrician.1 After reviewing before-and-after data, Dr. Ammerman concluded, “the data are very reassuring that in almost all cases medical marijuana legalized for adults does not lead to an increase in recreational use of marijuana by adolescents.”

For more information on methodology or to download the full Teen Use Report, please visit mpp.org/teenuse.

1 Ammerman, Seth, M.D. “Medical Marijuana: Update for the Pediatrician,” California Pediatrician, Vol. 27, No. 1 (Winter 2011): 12, available at http://www.aap-ca.org/news/caPed/California Pediatrician - Winter 2011.pdf.

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Appendix U

: State Medical M

arijuana Program Finances

State-By-State Report 2011Appendix U: State Medical Marijuana Program Finances

With many states around the country facing serious budget shortfalls, one con-cern frequently raised when debating the need for medical marijuana laws is the cost to state governments of implementing and administering such laws. However, data collected from states with functioning medical marijuana programs show that such concerns are unfounded. Most states require the administering agency to set fees for registry ID cards and dispensary registrations high enough to off-set administration costs, and in states where patients can obtain marijuana from dispensaries, transactions are often subject to sales or excise taxes. Consequently, no state medical marijuana program is currently facing significant budget deficits. In fact, most are operating at a surplus, with some generating millions in badly needed revenue.

As of late 2011, eight states – Arizona, Colorado, Delaware, Maine, New Jersey, New Mexico, Rhode Island, and Vermont – and the District of Columbia have laws that recognize dispensaries or other entities where patients can purchase medical marijuana. Of these, only Colorado, Maine, and New Mexico have fully-implemented systems with open dispensaries. A fourth state, California, does not have a statewide regulatory structure but does have several dispensaries licensed at the local level.

Of these, only California, Colorado, and New Mexico have readily available in-formation on revenue generated through taxes. In California, the non-partisan state Board of Equalization estimates that dispensaries generate $58-$105 mil-lion in annual sales tax revenue.1 In Colorado, for the fiscal year ending in June 2010, medical marijuana sales taxes brought in $2.2 million to state coffers,2 and between Boulder, Colorado Springs, Denver, and Fort Collins, an estimated $3.84 million in local sales taxes has already been collected in 2011.3 In New Mexico, sales by non-profit producers in the second quarter of 2011 (April – June) totaled $744,079, generating $55,938 in gross receipts tax revenue for state and local gov-ernments.4 This projects to over $223,000 per year in gross receipts tax revenue.

These states also bring in added revenue by assessing dispensaries application and registration fees. Dispensaries are licensed at the local level in both Colorado and California. In California, Oakland, which has licensed four medical mari-juana dispensaries, provides a typical example. The fee structure is graduating depending on how many patients the dispensaries serve and ranges from $5,000 (for under 500 patients) to $20,000 (for over 1,500 patients).5 In Colorado, the Department of Revenue collected at least $8.9 million in fees from July 2010 through March 2011 from medical cannabis businesses.6 The state application fees for medical marijuana centers are $7,500 for 300 or fewer patients, $12,500 for 301

1 “Berkeley cannabis collectives slapped with huge tax bills,” Berkeleyside, February 3, 2011. <http://www.berkeleyside.com/2011/02/03/berkeley-cannabis-collectives-slapped-with-huge-tax-bills>

2 “City reaps $209k in medical marijuana tax,” Coloradan.com, Nov. 6, 2010. <http://www.coloradoan.com/article/20101106/NEWS01/11060341/1002/CUSTOMERSERVICE02>

3 “State Medical Marijuana Programs’ Financial Information, Marijuana Policy Project, available at http://www.mpp.org/issues/medical-marijuana/.

4 Email communications with Dominick Zurlo, September 28, 2011.5 “Oakland approves plan to license medical marijuana farms,” Oakland Tribune, July 21, 2010. <http://www.

mercurynews.com/alameda-county/ci_15566683?nclick_check=1>6 “Oversight Office for Medical Pot is Well Off,” Denver Post, March 18, 2011. < http://www.denverpost.com/

news/marijuana/ci_17640484>

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s to 500 patients, and $18,000 for those serving 501 or more patients. A cultivation license is $1,250, and an infused products manufacturer license is $1,250.7 New Mexico has a similar graduated fee schedule, though the variance is based on how long the non-profit producer has operated. The fee is $5,000 for those who have been licensed less than a year, $10,000 for those licensed for more than one year, $20,000 for more than two years, and $30,000 for more than three years. In Maine, the Department of Human Services’ Licensing and Regulatory Services requires all dispensary applicants to pay a $15,000 application fee, $14,000 of which is refunded if they are not awarded a registration,8 and the annual renewal fee is $15,000.

