2019 STATE

OF THE STATES
REPORT

AN ANALYSIS OF
MEDICAL CANNABIS
ACCESS IN THE
UNITED STATES

AmericansForSafeAccess.org
Dear Reader,

Each year, Americans for Safe Access (ASA) analyzes, summarizes, and critiques legislation
and regulations as they become law and develops this report to assess how these programs
are serving the needs of patients. In 2014, when we first started writing this report, only 22
states were analyzed and graded. Now, six years later, we are analyzing 47 states in over
50 categories surrounding Patient Rights and Civil Protection from Discrimination, Access
to Medicine, Ease of Navigation, Functionality of the Program, and Consumer Safety and
Provider Requirements.

Through this report, ASA also recommends how states can improve programs, and we take
great pride in knowing that these recommendations are frequently followed and incorporated
by regulators and policymakers. While we are excited to see the number of states with medical
cannabis programs increase, we know this patchwork of laws is not working to provide access
to everyone who needs this medicine. Patients can still not travel to other states with their
medicine, and some states only offer protections that cover a small subset of patients using a
certain type of medicine. The types of medicine available, method of administration, purchase
limits, training requirements for staff, labeling requirements, etc. are different depending on the
state that you are lucky, or unlucky, enough to live in.

With international rescheduling of cannabis on the horizon, it is time the United States follow
the lead of other countries, and in particular, those nations where the regulation and control of
cannabis is placed in a centralized federal agency. For a look at our recommendations on how
to End the Federal Conflict, through a federal Office of Medical Cannabis read Chapter 7 of
our Medical Cannabis Briefing Book: https://www.safeaccessnow.org/briefingbook116.

We hope that you take the information in this report and use it to bring greater access to
patients all over the country.

With gratitude,

Steph Sherer
President and Founder
Americans for Safe Access
2
CONTENTS

MEDICAL CANNABIS BY THE NUMBERS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

EVOLUTION OF THIS REPORT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7

SCORING UPDATE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

STATE-BY-STATE GRADES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

HOW STATES WERE EVALUATED. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

MEDICAL CANNABIS TIMELINE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

THE MEDICAL USE OF CANNABIS.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

CATEGORY 1 PATIENT RIGHTS AND CIVIL PROTECTIONS

FROM DISCRIMINATION.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

CATEGORY 2 ACCESS TO MEDICINE.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20

CATEGORY 3 EASE OF NAVIGATION.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

CATEGORY 4 FUNCTIONALITY.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

CATEGORY 5 CONSUMER SAFETY AND

PROVIDER REQUIREMENTS. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

STATE MEDICAL CANNABIS PROGRAM

REGULATIONS AND OVERSIGHT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44

STATE REPORT CARDS.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46

CONCLUSION. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158

APPENDIX 1 UNIVERSAL IMPROVEMENTS &

MODEL LEGISLATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164

APPENDIX 2 RECOMMENDATION TO REGULATORS.. . . . . . . . . . . . . . . . . 172

APPENDIX 3 THE FEDERAL GOVERNMENT’S ROLE. . . . . . . . . . . . . . . . . . 174

3
MEDICAL CANNABIS IN
ACCESS
AMERICA
IN THE UNITED STATES

MEDICAL CANNABIS
BY THE NUMBERS

0
47
States with Medical
Deaths Caused by Cannabis

Cannabis Laws

3 MIL.+
Medical Cannabis Patients
in the U.S.

$ 500 MIL.+
Federal Tax Dollars Spent on Federal
Interference in Medical Cannabis
States before Rohrabacher-Farr CJS
Amendment

$ 9,000
Clinical Trial Data Using Cannabis
for Pain in Patient Years

95+
Qualifying Medical Conditions in
Medical Cannabis Programs

4
 25%
Average Drop in Opiate Related
Deaths in States with Medical

30,000+
Cannabis Laws

Studies Published on the

Endocannabinoid System

93%
Americans Supporting

$ 165 MIL.
Medical Cannabis

Federal Prescription Drug

Cost Savings in Medical Cannabis
States in 2013

103+
Known Cannabinoids
126 MIL.+
Number of Americans Suffering

70,237
from Chronic Pain

Deaths Caused by Prescription

Drugs in 2017

AmericansForSafeAccess.org 5
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

INTRODUCTION their medicine from a legal market, but provided no

framework to make that happen. Laws that regulated
Founded in 2002, Americans for Safe Access (ASA) the production and distribution of medical cannabis
has engaged state and federal governments, courts, were not considered until the early 2000s. By the late
and regulators to improve the development and 2000s, state legislators were including production and
implementation of state medical cannabis laws and distribution programs as a matter of course.
regulations. This experience has taught us how to assess
whether state laws meet the practical needs of patients. The first distribution models were nonprofit, member-
It has also provided us with the tools to advocate for based collectives, with members supplying their excess
improvements in programs that will better meet those cannabis and cannabis products to storefront operations.
needs. Through legislative and regulatory analysis and This model worked with smaller populations of patients,
patient feedback, we hope that this report can serve but as the patient population grew, the member-supplied
not as a final report card (as there is always room for model became more of a legal designation than the
improvement), but rather as an interim snapshot of actual business model for the majority of distribution
where state medical cannabis programs are in terms centers. In 2010, Colorado was the first state to classify
of serving patients. Furthermore, this report should medical cannabis distribution as a “business” regulated
be used by state lawmakers to determine areas under the state’s Department of Revenue, formally
to improve their state program rather than as a creating the medical cannabis industry.
benchmark of success.
Patient advocates recognized this transition would
Passing a medical cannabis law is only the first step require more than just regulations for business licensing,
in a lengthy implementation process, and the level of anti-diversion protocols, taxation, and zoning. Like all
forethought and advanced input from patients can make commercial markets in the U.S., product safety protocols
the difference between a well-designed program and would also have to be adopted. While cannabis has been
one that is seriously flawed. One of the most important proven to be a safe, non-toxic medication, cannabis and
markers of a well-designed program is whether all cannabis products can be contaminated in the course
patients who would benefit from medical cannabis will of cultivation or manufacturing processes. In this new
have safe and legal access to their medicine without fear marketplace, as with other commercial products they
of losing any of the civil rights and protections afforded consume, patients have the right to know how their
to them as residents of the United States. medicine has been produced and can verify that it is free
of contaminants. Patients should be able to be confident
IN 2010, COLORADO WAS THE FIRST that the medicine they are receiving has been handled
STATE TO CLASSIFY MEDICAL CANNABIS with the highest quality of care.
DISTRIBUTION AS A “BUSINESS”
REGULATED UNDER THE STATE’S In 2011, ASA teamed up with the American Herbal
DEPARTMENT OF REVENUE, FORMALLY Products Association (AHPA), the principal U.S. trade
CREATING THE MEDICAL CANNABIS association and voice of the herbal products industry,
INDUSTRY. to create industry-wide product safety protocols for
commercial cultivation, manufacturing, distribution, and
The current medical cannabis industry is a byproduct laboratory testing of medical cannabis products. In 2013,
of a movement of medical professionals, scientists, the American Herbal Pharmacopoeia (AHP) issued the
patients, their families, and policymakers advocating Cannabis Inflorescence Monograph, a comprehensive
to allow patients, under the guidance of a healthcare description of the plant’s botany and constituent
professional, to use cannabis therapies. This effort components. This specialized study by the world’s
started at the federal level and then, after encountering leading experts on the plant provides scientifically valid
a series of roadblocks, moved to the changing of methods of testing the identity, purity, potency, and
laws at the state level in the late 1990s. These early quality of cannabis products. Both the AHPA and AHP
laws anticipated that patients would need to obtain standards are rapidly being adopted by state regulators

6
 INTRODUCTION

to ensure consumer safety and are utilized through EVOLUTION OF THIS REPORT
ASA’s Patient Focused Certification program.
In addition to DC, the four U.S. territories, and the
TODAY, WE HAVE A PATCHWORK OF 33 states that are commonly recognized as having
MEDICAL CANNABIS LAWS ACROSS THE viable medical cannabis laws, another 14 states have
UNITED STATES. THIRTY-THREE STATES, adopted laws that only allow the possession of certain
THE DISTRICT OF COLUMBIA, GUAM, THE cannabis oil extracts rich in CBD. CBD, one of many
COMMONWEALTH OF THE NORTHERN active compounds in medical cannabis, is among the
MARIANA ISLANDS, THE U.S. VIRGIN cannabinoids that have been shown to have a positive
ISLANDS, AND PUERTO RICO HAVE therapeutic effect on intractable seizure disorders,
ADOPTED LAWS CREATING PROGRAMS especially in young children. Indiana joined the states
THAT ALLOW AT LEAST SOME PATIENTS with CBD-focused laws in 2017 and was followed by
LEGAL ACCESS TO MEDICAL CANNABIS. Kansas in 2018, leaving only Idaho, South Dakota, and
Nebraska without any form of medical cannabis law.
Today, we have a patchwork of medical cannabis laws These CBD-focused laws apply to a small subset of
across the United States. Thirty-three states, the District patients with a severely limited number of conditions
of Columbia, Guam, the Commonwealth of the Northern and maintain the criminalization of patients accessing
Mariana Islands, the U.S. Virgin Islands, and Puerto Rico medical products that use any of the other therapeutic
have adopted laws creating programs that allow at least ingredients or compounds from the plant, except in
some patients legal access to medical cannabis. Most of Virginia and Georgia, which allow the use of THCA.
those 33 states provide patients with protections from The laws are intended to serve qualified patients, but
arrest and prosecution, and incorporate a regulated serious questions remain regarding the production,
production and distribution program. Several programs manufacturing, or distribution of cannabis oil to those
also allow patients and their caregivers to cultivate a patients. Only a small minority of these laws create a
certain amount of medical cannabis themselves. While it system that supports the implementation of quality
took a long time for states to recognize the importance of control and quality assurance programs for in-state
protecting patients from civil discrimination (employment, production and access points, with the most glaring
parental rights, education, access to health care, etc.), question being: how are patients expected to obtain a
through advocacy and recommendations from our steady supply of medicine if they cannot obtain it in their
report, more laws now include these explicit protections. own state?
An additional 14 states allow for the limited use of
cannabidiol (CBD) products that contain no, or very little, Because of this growing patchwork landscape of medical
tetrahydrocannabinol (THC). cannabis laws, it is no longer practical to assess or
evaluate state laws on an “up/down” basis. Patient
While we have come a long way since the first advocates have been reluctant to count those states that
medical cannabis law passed in 1996, as of June 1, have adopted CBD-only laws as medical cannabis states
2019, none of the state laws adopted thus far can be because the protections offered extend only to a small set
considered ideal from a patient’s standpoint. Only of patients using a certain type of medicine that may or
a minority of states currently include the entire range of may not be available at some point in the future. These
protections and rights that should be afforded to patients distinctions preclude a simple “yes” or “no” classification
under the law, with some lagging far behind others. as a medical cannabis state.
Because of these differences and deficiencies, patients
have argued that the laws do not function equitably and Legislative proposals must be evaluated for strengths
are often poorly designed, poorly implemented, or both. and weaknesses on a case-by-case basis within their
As production and distribution models are implemented, political context. What is feasible in one state may
hostile local governments have found ways to ban such be impossible in another. Sometimes, even the most
activity, leaving thousands of patients without the access supportive and compassionate legislators will make the
state law was intended to create. mistake of passing laws that are overly restrictive and

7
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

fail to adequately meet the needs of the patients they one of the greatest public health crises of a generation.
were intended to help. Other legislative and regulatory On average, medical cannabis programs serve only
proposals are developed or implemented in bad faith 2-4% of each state’s population even though one-third of
with the intent of excluding patients and serving only the the country’s population lives with chronic pain, which is
narrowest segment of that population. Flawed measures often treated with opioids.
like these may technically be considered medical
cannabis laws, but are functionally inadequate. In November 2017, Americans for Safe Access launched
a campaign titled End Pain, Not Lives (EPNL). This
2018 WAS THE FIRST YEAR IN NEARLY campaign was borne from research findings that medical
THREE DECADES WHERE THE DRUG cannabis can be used as a tool to help combat the
OVERDOSE FATALITY RATE DECREASED opioid crisis in the U.S. The opioid epidemic continues
FROM THE PREVIOUS YEAR. to claim over 130 lives daily. Numerous research studies
show that states with medical cannabis programs have a
After hosting scores of community forums across the nearly 25% decrease in opioid overdose deaths.1 In fact,
U.S. to gather input from patients on what issues are more recent research suggests that this number is closer
most important to them, ASA has created a matrix to 40%.2 In June of 2019, conflicting research came out
to deconstruct medical cannabis laws in order to from Stanford University that showed opioid overdoses
evaluate and grade each component based on patient actually increased in medical cannabis states; however,
needs. Each year, more states adopt and improve unlike the original JAMA study this study, included
medical cannabis laws, and it is ASA’s hope that state states with CBD laws as well as states that had passed
legislators and regulators will use this matrix to help laws but had not yet implemented them. Further, other
them design comprehensive, functional laws and studies have shown that opioid usage among those with
regulations for patients. private insurance (as opposed to Medicaid or Medicare)
dropped significantly in medical cannabis states.3 2018
As medical cannabis programs continue to develop was the first year in nearly three decades where the
around the country, states have begun to approach drug overdose fatality rate decreased from the previous
medical cannabis from a public health perspective rather year (down 5.1%). While medical cannabis programs
than from a compassionate use perspective. While there cannot be identified as the sole cause for this reduction,
was an upward trend of program improvements across they have certainly played a significant role in helping
the country in 2018-2019, states are still not effectively patients find a safer alternative to managing their pain.4
using medical cannabis to address public health issues, However, even in states that score well under ASA’s
the most striking of which is in the response to the current framework, medical cannabis is not available to
opioid crisis. all patients who could benefit from it due to the conflict
between federal and state law, inadequacies in state law,
and a lack of adequate medical professional and patient
SCORING UPDATE education. The framework for state responses to the
opioid epidemic is included on the following page.
In last year’s report, ASA issued a rubric to assess
state responses to the opioid crisis. In years past,
we have given states up to 35 points for improving
their programs. This “improvement bonus” has been
fairly subjective, leading to inconsistencies in scoring
1 Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical Cannabis
and grading. For this year’s report, the “improvement Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010.
bonus” will be replaced with an assessment of how the JAMA Intern Med. 2014;174(10):1668–1673. doi:10.1001/jamainternmed.2014.4005
2 Powell D, Pacula RL, Jacobson, M. Do medical marijuana laws reduce
state has used medical cannabis as a tool to fight the addictions and deaths related to pain killers? Journal of Health Economics
opioid crisis. Using the scoring rubric below, medical 2018; 58: 29-42
3 https://www.sciencedirect.com/science/article/pii/
cannabis programs will be evaluated both on their actual S0091743519301860?via%3Dihub
effectiveness and on how they are being used to combat 4 https://www.cnn.com/2019/07/17/health/drug-overdose-deaths-2018-bn/
index.html

8
 INTRODUCTION

Opioid Response ___/40

Is cannabis available for treatment? -/15
• Does the state allow for chronic pain as a qualifying condition without restriction? /5
• Does the state allow cannabis to be issued instead of opioid prescriptions? /5
• Does the state allow for opioid use disorder? /5

Doctor education on the interactions between cannabis and opioids -/7

• Is doctor education on opioids available through the state department of health
or state medical society? /5
• Is opioid-cannabis education part of the curriculum? /2

Can pain patients use cannabis? -/3

• H
 as the state acknowledged the 2016 CDC guidelines on not testing for THC? /2
• H
 as the state issued specific guidance about testing for THC and other cannabinoids
in pain patients? /1

Can pain patients access medical cannabis? -/5

• Is there same-day access with a doctor’s recommendation? /2.5
• C an patients use their medical cannabis in home health facilities, hospices, and
treatment centers? /2.5

Can the patient afford medical cannabis? -/5

• V eteran discount? /1
• L ow income discount? /1
• Is medicine affordable based on patient feedback? /3

Research -/5
• A
 re there sufficient research & development tax breaks for medical cannabis facilities? /2.5
• D
 oes the state promote research? /2.5

9
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

MOST FREQUENT MEDICAL CONDITIONS FOR

MEDICAL CANNABIS RECOMMENDATIONS

The conditions, diagnoses and symptoms that

patients must present to receive a medical cannabis
recommendation can vary dramatically by state. The chart
above illustrates the distribution of medical cannabis
recommendations by qualifying condition in the states
that make such data available. This is limited
to the most frequently recommended
conditions and is not inclusive of every
condition for which a medical professional
might recommend cannabis. As is clearly
evident in this data chronic pain is the
primary condition being treated by medical
cannabis, hence our focus on the role of
cannabis in alleviating the opioid epidemic.

