Medical marijuana Work Group meeting schedule for draft recommendations Governor's Office and OFM John Lane (Gov) John.Lane@gov.wa.gov Nicholas Brown (Gov) Kelly Wicker (Gov) Jay Balesbas (OFM) jay.balasbas@ofm.wa.dov Chris Stanley (OFM) Chris. Stanley@ofm.wa.gov House Health Care and Wellness Committee Chair: Representative Elleen Cody {D) Ranking member: Representative Joe Schmick (R) Senate Health Care Committee Chair: Senator Randy Becker (R) Ranking member: Senator Karen Keiser (D) Other legisle memt Senator Jeanne Kohl-Welles (D) Senator Ann Rivers (R) Other:Report Recommendations Possession Amounts Initiative 692 was passed by Washington voters in November 1998 and was codified as chapter 68.51A RCW. Among other provisions, it granted patients with certain terminal or debilitating conditions (and their primary caregivers) an affirmative defense to “charges relating to marijuana.” Patients over age eighteen could “possess no more marijuana than is necessary for thgpatlent’s personal, medical use, initiative: The initiative did not address how a qualified ps | did it did not modify the Controlled Substances Act, chai ding possession, delivery regarding access to an “adequate, safe, cb qualifying patients.” ny hleeally mises source is eaieiad! a term not defined in law cto Ne cultivating plants, There is no legal source for seeds or ar it uncléajyst how patients are supposed to begin a garden, lated system would likely improve patient access andl be more secure and safe than‘age Sich as group growing and dispensaiies. This option would also be most likely to be suppor vorcement. However, the report acknowledged challenges to government regulation suclfgsihe response by the federal government and patient concerns about poor quality of the marijuana, The rule defining a sixty day supply was adopted on October 4, 2008. In developing the rule, department staff conducted extensive research and outreach to stakeholders. Four public workshops \were held! in addition to the formal hearing in August 2008. The department received and reviewed over 800 comments and staff spent many hours reviewing studies, searching out information on the internet, and exploring laws in other countries and states,Some stakeholders advocated for establishing as much 73 ounces and 99 plants as the sixty day supply. j Ultimately, the rule defined a sixty day supply as no more than twenty-four ounces of useable marijuana and no more than fifteen plants in any stage of growth. The significant analysis prepared by the department for WAC 246-75-010 explains the rule considered the following factors: ‘+ Patients indicated that they use a combination of different methods to administer medical marijuana. ‘+ Patient comments and studies suggest that using other forms, such as eating, vaporizing, tinctures, lotions and suppositories requires more > stoking it + Allowing possession of plants at varying stages of growth a§siis-patients and designated providers with maintaining a consistent supply of usegbfe iédical marijuana. * Although use of medical marijuana is @ health cares = angtatients should rely on their individuals Who rely on the law and to % physician for guidance, the rule must be clear taj individuals enforcing the law. © Lawenforcement comments indicated th ity-aep,60-day supply could encourage illegal trafficking. * Other states have experience with creating andl r patients and providers. . * Patients can overcome the pres dence of medical necessity In 2011, chapter 69.51A RCW was again ameftied in Enis ite Senate Bill (ESSB) 5073. One ( of the changes adopted thar tients to create and participate in BF share responsibility for acquiring and supplying a such as a location, equipment, supplies and ctive garden at any time and it may contain Grty-five plants} and no more than twenty-four f seventy-two ounces), Although collective the resources required to ofS UeIuen vation Oey fteen p gardens were intended to mel personal medical'use, the conced} {sa sixty day supply of marijuana at any given time was besed on idual growth, cultivation and processing of marijuana plants. However, possession 8 these large amounts does create concern. Reports of robberies, burglaries and other crimes involving medical marijuana appear frequently in the news media, Ifa government regulated system of producing, processing and retail sale of medical marijuana is created, patients will have access to an adequate, safe, consistent, and secure source. They will no own plants. For this reason, and to longer be reliant upon the cycle of growth and harvest of their mitigate the opportunity and motive for illegal activity, the Board makes the following recommendations:‘+ Reduce the amount a qualified patient or designated provider can possess at any given time from twenty-four ounces of useable marijuana (a sixty day