Other states that are in the process of implementing dispensary systems will also charge registration fees to dispensaries and similar entities. Application fees range from $20,000 in New Jersey ($2,000 of which is non-refundable) to a $2,500 non-refundable fee in Vermont. Registrations are similar to those in Colorado and New Mexico. For example, the District of Columbia will charge dispensaries $10,000 annually for a registration, and cultivation centers would pay $5,000 annually, while Vermont will charge $20,000 for the first year and $30,000 for subsequent years.

These states also collect revenue through fees for registry ID cards for patients, caregivers, and dispensary employees. Fees are generally around $100 for cards, with some states – including Michigan, Oregon, Maine, and the District of Columbia – reducing the fee for low-income patients. Through the first half of fis-cal year 2011 (October-March 2011), these fees have already generated $4,860,783 in revenue in Michigan, while the program required only $687,634 to operate during the same time frame.9

Expenses are generally minimal. Programs have reported expenses for database-related software, for machines to make registry cards, and for staffing. Some programs — especially ones with a few thousand patients or fewer — have been able to use software included with Microsoft Office for their databases, and at least one program shares the card-making machines with other health department pro-grams. New Mexico’s program purchased a machine to make holographic cards, which cost about $6,000-$8,000.

Most states employ only a handful of staffers. For example, New Mexico has two full-time employees and one manager who also oversees three other programs, while Alaska and Vermont’s programs each require less than one full-time em-ployee’s time. Oregon and Michigan’s programs, which are each operating in the black, employ 25 employees each. Some programs do not even need dedicated staffers. In Rhode Island, for example, staffers are not designated for the medical marijuana program, and instead work on all 35 licensure programs the health department oversees.

For more information on state medical marijuana programs’ financial impact, download our full report at http://www.mpp.org/reports/state-medical-mari-juana.html.

7 <http://www.colorado.gov/cs/Satellite?blobcol=urldata&blobheader=application%2Fpdf&blobkey=id&blobtable=MungoBlobs&blobwhere=1251643794376&ssbinary=true>

8 <http://www.maine.gov/dhhs/dlrs/rulemaking/adopted.shtml>9 Report on the Amount Collected and Cost of Administering the Medical Marihuana Program, April 1, 2011.

Submitted by Michigan Department of Community Health to Michigan House and Senate Appropriations Committees.

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Appendix V: M

edical Marijuana Program

Implem

entation Timelines

State-By-State Report 2011Appendix V: Medical Marijuana Program Implementation Timelines

The key to a medical marijuana program running smoothly is its timely and effec-tive implementation by the appropriate state agency. Some legislators considering medical marijuana laws believe programs will take several years to implement. In reality, in most states with medical marijuana laws, agencies have implemented medical marijuana ID card programs and finalized regulations within a year after the laws’ passage. In some cases, it has taken longer than that until a state’s dispen-saries are up and running, especially when a governor has stalled implementation. However, states like Colorado and Maine have shown that even dispensary pro-grams can be effectively implemented in one year if the executive branch does not delay.

The following chart summarizes each medical marijuana state’s timeline for implementation:

State Year Enacted

Date When State Began Accepting ID Card

Applications

Dispensaries (or the Equivalent) and Timelines for Their

Implementation

Comments

Alaska Nov. 1998 Early June 1999 N/A — Law does not include state dispensary registrations.

Implementation of the patient and caregiver ID card program took about seven months.

Arizona Nov. 2010 April 14, 2011 The Arizona Department of Health Services published final rules on March 28, 2011 and dispensary licenses were expected by summer 2011, until Gov. Jan Brewer suspended dispensary implementation on May 27, 2011.