Some jurisdictions empower medical

professionals to recommend medical
cannabis to any patient who may benefit
from it, which is vastly preferable to the
enumeration of qualifying conditions in the
law. ASA maintains a tracker of qualifying
conditions by jurisdiction, which is available
at safeaccessnow.org/condition. The
tracker will be updated to reflect conditions
as they are added to medical cannabis
programs.

10
 INTRODUCTION

STATE-BY-STATE GRADES 1. Patient Rights and Civil Protection from

Discrimination
The grade for each state’s medical cannabis program is 2. Access to Medicine
based on how well it meets the needs of patients in five 3. Ease of Navigation
categories, worth 100 points each, that are described 4. Functionality
in detail in the pages that follow. Up to 40 points were 5. Consumer Safety and Provider Requirements
awarded to states that made an effort to use medical
cannabis to combat the opioid crisis. Due to the As mentioned in the introduction, ASA developed these
incredible volume of bills in state legislatures (nearly criteria based on a series of over 100 public meetings
2,200 were introduced across the country since across the U.S. as well as surveys of our 100,000+
January 1, 2018), only laws passed, court decisions members. With laws and regulations changing daily, this
decided, and regulatory actions taken between document is a snapshot of ever-changing programs.
January 1, 2018 and June 1, 2019 were considered ASA has had to amend this report several times since
as additions to state programs. we began its writing, and we expect that some of this
information will be out of date as soon as the ink hits
paper. The criteria we selected reflect the current realities
HOW STATES WERE of state medical cannabis laws. Definitions for each
item can be found below. States that partially met the
EVALUATED definition for certain criteria, either directly or indirectly,
Each state was scored based on how well their current were eligible for partial points when appropriate.
law and regulations accommodate patient needs, as
broken down into five general categories: The full rubric is available at safeaccessnow.org/rubric.

11
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

MEDICAL CANNABIS
TIMELINE

TOTAL STATES: 8 TOTAL STATES: 13 TOTAL STATES: 20

PLUS DC
Alaska, California, Colorado, Hawaii, Michigan, Montana, New Mexico,
Maine, Nevada, Oregon, and Rhode Island, and Vermont Arizona, Delaware, District of
Washington Columbia, New Jersey, Connecticut,
Massachusetts, New Hampshire,
and Illinois

1996-2002 2002-2008 2009-2013

PATIENTS PATIENTS PATIENTS
50,000 471,438 1,073,596

FEDERAL RAIDS: 14 FEDERAL RAIDS: 241 FEDERAL RAIDS: 262

1996 – DOJ threatens licenses of 2002 – Federal court rules in Conant v. 2009 – US Attorney General announces
any doctor recommending cannabis Walters that government cannot revoke that DOJ will not prioritize prosecution
following passage of first medical physicians’ licenses for recommending of legal medical cannabis patients.
cannabis law. medical cannabis.
2011 – DOJ threatens elected officials in
1996–2002 – DOJ and DEA carry out 2007 – DEA administrative law judge 11 states implementing cultivation and
paramilitary raids. recommends allowing new source of distribution programs.
cannabis for research.
1998 – The Institute of Medicine 2012 – AHP issues Cannabis
(IOM) issues “Marijuana & Medicine: Monograph and AHPA issues
Accessing the Science Base” calling recommendations for regulators.
on the federal government to do formal
studies on cannabis. 2013 – DOJ issues a guidance memo
to prosecutors concerning marijuana
1998 – Congress blocks DC law. enforcement under the Controlled
Substance Act (CSA).

12
TOTAL STATES: 47
PLUS DC, CNMI, GUAM,
PUERTO RICO, AND USVI
Arkansas, CNMI, Florida, Guam, Louisiana,
Maryland, Minnesota, New York, North Dakota,
Ohio, Pennsylvania, Puerto Rico, USVI, and
West Virginia
CBD-only laws: Alabama, Georgia, Indiana, Iowa,
Kansas, Kentucky, Mississippi, North Carolina,
South Carolina, Tennessee, Texas, Virginia,
Wisconsin, and Wyoming

2014-2019
PATIENTS
3,000,000+

FEDERAL RAIDS: 2
2014 & 2015 – Rohrabacher-Farr CJS
amendment passes and prohibits the
Department of Justice from spending money
to prevent states from implementing medical
cannabis programs.
2015 – The CARERS Act, the first medical
cannabis bill in US Senate history, is
introduced.
2015 – Court upholds the Rohrabacher-Farr
amendment in U.S. vs Marin Alliance for
Medical Marijuana.
2016 – Court extends Rohrabacher-Farr
protections to individuals in U.S. vs McIntosh.
2016 – DEA announces it will not move
cannabis out of its Schedule I status.
2018 – Cole memo rescinded.
AmericansForSafeAccess.org 13
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

THE MEDICAL USE

OF CANNABIS TRICHOMES
Resin-filled glands that
contain the majority of the
cannabinoids and terpenoids
in a cannabis plant.

Inflorescence
Cannabis
(flower)

DELIVERY METHODS
PATIENTS USE MANY METHODS TO TAKE
CANNABIS. THE METHOD USED CAN
DEPEND ON PERSONAL CHOICE, THE
MEDICAL CONDITION BEING TREATED,
THE AGE OF THE PATIENT, THE PATIENT’S
TOLERANCE FOR THE METHODS, ETC.

INHALATION BENEFIT
Anti-inflammatory,
Types of products: whole plant, immunomodulatory,
neuroprotective and
THCA
oils, waxes, and concentrates anti-cancer
Expected onset: 0-10 minutes
Duration: 1-4 hours  

INGESTION BENEFIT
Effective against MRSA,
Product types: edible products, sedative, topical analgesic CBN
for burns, and may
beverages, teas, capsules stimulate bone growth
Expected onset: 30 to 90 minutes
Duration: Up to 8 hours

TOPICAL
Product types: lotions, salves, oils
Expected onset: a few minutes
ECS: EAT, SLEEP,
Duration: 1-4 hours RELAX, FORGET, AND
PROTECT
BUCCAL The endocannabinoid system is the
body’s mechanism for preserving
Product types: alcohol-based
homeostasis (keeping all body functions
tinctures, lozenges
running smoothly). This system is
Expected onset: 0-60 minutes
composed of a sophisticated group of
Duration: 1-8 hours
neuromodulators, their receptors, and
signaling pathways involved in regulating
a variety of physiological processes,
including movement, mood, memory,
appetite, and pain.
The endocannabinoid system is probably
the most ubiquitous system in the human
body, with the cannabinoid receptors
CB1 and CB2 located throughout the
brain and the periphery of the body.

14
 CANNABINOIDS & TERPENOIDS

CBD
BENEFIT
LIMONENE
Potent immunostimulant via inhalation, anxiolytic, apoptosis
of breast cancer cells and acne bacteria
Non-psychotropic, anti-
LEMON SYNERGISTIC CANNABINOIDS: CBD, CBG, THC
depressant, anti-inflammatory,
anti-convulsant, anti-nausea,
anti-anxiety, analgesic,
sedative, sleep aid, and
muscle relaxant
α-PINENE
Anti-inflammatory, bronchodilatory, acetylcholinesterase
inhibitor (aiding memory)
PINE SYNERGISTIC CANNABINOIDS: CBD, THC

β-MYRCENE
Blocks inflammation, analgesic, sedative, muscle relaxant,
BENEFIT hypnotic, blocks hepatic carcinogenesis by aflatoxin

THC Psychotropic, analgesic,

anti-inflammatory,
anti-microbial, and
HOPS SYNERGISTIC CANNABINOIDS: CBD, CBG, THC

muscle relaxant
LINALOOL
Anti-anxiety, local anesthetic, analgesic,
anticonvulsant/anti-glutamate
LAVENDER SYNERGISTIC CANNABINOIDS: CBD, THC, THCV, CBDV

β-CARYOPHYLLENE
BENEFIT Gastric cytoprotective, anti-malarial, selective CB2 agonist,

CBC
Anti-inflammatory, anti-inflammatory
analgesic, anti-anxiety, PEPPER SYNERGISTIC CANNABINOIDS: THC
and antidepressant

NEROLIDOL
Sedative
ORANGE SYNERGISTIC CANNABINOIDS: THC, CBN

BENEFIT

CBG Muscle relaxant, anti-

eurythmic, analgesic, PHYTOL
digestive aid GABA via SSADH inhibition
GREEN TEA SYNERGISTIC CANNABINOIDS: CBG

YEARLY
DEATHS POTENTIAL SIDE EFFECTS
2017 OPIOIDS Sedation, dizziness, nausea,

47,600
vomiting, constipation, physical
dependence, tolerance, respiratory
depression, and death
Over half from
prescribed opioids
POTENTIAL SIDE EFFECTS
PRESCRIPTION Liver failure, loss of language, cognitive
DRUGS decline, respiratory depression, rage,

70,200
suicide, paranoia, and death

POTENTIAL SIDE EFFECTS

Dry mouth, dizziness, increased
(Source: CDC 2017) CANNABIS appetite, dry eyes, sedation,

0
euphoria, disorientation, and
short-term memory impairment

AmericansForSafeAccess.org 15
 1
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

Category
PATIENT RIGHTS
AND CIVIL
PROTECTIONS FROM
DISCRIMINATION

ARREST PROTECTION – 40 PTS

AFFIRMATIVE DEFENSE – 15 PTS
CHILD CUSTODY PROTECTIONS – 10 PTS
DUI PROTECTIONS – 5 PTS
EMPLOYMENT PROTECTIONS – 5 PTS
EXPLICIT PRIVACY STANDARDS – 7 PTS
HOUSING PROTECTIONS – 5 PTS
DOES NOT CREATE NEW CRIMINAL PENALTIES FOR PATIENTS – 5 PTS
ORGAN TRANSPLANTS – 5 PTS
RECIPROCITY – 3 PTS

16
 CATEGORY 1 PATIENT RIGHTS AND CIVIL PROTECTIONS FROM DISCRIMINATION

Arrest Protection 40 DUI Protections 5

pts
pts
DOES THE LAW SUFFICIENTLY PROTECT DOES THE LAW RECOGNIZE THAT PATIENTS
PATIENTS FROM ARREST? MAY HAVE RESIDUAL THC METABOLITES IN THEIR
BLOODSTREAM WITHOUT BEING IMPAIRED?
Arrest protection refers to explicit legislative language
that instructs law enforcement to refrain from arresting Many states allow their Driving Under the Influence
individuals who are in compliance with state law. (DUI) or Driving Under the Influence of Drugs (DUID)
statutes to be used as a means of penalizing drivers
who are medical cannabis patients, even without
Affirmative Defense 15
evidence of impairment while driving. An individual’s
pts participation in a state medical cannabis program
DOES THE LAW OFFER A CLEAR should not constitute probable cause for a sobriety test,
AFFIRMATIVE DEFENSE IN STATE COURT? nor should the presence of cannabis metabolites in the
body - which can be detected days or weeks after last
An affirmative defense refers to a criminal defendant’s
use - indicate actual impairment. By treating cannabis
right to argue medical necessity or compliance with
like any other medication under a state’s DUI or DUID
state law as a defense in state court. With an affirmative
laws, patients will still be prohibited from driving while
defense, the burden is on the defendant to prove that
impaired or using cannabis while driving, but patients
they were not in violation of the law. Ideally, a state
will not be unnecessarily subjected to arrest and
will afford a necessity defense for medical cannabis
prosecution solely for being a medical cannabis patient
conduct that does not conform to the strict limits of
or having metabolites in their bodies.
the state law: for example, possessing amounts above
the statutory limit in order to have a consistent supply
of medicine. Some states have an implied affirmative
defense within their arrest protection. Employment 5
pts
Protections
Parental Rights 10
CAN AN EMPLOYEE BE FIRED MERELY FOR BEING
A PATIENT OR FOR HAVING CANNABIS IN THEIR
Protections pts
SYSTEM, IF IT DOES NOT AFFECT THEIR JOB
PERFORMANCE?
ARE PARENTS AT RISK OF LOSING THEIR CHILDREN
An individual’s status as a medical cannabis patient,
IN A CHILD CUSTODY, DIVORCE AND SEPARATION
or a positive test for cannabis metabolites, should not
PROCEEDINGS BASED ON THEIR PATIENT STATUS?
be an employer’s sole basis for either refusal to hire
Most states list marijuana possession and cultivation or dismissal of that person. Because of their regular
as an indication of child abuse and/or neglect. Explicit cannabis use, most patients will test positive without
protections against such assumptions can, and should, being impaired. Medical cannabis use should be
instruct state agencies and family courts to recognize treated like any other prescription medication under
that a parent’s status as a medical cannabis patient state law. While some states have explicit protections,
should not be a determining factor in any CPS or court many laws are inadequate in providing necessary
intervention, or other family court proceedings like safeguards against employment discrimination. Despite
divorce including or others that altering parental rights. concerns to the contrary, it is possible to provide
States that set an “unreasonable danger” standard or workplace protections for patients while adhering to the
have similar provisions should include clear guidance federal drug-free workplace requirements that certain
that a patient acting in accordance with the state law is employers must meet, as many states have successfully
not creating an unreasonable danger. done so.

17
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

Explicit Privacy 7 Organ Transplants 5

pts
Standards pts
ARE PATIENTS EXPLICITLY PROTECTED
ARE PATIENTS’ MEDICAL RECORDS KEPT PRIVATE FROM BEING DISCRIMINATED AGAINST
FROM ACCESS BY LAW ENFORCEMENT AND RISK RECEIVING AN ORGAN TRANSPLANT?
FROM EXPOSURE TO THIRD PARTIES?
Several hospitals in the U.S. have removed medical
Medical cannabis patients deserve the same healthcare cannabis patients from their organ transplant lists after
privacy rights as all other patients in the U.S., but these the patients tested positive for cannabis metabolites.
rights are often abridged. Information about patients, This exclusionary practice is based on outdated policies
caregivers, or healthcare providers contained in a with no scientific basis, that assume cannabis use
registry should be kept confidential in perpetuity and automatically indicates substance abuse and therefore
unneeded data should be destroyed. Some states poses a danger that the transplanted organ will be
explicitly protect patient information and some have rejected. Transplant candidates should not be forced off
even criminalized privacy violations. The unsanctioned the treatment a doctor has recommended while they
release of registry information should carry substantial wait for life-extending measures.
administrative penalties.  

Reciprocity 3
Housing Protections 5
pts
pts
ARE PATIENTS WHO ARE LEGALLY
CAN LANDLORDS EVICT PATIENTS FROM RECOGNIZED IN THEIR HOME JURISDICTION
THEIR HOMES BASED ON THEIR MEDICAL STATUS? PROTECTED WHEN VISITING OUTSIDE THE STATE?

Patients who use medical cannabis should not have to Reciprocity refers to laws providing some measure
live in fear of losing their housing. Patients have routinely of legal protection for non-resident medical cannabis
been evicted from public and private housing in medical patients. These laws generally require that patients
cannabis states that have not created explicit protections carry documentation of their status in their home state’s
against such discrimination. While some states do program. Reciprocity is important for traveling patients,
protect patients from housing discrimination, the federal patients who are seeking specialty treatments, and
government has left decisions to the discretion of local those who need to stay in the care of friends or family
housing authorities, and has issued guidance to evict out of state, as many state medical cannabis programs
tenats who are found to be medical cannabis patients. require residency for participation or legal protections.

Does Not Create 5

pts
New Criminal Penalties
for Patients
DOES THE MEDICAL ACCESS LAW SUBJECT PATIENTS
TO NEW CRIMINAL MISDEMEANORS OR FINES?

Some states create new criminal penalties related to

their medical cannabis programs, including fraudulent
use of the medical cannabis program (i.e. diversion),
violation of privacy provisions, and falsely identifying
oneself as a participant in the medical cannabis
program. As states allow for the non-medical use of
cannabis states should not punish existing patients for
failure to comply with the provisions of the new law.

18
 2
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

Category
ACCESS
TO MEDICINE

ALLOWS DISTRIBUTION PROGRAMS – 40 PTS

NONCOMMERCIAL CULTIVATION – 20 PTS
EXPLICIT RIGHT TO EDIBLES/CONCENTRATES/OTHER FORMS – 10 PTS
DOES NOT IMPOSE LIMITS OR BANS ON THC – 10 PTS
DOES NOT IMPOSE LIMITS OR BANS ON CBD – 10 PTS
LOCAL BANS/ZONING – 10 PTS

20
 CATEGORY 2 ACCESS TO MEDICINE

Allows Distribution 40
pts Allows Delivery 5
pts
Programs total
DOES THE STATE LAW ALLOW FOR
ARE THERE LOCATIONS WHERE PATIENTS THE DELIVERY OF MEDICAL CANNABIS
CAN LEGALLY PURCHASE MEDICINE? TO LEGAL PATIENTS?