supply) to three ounces (a one week supply). * Allow additional limits for marijuana infused products in solid or liquid form. * Eliminate the ability for a qualified patient or designated provider to possess marijuana plants in any stage of growth. Define “plant” to avoid any misconstruction of this proviston, + Eliminate the ability for designated providers to also be qualified patients and thus possess double the legal limit of medical marijuana, + Require labeling to include the levels of tetrahydrocannabiggh medical marijuana products. (THC) and cannabinoids in any time. A public hearing fe els vo ey must be made within, . fuindrea’e a days J ;ctable pain, chronic pain, or pain to a specific body part as the ition. Of the other six, four were for nausea/vomiting and two erience and other similar situations, it appears that “intractable interchangeably even though chronic pain can be mild and/or intermittent. It also appears that the lack of definition for these terms may result in authorizations for patients who do not meet the true intent of the law. pain” and “chronic pain’ are'Ust RCW 69.51A.030 sets out the requirements and restrictions for health care professionals who authorize medical marijuana for their patients. The requirements are: * Completing a physical examination of the patient as appropriate, based on the patient's condition and age;These rest Documenting the terminal or debilitating medical condition of the patient in the patient's medical record and that the patient may benefit from treatment of this condition or its : symptoms with medical use of cannabis; Informing the patient of other options for treating the terminal or debilitating medical condition; and Documenting other measures attempted to treat the terminal or debilitating medical condition that do not involve the medical use of cannabis. agrees to be a customer of, a particular liceriss processor of cannabis productsz Examine or offer to examine af ‘ein produces, processes, or dispenses cannabis if the health care profess APdical use of cannabis. Pa s man incase the Bent suters paternal or debiiating condition, Based ot going, the Bt ects following: cS a ; actable pain” ta clearly indicate the condition must be severe re with the patient’s dally activities and ability to function, and can Define "tating" and enough to Significantly int be snjectvely eat pvaluated Enact amprehen Ri firements defining the standard of care for health care professionals who authorize medical marijuana similar to those required by ESHD 2876 (2010) regarding the Use of oploids to manage chronic pain, The requirements should address topics such as adequacy of examination, follow-up care and recording keeping Restrict a health care professional's practice to ensure it does not consist primarily of authorizing medical marijuana Require an expiration of authorizations to ensure a regular cycle of re-examination and follow up care. :+ Eliminate the provision allowing for petitions to add qualifying conditions, Patients with conditions other than those already authorized can follow the legislative process to change the law and can avall themselves of the recreational marijuana market until such time as the law is changed. in the alternative, amend the petition provision to allow the Medical Quality Assurance Commission to make a preliminary finding of good cause prior to holding a hearing ‘and expand the time frame for the hearing to be completed Registry Nineteen states and the District of Columbia currently have aa juana laws, Of those, Washington is (one of the few (only)] that does not have a pati oe Registries provide a record of qualifying patients and authorizing health care professior alow immediate verification of a patient's status if questioned by law enforcement or anotfggtity-alid may provide a card or other documentation identifying the holder as a qualified i provide a structure for the perlodic expiration and renewal of authorization: s phir concerh fe: federal SUB he system and registry, no longer os fs 28 a condition of receiving an authorization. fred barticpate in the registry in conjunction with 2 foul be entered into the registry by the The information must contain sufficient unique identifiers pn ere’ Nor tation card number, or soc secry mente to ecu ssn of heipatient or designated provider, # Registra Jd expi Jsphualy and the patient or designated provider may be re-entered in the registry ts ay ‘of follow-up examination, + Cards should be iss: the registry to identify patients and designated providers. ©The registry should be a to law enforcement, ‘© Disciplining 2 uthorities for the health care professions allowed to authorize medical marijuana should have access to the registry to monitor compliance by thetr lleensees. + The registry should be established and maintained by the Department