Implementation of the patient and caregiver ID card program took about 5.5 months. However, Gov. Jan Brewer filed a lawsuit in federal court seeking a declaratory judgment on whether the medical marijuana program conflicts with federal law and froze dispensary implementation on May 27, 2011. Had it not been for Gov. Brewer’s action, dispensaries would have been registered within a year of the law’s enactment.

California Nov. 1996; voluntary ID cards enacted in Oct. 2003; funding enacted July 31, 2004

Each of 58 counties had to implement ID cards, and some delayed. An initial pilot program began in fall 2005. Two small counties still have not implemented ID cards.

N/A — Although there are hundreds of dispensaries in California, its state law does not include state dispensary registrations.

The county-by-county implementation of ID cards in California has not been a successful model. Some counties dragged their feet, and three even sued (unsuccessfully) to claim the law was preempted by federal law.

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Colorado Nov. 2000 voter amendment to constitution; June 2010 dispensary law

June 1, 2001 Dispensaries already existed before the state law passed in June 2010. They had to complete state forms and pay a fee by Aug. 1, 2010. Dispensary regulations were finalized on June 15, 2011 and went into effect on July 30, 2011.

Implementation of the patient and caregiver ID card program took just under seven months. The dispensary regulation bill began phasing in within two months of its passage, with the initial state form and fees due. Dispensary regulations were finalized and went into effect within one year of the law’s passage.

Delaware May 2011, went into effect July 1, 2011

Has not happened yet; anticipated in spring 2012

Dispensary regulations are expected by July 2012, and there will likely be three registered dispensaries by Jan. 2013, with three more by Jan. 2014.

The Delaware Department of Health and Social Services (DHSS) will finalize dispensary regulations and registry ID card applications and will issue a call for compassion center applications by July 1, 2012. DHSS will issue registration certificates to the highest scoring applicants in each of the three counties by January 1, 2013, a little over one and a half years after the law’s passage.

District of Columbia

Nov. 1998 initiative. Due to Congress’s intervention, the law did not go into effect until 2010. The D.C. Council revised it in May 2010, and it went into effect in July 2010.

Has not happened yet; anticipated in early 2012

Regulations were published and went into effect on April 15, 2011, and amended again on August 12, 2011; dispensaries are anticipated by spring 2012.

Dispensary regulations were drafted within 10 months of the law’s effective date. D.C.’s Department of Health began accepting applications from prospective cultivation site operators on August 5, 2011 and is expected to issue licenses by Jan. 2012. Dispensary licenses are expected to follow by spring 2012, less than two years after the passage of the law.

Hawaii June 2000 Dec. 28, 2000 N/A — Law does not include state dispensary registrations.

Implementation of the patient and caregiver ID card program took just over six months.

Maine Nov. 1999 initiative, revised by voters in Nov. 2009, and by the legislature in spring 2010 and spring 2011.

Early July 2009 Six dispensary registrations were issued in July 2010 and two more were issued in Aug. 2010. This was within 10 months of enactment of the law.

Maine’s initial law did not have a patient registry or regulated dispensaries. The new law was fully implemented within a year of its passage, with regulations enacted and ID cards and dispensary registrations issued. Four of the eight dispensaries are now up and running. As a result of a law passed in May 2011, patient registration ID cards are now optional.

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Appendix V: M

edical Marijuana Program

Implem

entation Timelines

State-By-State Report 2011State Year Enacted

Date When State Began Accepting ID Card

Applications

Dispensaries (or the Equivalent) and Timelines for Their

Implementation

Comments

Michigan Nov. 2008 April 4, 2009 N/A — Law does not include state dispensary registrations.

Implementation of the patient and caregiver ID card program took about five months.

Montana Nov. 2004 voter initiative

Dec. 14, 2004 N/A — Law does not include state dispensary registrations.

Implementation of the patient and caregiver ID card program took 42 days.

Nevada Legislation to implement voter initiative: June 2001

Oct. 1, 2001 N/A — Law does not include state dispensary registrations.

Implementation of the patient and caregiver ID card program took under four months.

New Jersey Jan. 2010 None yet, expected in fall 2011

None yet. Regulations were issued in Nov. 2010, but the legislature rejected them. They were revised in Jan. 2011 and are awaiting finality. Six “alternative treatment center” (ATC) licenses were issued in March 2011. However, Gov. Christie halted ATC implementation on June 15, and then restarted it on July 19, 2011.