While most states regulate the production and Many legal medical cannabis patients cannot travel
distribution of medical cannabis, some states have to access points to receive medical cannabis due
failed to do so. ASA has found that a majority of patients to physical, economic, or time constraints. This is
rely on local dispensaries and that access to medical especially problematic for legal patients who are
cannabis in states without licensed dispensaries is in the hospital, are bedridden, or live far from an
severely limited. Many patients do not have the time, access point. Allowing for delivery of medicine is
skills, or resources to cultivate their own medicine, and a compassionate and common-sense solution for
cultivation is not a solution for a patient who needs these patients. Common-sense protocols can be
medicine sooner rather than later. It is imperative that used to ensure safety and discretion. There is no
states provide for regulated distribution if they wish to evidence to show that delivering medicine leads
have a functional, effective medical cannabis program. to crime or diversion of medical cannabis for non-
States that have taken measures for the implementation medical use. States should be clear that provisions
of dispensary programs were awarded partial points. allowing for “delivery” refer to home delivery
rather than the criminal law context of delivery of a
controlled substance.
SUBPOINTS:

No Sales Tax or 5
Allows Access 15
pts
Reasonable pts

to Dried Flowers Sales Tax

DOES THE STATE PROHIBIT ACCESS TO IS MEDICAL CANNABIS EXEMPT FROM
THE MOST COMMONLY USED FORM SALES TAX OR IS THE TAX RATE
OF CANNABIS? REASONABLE?

A majority of medical cannabis states have allowed Medical cannabis is real medicine that millions of
patients access to the dried flowers of whole-plant Americans use to treat serious medical conditions
cannabis either for direct inhalation or to process their such as cancer, HIV/AIDS, chronic pain, and
own medicated edibles or concentrates. However, more. Unfortunately, medical cannabis is generally
a few states have limited access to dried flowers in more expensive than other medication and not
favor of non-inhaled cannabis preparations. This is the currently covered by any public or private insurance
most obvious flaw in some states, but it is also part of policies. Ideally, this medicine would be exempt
many of the “CBD-only” laws that restrict patients to a from sales tax to ease the financial burden on legal
manufactured product only. ASA’s experience shows patients. Taxation of medicine should be avoided,
that restricting patients from whole-plant cannabis but when necessary, it should be reasonable. ASA
use can prevent patients from accessing the most recommends taxation that is comparable to similar
effective medicine for their particular condition and products – herbal medicine, over-the-counter
can make proper dosing more difficult to achieve. remedies, etc. Excessive sales tax is a financial
hardship and may compel some patients to buy
medical cannabis in the unregulated illicit market.

21
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

Allows for a 5 Ownership/ 2

Reasonable pts
Employ­ment pts

Number of Dispensaries Restrictions

DOES THE STATE BURDEN PATIENTS BY ARE PEOPLE WITH PRIOR MARIJUANA
PLACING SIGNIFICANT LIMITS ON THE OFFENSES OR OTHER MISDEMEANORS
NUMBER OF LOCATIONS WHERE THEY OR FELONIES PROHIBITED FROM BEING
MAY OBTAIN THEIR MEDICINE? MEDICAL CANNABIS PROVIDERS?

Safe, affordable access is directly related to the

Ownership and employment restrictions related
number of dispensaries in any given geographical
to cannabis businesses are commonly included
area. When there are insufficient dispensaries, the
in legislation. Most restrictions on ownership of
cost of medical cannabis goes up while the quality of
medical cannabis businesses stem from background
care goes down. Limitations or arbitrary caps on the
check procedures. These types of restrictions
number of dispensaries should be avoided. When
disproportionately impact people of color and
limits are imposed, they must account for patients
have a discriminatory effect. Marijuana-related
who live outside urban areas and those with mobility
convictions should not automatically exclude a
issues or who are confined to their homes.
person from ownership of, or employment by, a
cannabis business; instead, each individual should
be considered on a case-by-case basis.    
Does Not Require
Vertical Integration 2
pts
DOES THE STATE REQUIRE THAT 
Provisions for 2
DISPENSARIES MUST GROW THEIR OWN Labor Standards pts

MEDICINE?
ARE EMPLOYEES OF MEDICAL CANNABIS
Vertical integration refers to the requirement that BUSINESSES AFFORDED PROTECTIONS? 
distribution centers also cultivate and manufacture
Workplace safety and employment standards should
all or most of their products. While vertical
be part of the development and implementation of
integration allows producers to maximize cost
medical cannabis laws, including consideration of
effectiveness, it can also lead to supply problems
such issues as living wages, sick pay, and a standard
and increased costs for consumers. ASA’s
40-hour work week as well as health care coverage
experience has shown that vertical integration is a
and other benefit packages. These provisions should
decision best left to each individual provider.
also cover a neutrality, recognition, or existing
collective bargaining agreement with a certified
labor union.

22
 CATEGORY 2 ACCESS TO MEDICINE

Environmental 2 Noncommercial 20
pts
Impact Regulations pts Cultivation total

DOES THE STATE HAVE SPECIFIC

REQUIREMENTS FOR MEDICAL CANNABIS
PROVIDERS IN TERMS OF THEIR IMPACT ON SUBPOINTS:
THE ENVIRONMENT?

ASA places a premium on policies that encourage

sustainable practices, including but not limited to Personal 15
pts
implementation of best management practices that
promote environmentally sound production and
Cultivation
processing methods that reduce the potential for ARE PATIENTS ALLOWED TO GROW THEIR
high-carbon footprints by allowing open air, row OWN MEDICINE?
cover, and greenhouse methods of cultivation. States
Unfortunately, states have been moving to limit
should avoid restricting the ability for cultivators
personal cultivation by patients and their caregivers,
to utilize natural sunlight and creating overly
restricting and, in some cases, completely
burdensome plastic packaging requirements.
obstructing access to medical cannabis. In states
that have relied exclusively on regulated production
and distribution programs, patients have frequently
Choice of 2
pts been left without any options if those programs fail
Dispensary Without to meet the basic needs of proximity, affordability,
Restrictions safety, or privacy.

ARE PATIENTS REQUIRED TO DESIGNATE A

SINGLE DISPENSARY WHERE THEY MAY
5
Collective
pts
ACQUIRE MEDICINE?
Gardening
Some states require that patients designate a single
dispensary from which they may acquire their CAN SEVERAL PATIENTS FORM
medicine. While such an approach may be easier to A GROUP TO MUTUALLY GROW THEIR
regulate, it can result in patients bearing artificially MEDICINE, IN ORDER TO OFFSET COSTS
high costs, reduced choice in available cultivars and AND BEST UTILIZE SHARED EXPERTISE?
products, and extra expense and bureaucracy. Allowing experienced caregivers to cultivate for a
limited number of patients can ensure adequate
access to a reliable supply of safe, affordable
medicine. Collective gardens intended strictly for
private consumption among a small group of patients
should not be subject to regulatory authority, provided
the activity remains non-commercial. Collective
gardening is not associated with dispensaries or
other commercial businesses that engage in sales,
advertising, or trade. States without explicit collective
gardening rights that do allow individual caregivers
to grow for more than one patient were eligible for
partial points in this category.

23
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

Explicit Right to 10 Does Not Impose 10

Edibles/Concentrates/ pts
Limits or Bans on CBD pts

Other Forms DOES THE STATE REQUIRE THAT ALL FORMS OF

ARE PATIENTS EXPLICITLY ALLOWED TO OBTAIN MEDICAL CANNABIS MUST HAVE A MINIMUM
FORMS OF CANNABIS OTHER THAN DRIED CBD LEVEL?
FLOWERS? Some states have passed “CBD-enriched” or “CBD-
Some states explicitly provide for the manufacture only” legislation. The legislative intent behind this has
and use of edible products or concentrated forms of been to eliminate the intoxicating properties of cannabis,
medical cannabis. Some states do not explicitly allow namely THC, however these preparations only benefit
these forms of medicine, but may tolerate the sale and a small portion of a state’s patient population because
production of such items. Edibles are important, as this CBD has been shown to work more effectively in tandem
form of administration is ideal or preferred for certain with other plant components. Even among the minority
ailments and can offer ease of use for certain patients. of patients who can benefit from low-THC preparations,
States without this explicit right, but that allow for minimum CBD requirements restrict access to the
availability of these products in practice, were eligible ratios of CBD to THC that may work best for them.  For
for partial points. While tolerance is better than denying example, while some pediatric patients with seizure
access to alternative forms, clear guidance is optimal, disorders benefit greatly from 30:1 ratios, other children
and ASA encourages states to protect and regulate will respond better to 1:1 ratios (and anything in between
the manufacturing, use, and distribution of edible and or beyond). Imposing arbitrary cannabinoid level
concentrated medical cannabis products. minimum requirements that are not rooted in science
provide no benefit to the public health of a state.

Does Not Impose 10

Limits or Bans on THC pts Local Bans/Zoning 10
pts
DOES THE STATE LAW ALLOW LOCAL
DOES THE STATE HAVE A MAXIMUM LEVEL OF THC
JURISDICTIONS TO BAN MEDICAL CANNABIS
ALLOWED IN CULTIVARS OR INFUSED PRODUCTS?
BUSINESSES OR TO USE ZONING LAWS TO
THC is a proven therapeutic component of the cannabis EXCLUDE THEM?
plant that the FDA has recognized for medical use
Cities and counties have a legitimate role in regulating
and has been demonstrated to work in synergy with
land use within their borders. In some states, however,
other important therapeutic cannabinoids such as
local governments can ban medical cannabis activity
CBD.  States that have passed so-called “CBD-only”
that is allowed under state law. In other cases, cities
legislation, which in some cases are better described as
and counties have used local zoning regulations to
“low-THC” programs, have imposed arbitrary limits on
effectively exclude medical cannabis businesses. Local
the amount of THC permitted in the medical preparation
bans and onerous zoning regulations are harmful to
or enacted outright bans. THC has far more proven
patients because they cut off legitimate access to
medical applications than CBD alone, and CBD has
medicine for legal patients. Research conducted by
been shown to work more effectively in tandem with
ASA, and our experience with local regulations over
other plant components like THC.
the last 17 years, has shown that sensible regulations
preserve legal access for legitimate patients while
reducing crime and complaints in communities. An
ideal state law would limit or eliminate the right of
local jurisdictions to ban medical cannabis activity
while preserving the city or county’s authority to adopt
reasonable local zoning rules.

24
 Category
EASE
3
OF NAVIGATION

COMPREHENSIVE QUALIFYING CONDITIONS – 50 PTS

ADDING NEW CONDITIONS – 10 PTS
REASONABLE ACCESS FOR MINORS – 10 PTS
REASONABLE CAREGIVER BACKGROUND CHECK REQUIREMENTS – 4 PTS
NUMBER OF CAREGIVERS – 2 PTS
PATIENT/PRACTITIONER-FOCUSED TASK FORCE OR ADVISORY BOARD – 2 PTS
REASONABLE FEES (PATIENTS & CAREGIVERS) – 10 PTS
ALLOWS MULTIPLE-YEAR REGISTRATIONS – 2 PTS
REASONABLE PHYSICIAN REQUIREMENTS – 5 PTS
DOES NOT CLASSIFY CANNABIS AS A MEDICINE OF LAST RESORT – 5 PTS

26
 CATEGORY 3 EASE OF NAVIGATION

Comprehensive 50 Reasonable Access 10

Qualifying Conditions pts
for Minors pts

DOES THE STATE ALLOW DOCTORS OR ARE YOUTH UNREASONABLY RESTRICTED

POLITICIANS TO DETERMINE WHICH PATIENTS FROM LEGAL PROTECTIONS FOR MEDICAL
HAVE ACCESS TO MEDICAL CANNABIS? CANNABIS USE?

Every state that has enacted protections for medical Though some states limit the age of a patient, many of
cannabis patients has mentioned conditions that may these restrictions may be overcome through parents
be effectively treated by cannabis (see Chart 1). Some or guardians consenting to the treatment and agreeing
states recognize the Constitutional right of physicians to to be in control of the minor patient’s acquisition and
recommend cannabis to any patients who could benefit administration of medical cannabis. States that require
from it, while other states limit the ability of physicians to pediatric patients to have a recommendation from
certify patients for participation in their medical cannabis multiple doctors fail to realize that the added time and
program with restrictive qualifying conditions lists. Many expense is a great challenge to meet, especially for
states provide for a rigorous process to expand their families raising a special needs child. More research
“approved ailment” list through the state department of has begun around using medical cannabis to treat
health. ASA’s position is that there should be access to youth, and it is important to allow parents, along with
medical cannabis for every patient who needs it, and that their children’s physicians, to determine the best, most
the decision to use cannabis as a treatment should be left effective medication for their children.
to the patients and their physicians, not the state. A state
will receive 50 points automatically if it allows cannabis
to be used for any qualifying condition. Reasonable Caregiver 4
Background Check pts

Adding New 10 Requirements

Conditions pts
DOES THE STATE PROHIBIT THOSE WITH CANNABIS
OFFENSES FROM BEING CAREGIVERS?
DOES THE STATE ALLOW FOR NEW QUALIFYING
CONDITIONS TO BE ADDED THROUGH A caregiver is a person who assists the patient with
RULEMAKING WITHOUT THE NEED FOR procuring and administering his or her medication. Some
LEGISLATIVE APPROVAL? states prohibit patients from having caregivers with
criminal histories related to drugs. It is ASA’s position that
In most states that have a restrictive list of qualifying this type of restriction serves no purpose, as they do not
conditions, a procedure exists for the addition of new protect patients from criminals; rather, they punish the
conditions to the list of approved ailments that may patient for having a family member or trusted confidant
be effectively treated by cannabis. New studies are who may have had a criminal past. These provisions
being published regularly, and treatments that are disproportionately impact people of color.
not contemplated by the law should be available to
physicians, much like “off-label” use is available in the
realm of prescription medication. It is ASA’s position that
if these restrictions are imposed, then the procedure to
add new conditions should be uncomplicated and timely.
While many states have created such a process, the
hurdles to add new conditions are impossible to meet.
The scoring for this section includes 5 points for having
a process in place to add new conditions, and 5 points
if that system is working as intended. States that allow
healthcare practitioners to recommend cannabis for any
condition automatically receive full points in this category.

27
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

Number of Caregivers 2 Patient/Practitioner- 2

DOES THE STATE RECOGNIZE THAT
pts
Focused Task Force pts

A SINGLE CAREGIVER PER PATIENT MAY or Advisory Board

NOT BE SUFFICIENT TO PRACTICALLY ASSIST
DOES THE LAW CREATE AN OVERSIGHT BODY,
A PATIENT WHO REQUIRES A CAREGIVER IN ORDER
AND DOES THAT BODY HAVE SUFFICIENT
TO OBTAIN OR ADMINISTER THEIR MEDICINE?
REPRESENTATION BY PATIENTS, CAREGIVERS, AND
The number of caregivers allowed for a qualified RELEVANT MEDICAL PROFESSIONALS?
patient varies from state to state, as does the number
Regulatory agencies for medical cannabis programs
of patients a caregiver may serve. Some states are very
vary by state. ASA has found that keeping the medical
restrictive and allow only one caregiver per patient,
cannabis program within the Department of Public
thus putting patients who have mobility problems in
Health, or its equivalent, provides the most effective
a situation where they must rely on a single person
assistance to patients and their providers. States
to assist with their access to and use of cannabis.
that have developed a regulated program should
Although ASA is mindful about diversion to the illicit
create task forces or advisory boards to help guide
market, we support patients being able to designate
the administration of the medical cannabis program
caregivers as determined by their unique situations
and provide assistance in developing regulations.
so that they always have access to cannabis when
These task forces and advisory boards can be a
needed. For example, an elderly patient may need to
boon to the program by providing a voice for those
have multiple family members serve as caregivers
most knowledgeable about its effectiveness: patients
because no individual in a family has the availability to
and healthcare professionals. The makeup of such
consistently assist the patient.
task forces or boards should only include a minimal
presence from law enforcement, if any, as the priorities
of police and prosecutors may be at odds with the
needs of patients. ASA supports the development
of these programs and encourages the inclusion of
patients and healthcare providers in them.

