Highlight on Arkansas: medical marijuana amendment approved

On November 8, 2016, Arkansas voters approved Issue 6, the Arkansas Medical Marijuana Amendment which amended the state’s constitution, by a margin of 53 percent in favor to 47 percent against, and became the first state in the South to legalize medical marijuana. The governor had voiced his opposition to the measure. With the approval, more than half of the states in the U.S. have now legalized medical marijuana.

A “yes” vote supported legalizing medical marijuana for 17 qualifying conditions, creating a Medical Marijuana Commission, and allocating tax revenue to technical institutes, vocational schools, workforce training, and the state’s general fund. A “no” vote opposed the amendment to legalize medical marijuana. The amendment will allow patients with a variety of medical conditions, including cancer, Tourette’s syndrome, Crohn’s disease, fibromyalgia, post-traumatic stress disorder, and HIV/AIDS, along with a doctor’s permission to buy marijuana from dispensaries. Patients, however, won’t be allowed to grow their own marijuana.

The Arkansas Department of Health was given up to 120 days to adopt rules for various provisions of the amendment, including, but not limited to:

  1. applications for and renewals of registry identification cards;
  2. labeling and testing standards for marijuana distributed to patients;
  3. care givers assisting patients who are physically disabled or under the age of 18;
  4. requirements for oversight, recordkeeping, security requirements for dispensaries and cultivation facilities;
  5. the manufacture, processing, packaging, and dispensing of marijuana to patients;
  6. procedures for suspending or terminating the licenses of dispensaries and cultivation facilities that violate the provisions of the amendment;
  7. procedures for inspections and investigations of dispensaries and cultivation facilities; and
  8. advertising restrictions for dispensaries and cultivation facilities;

A separate marijuana question had been approved, but Arkansas’ Supreme Court last month directed that votes not be counted. Justices said the petition lacked enough valid signatures. In 2012, Arkansas voted on the Arkansas Medical Marijuana Question, which failed to garner enough support. Following the approval of Issue 6, opponents vowed to fight the amendment in the Arkansas legislature.


Highlight on New Mexico: New health Secretary has several issues on her plate

The New Mexico Department of Health is undergoing some changes, making important decisions, and overrun with its workload. The new Secretary of Health must figure out how the agency will manage its large load of applications for medical marijuana approval and ensure that providers continue to accept the state’s growing number of Medicaid beneficiaries.

A new leader

New Mexico has a new Secretary for the state Department of Health. Governor Susana Martinez recently appointed Lynn Gallagher to the position. Gallagher has been the Department of Health’s Deputy Secretary, and has also served as General Counsel for the Aging and Long-Term Services Department. Secretary Gallagher described her appointment as “bittersweet,” as it follows the death of Secretary Retta Ward.

Department overloaded with medical marijuana requests

One of the new Secretary’s immediate problems is managing the influx of medical marijuana card requests. According to the Department, the state has about 24,000 people in the medical cannabis program, up from 14,000 last year. On average, New Mexico is receiving 2,700 applications per month. The hard copy system is not helping matters, and approvals are taking about 50 days despite the eight-person team. The state soon plans to bring in some temporary workers to relieve the load.

Underused school-based services cut

The New Mexico Department of Health has chosen not to renew the contracts for school based health centers at Roosevelt Middle School, School on Wheels, Maxwell Municipal Schools, Mountainair Middle and High School, and Belen High School. The department has deemed that primary care services at these school health centers have been underused. Lists of alternative centers that are available for local students have been provided.

A Medicaid provider crisis looks to become even worse

An article written by a public policy analyst calls for the state to reform its Medicaid program, arguing that the current program places an incredible burden on physicians, even before the reimbursement reductions are implemented. In 2014, a Wall Street Journal article emphasized how New Mexico’s Medicaid expansion was vital to those who were suddenly able to obtain care, but exposed the program’s burden on providers. A family doctor turned away all newly eligible Medicaid enrollees who sought care at her practice because of the low reimbursement rates. She noted that Medicaid reimbursed her half of what commercial insurers paid for a moderately complex visit, and regretfully stated that she could not grow the proportion of Medicaid patients that she saw because of the strain it would put on herself and her family.