of Health. * Consistent and reliable funding must be provided to establish and maintain the registry. + The registry should contain suificient security features to protect patient privacy. Information in the registry that could identify patients should be excluded from public disclosureUse and Possession by Minors. The health and welfare of minors (children under age eighteen) in Washington Is of utmost concern. A qualifying patient, by definition suffers from a terminal or debilitating medical condition. Children with terminal or debilitating medical conditions require careful assessment, as well as coordination of care between health care providers and the child’s parent or guardian. Children should be authorized to use ‘medical marijuana only in the most dire situations and when all other medical treatment options have been tried and failed, Health care professionals should be held to the strictest standards when they authorize medical marijuana for children, Particular care should be given to dosage amounts, routes of administration and THC levels. In addition, children should not Hegifaged in situations where they could oe 1998 contained rest the child’s parent or guardian was responsible for prover! ji¥olved in ae ila fapiiana, . Gi hild’s parent ease ys be requifed to act as the child’s designated provider and ee ee * The oafeivoreuaratan ShGdjd have Ele control over the child’s medical mari should be'bBwed to possessjno more medical marijuana than necessaty for his or her next dose. > + Medical marijuat asin personnel in the sari mnner as any other medication. Consistent with current law, schools should not ie compelled to accommodate on-site use of medical marijuana on school grounds oF school buses. + Medical marijuana products should be prohibited from being labeled in a manner that mimics candy, soda or other treats attractive to children. {4 ina school setting should be held and administered by schoolWashington State Liquor Control Board Scope of Work 3ESSB 6034 Sec. 141 Proviso: Recommendations on Medical Marljuana Budget Proviso Language: SB 5034 Sec, 144(2): (a) The liquor control board must work with the department of health and the department of revenue to dovelop recommendations for the legislature regarding the interaction of medical marijuana regulations and the provisions of Initiative Measure No. 502, At @ minimum, tho recommendations must include provisions addressing the following: (i) Age limits; (ji) Authorizing requirements for medical marjuana; {li) Regulations regarding health care professionals; {Iv} Coltective gardens; {v) Possession amounts (\i} Location requirements; (ull) Requirements for medical marijuana producing, processing and retail licensing; and (ill) Taxation of medical marijuana in relation to recreational marijuana, (b) The board must submit its recommendations to the appropriate committees of the legislature by January 1, 2044. Work Group Members: * Department of Health (00H); Kelly Cooper, Acting Director for Policy, Legislative, & Constituent Relations ; Krisll Weeks, Diractor, Office of Legal Services * Liquor Control Board (LCB): Rick Garza, Director; Ingrid Mungla, Slaff Attorney + Dopartment of Revenue (DOR): Drew Shirk, Assistant Director, Legislation & Policy Division; Kathy Ryan, Tax Policy Specialist, Legislation & Policy Division + Governor's Office: John Lane, St. Policy Advisor-for Public Safety & Government Operations + Legislative Committee Staff; Kathy Buchli, Coordinator/Sr. Counsel Senate Health Care Committee Dean Carison, Senate Ways & Means Committee, Revenue Goordinator; Christopher Blake, Counsel, Office of Program Research; Dominique Meyers, Fiscal Analyst, House Finance Committee Issue area assignments: 1. Recommended age limit: DOH 2. Authorizing requirements for medical marijuana: DOH 3. Regulations regarding health care professionals: DOH Collective gardens: DOH Possession amounts: DOH, Location requirements: LCB. 4 6. 6. 7. Requirements for medical marijuana producing, processing, and retell ic 8, Tax structure of marijuana as an agricultural produ: DOR 9. ‘Taxation of medical marijuana in relation to recreational marijuana: DORWashington State Liquor Control Board Medical Marijuana Work Group Timeline 3ESSB 5034 section 141 directs the Liquor Control Board (LCB) to work with the Department of Revenue (DOR) and the Department of Health (DOH) to develop recommendations for the legislature regarding the interaction of medical marijuana (MMW) regulations and the provisions of Initiative 602 which established a recreational marijuana (MJ) system. Below is the MMJ Work Group's timeline for providing the legislature with the above mentioned recommendations, including all significant milestones. Date (2013) Milestone July 45 Work group meeting: Draft timeline August 26 Work group meeting: Scope