Reasonable Fees 10
pts
for Patients &
Caregivers
ARE PATIENTS ASSESSED A FEE BY THE STATE
SIMPLY TO HAVE LEGAL PROTECTION AND ACCESS
TO MEDICINE?

Fees for patient registration should be set to meet

reasonable administrative costs of the registry program.
Patient fees should not cover costs of medical marijuana
business oversight, nor should they be looked at as a
source of revenue for any other purposes. Reasonable
fees are particularly important due to the lack of health
insurance coverage for medical cannabis expenses.
Because of the financial challenges of many chronically
ill patients, ASA recommends a sliding scale fee tied to
state or federal benefits for which a patient qualifies.

28
 CATEGORY 3 EASE OF NAVIGATION

Allows Multiple-Year 2
prohibited by legislation. Health care professionals who
are allowed to recommend medical cannabis should not
Registrations pts
be allowed to have direct or indirect financial interest
DO PATIENTS FILL OUT RENEWAL FORMS in a dispensary, manufacturer, laboratory or cultivation
AND PAY A RENEWAL FEE ON AN ANNUAL BASIS? operations, or financially benefit from any business
that might benefit from a patient’s or caregiver’s use,
It makes little sense to make patients with chronic, long- acquisition, or purchase of medical cannabis.
lasting conditions go through an annual renewal process
when their condition is almost certainly going to be with
them for years to come. ASA recommends that multi-
year registrations be available to these patients based on
the condition listed on their application.
Does Not Classify 5
pts
Cannabis as a
Medicine of
Reasonable Physician 5 Last Resort
Requirements pts
DOES THE STATE LAW CLASSIFY MEDICAL
DOES THE LAW CONTAIN PROVISIONS THAT CANNABIS AS A MEDICINE OF LAST RESORT?
WOULD PREVENT PHYSICIANS FROM UTILIZING
Some state laws only allow medical cannabis as
MEDICAL CANNABIS AS PART OF THEIR PRACTICE?
a last resort, after all other treatments have failed.
Some states require patients to have an ongoing This approach is harmful and interferes with the
relationship with their doctor, often referred to as a doctor-patient relationship. Doctors should be able to
“bona fide” relationship. Generally, states define the recommend or approve medical cannabis use at any
relationship to include a complete examination and point in a patient’s treatment. Requiring patients to try
medical history, along with an ongoing expectation less desirable treatments first is an unnecessary burden
of care provided by the physician. Some require that and may cause needless suffering. Emerging science
physicians register with the state, or impose education and the experience of healthcare practitioners and
requirements on physicians, which may be beneficial patients all over the country indicate that cannabis is a
to patients but could be onerous to physicians and are safe, legitimate medicine with real benefits for patients.
not a requirement for writing prescriptions for more State law should respect the welfare of the patients, the
dangerous pharmaceutical medications. ASA’s position doctor’s discretion, and the science of cannabis.
is that physicians should only treat ailments and
recommend treatments that they are familiar with and
feel comfortable discussing. Within the medical field,
there are many specialties; prohibiting patients from
choosing a doctor who specializes in medical cannabis
is antithetical to the practice of medicine.

Any physician in good standing with the state should

be allowed to recommend the use of medical cannabis
to his or her patients. Physicians who use medical
cannabis themselves should not be restricted from
recommending it. Because patients with chronic
illnesses often seek health care services from a variety
of sources, ASA prefers that nurse practitioners,
physician assistants, dentists, naturopathic doctors,
chiropractors and other healthcare professionals be
allowed to recommend medical cannabis, if it is not

29
 Category
FUNCTIONALITY
4

PATIENTS ABLE TO ACCESS MEDICINE AT DISPENSARIES OR VIA CULTIVATION – 50 PTS

NO SIGNIFICANT ADMINISTRATIVE OR SUPPLY PROBLEMS – 15 PTS
PATIENTS CAN RECEIVE LEGAL PROTECTIONS WITHIN A REASONABLE TIME AFTER
RECEIVING RECOMMENDATION – 10 PTS
REASONABLE POSSESSION LIMIT – 5 PTS
REASONABLE PURCHASE LIMITS – 5 PTS
ALLOWS PATIENTS TO MEDICATE WHERE THEY CHOOSE – 5 PTS
COVERED BY INSURANCE/STATE HEALTH AIDE – 3 PTS
FINANCIAL HARDSHIP (FEE WAIVERS/DISCOUNT MEDICINE) – 7 PTS

30
 CATEGORY 4 FUNCTIONALITY

Patients Able to 50 Patients Can Receive 10

Access Medicine at pts
Legal Protections pts

Dispensaries Within a Reasonable

or Via Cultivation Time After Receiving
ARE THERE A SUFFICIENT NUMBER OF EASILY Recommendation
ACCESSIBLE RETAIL DISTRIBUTION POINTS DOES MEDICAL NEED DETERMINED BY A MEDICAL
FOR PATIENTS TO OBTAIN THEIR MEDICINE BY PROFESSIONAL ESTABLISH IMMEDIATE LEGAL
PURCHASING IT, AND/OR ARE PATIENTS OR PROTECTIONS? 
THEIR DESIGNATED CAREGIVERS ALLOWED TO
GROW THE MEDICINE NEEDED TO TREAT THE Ideally, protection from arrest and prosecution should
PATIENT ’S CONDITION?  begin the moment a patient leaves the doctor’s office
with a recommendation. In cases where patients must
Ideally a patient or caregiver would be able to gain register with the state to obtain arrest protection, an
access to their medicine through multiple means, affirmative defense should be granted to defendants
including dispensaries, cooperative gardens, and with a valid authorization so as not to leave patients
personal cultivation. Personal cultivation is an important vulnerable while their documentation is processed.
option if a state fails to expeditiously license sufficient
dispensaries, if there is a change in ownership, or if
there are supply issues in the commercial program.
States implementing access programs were eligible for
Reasonable 5
pts
partial points. Possession Limit
DO LIMITS ACCOMMODATE ROUTE OF
ADMINISTRATION AND HARVEST AMOUNTS?
No Significant 15
Administrative or pts While it might make sense to have possession
thresholds that give law enforcement guidance on
Supply Problems personal medical use, it does not make sense for the
state to determine the quantity any patient might need
DOES THE PROGRAM WORK AS INTENDED AND
for his or her particular illness. The type and severity of
PROVIDE A SUFFICIENT SUPPLY OF CANNABIS TO
symptoms, the cultivar of cannabis, factors specific to
MEET PATIENT NEEDS?
each patient (e.g., age, body composition, metabolism),
While ASA supports the creation of a statewide and the route of administration each greatly impact the
regulatory framework for medical cannabis, amount that a specific patient may need at any point in
administrative oversight has become a hindrance time. The decision as to how much cannabis is sufficient
to safe access in some states. Some states have to treat a patient’s illness should ultimately correspond
programs that inadvertently caused shortages (and to the amount that allows the patient an uninterrupted
therefore disruptions) in the supply and variety of supply rather than arbitrary caps that can needlessly
available medical cannabis. Restrictions on commercial burden seriously ill patients. In order to create safe
cultivation plant numbers, the number of cultivation access to a consistent supply of medical cannabis
or access points, or over-regulation of certain areas and related products that work best for them, patients
of production and distribution can have an adverse should be able to possess and maintain a 90-day supply
effect on the patient population. States should consider of medicine.
third-party certification as a way to ease administrative
burdens. ASA discourages the development of policies
that unnecessarily restrict or otherwise hamper the
supply of medical cannabis.

31
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

Reasonable 5 Covered By Insurance 3

Purchase Limits pts
or State Health pts

DO LIMITS ALLOW FOR AN ADEQUATE Programs

SUPPLY OF MEDICINE? IS MEDICAL CANNABIS COVERED BY INSURANCE
When a state is considering imposing purchase limits OR STATE HEALTH PROGRAMS?
on patients that will restrict the amount they can Until federal laws regarding medical cannabis are
obtain from a dispensary, it should take into account reformed, patients will not be able to use federal
the distance a patient must travel, the severity of an medical benefits and health insurance providers will
individual’s medical condition, and any patient mobility be reluctant to include coverage for medical cannabis.
issues. Certain cultivars or products may have limited However, there is no reason why state law should
availability, and patients who need those products prevent private insurance carriers from covering medical
should not be denied access in favor of concerns cannabis. An ideal law would require that insurance
with regulatory expediency. The best policy does not carriers and state health programs treat medical
restrict patients’ ability to purchase medicine to certain cannabis like any other legal medication.
windows of time, as such limits may disrupt patients’
ability to maintain a consistent supply of medical
cannabis.
Financial Hardship 7
(Fee Waivers/Discount pts

Allows Patients to Medicine)

5
Medicate Where pts DOES THE STATE OFFER DISCOUNTED
They Choose REGISTRATION FEES OR REQUIRE DISPENSARIES
TO OFFER DISCOUNTED MEDICINE FOR LOW-
ARE PATIENTS ALLOWED TO USE THEIR MEDICINE INCOME PATIENTS?
FREELY WITH RESPECT TO LOCATION, JUST AS
PATIENTS OF RX MEDICATION? With medical cannabis not currently covered by health
insurance, many patients are unable to afford treatment
Some states restrict the locations where patients can without experiencing undue hardship. To ease the
use medical cannabis. While it may make sense to financial burden, ASA encourages the adoption of
limit the right to use inhaled cannabis to places where sliding-scale fees and donation programs that cover all
other smoking is allowed, it is abhorrent to otherwise or part of the cost of doctor’s visits, registration fees,
limit locations where a sick person can use his or her and medicine for patients in need.
medicine. Cannabis should be treated like any other
medication in this regard.

32
 Category
CONSUMER SAFETY
5
AND PROVIDER
REQUIREMENTS

STATES WERE EVALUATED FOR CONSUMER SAFETY AND PROVIDER

REQUIREMENTS IN FOUR AREAS:
DISPENSARIES – 25 PTS
(1) DISPENSARIES
GROW / CULTIVATION – 25 PTS
(2) CULTIVATION
MANUFACTURING – 25 PTS
(3) MANUFACTURING
LABORATORY OPERATIONS – 25 PTS
(4) LABORATORY TESTING

34
 CATEGORY 5 CONSUMER SAFETY AND PROVIDER REQUIREMENTS

DISPENSARIES Facility Sanitary

Conditions
Staff Training 5
pts
IS THE FACILITY CLEAN AND SAFE? 

State laws should require that medical cannabis

ARE DISPENSARY WORKERS REQUIRED
dispensing facility operations be conducted in
TO BE TRAINED IN BOTH MEDICAL CANNABIS
sanitary conditions. ASA recommends using existing
AND THE STATE LAW?
sanitation standards for food packaging, storage, and
Many state governments have training requirements distribution, as well as herbal medicine handling and
for the staff of dispensaries. It is ASA’s position that storage standards, as models for sensible regulations
dispensary staff, as health care professionals, must to protect patients from contaminants. The American
be adequately trained in order to best understand Herbal Products Association’s Recommendations for
the medication and products they sell and be able Regulators is a good place to start this process.
to provide patients with up-to-date information. New
medical cannabis patients are often unfamiliar with the
cultivars and routes of administration available to them. Reasonable Security
A well-educated staff can, and should, provide answers
to common questions. ASA maintains that proper
Protocols
training of employees is essential to deliver safe, quality ARE THE SECURITY PROTOCOLS
cannabis products to patients and caregivers. Training FOR MEDICAL CANNABIS REASONABLE
should include information about state and federal AND EFFECTIVE?
regulations, law enforcement interaction, and regulatory
inspection preparedness. State laws or regulations should require legal medical
cannabis businesses to develop and implement a
reasonable and effective security plan. The plan should

Standard Operating address physical security, loss prevention, training,

etc. However, state laws should not place arbitrary
Procedures 5
pts or onerous restrictions on legal medical cannabis
and Protocols businesses where they are unwarranted.

ARE DISPENSARY FACILITIES REQUIRED TO

DEVELOP AND MAINTAIN STANDARD OPERATING
PROCEDURES AND PROTOCOLS?
Storage Protocols
ARE THE STORAGE PROTOCOLS ADEQUATE
Early medical cannabis laws only provided protection
TO PROTECT THE QUALITY OF THE
from criminal prosecution. As the field of medical
MEDICINE AND PREVENT LOSS?
cannabis has developed, new laws are incorporating
requirements to ensure patient and product safety. State laws should require medical cannabis businesses
State laws should require medical cannabis businesses at every stage of the production and distribution chain
to develop and follow standard operating procedures to store medicine in a manner that is sanitary, preserves
and protocols to ensure product safety and industry the integrity of the cannabis or derived product, and is
legitimacy.  Such standard operating procedures and secure. This is important to protect patients from mold,
protocols should include, at a minimum, the following mildew, and other contaminants that may be harmful.
considerations: Furthermore, state laws should require adequate loss
control procedures to prevent theft or robbery.

35
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

Inventory Control 
Product Contents,
DOES THE STATE LAW REQUIRE INVENTORY Including Source
CONTROL MECHANISMS? Material Identification
State law should require reasonable inventory control Cannabis regulations often dictate the type of packaging
protocols to ensure the integrity of the supply chain and for raw plant material and derived products. In some
prevent diversion of medical cannabis for non-medical cases, the packaging requirements may prevent the
use. The inventory tracking system should include a consumer from seeing the contents or render the cannabis
continuous chain of custody for cannabis and cannabis as part of a compound making the form of plant material
products, periodic inventory counts, and a procedure for (e.g., leaves, stems, seeds, flowers) unrecognizable. When
dealing with lost or stolen medicine. this occurs, dispensaries should be required to label the
product’s contents, including identifying the source plant
material used or contained within. Nutritional information
Recall Protocol and 5
should also be included for edible products.

Adverse Event pts

Reporting Allergens
IS THE MEDICAL CANNABIS FACILITY REQUIRED When labeling derived products that have been mixed
TO DEVELOP AND IMPLEMENT A PRODUCT with foodstuffs or known common allergens, or that
RECALL STRATEGY?   have been packaged or produced in a facility that
uses known common allergens, consumers should be
As with other products produced for human
notified. All products labeled by dispensing facilities
consumption, spoilage, human error, and the
that might contain known common allergens should be
unexpected all pose the risk of contamination. As a
required to provide a list on the product’s label.
result, ASA encourages the development of product
recall and adverse-event reporting programs. Product
recall strategies should include transportation
guidelines that allow the patient to return recalled
Potency/Compound
products to the dispensary from which the product Identification
came and a mechanism for the dispensary to return the Medical cannabis patients often rely on product labels
recalled products to the original manufacturer and/or to gauge the strength of the various compounds present
cultivator. Additionally, the rules and regulations should in the medicine they consume. Labeling requirements
require that all recall programs include the recording of for cannabis and cannabis-derived products should
consumer-reported adverse events. include a listing of the product’s active compounds and
the potency of each.