The Department of Health and Senior Services initially issued rules that were more restrictive than the law, leading to the legislature rejecting those rules. After the rules were revised in Jan. 2011, the legislature filed another formal resolution of disapproval regarding certain provisions, but the regulations are likely to be finalized in late 2011 or early 2012. Alternative treatment center implementation has taken over 1.5 years, but appears to be nearing its completion. After Gov. Christie held a press conference on July 19, announcing his intent to fully implement the law, the six licensed dispensaries are expected to be up and running in late 2011.

New Mexico April 2007 July 6, 2007 (initially temporary ID certificates were available)

The first “licensed producer” registration was issued in March 2009, less than two years after passage. Four more were licensed in Nov. 2009 and 20 were licensed in 2010.

Although New Mexico was the first state to license larger-scale cultivation and dispensing, its rules were finalized and the first producer was licensed in less than two years. Twenty-five licensed producers are currently licensed in the state.

Oregon Nov. 1998 May 1, 1999 N/A — Law does not include state dispensary registrations.

Implementation of the patient and caregiver ID card program took just under six months.

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Rhode Island January 2006; dispensaries authorized in June 2009

March 31, 2006 “Compassion center” regulations were finalized in March 2010. Three applicants were approved on March 15, 2011, less than two years after the law’s enactment, but Gov. Chaffee delayed the issuance of final registrations on May 2, 2011.

Implementation of the patient and caregiver ID card program took under three months. The health department was expected to issue compassion center registrations in Sept. 2010. However, it maintained that none of the applicants qualified, so it restarted the application process. After approving three compassion centers on March 15, 2011, Gov. Lincoln Chaffee reversed course on May 2, 2011, after receiving a letter from the U.S. attorney, and he has delayed issuing the certificates of registration to the compassion centers.

Vermont Passed May 2004, effective date July 1, 2004; dispensaries authorized on June 2, 2011

Oct. 26, 2004 Dispensary regulations are expected within a year of the law’s effective date

Implementation of the patient and caregiver ID card program took five months. The legislature passed a law authorizing the licensing of four dispensaries in May 2011. The Department of Public Safety will adopt rules, likely within a year of the law’s effective date. Within 30 days of the adoption of rules, the Department of Public Safety shall begin accepting dispensary applications. The law mandates that four dispensary registration certificates be issued by June 2, 2012, one year after the law’s enactment.

Washington state

Nov. 1998 N/A — There are no ID cards in Washington state.

N/A — Law does not include state dispensary registrations.

Washington currently has no program to implement.

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Appendix W

: Medical M

arijuana Laws and C

ivil Protections

State-By-State Report 2011Appendix W: Medical Marijuana Laws and Civil Protections

This chart reviews known state court cases related to civil protections and medi-cal marijuana laws. Most of the court decisions have dealt with whether patients can be terminated for testing positive for marijuana metabolites, which stay in one’s system weeks after impairment wears off. Courts in California, Michigan, Montana, Oregon, and Washington have ruled that those state laws did not pro-tect patients from being terminated, but the Michigan decision is being appealed and the Montana decision is not binding.

The chart also reviews medical marijuana laws’ provisions that may support claims for civil protections — such as protections from discrimination in housing, employment, child custody cases, or enrollment in a university — and specific language limiting any such protections. This chart does not include information about protections for physicians.

State Court Decisions or Litigation

Language Most Relevant to Civil Protections

Limitations Related to Civil Protections

Alaska None known. A.S. 17.37.030 (b) “Except as otherwise provided by law, a person is not subject to arrest, prosecution, or penalty in any manner for applying to have the person’s name placed on the confidential registry maintained by the department under AS 17.37.010.”

A.S. 17.37.030 (d) “Nothing in this chapter requires any accommodation of any medical use of marijuana (1) in any place of employment …”

Arizona None known.

A.R.S. § 36-2814 says registered patients are not “subject to … penalty in any manner, or denial of any right or privilege, including any civil penalty or disciplinary action by a court or occupational or professional licensing board ...” for the permissible conduct. A.R.S. § 36-2813 prohibits discrimination by schools, landlords, and employers, as well as discrimination in respect to organ transplants, other medical care, and custody and visitation, unless an exception applies. Employers generally cannot penalize patients for a positive drug test unless the patient used marijuana or was impaired by it at work.