of work and work assignments September 9 Work group meeting: Check-in and evaluate progress of dratt recommendations and address specific questions September 27 Work group meeting: Check-in and evaluate progress of draft recommendations and address specific quostions October 7 Work group meeting: Finalize draft recommendations October 14 Briefing on draft recommendations to Governor's offico, OFM, appropriate House and Senate committee chairs, ranking members and other legislative members October 21 Provide draft recommendations to stakeholders for comment November 8 Deadline for written commenis November 12 Work group meeting: Review stakeholder comments and consider revisions to draft recommendations November 21-22 Present draft recommendations to appropriate House and Senate committees at Legislative Assembly Days December 2 Work group meeting: Finalize recommendations to the legislature December TBD iefing on final recommendations to Governar’s office, OFM, appropriate House and Senate committee chairs, ranking members and other legislative members December TBD. LCB Board meeting: present work group recommendations Jan ary 1, 2014 Deliver final recommendations to the legislature: Qciober 7, 2013, v. 1VWashington State uor Control Board Medical Marijuana Work Group Timeline 3ESSB 5034 section 141 directs the Liquor Control Board (LCB) to work with the Department of Revenue (DOR) and the Department of Health (DOH) to develop recommendations for the legislature regarding the interaction of medical marijuana (MIM\) regulations and the provisions of Initiative 502 which established a recreational marijuana (MJ) system. Below is the MMJ Work Group's timeline for providing the legislature with the above mentioned recommendations, including all significant milestones. Date (2013) Milestone July 15 Work group meeting: Draft timeline August 26 Work group meeting: Scope of work and work assignments September 9 Work group mesting: Check-in and evaluate progress of draft recommendations and address specific questions Soptomber 27 Work group meeting: Check-in and evaluate progress of draft recommendations and address specific questions October 7 Work group meeting: Finalize draft recommendations October 14 Briefing on draft recommendations to Govemor's office, OFM, appropriate House and Senate committee chairs, ranking members. and other legislative members October 21 Provide draft recommendations to stakeholders for comment November 12 Work group meeting: Review stakeholder comments and consider revisions to draft recommendations: November 21-22 Present draft recommendations to appropriate House and | Senate committees at Legislative Assembly Days December 2 Work group meeting: Finalize recommendations to the legislature December TBD —_Briefing on final recommendations to Governor's office, OFM, appropriate House and Senate committee chairs, ranking members and other legislative members January 1,2014 Deliver final recommendations to the legislature October 1, 2013, v, IVWashington State Liquor Control Board Medical Marijuana Work Group Timeline 3ESSB 5034 section 141 directs the Liquor Control Board (LCB) to work with the Department of Revenue (DOR) and the Department of Health (DOH) to develop recommendations for the legislature regarding the interaction of medical marijuana (MM¥J) regulations and the provisions of Initiative 502 which established a recreational marijuana (MJ) system. Below is the MMJ Work Group’s timeline for providing the legislature with the above mentioned recommendations, including all significant milestones. Date (2013) July 15 August 26 September 9 September 27 ctober 7 SO October 11 October 21 November 12 November 21-22 December 2 Die. 1o-Fvance, di) ~ Perse Ree January 1, 2014 Milestone Work group meeting: Draft timeline Work group meeting: Scope of work and work assignments Work group meeting: Check-in and evaluate progress of draft recommendations and address specific quostions Work group meeting: Check-in and evaluate progress of draft recommendations and address specific questions Work group meeting: Finalize draft recommendations Briefing on draft recornmendations to Governor's office, OFM; appropriate House and Senate committee chairs, ranking members and other legislative members Provide draft recommendations to stakeholders for comment Work group meeting: Review stakeholder comments and consider revisions to draft recommendations Prevent draft racommondations to appropiate House and HVS: Hea hives, Senate committees at Legislative Assembly Days real FANE Work group meeting: Finalize recommendations to the legislature Briefing on final recommendations to Governor's office, OFM, appropriate House and Senate committee chairs, ranking members and other legislative members Deliver final recommendations to the legislature September 23, 2013, v. Il