Product Labeling 5
pts
Some state government regulatory models allow or Required Testing 5
pts
require dispensaries to obtain medical cannabis that ARE MEDICAL CANNABIS AND MEDICAL
is repackaged at the dispensary.  If the dispensary can CANNABIS PRODUCTS REQUIRED TO BE TESTED
engage in such activities, then it should be required to BEFORE BEING DISTRIBUTED TO A PATIENT?
meet these minimum standards for labeling:
State government regulations are increasingly requiring
laboratory testing to verify product safety and help
patients understand the potency of products’
active compounds. Laboratory testing regulations should
ensure that the analytical records of cannabis and derived
products are made available at all levels of the supply

36
 CATEGORY 5 CONSUMER SAFETY AND PROVIDER REQUIREMENTS

chain, including to the dispensary (should they be

engaged in the processing, packaging, and labeling of
Standard Operating 5
medical cannabis or derived products) and consumers.  Procedures and pts

Such laboratory testing results should include the analytical Protocols

results necessary to provide the information required to
ARE CULTIVATION FACILITIES REQUIRED TO
produce, or verify the accuracy of, a product’s label.
DEVELOP AND MAINTAIN STANDARD OPERATING
PROCEDURES AND PROTOCOLS? 
Active Compound As product safety guidelines have been added to
Identification & Potency many state government regulatory programs, the
requirement for businesses to create and implement
Cannabis and cannabis-derived products vary greatly standard operating procedures and protocols has
based on the cultivar of cannabis as well as the technique become common. Standard operating procedures and
or method used to create the cannabis products. In protocols serve to ensure that a facility’s operations are
order to ensure that cannabis and derived products are conducted in a manner that is safe for all staff working
accurately labeled, laboratory testing facilities should be in the facility as well as the surrounding environment,
required to provide analytical services that can accurately and that proper records are kept to ensure product
determine the presence of active compounds and the safety. Written standard operating procedures and
potency of all compounds determined to be in the raw protocols also serve as internal training and resource
cannabis and cannabis-derived products. guides for the staff and should include, at a minimum,
the following key components designed to address

Contaminants workplace, environmental, and product safety issues:

Laboratory testing facilities should be required to utilize

validated methodologies and provide analysis that Facility and Equipment
accurately tests raw cannabis and cannabis-derived Sanitary Conditions
finished products for the presence of contaminants, to
IS THE FACILITY AND THE EQUIPMENT
include microbiological, residual solvent, pesticide, heavy
USED CLEAN AND SAFE? 
metals, mycotoxin, and foreign matter contaminants
Contamination can occur at any stage during the
cultivation and processing of cannabis. State laws
CULTIVATION should require that medical cannabis cultivation and
processing, manufacturing, distribution, and laboratory
testing be conducted in sanitary conditions. ASA
Staff Training 5
pts
recommends using existing sanitation standards
for farming, food packaging, and herbal medicine
ARE CULTIVATION STAFF REQUIRED TO processing as models for sensible regulations to protect
BE TRAINED IN BOTH MEDICAL CANNABIS patients from contaminants. The American Herbal
KNOWLEDGE AND THE STATE LAW?  Products Association Recommendations for Regulators
Many state governments have training requirements is a good place to start this process.
for the staff of cultivation facilities. It is ASA’s position
that cultivation facility staff should be required to
successfully complete a training curriculum that

includes an overview of medical cannabis knowledge as

well as applicable state and local laws and regulations.
Such training is essential to maintaining workplace
safety, regulatory compliance, and product safety. 

37
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

Workforce Safety cannabis forward and backward through the supply

Protocols chain. Successful lot and batch tracking systems allow

the consumer, dispensary, manufacturer, and processor
Cannabis, like other crops produced for human to obtain information regarding the production facility,
consumption, requires the use of various types including details pertaining to the treatment and
of equipment, mediums, amendments, and plant laboratory testing of the plant material or product.
treatments during the course of its production. The
proper use and storage of these items, coupled with
the use of appropriate personal protective equipment Reasonable Security
by employees who are operating equipment and Protocols
working with cultivation mediums, amendments, and
plant treatments, helps to ensure that the workplace is State laws or regulations should require legal medical
safe and accident-free. Standard operating procedures cannabis businesses to develop and implement a
and protocols addressing workplace safety are a key reasonable and effective security plan. The plan should
component to ensuring that the equipment is used address physical security, loss prevention, theft or
appropriately and that workers understand the proper robbery prevention, and training. However, state laws
use of mediums, amendments, and plant treatments. should not place arbitrary or onerous restrictions
on legal medical cannabis business where they are
unwarranted.
Storage Protocols
(Short-Term and Long- Disposal/Waste
Term Storage)
To protect the safety and purity of cannabis and
State laws should require that medical cannabis cannabis products, states should require that cannabis
businesses store medicine in a manner that is sanitary cultivation and processing facilities create and
and appropriate for the products on hand at every stage implement waste disposal procedures and protocols
of the production and distribution chain. Cannabis is that are designed to ensure that no discarded cannabis
a perishable product, and different types of storage can contaminate or be confused with cannabis destined
containers may be needed to prevent contamination for distribution to patients or manufacturing facilities.
and preserve freshness at different stages of the Such protocols include segregating material that is to
production process. In order to reduce the risk of be discarded from other material and rendering material
spoilage and contamination, state law should allow to be discarded as clearly unusable.
for both short-term and long-term storage options as
opposed to requiring that all cultivated cannabis be
immediately sealed once processing is completed. Water Management
To address environmental concerns surrounding the
Batch and Lot Tracking cultivation of cannabis, several state governments have
developed regulatory programs to address water use
As product safety has become more of a consideration and the agricultural discharges sometimes associated
in state government regulations and recall and adverse with cannabis cultivation. Cultivation facilities should be
event reporting programs are increasingly required of required to develop and implement a water management
cannabis facilities, lot and batch tracking has become plan that acts to ensure that water is used appropriately
a necessary component to ensuring product safety and not wasted, that the water used is safe for the
throughout the supply chain. The need for lot and cultivation of the crop, and that all wastewater leaving the
batch tracking touches all aspects of the supply chain cultivation site is safe for the surrounding environment.
and must be implemented during propagation and
cultivation of cannabis in order to effectively track the

38
 CATEGORY 5 CONSUMER SAFETY AND PROVIDER REQUIREMENTS

Pesticide Guidance 5 Recall Protocol and 5

and Protocols pts
Adverse Event pts

(Pesticide Guidance and Reporting

Disclosure/Labeling) IS THE MEDICAL CANNABIS FACILITY REQUIRED
WHAT TYPE OF PESTICIDES ARE USED DURING TO DEVELOP AND IMPLEMENT A PRODUCT
THE CULTIVATION PROCESS AND HOW DOES THE RECALL STRATEGY?
CONSUMER KNOW? Product recall strategies are an integral step to
The use of pesticides during the cultivation of cannabis ensuring the safety of medical cannabis consumers.
can lead to irreversible contamination. The U.S. State regulations should require cultivation facilities
Environmental Protection Agency has not established to implement a product recall program that includes
tolerance thresholds for pesticide products used during transportation guidelines that allow the consumer, a
the cultivation of cannabis, resulting in a lack of clear manufacturing facility, and/or a dispensary to return
guidance on the federal level regarding the appropriate adulterated and recalled products to the facility from
usage of pesticide products. In order to protect which the products originated. Additionally, the rules
consumers from encountering pesticide-adulterated and regulations should require that all recall programs
products, ASA encourages state governments to limit include the recording of consumer-reported adverse
allowable pesticides to “minimum risk pesticides” as events. Labs or third-party vendors should also be
identified in 40 CFR 152.25(f) or produce a specific list required to collect the representative samples to ensure
of state-government-approved pesticide products.   no adulteration has taken place.
Cultivation facilities should be required to track and
record pesticide use and fully disclose which pesticide
products were used during the cultivation of each lot MANUFACTURING
and batch of cannabis produced. State governments
should require that cultivation facilities disclose
pesticide use in their labeling requirements. Staff Training
ARE MANUFACTURING FACILITY STAFF
REQUIRED TO BE TRAINED IN MEDICAL CANNABIS
Required Testing 5
pts
KNOWLEDGE AND THE STATE LAW? 

ARE CULTIVATORS REQUIRED TO TEST ALL Many state governments have training requirements for
MEDICAL CANNABIS PRODUCED AND BE the staff of manufacturing facilities. It is ASA’s position
PREPARED TO DISCLOSE THOSE RESULTS? that manufacturing facility staff should be required
  to successfully complete a training curriculum that
In order to ensure patient safety and accurate labeling of includes an overview of medical cannabis knowledge as
medical cannabis and medical cannabis products, state well as applicable state and local laws and regulations
governments should require that representative samples and good manufacturing practices. Such training is
of each batch and lot of medical cannabis produced essential to maintaining workplace safety, regulatory
by a cultivation facility be analyzed by an independent, compliance, and product safety.  
third-party laboratory testing facility to determine their
purity, chemical profile, potency, and quality, screen for
potential contaminants, and verify that the product safety
practices at the cultivation facility are adequate and
effective. Laboratory facilities should be required, or at
least allowed, to retain portions of representative samples
for analysis at a later date should there be an adverse
event or other product safety concern.

39
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

Standard Operating 5 Workforce Safety 5

Procedures pts Protocols pts

and Protocols Cannabis products, like other herbal products produced

for human consumption, come into contact with various
ARE MANUFACTURING FACILITIES REQUIRED TO
types of equipment and materials designed to assist
DEVELOP AND MAINTAIN STANDARD OPERATING
with the extraction, mixing, development, and packaging
PROCEDURES AND PROTOCOLS?
of cannabis and cannabis-derived products. Observing
As product safety guidelines have been added to many appropriate safety procedures regarding the use
state government regulatory programs, the development and storage of equipment and materials used during
and implementation of standard operating procedures the manufacturing process helps to ensure that the
and protocols has become a common requirement. workplace is safe and accident-free. Standard operating
Standard operating procedures and protocols serve to procedures and protocols addressing workplace safety
ensure that a facility’s operations are conducted in a are key to ensuring that workers understand the proper
manner that is safe for all staff working in the facility as use, handling, and storage of equipment and materials
well as the surrounding environment and that proper used during the manufacturing process.
records are kept to ensure product safety. Written
standard operating procedures and protocols also serve
as internal training and resource guides for the staff Storage Protocols
and should include, at a minimum, the following key As cannabis is a perishable product, state laws should
components designed to protect workers as well as require medical cannabis businesses to store medicine
product safety, purity, and consistency: in a manner that is sanitary and appropriate for the
product on hand at every stage of the production and
distribution chain. Upon its arrival at a manufacturing
Facility and facility, cannabis should be stored in a separate
Equipment 5
pts incoming holding area until the raw plant material or

Sanitary Conditions derived product can be inspected, verified for quality,

logged into inventory, and moved into a storage area
IS THE FACILITY AND THE EQUIPMENT
designated for materials ready to be used in the
USED CLEAN AND SAFE?
manufacturing process. In order to reduce the risk of
Contamination can occur at any time during the spoilage and contamination, storage procedures and
manufacturing of cannabis-derived products. State protocols should include separate and distinct storage
laws should require that medical cannabis cultivation, areas for products that are considered to be in-holding,
processing, manufacturing, distribution, and laboratory in-process, awaiting labels, and ready for distribution.
testing be conducted in sanitary conditions. ASA
recommends using existing sanitation standards
for farming, food packaging, and herbal medicine Reasonable Security
processing as models for sensible regulations to protect Protocols
patients from contaminants. The American Herbal
State laws or regulations should require legal medical
Products Association Recommendations for Regulators
cannabis businesses to develop and implement a
is a good place to start this process.
reasonable and effective security plan. The plan should
address physical security, loss prevention, theft or
robbery prevention, and training. However, state laws
should not place arbitrary or onerous restrictions
on legal medical cannabis business where they are
unwarranted.

40
 CATEGORY 5 CONSUMER SAFETY AND PROVIDER REQUIREMENTS

Batch and Lot Tracking Product Contents,

As product safety has become more of a consideration
Including Source
in state government regulations, and recall and adverse Material Identification
event reporting programs are increasingly required of State government regulations should require
cannabis facilities, lot and batch tracking has become manufacturing facilities to label each product in a
a necessary component to ensuring product safety manner that clearly discloses a list of all ingredients,
throughout the supply chain. The need for lot and including the portion of the cannabis plant used or the
batch tracking touches all aspects of the supply chain source of cannabis if not raw plant material.  Nutritional
and must be implemented during propagation and panels should be included for edible products.
cultivation of cannabis in order to effectively track the
cannabis forward and backward through the supply
chain. Successful lot and batch tracking systems allow Allergens
the consumer, dispensary, manufacturer, and processor
to obtain information regarding the production facility, Allergen warnings should be required on the labels
including details pertaining to the treatment and of edible cannabis products that contain, or were
laboratory testing of the plant material or product. produced, manufactured, or packaged in a facility that
uses known common allergens.

Disposal/Waste
Potency and Compound
To protect the safety and purity of cannabis and
cannabis products, states should require that cannabis
Identification
manufacturing facilities create and implement waste Medical cannabis patients often rely on product labels
disposal procedures and protocols that are designed to determine which medicinal compounds are present
to ensure that no discarded cannabis or cannabis- and at what strength. Labeling requirements for
derived products can contaminate or be confused with cannabis and cannabis-derived products should include
cannabis-derived products destined for distribution a listing of the products’ active compounds and the
to patients. Such protocols include segregating potency of each, and not be limited to only CBD and
material that is to be discarded from other material and THC, if other cannabinoids are present.
rendering material to be discarded as clearly unusable.

Required Testing 5
Product Labeling 5
pts
pts ARE MANUFACTURING FACILITIES REQUIRED
WHAT INFORMATION SHOULD BE TO TEST ALL MEDICAL CANNABIS PRODUCTS
REQUIRED ON MEDICAL CANNABIS IN ORDER TO ENSURE THE ACCURACY OF
PRODUCT LABELS?  LABELING AND VERIFY THE QUALITY, PURITY, AND
Consumers often have a range of medical cannabis CONSISTENCY OF THE PRODUCTS PRODUCED?  
products available to them, some of which contain a In order to ensure patient safety and accurate labeling
broad variety of ingredients. Consumers should be able of medical cannabis and medical cannabis products,
to expect clear and accurate labeling that includes the state governments should require that representative
following product information: samples of each batch and lot of all cannabis-derived
products be analyzed by an independent, third-party
laboratory testing facility to determine their purity,
chemical profile, potency, and shelf-life, screen for
potential contaminants, and verify that the product is of
the quality and consistency it purports to be. Laboratory

41
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

facilities should be required, or at least allowed, to retain

portions of representative samples for analysis at a later
Method Validation in 5
date should there be an adverse event or other product Accordance With AHP pts

safety concern. Labs or third-party samplers should be Guidelines

required to collect the representative samples.
HAS THE MEDICAL CANNABIS OR MEDICAL
CANNABIS PRODUCT BEEN TESTED USING A
STANDARDIZED METHOD?
Recall Protocol and 5
Adverse Event pts In December 2013, the American Herbal Pharmacopoeia
(AHP) released a cannabis monograph that outlines the
Reporting quality control criteria for identifying the quality, purity,
and potency of the cannabis plant. It also provides
Product recall strategies are an integral step to ensuring analytical standards to guide cannabis laboratory
the safety of medical cannabis consumers. State operations, with a baseline for contaminant testing
governmental regulations should require all and standardized methodologies for cannabis analysis.
manufacturing facilities to implement a product recall Multiple state governments have adopted the standards
program that includes transportation guidelines that for laboratory analysis provided by AHP in the cannabis
allow the consumer and/or dispensary to return monograph.
adulterated and recalled products to the facility from
which they originated. Additionally, the rules and
regulations should require that all recall programs include
the recording of consumer-reported adverse events.
Result Reporting 5
pts
IS THE LABORATORY REQUIRED TO DISCLOSE
LABORATORY OPERATIONS THE TYPE OF METHOD USED TO DETERMINE THE
REPORTED TEST RESULTS?  

Laboratory testing facilities should be required to

Staff Training 5
pts disclose the type of method and instrumentation (where
applicable) used to generate the provided test result.
ARE MANUFACTURING FACILITY STAFF
For example, was the presence of bacteria ruled out
REQUIRED TO BE TRAINED IN MEDICAL CANNABIS
due to visual inspection with a microscope or was the
KNOWLEDGE AND THE STATE LAW?
product cultured?  
Many state governments have training requirements
for the staff of laboratory testing facilities. It is ASA’s
position that laboratory staff should be required to
successfully complete a training curriculum that Independent 5
includes an overview of medical cannabis knowledge as or Third Party pts
well as applicable state and local laws and regulations
and good laboratory practices. Such training is essential CAN CULTIVATORS AND MANUFACTURERS TEST
to maintaining workplace safety, regulatory compliance, THEIR OWN PRODUCTS IN-HOUSE TO VERIFY
and product safety.   LABELING AND PRODUCT SAFETY? 

In order for a laboratory to maintain integrity while

serving as a body that can verify the quality, purity,
and composition of a product, it must maintain its
independence. As such, the verification of medical
cannabis and medical cannabis products should be
performed by independent third-party entities.

42
 CATEGORY 5 CONSUMER SAFETY AND PROVIDER REQUIREMENTS

Standard Operating 5 Disposal/Waste Protocols

Procedures and pts

Protocols The laboratory testing facility should be required to

have clear disposal protocols in place that regularly track
ARE LABORATORY TESTING FACILITIES REQUIRED the amount of waste produced by the operation, as well
TO DEVELOP AND MAINTAIN STANDARD as include provisions for the safe disposal of chemicals,
OPERATING PROCEDURES AND PROTOCOLS? standards, and reagents generated during testing
activities. Most states fail to appreciate that labs have
ASA recognizes that the accuracy and consistency of different waste streams that need to be accounted for. The
laboratory analysis is dependent on a facility’s ability same waste disposal practices that apply to cultivation
to implement standard operating procedures and and manufacturing operations are not always sufficient,
protocols that address and standardize testing activities. i.e. the unrecognizable and unusable clauses that are
State governments should require that laboratory always present. Labs will generate controlled substance
testing facilities develop and implement standard hazardous waste that must be disposed of through
operating procedures and protocols to ensure regulatory licensed environmental (for chemical test sample extracts)
compliance and worker safety while protecting the quality, or biohazard (for micro test sample extracts) providers.
purity, and consistency of the products with which the
laboratory works. Standard operating procedures and
protocols should include the following topics: Storage Protocols
Laboratory facilities should be required to store test
Equipment and and reserve samples under appropriate environmental

Instrument Calibration conditions that protect the integrity of the sample while
ensuring their security prior to analysis. Post-analysis
Regular calibration of all equipment and instruments samples and extracts should be stored appropriately
used in the laboratory testing facility should be required while awaiting test results, and disposed of promptly
to help ensure the ongoing accuracy of analytical results. thereafter. Reserve samples should be stored for a
specified period of time for no greater than two months.