The prohibitions on discrimination by employers, landlords, and schools do not apply if “failing to [penalize the cardholder] would cause the [entity] to lose a monetary or licensing related benefit under federal law or regulations.” ARS §36-2802 provides that the law does not allow anyone to undertake “any task under the influence of marijuana when doing so would constitute negligence or professional malpractice.” HB 2541 allows employers to take actions based on “good faith” beliefs about employee impairment.

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Limitations Related to Civil Protections

California In Ross v. Ragingwire, the state Supreme Court ruled that the law does not protect patients from firing for testing positive for metabolites. It noted that the legislature could enact such protections. The legislature did so in 2008, passing AB 2279, but the bill was vetoed.

Voters declared their intent “[t]o ensure that seriously ill Californians have the right to obtain and use marijuana for medical purposes” and to “ensure that patients and their primary caregivers who obtain and use marijuana for medical purposes upon the recommendation of a physician are not subject to criminal prosecution or sanction.”

(Calif. Health & Safety Code § 11362.5 (b))

Calif. Health & Safety Code

§ 11362.785 (a) provides “Nothing in this article shall require any accommodation of any medical use of marijuana on the property or premises of any place of employment or during the hours of employment or on the property or premises of any jail, correctional facility, or other type of penal institution in which prisoners reside or persons under arrest are detained.”

Colorado A paralyzed patient is suing his employer because his employment was terminated for the medical use of marijuana. In August 2011, the Colorado Court of Appeals ruled 2-1 against unemployment benefits for medical marijuana patient Jason Benior who was fired for testing positive.

C.R.S. § 25-1.5-106 (8) says “the use of medical marijuana is allowed under state law” to the extent it is carried out in accordance with the state constitution, statutes, and regulations. Patients and caregivers may be protected by the state’s “Lawful Off-Duty Activities Statute,” which protects employees from being penalized for legal outside-of-work behavior.

Col. Const. Art. XVIII, § 14. (10) (b) specifies “Nothing in this section shall require any employer to accommodate the medical use of marijuana in any work place.”

Delaware None known. 16 Del. Code §4903A (a-b) says registered patients and caregivers are not “subject to … denial of any right or privilege, including but not limited to civil penalty or disciplinary action by a court or occupational or professional licensing board or bureau ...” for the permissible conduct. §4905A (a-b) prohibits discrimination by schools, landlords, and employers, as well as discrimination in respect to organ transplants, other medical care, and custody or visitation, unless an exception applies. Employers generally cannot penalize patients for a positive drug test for marijuana unless the patient used or was impaired by marijuana at work or during work hours.

16 Del. Code §4904(A) and 4905A (a-b) provide limitations on the protections. The prohibitions on discrimination by employers, landlords, and schools do not apply if “failing to [penalize the cardholder] would cause the [entity] to lose a monetary or licensing-related benefit under federal law or regulation.” §4904A (a) provides that the chapter does not allow anyone to undertake “any task under the influence of marijuana, when doing so would constitute negligence or professional malpractice.”

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Appendix W

: Medical M

arijuana Laws and C

ivil Protections

State-By-State Report 2011State Court Decisions

or LitigationLanguage Most Relevant to Civil

ProtectionsLimitations Related to Civil

ProtectionsDistrict of Columbia

None known. 57 DCR 3360 (1) provides “All seriously ill individuals have the right to obtain and use marijuana for medical purposes when a licensed physician has found the use of marijuana to be medically necessary and has recommended the use of marijuana …” Sec. 3

“(a) Notwithstanding any other District law, a qualifying patient may possess and administer medical marijuana, and possess and use paraphernalia, in accordance with this act and the rules issued pursuant to section 14.”