As if the situation wasn’t bad enough then, the New Mexico Human Services Department recently proposed reimbursement cuts for providers serving Medicaid patients in order to relieve pressure on state and federal government spending. Although preventive care and obstetrics services would be exempt from the cuts, over 2,000 general physicians would be subject to rate decreases.  Hospitals would see their rates slashed by 3 to 8 percent. These cuts stem from the projected $417 million deficit that the Medicaid program will crease in 2016 and 2017, as well as estimates that 43 percent of state residents would be enrolled in Medicaid by 2020. Already, Medicaid patients are subject to lengthy wait times for visits, from three weeks to almost two months. The rate cuts are expected to worsen the wait times.




Highlight on Washington: State to combine medical, retail consumer marijuana outlets

Washington is in the process of restructuring its marijuana regulations to implement the merger of the medical and retail consumer markets. New laws and regulations become effective July 1, 2016. As of that date, the state will operate a cannabis database including individuals whose health care practitioners have  prescribed marijuana for their medical use and their “designated providers,”  individuals age 21 or older who are authorized to buy or grow cannabis for the patient’s use.

A long, strange trip to the new law

Washington legalized the medical use of marijuana or cannabis in 1998 through a citizen initiative. According to the legislative findings in the 2015 Cannabis Patient Protection Act, patients faced difficulties finding a legal supply. The law was amended to allow patients to grow their own cannabis in limited quantities in their own homes or in collective gardens. However, there were no standards for purity or efficacy as ordinarily exist for prescribed medications.

In 2012, Washington passed another citizen initiative allowing the recreational use of marijuana by individuals age 21 and older. This law provided for the regulation and taxation of cannabis, including testing to verify compliance with standards for impurities and THC content. Producers, processors, and retail sellers all must be licensed. This development placed the state in the “untenable position” of having protections for recreational users but not for medical users.

Retail purchase for recreational use

Retail stores licensed to sell cannabis opened in July 2014. They are permitted to sell to anyone age 21 or over up to one ounce of usable marijuana, 16 ounces of marijuana-infused product in solid form, 72 ounces of infused product in liquid form, or seven grams of marijuana concentrate.

In order to sell to patients using cannabis for medical purposes, existing licensed retailers must obtain a medical endorsement to  their licenses. Dispensaries, which were licensed to sell to patients for medical use, may obtain retail licenses and continue to sell either to patients alone or to all lawful purchasers.

Rights of medical users

Patients who are not registered but have been prescribed cannabis by their health care practitioner are permitted to possess more than a retail consumer. As of July 1, 2016, to obtain maximum legal protection, patients will have to permit their health care practitioner to report them to the cannabis database. The practitioner’s report will include the medical condition the patient is treating with cannabis, identify any designated provider, and, if the patient needs a larger amount than the law typically allows for medical use, state the quantity of cannabis that the patient should be permitted to possess. Each patient and each designated provider registered with the database will be issued a “recognition card.”

Patients under the age of 18 may be authorized to use cannabis; their designated provider would be their parent or guardian. Patients between the ages of 18 and 21 may enter cannabis stores but may not consume cannabis on the premises.

As of July 1, 2016, a patient who is registered with the database:

  • may purchase up to three times the amount permitted to recreational users from a licensed retail store, i.e., three ounces of usable marijuana, 48 ounces of solid marijuana-infused product, 216 ounces of a liquid marijuana-infused product.
  • may possess up to or 21 grams of concentrate.
  • may grow cannabis at home for medical use, including may have up to six plants and up to eight ounces of usable marijuana from the plants. The patient’s health care practitioner may recommend that the patient be permitted up to 15 plants and up to 16 ounces of marijuana from the plants.
  • may form a cooperative comprising up to four patients or designated providers to grow cannabis for their medical use.
  • may not be arrested for possession of the permitted amount of cannabis. Presentation of the identification card verifies the immunity from arrest.

Before July 1, 2016, any patient, or after July 1, 2016, any patient who is not registered with the database but has authorization from a health care practitioner:

  • may purchase the amount authorized for recreational users from a licensed retail store.
  • may grow cannabis at home for medical use and possess up to four plants and up to six ounces of cannabis from those plants.
  • may raise the medical authorization as an affirmative defense in court if he or she is arrested for unlawful possession.