Facility and Equipment

Sanitary Conditions Workforce Safety
The testing facility and all equipment used therein should
Protocols
be subject to regular sanitation protocols designed Laboratory testing facilities should be required to develop
to ensure that new samples that come into contact and implement standard operating procedures and
with equipment and instruments cannot become protocols that ensure workplace safety. Such protocols
contaminated with residuals from previous test samples. should address the proper use and storage of any
solvents or chemicals on site as well as the proper use of
all equipment and instruments utilized in the facility.
Sample Tracking
State governments should require that samples be
subject to a detailed tracking protocol.

43
 STATE MEDICAL CANNABIS
PROGRAM REGULATIONS
AND OVERSIGHT MEDICAL CANNABIS
REGULATORY AGENCY
State agencies or groups of several agencies (such as
the Departments of Health, Agriculture, Consumer Affairs,
etc.) are tasked with creating and monitoring regulations

REGULATIONS through all phases of the production line, issuing licenses

for businesses, and coordinating patient enrollment. These
MORE THAN 310 MILLION AMERICANS LIVE agencies also conduct inspections or work with third-party
accreditors to ensure compliance, monitor adverse event
IN STATES WITH MEDICAL CANNABIS LAWS.
reporting, and implement product recalls if necessary.
THESE PROGRAMS ARE INFLUENCED BY
LOCAL, STATE, AND FEDERAL REGULATIONS.
AFTER A LAW IS ENACTED, STATE AGENCIES
CREATE A SERIES OF REGULATIONS THAT
GOVERN EVERYONE PARTICIPATING IN THE
PROGRAM AND ALL PRODUCTS PRODUCED.

SUPPLY CHAIN ! ! ! !
REGULATIONS BEGIN AT THE APPLICATION
STAGE, WHERE CRITERIA ARE SET FOR
WHO CAN OWN, OPERATE, AND WORK TESTING LAB FACILITY
IN MEDICAL CANNABIS BUSINESSES, All staff have proper training. Companies must adhere to Good Laboratory
AND END WITH PURCHASING CRITERIA Practices and be accredited by an International Laboratory Accreditation
AT THE RETAIL POINT. FROM SEED TO Cooperation (ILAC) signatory for ISO 17025 accreditation and related
CONSUMPTION, REGULATIONS INCLUDE certifications. Testing laboratories must offer potency testing for a variety of
TRACK AND TRACE FUNCTIONS, SECURITY cannabinoids and screen for pesticides and contaminants. Specifications
REQUIREMENTS, PRODUCT SAFETY for these tests are set by the American Herbal Pharmacopoeia Cannabis
Monograph. Strong regulatory regimes require laboratories to retain
PROTOCOLS, STAFF TRAINING, AND
samples in order to assist in product recalls and public health inquiries.
ADVERSE EVENT REPORTING AND RECALL
PROCEDURES. MEDICAL CANNABIS
BUSINESSES ARE SUBJECT TO INSPECTIONS.
REGULATORS NOW HAVE RESOURCES,
SUCH AS THE AMERICAN HERBAL
PHARMACOPOEIA CANNABIS MONOGRAPH
! !
AND THE AMERICAN HERBAL PRODUCTS
ASSOCIATION RECOMMENDATIONS FOR
REGULATORS, TO INFORM THE CREATION
OF ROBUST PRODUCT SAFETY PROTOCOLS.
ALL COMPANIES MUST DEMONSTRATE
ABILITY TO TRACK ADVERSE EVENTS AND
INITIATE A RECALL.
!

CULTIVATION FACILITY MANUFACTURING FACILITY

All staff have required legal compliance and product safety All staff have required legal compliance and product safety
protocol adherence training. Companies must adhere to protocol adherence training. Companies must adhere to
Good Agricultural Practices. Facilities may only use certain Good Manufacturing Practices. Products are packaged to
approved pesticides. prevent accidental ingestion by children.

AmericansForSafeAccess.org

!
PRODUCT SAFETY TRANSPORTATION RECALL
Each batch of raw plant material and cannabis- Regulations extend to transportation of cannabis products When a product containing contaminants, molds, or
derived product must be quality assurance tested throughout the supply chain. Regulations require drivers mildew – or an improperly labeled product – enters
in order to ensure the integrity, purity, and proper to be registered with the state and require paperwork the supply chain, regulatory agencies trigger a product
labeling of medical cannabis products. at pickup and drop-off locations, including weighing the recall to prevent patient consumption. This includes
product. Regulations also include special instructions for alerting the manufactures, retail outlets, and the
dealing with waste. public. Recalled products are destroyed.
44
 $ DEPARTMENT
OF COMMERCE

DEPARTMENT INSPECTIONS
OF HEALTH Medical cannabis businesses must pass inspections to
maintain licenses to operate. These inspections may be
conducted by the state medical cannabis regulatory agency,
accredited third-party agencies, law enforcement, OSHA,
municipal safety inspectors, etc.
DEPARTMENT
OF AGRICULTURE

! ! !

OWNERS AND STAFF MEDICAL PROFESSIONALS

Regulations include legal conduct for owners and staff
Regulators create guidelines for medical
and often require unique IDs issued by the state. All staff
professionals to enroll their patients into the
and management are required to have legal compliance
program, including forms and number of visits
and product safety protocol adherence training.
required. Some require medical professionals
to take specific training courses and have
built-in audits.

DISPENSING/RETAIL FACILITY PATIENTS AND THEIR

Staff are trained to provide guidance to patients in making CAREGIVERS
cannabis product selections. Regulations require the retail store
to maintain certain hours and limit the scope of advertising Regulators create enrollment and renewal procedures
to fit within community standards. Security cameras and for patients that usually include the issuance of an ID.
increased foot traffic help deter crime. Under state laws, Rules for patients also govern how much medicine a
dispensaries can only serve verified patients and caregivers. patient can possess, places where patients can legally
use their medicine, and the transportation of cannabis.

QUALIFICATION
ONCE THE AUTHORIZING STATUTE HAS
BEEN ADOPTED, REGULATORS SET THE
REQUIREMENTS FOR PATIENT AND MEDICAL
MEDICAL CANNABIS PRODUCTS PROVIDER PARTICIPATION IN THE MEDICAL
Products are labeled in accordance with state guidelines
CANNABIS PROGRAMS, CREATE RELEVANT
to display cannabinoid profile and other useful information, GUIDELINES AND FORMS, AND SET RULES
including the expiration date if the item is perishable. REGARDING TRANSPORTATION AND USE.

45
 State
Report
Cards

B+
46
 STATE REPORT CARDS KEY FOR STATE GRADES

WASHINGTON

B- B+
B C+ C
A- F C- B
F F B+ B- B+
B+ F C-
F B C+
F C+
D- A- F B F F C+
B+ B C B
F F B
DC

C- F F
B+ B C+
F F F F
F D
C
C GUAM

C
COMMONWEALTH
OF THE PUERTO RICO
C-
NORTHERN
MARIANA ISLANDS
D
D+ VIRGIN ISLANDS

B+

MAP KEY KEY FOR STATE GRADES

Blue:  ull medical cannabis
F A+: 96-100
program A: 93-95
A-: 90-92
Yellow: CBD-specific program
[includes low-THC] B+: 87-89
B: 83-86
Green: Medical and adult
B-: 80-82
use program
C+: 77-79
Gray: No medical or adult C: 73-76
use program
C-: 70-72
D+: 67-69
D: 63-66
D-: 60-62
F: Below 60%

47
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

ALABAMA
2018-2019 IMPROVEMENTS F
For yet another year, Alabama showed resistance to implementing a comprehensive medical
cannabis program. While a medical cannabis bill moved through the Alabama Senate, the
House gutted the provisions and made it into a bill that is focused only on studying legal
access, rather than granting it. The Study Commission created by the bill would look at the
potential of implementing medical cannabis legislation, with a report due by December 1,
2019. However, there is still significant opposition in the State. One Senator went as far as
saying that patients who need cannabis should just get it from the illicit market.

Alabama has a long way to go before it can be considered a functional jurisdiction for safe
and legal access to medical cannabis therapy. Even by the standards of CBD-only laws, the
Alabama law provides little in the way of legal protections or facilitating access for its patients
who have met the limited patient eligibility criteria. The state legislature needs to approve a
program that allows for in-state production and distribution of medical cannabis, establish
comprehensive legal protections for patients, lift artificial requirements for THC and CBD 2015 2016 2017 2018-19
content, and adopt product safety standards.
F F F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 23/100 EASE OF NAVIGATION 68/100

Arrest Protection.............................................................................................................................. 0/40 Comprehensive Qualifying Conditions.......................................................................... 35/50
Affirmative Defense........................................................................................................................ 10/15 Adding New Conditions.............................................................................................................. 0/10
Parental Rights Protections..................................................................................................... 8/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 8/10
Explicit Privacy Standards........................................................................................................ 0/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 7/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 13/100
Allows Distribution Programs................................................................................................ 0/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 35/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 0/5 Dispensaries or by Cultivation.......................................................................................... 5/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 10/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 2/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 0/10
Does Not Impose Bans or Limits on THC..................................................................... 3/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 0/10

Base Categories Points: .....................................................139

Opioid Response Points: ...................................................5
Points Total: .............................................................................................144/500
Score Percentage: ........................................................................28.80%
FINAL GRADE F
48
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 ALABAMA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 0/100 Is Cannabis Available for Treatment?...........................................................................................................

– Does the state broadly allow chronic pain as a condition without restrictions?................
0/15
0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 0/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 0/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 0/2
– Storage Protocols................................................................................................................................. 0/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 0/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 0/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 0/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 0/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 0/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Potency....................................................................................................................................................... 0/1.67 – Are there state-specific research licenses or research and development
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 0/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.71 Background
– Workforce Safety Protocols .......................................................................................................... 0/0.71
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 In 2014, the Alabama state legislature passed SB 174, a CBD law. Officially
– Reasonable Security Protocols.................................................................................................... 0/0.71 entitled “Carly’s Law,” it offered an affirmative defense for the possession
– Batch and Lot Tracking..................................................................................................................... 0/0.71 and use of CBD; however, the program was extremely limited and did
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71
not effectively enable the possession and use of CBD-rich medicine by
Pesticide Guidance.............................................................................................................................. 0/5 Alabama patients. This law only allowed patients CBD access after a
– Pesticide Guidance.............................................................................................................................. 0/2.5 medical practitioner at the University of Alabama Birmingham (UAB)
– Pesticide Labeling................................................................................................................................ 0/2.5 Department of Neurology had made a diagnosis for a “debilitating
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1.25
epileptic condition,” at which point the physician could prescribe
– Contaminants.......................................................................................................................................... 0/1.25 CBD-rich preparations that contained no more than 3% THC and were
– Potency....................................................................................................................................................... 0/1.25 “essentially free from plant material.”
– Sample Retention................................................................................................................................. 0/1.25
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 In 2016, HB 61, or “Leni’s Law,” was passed. It extends the affirmative
defense language to several conditions and removes the requirement
Manufacturing 0/25 that the patients be enrolled in a UAB study program. Under Leni’s Law,
Staff Training............................................................................................................................................. 0/5 patients are eligible for the affirmative defense if they are simply diagnosed
Standard Operating Procedures............................................................................................... 0/5 with a debilitating condition, regardless of the age of the patient. However,
– Facility and Equipment Sanitary Conditions...................................................................... 0/1 a “prescription” is still required in order for a minor’s parents or legal
– Workforce Safety Protocols .......................................................................................................... 0/1
– Storage Protocols ................................................................................................................................ 0/1 guardian to be eligible for the affirmative defense. Because physicians
– Reasonable Security Protocols.................................................................................................... 0/1 cannot legally write prescriptions, only recommendations, for medical
– Batch and Lot Tracking..................................................................................................................... 0/1 cannabis due to its Schedule I status, parents and guardians of minor
Product Labeling................................................................................................................................... 0/5 patients may be ineligible for legal protections.
– Product Contents, Including Source Material Identification.................................... 0/1.67
– Allergens..................................................................................................................................................... 0/1.67 In 2019, Alabama began accepting applications for hemp cultivators
– Potency and Compound Information ..................................................................................... 0/1.67
Required Testing.................................................................................................................................... 0/5 under the state research program. Also in 2019, there was significant
– Active Ingredient Identification.................................................................................................... 0/1 movement in the Alabama State House to move forward a medical bill,
– Contaminants.......................................................................................................................................... 0/1 but all these efforts ended up failing.
– Potency....................................................................................................................................................... 0/1
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 0/1
Opioid Response
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 In 2017, Alabama physicians wrote 107.2 opioid prescriptions for every
100 people. This was the highest prescribing rate in the country, and
Laboratory Operations 0/25 nearly twice the US average. Alabama could greatly reduce its number
Staff Training............................................................................................................................................. 0/5 of prescriptions issued if it simply were to loosen the tight restrictions on
Method Validation in Accordance with AHP Guidelines...................................... 0/5 the state’s incredibly limited CBD program. A robust medical cannabis
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 0/5
program would significantly help Alabama’s ongoing fight against the
Standard Operating Procedures and Protocols.......................................................... 0/5 opioid epidemic. Alabama legislators should focus on passing a program
– Equipment and Instrument Calibration.................................................................................. 0/0.83 that actually serves patients and allows cannabis to be used for pain
– Sample Tracking.................................................................................................................................... 0/0.83 conditions to reduce preventable opioid overdose deaths.
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0/0.83 Patient Feedback
– Workforce Safety Protocols .......................................................................................................... 0/0.83 Patients in Alabama reported that it is unacceptable that the only
access to medical cannabis is through the state’s extremely limited
CBD program or through the illicit market.

49
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

ALASKA
2018-2019 IMPROVEMENTS
Perhaps the most significant changes to Alaska’s program were allowing consumers to be
C
able to consume cannabis on-site at the place of purchase in 2019 and the promulgation of
new sampling and testing regulations in 2018. On-site consumption can be helpful for patients
who live in subsidized housing or are otherwise prevented from consuming their medicine on
the property where they reside, and robust sampling and testing requirements are critical to
ensuring consumer safety and product quality. Alaska also certified some technical changes to
ownership regulations in 2018.