57 DCR 3360 (4) (d) says “Nothing in this act permits a person to: (1) Undertake any task under the influence of medical marijuana when doing so would constitute negligence or professional malpractice …”

Hawaii None known. HRS § 329-122 states: “Notwithstanding any law to the contrary, the medical use of marijuana by a qualifying patient shall be permitted if: …”

HRS § 329-122 (c) provides: “The authorization for the medical use of marijuana in this section shall not apply to: … (2) The medical use of marijuana:

… (B) In the workplace of one’s employment … ”

Maine None known. 22 M.R.S.A. § 2423-E provides that persons whose conduct is authorized by the act “may not be denied any right or privilege or be subjected to … penalty or disciplinary action” for the authorized conduct. The same section provides, “A school, employer, or landlord may not refuse to enroll or employ or lease to or otherwise penalize a person solely for that person’s status as a qualifying patient or a primary caregiver” unless an exception applies. It also provides, “A person may not be denied parental rights and responsibilities with respect to or contact with a minor child …” unless the person’s behavior is contrary to the best interests of the child.

The protections from discrimination by employers, landlords, and schools do not apply if “failing to [penalize the person] would put the school, employer, or landlord in violation of federal law or cause it to lose a federal contract or funding.” Maine’s law “does not permit any person to: Undertake any task under the influence of marijuana when doing so would constitute negligence or professional malpractice or would otherwise violate any professional standard …” The law also does not require “An employer to accommodate the ingestion of marijuana in any workplace or any employee working while under the influence of marijuana.”

Michigan On Feb. 11, 2011, the U.S. District Court for the Western District of Michigan ruled against sinus cancer survivor Joe Casias, who sued Wal-Mart for terminating his employment for failing a drug test. The Michigan ACLU, which represents Mr. Casias, is appealing to the Sixth Circuit Court of Appeals.

The introductory clause says a purpose is to “provide protections for the medical use of marihuana.” MCL 333.26424 (a) provides that those abiding by the act cannot be subject to “… penalty in any manner, or denied any right or privilege, including but not limited to civil penalty or disciplinary action by a business or occupational or professional licensing board or bureau.” Sec. 4 (c) provides, “A person shall not be denied custody or visitation of a minor for acting in accordance with this act, unless the person’s behavior is such that it creates an unreasonable danger to the minor that can be clearly articulated and substantiated.”

MCL 333.26424 provides “(b) This act shall not permit any person to do any of the following: … (1) Undertake any task under the influence of marihuana, when doing so would constitute negligence or professional malpractice. … (c) Nothing in this act shall be construed to require: … (2) An employer to accommodate the ingestion of marihuana in any workplace or any employee working while under the influence of marihuana.”

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State Court Decisions or Litigation

Language Most Relevant to Civil Protections

Limitations Related to Civil Protections

Montana In 2009, the Montana Supreme Court upheld the dismissal of a patient who tested positive for marijuana metabolites in Johnson v. Columbia Falls Aluminum. The decision is a memorandum opinion, and is not binding precedent on other cases.

MCA § 50-46-201 provides that those abiding by the act “may not be arrested, prosecuted, or penalized in any manner or be denied any right or privilege, including but not limited to civil penalty or disciplinary action by a professional licensing board or the department of labor and industry” for the medical use of marijuana in accordance with the act.

SB 423, Sec. 11, which was enacted in 2011, does not require employers to accommodate medical marijuana use, a school to allow patients to participate in extracurricular activities, or a landlord to allow medical marijuana cultivation or use. It provides that employers can prohibit medical marijuana use in contracts, and it does not provide a cause of action for wrongful discharge or discrimination. A patient or provider may only cultivate with his or her landlord’s written permission. (Sec. 4 and 5, SB 423.)

Nevada None known. NRS 453A.510 “A professional licensing board shall not take any disciplinary action against a person licensed by the board on the basis that: 1. The person engages in or has engaged in the medical use of marijuana” according to the law or that they are or were a caregiver.

NRS 453A.800 “The provisions of this chapter do not: …  2. Require any employer to accommodate the medical use of marijuana in the workplace.”

New Jersey None known. N.J.S.A 24:6I-2 (e) states “… the purpose of this act is to protect from arrest, prosecution, property forfeiture, and criminal and other penalties, those patients who use marijuana to alleviate suffering ...” N.J.S.A 24:6I-6 (b) provides that patients, caregivers, and others acting in accordance with the law “shall not be subject to any civil or administrative penalty, or denied any right or privilege, including, but not limited to, civil penalty or disciplinary action by a professional licensing board, related to the medical use of marijuana.”

N.J.S.A 24:6I-14 “Nothing in this act shall be construed to require … an employer to accommodate the medical use of marijuana in any workplace.”