Although Alaska has a long-standing medical cannabis program, product safety standards
had been lacking for Alaska patients. Rulemaking associated with Alaska’s adult use
program improved consumer safety and provider requirements. However, Alaska physicians
still must state that they considered medications other than cannabis before providing a
recommendation, making cannabis ineligible as a medicine of first resort. Alaska also falls short
on providing civil protections for patients. From a product safety perspective, Alaska could
2015 2016 2017 2018-19
improve staff training and protocols associated with recalls. On a positive note, universities can
now hold licenses, which is beneficial to research and development processes. D- D- C C

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 65/100 EASE OF NAVIGATION 80/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 44/50
Affirmative Defense........................................................................................................................ 13/15 Adding New Conditions.............................................................................................................. 7/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 2/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 7/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 3/5
ACCESS TO MEDICINE 65/100
Allows Distribution Programs................................................................................................ 22/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 74/100
– Allows Delivery.................................................................................................................................. 3/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 3/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 1/5 Dispensaries or by Cultivation.......................................................................................... 40/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 15/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 7/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 15/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 4/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 0/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 8/10

Base Categories Points: .....................................................357

Opioid Response Points: ...................................................11
Points Total: .............................................................................................368/500
Score Percentage: ........................................................................73.80%
FINAL GRADE C
50
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 ALASKA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 73/100 Is Cannabis Available for Treatment?........................................................................................................... 3/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 3/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 15/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 1/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 1/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 18/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0.71/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 Safe access to medical cannabis was first approved in Alaska
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 through Measure 8 (1998), an initiative passed by 58% of voters.
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
Alaska Senate Bill 94 was passed in June 1999 and modified the law
– Disposal/Waste...................................................................................................................................... 0.71/0.71
– Water Management............................................................................................................................ 0.71/0.71 created by Measure 8 to require medical cannabis patients to register
Pesticide Guidance.............................................................................................................................. 3/5 with the state health department and limit the amount of cannabis
– Pesticide Guidance.............................................................................................................................. 3/2.5 they and their caregivers may legally possess. Any patient with a
– Pesticide Labeling................................................................................................................................ 0/2.5
valid registry card may legally use cannabis for medicinal purposes
Required Testing.................................................................................................................................... 5/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 and their caregiver may assist them in doing so. Patients or their
– Contaminants.......................................................................................................................................... 1.25/1.25 caregivers may possess up to one ounce of usable cannabis and
– Potency....................................................................................................................................................... 1.25/1.25 cultivate up to six cannabis plants (three mature, three immature).
– Sample Retention................................................................................................................................. 1.25/1.25
Patients and caregivers can possess paraphernalia associated
Recall Protocol and Adverse Event Reporting.............................................................. 5/5
with growing or consuming cannabis for medical use. All patients
and caregivers must enroll in the state registry and possess a valid
Manufacturing 20/25
identification card to be legally protected. A primary caregiver must
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
be at least 21 years old, not currently on probation or parole, and
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 have no drug related felony convictions. In 2014, voters approved
– Workforce Safety Protocols .......................................................................................................... 1/1 an adult use retail program, but there is no dedicated retail system
– Storage Protocols ................................................................................................................................ 1/1 that regulates cannabis like a medicine. Since 2014, there have been
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1
various regulatory updates, including allowing on-site consumption.
Product Labeling................................................................................................................................... 1/5
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 Opioid Response
– Allergens..................................................................................................................................................... 1.67/1.67
There were 621 registered cardholders in Alaska in 2018, down 64%
– Potency and Compound Information ..................................................................................... 1.67/1.67
Required Testing.................................................................................................................................... 5/5 from 2015. This drop is likely attributable to Alaska’s legalization
– Active Ingredient Identification.................................................................................................... 1/1 of cannabis for non-medical purposes and a lack of incentives
– Contaminants.......................................................................................................................................... 1/1 for patients to join the medical program. During the same period,
– Potency....................................................................................................................................................... 1/1
Alaska’s overdose deaths from prescription opioids decreased from
– Shelf Life Testing................................................................................................................................... 1/1
– Sample Retention................................................................................................................................. 1/1 37 to 25, a 32% decrease. Although Alaska allows for severe pain as a
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 qualifying condition, the state is not using cannabis to its full potential
in reducing the number of preventable opioid deaths. Alaska needs to
Laboratory Operations 20/25 allow patients to have same-day access to cannabis upon registering
Staff Training............................................................................................................................................. 0/5 for the program, add opioid use disorder as a qualifying condition,
Method Validation in Accordance with AHP Guidelines...................................... 5/5 and create a better framework to incentivize businesses to remain
Result Reporting.................................................................................................................................... 5/5
medical-only establishments.
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 5/5
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83 Patient Feedback
– Sample Tracking.................................................................................................................................... 0.83/0.83 Patients are frustrated with growers and dispensaries failing to
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83 promote medical products, as the primary focus seems to be on the
– Storage Protocols................................................................................................................................. 0.83/0.83 adult-use market.
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83

51
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

ARIZONA
2018-2019 IMPROVEMENTS
C-
As of April 2019, Arizona had 197,025 patients enrolled in the medical cannabis program.
While the legislature and state regulators were relatively quiet during 2018-2019,
patients won several victories in the courts. An AZ court ruled that a recommendation
letter from a California doctor is just as valid as an AZ-issued medical cannabis ID
card, which has significant implications for patient reciprocity. In May 2019, the AZ
Supreme Court ruled that medical cannabis extracts are legal, and a federal judge in
Arizona ruled that Walmart improperly terminated an employee for state-legal medical
cannabis use. SB 1494 was passed and will greatly improve the testing standards for
medical cannabis and medical cannabis products and reduce patient fees. Mandatory
independent testing will begin on November 1, 2020.

2015 2016 2017 2018-19

C+ B- C+ C-

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 97/100 EASE OF NAVIGATION 87/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 46/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 9/10
Parental Rights Protections..................................................................................................... 8/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 5/5 – System Works for Adding New Conditions.................................................................... 4/5
Employment Protections............................................................................................................ 5/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... 5/5 Number of Caregivers.................................................................................................................. 1/2
Does Not Create New Criminal Penalties for Patients...................................... 4/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 10/10
Reciprocity............................................................................................................................................. 3/3 Allows Multiple-Year Registrations .................................................................................. 2/2
Reasonable Physician Requirements.............................................................................. 3/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 4/5
ACCESS TO MEDICINE 81/100
Allows Distribution Programs................................................................................................ 33/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 74/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 4/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 50/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 7/10
– Environmental Impact Regulations...................................................................................... 1/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 10/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 10/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 5/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 8/10

Base Categories Points: .....................................................394.63

Opioid Response Points: ...................................................20
Points Total: .............................................................................................414.63/500
Score Percentage: ........................................................................72.6%
FINAL GRADE C-
52
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 ARIZONA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 70.7/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 6/7
Dispensing 20/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 1/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 2/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 1/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 2.5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 15.3/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 2.84/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 Arizona’s current medical cannabis program was passed in 2010 by 50.13%
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 of voters. The Arizona Medical Marijuana Act (AMMA) allows a patient
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
with an Arizona registry ID card to use cannabis for medical purposes.
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 Patients may appoint a designated caregiver for assistance. Patients and
Pesticide Guidance.............................................................................................................................. 2.5/5 their caregivers may possess up to 2.5 ounces of usable cannabis and may
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 cultivate up to 12 plants if they live at least 25 miles away from a registered
– Pesticide Labeling................................................................................................................................ 0/2.5
dispensary. The law recognizes out-of-state medical cannabis IDs for the
Required Testing.................................................................................................................................... 5/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 purposes of criminal protections but does not permit visiting patients to
– Contaminants.......................................................................................................................................... 1.25/1.25 obtain cannabis from Arizona dispensaries. Due to a series of lawsuits, the
– Potency....................................................................................................................................................... 1.25/1.25 Arizona Department of Health Services did not post rules for the Medical
– Sample Retention................................................................................................................................. 1.25/1.25
Marijuana Dispensary portion of the AMMA until 2012.
Recall Protocol and Adverse Event Reporting.............................................................. 0/5

Since the passage of the AMMA, the legislature has passed several laws
Manufacturing 5.67/25
restricting the rights of patients. HB 2541, which was passed in 2011,
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 3/5
allows an employer to fire a patient for workplace impairment solely on
– Facility and Equipment Sanitary Conditions...................................................................... 0/1 the word of a “reliable” colleague or a positive drug test. HB 2585 added
– Workforce Safety Protocols .......................................................................................................... 0/1 cannabis patient data to the prescription drug monitoring program that
– Storage Protocols ................................................................................................................................ 1/1 same year. In 2012, HB 2349 prohibited medical cannabis at schools,
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1
vocational schools, and college campuses, but the Arizona Supreme
Product Labeling................................................................................................................................... 1.67/5 Court overturned this law as unconstitutional in State v. Maestas. In
– Product Contents, Including Source Material Identification.................................... 0/1.67 2015, HB 2346 specified that the AMMA does not require workers’
– Allergens..................................................................................................................................................... 0/1.67 compensation benefits to include reimbursement for medical cannabis.
– Potency and Compound Information ..................................................................................... 1.67/1.67
Required Testing.................................................................................................................................... 1/5
In 2017, the legislature passed HB 2061, which requires dispensaries and
– Active Ingredient Identification.................................................................................................... 0/1 doctors to warn of the potential risk of using cannabis while breastfeeding
– Contaminants.......................................................................................................................................... 0/1 or pregnant. Arizona also opened its first drive-thru dispensary in 2017.
– Potency....................................................................................................................................................... 0/1
– Shelf Life Testing................................................................................................................................... 0/1 Opioid Response
– Sample Retention................................................................................................................................. 1/1
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 Approximately 88% of the program participants use cannabis for chronic
pain. Cannabis flower remains the most popular form of medicine. In
Laboratory Operations 14.66/25 between 2010, when Arizona approved medical cannabis, and 2017,
Staff Training............................................................................................................................................. 0/5 Arizona providers wrote 30% fewer opioid prescriptions per person,
Method Validation in Accordance with AHP Guidelines...................................... 3/5 dropping from 88.5 per 100 to 58.7 per 100. Despite having a broad
Result Reporting.................................................................................................................................... 5/5 definition of pain, Arizona does not include opioid use disorder as a
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 1.66/5
qualifying condition. Additionally, the state has not required its physicians
– Equipment and Instrument Calibration.................................................................................. 0/0.83 to take mandatory training on either opioid prescribing or the interaction
– Sample Tracking.................................................................................................................................... 0/0.83 of opioids and cannabis.
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83 Patient Feedback
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83 Some patients reported concern by the lack of mandatory testing and
labeling when it came to pesticides. Fortunately, in 2019, the state responded
to some of these concerns by requiring improved testing procedures. Costs
of products were also reported to remain exceptionally high.

53
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

ARKANSAS
2018-2019 IMPROVEMENTS
C+
Arkansas’ medical cannabis legislation was passed in 2016, and sales of medical
cannabis to patients finally began in May 2019. As of May 31, 2019, 12,906 patients
had registered for the program and several medical cannabis cultivation facilities and
dispensaries are now operational; however, there are still a significant number that have
not yet commenced operations. In March of 2019, regulators released draft regulations
about the transportation of cannabis from cultivation facilities to dispensaries
throughout the state. Arkansas has issued licenses to 32 medical cannabis dispensaries.
Although the program was passed three years ago, perennial opponent to cannabis
reform Governor Asa Hutchinson has said that it is “too early” to consider adding
additional qualifying conditions to the program.

2015 2016 2017 2018-19

NA B- B- C+

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 91/100 EASE OF NAVIGATION 79/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 40/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 8/10
Parental Rights Protections..................................................................................................... 10/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 3/5 – System Works for Adding New Conditions.................................................................... 3/5
Employment Protections............................................................................................................ 3/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 5/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... 5/5 Number of Caregivers.................................................................................................................. 1/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 8/10
Reciprocity............................................................................................................................................. 3/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 69/100
Allows Distribution Programs................................................................................................ 33/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 76/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 3/5 Dispensaries or by Cultivation.......................................................................................... 40/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 2/2 Reasonable Time Frame of Doctor’s Recommendation............................... 10/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 4/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 9/10
Local Bans/Zoning.......................................................................................................................... 7/10

Base Categories Points: .....................................................390

Opioid Response Points: ...................................................5
Points Total: .............................................................................................395/500
Score Percentage: ........................................................................79%
FINAL GRADE C+
54
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 ARKANSAS

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 75/100 Is Cannabis Available for Treatment?........................................................................................................... 3/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 3/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 20/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 1/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 1/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 20/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions...................................................................... 0.71/0.71
– Workforce Safety Protocols .......................................................................................................... 0.71/0.71 Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In November of 2016, Arkansas voters approved a constitutional
– Reasonable Security Protocols.................................................................................................... 0.71/0.71
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
amendment that provided for a medical cannabis program. In the 12
– Disposal/Waste...................................................................................................................................... 0.71/0.71 months that followed, the Arkansas Department of Health worked
– Water Management............................................................................................................................ 0.71/0.71 diligently to create rules and regulations implementing the voter-
Pesticide Guidance.............................................................................................................................. 5/5 approved program. Arkansas still has areas for improvement, like
– Pesticide Guidance.............................................................................................................................. 2.5/2.5
– Pesticide Labeling................................................................................................................................ 2.5/2.5
allowing patients to cultivate their own medicine, but The Natural
Required Testing.................................................................................................................................... 5/5 State has shown significant program improvements in just its first
– Active Ingredient Identification.................................................................................................... 1.25/1.25 year. Following the passage of the constitutional amendment, there
– Contaminants.......................................................................................................................................... 1.25/1.25 was a flurry of legislative activity (16 bills) that made technical and
– Potency....................................................................................................................................................... 1.25/1.25
– Sample Retention................................................................................................................................. 1.25/1.25
nuanced changes to the program that voters passed.
Recall Protocol and Adverse Event Reporting.............................................................. 5/5
In May of 2017, Arkansas implemented Rules and Regulations for
the Registration, Testing and Labeling of Cannabis, which greatly
Manufacturing 20/25 strengthened their program. Arkansas also implemented rules
Staff Training............................................................................................................................................. 0/5 governing the oversight of medical cannabis cultivation facilities
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions...................................................................... 0/1 and dispensaries.
– Workforce Safety Protocols .......................................................................................................... 0/1
– Storage Protocols ................................................................................................................................ 0/1
– Reasonable Security Protocols.................................................................................................... 0/1 Opioid Response
– Batch and Lot Tracking..................................................................................................................... 0/1 Thirty-one percent of Arkansas patients use cannabis for intractable
Product Labeling................................................................................................................................... 5/5
pain, the greatest percentage out of any category listed as a
– Product Contents, Including Source Material Identification.................................... 1.67/1.67
– Allergens..................................................................................................................................................... 1.67/1.67 qualifying condition. Arkansas only allows patients to use medical
– Potency and Compound Information ..................................................................................... 1.67/1.67 cannabis to treat chronic pain if their pain has been unresponsive to
Required Testing.................................................................................................................................... 5/5 ordinary medications, treatment, or surgery for more than 6 months.
– Active Ingredient Identification.................................................................................................... 1/1 This definition of pain is incredibly limiting and forces patients
– Contaminants.......................................................................................................................................... 1/1
– Potency....................................................................................................................................................... 1/1 to suffer unreasonably for months before seeking cannabis as a
– Shelf Life Testing................................................................................................................................... 1/1 treatment. The opioid overdose rate increased significantly between
– Sample Retention................................................................................................................................. 1/1 2013 and 2017 (11.1 per 100,000 to 15.5 per 100,000), but there was
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 no significant increase in 2018. As sales of medical cannabis just
began, it is too early to tell if the availability of medical cannabis will
Laboratory Operations 15/25 impact the state’s opioid crisis.
Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 5/5
Result Reporting.................................................................................................................................... 5/5 Patient Feedback
Independent or Third Party........................................................................................................... 0/5
Standard Operating Procedures and Protocols.......................................................... 5/5 At the time of the patient survey, the primary concern of Arkansas
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83 patients was the timeline of the program’s rollout. As the state has
– Sample Tracking.................................................................................................................................... 0.83/0.83 begun issuing medical cannabis cards and implementing medical
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
cannabis laws, this may be less of a patient concern.
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83

55
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

CALIFORNIA
2018-2019 IMPROVEMENTS
Some estimates put California’s patient population at nearly 1,000,000. This is difficult to keep
track of because registering for a card in the state is not mandatory. The foundation of a well-
B+
functioning program is patient access. Unfortunately, nearly two-thirds of California counties
don’t provide sufficient medical access points, and excessively high taxes are making medicine
unaffordable, especially now that co-op collectives have shut down. In July of 2018, regulators
found that one out of five samples sent to labs had inaccurate labeling or contamination from
pesticides, bacteria, or chemicals. Gov. Brown slightly increased patient privacy protections
by signing a bill preventing cannabis businesses from sharing consumers’ information for
commercial purposes but vetoed a bill that would have allowed businesses to return to giving
away free medical cannabis and that would have allowed medical cannabis in schools. As one
of his last acts as governor, he signed bills to reduce prior cannabis convictions and require that
cannabis operations follow CA OSHA for cannabis operators.
In 2019, medical cannabis cooperatives became illegal under state law, which is a devastating
blow to low- or fixed-income patients. The state also released updated guidance on testing
and carried out enforcement actions against unlicensed businesses. Twenty-four cities sued
California regulators over a rule that allows deliveries in a municipality that banned cannabis
businesses; the case is still pending. SB 34, a bill that would shield medical cannabis compassion 2015 2016 2017 2018-19
programs from taxation, is currently pending as well. California continues to fail to provide civil
protections for patients in the areas of housing and employment. B+ B+ B+ B+

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 79/100 EASE OF NAVIGATION 93/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 50/50
Affirmative Defense........................................................................................................................ 13/15 Adding New Conditions.............................................................................................................. 10/10
Parental Rights Protections..................................................................................................... 10/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 5/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 10/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 3/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 7/10
Reciprocity............................................................................................................................................. 1/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 82/100
Allows Distribution Programs................................................................................................ 34/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 82/100
– Allows Delivery.................................................................................................................................. 3/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 1/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 40/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 12/15
– Ownership/Employment Restrictions................................................................................ 2/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 2/2 Reasonable Time Frame of Doctor’s Recommendation............................... 10/10
– Environmental Impact Regulations...................................................................................... 2/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 5/3
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 15/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 7/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 9/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 4/10