New Mexico None known. N.M.S.A. § 26-2B-4 (4) (a) provides that qualified patients “shall not be subject to arrest, prosecution or penalty in any manner for the possession of or the medical use of cannabis if the quantity of cannabis does not exceed an adequate supply.”

N.M.S.A. § 26-2B-5(A)

“Participation in a medical use of cannabis program by a qualified patient or primary caregiver does not relieve the qualified patient or primary caregiver from: ... (3) criminal prosecution or civil penalty for possession or use of cannabis: … (c) in the workplace of the qualified patient’s or primary caregiver’s employment …”

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Appendix W

: Medical M

arijuana Laws and C

ivil Protections

State-By-State Report 2011State Court Decisions

or LitigationLanguage Most Relevant to Civil

ProtectionsLimitations Related to Civil

ProtectionsOregon In April 2010, the

Oregon Supreme Court ruled in Emerald Steel v. BOLI that patients are not protected from being fired for testing positive for metabolites.

ORS 475.328 “(1) No professional licensing board may impose a civil penalty or take other disciplinary action against a licensee based on the licensee’s medical use of marijuana in accordance with the provisions of ORS 475.300 to 475.346 or actions taken by the licensee that are necessary to carry out the licensee’s role as a designated primary caregiver to a person who possesses a lawful registry identification card.”

ORS 475.340 “Nothing in ORS 475.300 to 475.346 shall be construed to require: … (2) An employer to accommodate the medical use of marijuana in any workplace.”

Rhode Island

None known. RIGL § 21-28.6-4 (a) and (c) provide that patients and caregivers abiding by the act “shall not be subject to arrest, prosecution, or penalty in any manner, or denied any right or privilege, including but not limited to, civil penalty or disciplinary action by a business or occupational or professional licensing board or bureau” for the medical use of marijuana. RIGL § 21-28.6-4 (c) provides, “No school, employer, or landlord may refuse to enroll, employ, or lease to or otherwise penalize a person solely for his or her status as a cardholder.” RIGL § 21-28.6-4 (n) provides, “For the purposes of medical care, including organ transplants, a registered qualifying patient’s authorized use of marijuana shall be considered the equivalent of the authorized use of any other medication used at the direction of a physician, and shall not constitute the use of an illicit substance.”

RIGL § 21-28.6-7 states “(a) This chapter shall not permit:

(1) Any person to undertake any task under the influence of marijuana, when doing so would constitute negligence or professional malpractice …” and “(b) Nothing in this chapter shall be construed to require:

… (2) An employer to accommodate the medical use of marijuana in any workplace.”

Vermont None known. The explicit patient and caregiver protections in the medical marijuana law are from criminal penalties, “A person who has in his or her possession a valid registration card issued pursuant to this subchapter and who is in compliance with the requirements of this subchapter … shall be exempt from arrest or prosecution under subsection 4230(a) of this title.” (18 V.S.A. § 4474b.)

18 V.S.A. § 4474c. provides “(a) This subchapter shall not exempt any person from arrest or prosecution for: (1) Being under the influence of marijuana while:

… (B) in a workplace or place of employment; or

… (2) The use or possession of marijuana by a registered patient or a registered caregiver: … (B) in a manner that endangers the health or well-being of another person.”

Page 232: State by State Laws Report 2011

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Limitations Related to Civil Protections

Washington In Roe v. Teletech Customer Care Management, the Washington State Supreme Court ruled in favor of an employer who was sued after terminating a medical marijuana patient. The ruling was issued on June 9, 2011.

Under SB 523 (enacted in part in 2011), medical marijuana cannot be the “sole disqualifying factor” for an organ transplant unless it could cause rejection or organ failure, though a patient could be required to abstain before or during the transplant. (Sec. 408) The law also limits when parental rights and residential time can be limited due to the medical use of marijuana. (Sec. 409, SB 523)

“Nothing in this chapter requires any accommodation of any on-site medical use of cannabis in any place of employment, in any school bus or on any school grounds, in any youth center, in any correctional facility, or smoking cannabis in any public place or hotel or motel.” ((RCW 69.51A.060(4).) An employer explicitly does not have to accommodate medical marijuana if it establishes a drug-free workplace. (RCW 69.51A.060 (6))