Base Categories Points: .....................................................420

Opioid Response Points: ...................................................27
Points Total: .............................................................................................447/500
Score Percentage: ........................................................................89.4%
FINAL GRADE B+
56
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 CALIFORNIA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 84/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 5/5
Doctor Education........................................................................................................................................................... 7/7
Dispensing 18.75/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 2/2
Standard Operating Procedures............................................................................................... 3.75/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 3/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 1/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 5/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 2.5/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 2/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 1/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 2.5/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 20/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5 Background
– Facility and Equipment Sanitary Conditions...................................................................... 0.71/0.71
– Workforce Safety Protocols .......................................................................................................... 0.71/0.71 In 1996, California became the first medical cannabis state when voters approved
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 Prop 215, the Compassionate Use Act. That law allows doctors to recommend
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 cannabis for any serious or persistent medical condition and allows patients
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71 to legally use, possess, and grow cannabis and designate caregivers to assist
– Disposal/Waste...................................................................................................................................... 0.71/0.71 them. In 2003, the California legislature passed the Medical Marijuana Program
– Water Management............................................................................................................................ 0.71/0.71 Act, establishing a voluntary ID card program, protections for transporting
Pesticide Guidance.............................................................................................................................. 5/5 cannabis, and a legal framework to protect not-for-profit dispensing collectives
– Pesticide Guidance.............................................................................................................................. 2.5/2.5
– Pesticide Labeling................................................................................................................................ 2.5/2.5
and cooperatives. The voluntary registry issues ID cards that offer protection from
Required Testing.................................................................................................................................... 5/5 arrest for patients and caregivers in possession of no more than eight ounces of
– Active Ingredient Identification.................................................................................................... 1.25/1.25 cannabis or cultivating no more than six mature or 12 immature plants. Patients
– Contaminants.......................................................................................................................................... 1.25/1.25 and designated caregivers without a state ID card, or those in possession of
– Potency....................................................................................................................................................... 1.25/1.25 larger quantities, are afforded an affirmative defense. Qualified patients on
– Sample Retention................................................................................................................................. 1.25/1.25 probation or parole may legally use medical cannabis with the consent of their
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 probation or parole officer. In 2015, the state passed the Medical Cannabis
Regulation and Safety Act (MCRSA), a trio of bills that creates a state-regulated
Manufacturing 25/25 cultivation and dispensary system and protects medical cannabis patients in
Staff Training............................................................................................................................................. 5/5 need of an organ transplant. Voters approved the Adult Use of Marijuana Act
Standard Operating Procedures............................................................................................... 5/5 (Proposition 64) in 2016, which expanded rights for patients by adding parental
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 rights protections, enhancing patient privacy rules, prohibiting cities from
– Workforce Safety Protocols .......................................................................................................... 1/1 banning personal cultivation, and exempting card-holding patients from sales tax.
– Storage Protocols ................................................................................................................................ 1/1
– Reasonable Security Protocols.................................................................................................... 1/1 In July of 2017, the governor signed the Medicinal and Adult-Use Cannabis
– Batch and Lot Tracking..................................................................................................................... 1/1 Regulation and Safety Act (MAUCRSA). On November 16, 2017, California published
Product Labeling................................................................................................................................... 5/5 emergency rules and regulations that implemented Prop. 64 and MAUCRSA. These
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 emergency regulations also impacted the state’s medical program, particularly in
– Allergens..................................................................................................................................................... 1.67/1.67 regards to how businesses are licensed, purchasing limits for patients, and much-
– Potency and Compound Information ..................................................................................... 1.67/1.67
needed regulations for the manufacturing of cannabis products.
Required Testing.................................................................................................................................... 5/5
– Active Ingredient Identification.................................................................................................... 1/1 Governor Brown was primarily unhelpful to patient access. Governor Newsom is
– Contaminants.......................................................................................................................................... 1/1 better poised to continue to improve the state’s medical cannabis program. The
– Potency....................................................................................................................................................... 1/1
lack of access points and high fees remains an ongoing problem in California.
– Shelf Life Testing................................................................................................................................... 1/1
– Sample Retention................................................................................................................................. 1/1
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 Opioid Response
In 2017, there were 2,199 opioid overdose deaths in California. At a rate of 5.3
Laboratory Operations 20/25 per 100,000 persons, this is well below the national average of 14.6 per 100,000.
Staff Training............................................................................................................................................. 5/5 California needs to continue to evolve and develop research that uses cannabis
Method Validation in Accordance with AHP Guidelines...................................... 0/5 to further drive down the opioid overdose rate. Additionally, a University of
Result Reporting.................................................................................................................................... 5/5 California Irvine study found that the total rates of suicide, and in particular,
Independent or Third Party........................................................................................................... 5/5 suicide by firearm, dropped significantly since California legalized medical
Standard Operating Procedures and Protocols.......................................................... 5/5 cannabis in 1996; given the link between opioid addiction and increased risk for
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83 suicide, promoting cannabis as an alternative to opioids could push the rates of
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83 both opioid overdose deaths and suicides down even further.
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83 Patient Feedback
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83 Since adult use has been legalized, cannabis patients reported concern over the
limited supply of cannabis products and the higher costs of medical cannabis, due
to high taxes on medical cannabis products. Inconsistent product availability in
dispensaries makes it difficult for patients to find the same products that worked
for them before and reported that there are also issues with product quality. In
addition, patients reported that the staff at dispensaries should be better trained.
57
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

COLORADO
2018-2019 IMPROVEMENTS
As of June 2019, Colorado had 83,879 registered patients. Colorado saw some significant
improvements to its program over the last year. Minor patients can now receive cannabis in schools,
B
and minors can have each of their parents be a caregiver. Separately, the program added autism
and any condition for which an opioid could be prescribed as qualifying conditions and began to
allow delivery. Regulations were updated to include heavy metal testing, allow the production of
nasal sprays, inhalers, and suppositories, clarify the waste recycling regulations, and remove the
requirement of vertical integration. Further, the state released a request for applications for medical
cannabis research grants, including proposals that look at the reduction of opioid consumption
through medical cannabis use. The Colorado Supreme Court ruled that an alert from a drug-sniffing
dog can no longer be used for probable cause. Colorado continues to do well in most aspects of
providing safe and legal access to its medical cannabis patients. In terms of the law, the biggest
oversight is the lack of civil protections in the areas of housing, employment, and parental rights.

On the regulatory side of things, the state should improve its product safety requirements by
evenly enforcing regulations across the state instead of at the county level. The state should
create a better system for adding qualifying conditions or follow the lead of states like Maryland,
Massachusetts, and the District of Columbia that have replaced condition lists with granting
2015 2016 2017 2018-19
physicians the right to recommend medical cannabis to any patient for whom the benefits
outweigh the risks.
B B- B- B

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 62/100 EASE OF NAVIGATION 88/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 46/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 7/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 2/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 10/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 0/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 10/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 4/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 88/100
Allows Distribution Programs................................................................................................ 35/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 92/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 4/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 50/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 15/15
– Ownership/Employment Restrictions................................................................................ 2/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 9/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 3/3
Noncommercial Cultivation..................................................................................................... 15/20
Covered by Insurance/State Health Aid........................................................................ 0/5
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 6/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 8/10

Base Categories Points: .....................................................393.66

Opioid Response Points: ...................................................20.5
Points Total: .............................................................................................415/500
Score Percentage: ........................................................................82.8%
FINAL GRADE B
58
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 COLORADO

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 63.67/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 5/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 18.33/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 3.33/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 1/5
– Potency/Compound Identification............................................................................................ 0/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 2.5/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 14/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions...................................................................... 0.71/0.71
Background
– Workforce Safety Protocols .......................................................................................................... 0.71/0.71 Colorado’s original medical cannabis initiative, Amendment 20, was a citizens’
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 initiative that passed in 2000. It amended the state constitution to authorize
– Reasonable Security Protocols.................................................................................................... 0.71/0.71
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
patients to use and possess up to two ounces of medical cannabis, cultivate up
– Disposal/Waste...................................................................................................................................... 0.71/0.71 to six plants (3 mature, 3 immature), and be assisted by a caregiver. Colorado’s
– Water Management............................................................................................................................ 0.71/0.71 second medical cannabis law, the Colorado Medical Marijuana Code (C.R.S.
Pesticide Guidance.............................................................................................................................. 4/5 12-43-101 et. seq.), was enacted by the legislature in the summer of 2012
– Pesticide Guidance.............................................................................................................................. 2/2.5
– Pesticide Labeling................................................................................................................................ 2/2.5
to establish a dual licensing mechanism that regulates Colorado medical
Required Testing.................................................................................................................................... 5/5 cannabis businesses at both the state and local level. Colorado allows local
– Active Ingredient Identification.................................................................................................... 1.25/1.25 governments to adopt regulations regarding medical cannabis businesses
– Contaminants.......................................................................................................................................... 1.25/1.25 and caregiver conduct, which has led to the uneven application of the law. In
– Potency....................................................................................................................................................... 1.25/1.25
– Sample Retention................................................................................................................................. 1.25/1.25
addition, the Colorado Medical Marijuana Code permits various state agencies
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 to continuously enact new regulations for the medical cannabis community.
In 2016, the legislature passed two bills pertaining to the medical cannabis
Manufacturing 11.33/25 program. HB 1371 created protections for children and their parents by
Staff Training............................................................................................................................................. 0/5 preventing them from being punished for possessing and consuming medical
Standard Operating Procedures............................................................................................... 5/5
cannabis on campus and by prohibiting the use of a minor’s patient status
– Facility and Equipment Sanitary Conditions...................................................................... 1/1
– Workforce Safety Protocols .......................................................................................................... 1/1 as a reason for denying that child admission into a school. SB 40 extended
– Storage Protocols ................................................................................................................................ 1/1 ownership rights of cannabis businesses to non-Colorado residents.
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1 In 2017, SB 192 was passed. It allowed for delivery of cannabis and single-
Product Labeling................................................................................................................................... 3.33/5 instance transfers between adult-use dispensaries and medical dispensaries.
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 The passage of SB 17-017 added PTSD and other stress-related conditions to
– Allergens..................................................................................................................................................... 1.67/1.67
the state’s list of qualifying conditions.
– Potency and Compound Information ..................................................................................... 0/1.67
Required Testing.................................................................................................................................... 3/5 In 2019, under the leadership of Governor Polis, the medical program saw
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 1/1
many needed improvements related to qualifying conditions, testing, and
– Potency....................................................................................................................................................... 1/1 product formulations.
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 0/1 Opioid Response
Recall Protocol and Adverse Event Reporting.............................................................. 0/5
Colorado deserves credit for its new law allowing medical cannabis to be used
for any condition for which an opioid would be prescribed. This goes further
Laboratory Operations 20/25 than many states because it covers both chronic and acute pain. The state also
Staff Training............................................................................................................................................. 5/5
deserves recognition for developing a research grant program for cannabis
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 5/5 research. Governor Polis is clearly an ally to medical cannabis patients, and
Independent or Third Party........................................................................................................... 5/5 he should continue to work with the patient community to improve the state’s
Standard Operating Procedures and Protocols.......................................................... 5/5 program. While Colorado’s opioid overdose death rate remains below the
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83
national average, 578 people died from an opioid overdose in 2017.
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83 Patient Feedback
– Storage Protocols................................................................................................................................. 0.83/0.83 Prospective medical cannabis patients reported being hesitant to use cannabis
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83 products due to gun control laws associated with cannabis use. Many doctors
are still unwilling to recommend medical cannabis and patients lament that
medical cannabis is taxed and that there is still no insurance to help defray its
cost. Patients also noted that the fee to obtain a medical card should be waived.

59
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

COMMONWEALTH
OF THE NORTHERN D+
MARIANA ISLANDS
(CNMI)
2018-2019 IMPROVEMENTS
The CNMI deserves recognition for passing a cannabis law in 2018. Due to the small
population size (about 55,000 residents), lawmakers decided to legalize cannabis for medical
and non-medical purposes to sustain the program. There are several important protections
for patients in the CNMI program, including a robust qualifying condition list, strong patient
civil rights protections, and a tax exemption. As the territory implements regulations, the
Islands’ grade will no doubt improve. 2015 2016 2017 2018-19

NA F F D+

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 68/100 EASE OF NAVIGATION 83/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 40/50
Affirmative Defense........................................................................................................................ 10/15 Adding New Conditions.............................................................................................................. 5/10
Parental Rights Protections..................................................................................................... 15/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 10/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 3/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 10/10
Reciprocity............................................................................................................................................. 3/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 86/100
Allows Distribution Programs................................................................................................ 34/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 82/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 45/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 15/15
– Ownership/Employment Restrictions................................................................................ 2/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 9/10
– Environmental Impact Regulations...................................................................................... 2/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 5/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 3/3
Noncommercial Cultivation..................................................................................................... 15/20
Covered by Insurance/State Health Aid........................................................................ 0/5
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 0/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 7/10

Base Categories Points: .....................................................336

Opioid Response Points: ...................................................7.5
Points Total: .............................................................................................343.84/500
Score Percentage: ........................................................................68.6%
FINAL GRADE D+
60
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 CNMI

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 17.10/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 0/7
Dispensing 3.34/25 – Is doctor education on opioids available through the state’s department of health?...... 0/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 0/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 0/2
– Storage Protocols................................................................................................................................. 0/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 0/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 0/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 3.34/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 0/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 4/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 Governor Ralph Torress (R) signed a cannabis law in September of 2018.
– Reasonable Security Protocols.................................................................................................... 0/0.71 The program is currently being developed. Patients who do not wish to
– Batch and Lot Tracking..................................................................................................................... 0/0.71
cultivate their own cannabis will not be required to obtain an ID card,
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 only a physician’s recommendation.
Pesticide Guidance.............................................................................................................................. 0/5
– Pesticide Guidance.............................................................................................................................. 0/2.5
– Pesticide Labeling................................................................................................................................
Required Testing....................................................................................................................................
0/2.5
3.75/5
Opioid Response
– Active Ingredient Identification.................................................................................................... 1.25/1.25 ASA applauds the CNMI for including debilitating pain as a qualifying
– Contaminants.......................................................................................................................................... 1.25/1.25 condition but notes that opioid use disorder is missing from the territory’s
– Potency....................................................................................................................................................... 1.25/1.25
qualifying condition list. The WHO estimates that 22.5 % of the islands’
– Sample Retention................................................................................................................................. 0/1.25
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 residents use cannabis, but there is a noticeable lack of data from the
U.S. Department of Health and Human Services (HHS) about the number
Manufacturing 5/25 of opioid overdoses on the islands. The territory only recieved $135,000
Staff Training............................................................................................................................................. 0/5
to fight the opioid crisis as part of the Federal Government’s block grant
Standard Operating Procedures............................................................................................... 0/5 program, or the equivalent of $2.60/person for the whole year.
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
– Workforce Safety Protocols .......................................................................................................... 0/1
– Storage Protocols ................................................................................................................................ 0/1
– Reasonable Security Protocols.................................................................................................... 0/1
Patient Feedback
– Batch and Lot Tracking..................................................................................................................... 0/1 We did not receive responses to our patient feedback survey from the
Product Labeling................................................................................................................................... 5/5 CNMI.
– Product Contents, Including Source Material Identification.................................... 1.67/1.67
– Allergens..................................................................................................................................................... 1.67/1.67
– Potency and Compound Information ..................................................................................... 1.67/1.67
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1
– Contaminants.......................................................................................................................................... 0/1
– Potency....................................................................................................................................................... 0/1
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 0/1
Recall Protocol and Adverse Event Reporting.............................................................. 0/5

Laboratory Operations 5/25

Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 0/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

61
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

CONNECTICUT
2018-2019 IMPROVEMENTS
C+
As of June 1, Connecticut had 33,679 patients that were served by only nine
dispensary facilities. Much of the legislative focus in Connecticut in 2018-2019
focused on an adult-use cannabis bill that never materialized. Unfortunately,
with all the effort and energy put into adult-use legislation, some of the problems
in the state’s medical program remained unaddressed. Connecticut did add
osteogenesis imperfecta, intractable headaches, rheumatoid arthritis, muscular
dystrophy, and neuropathic pain associated with degenerative spinal disorders
as qualifying conditions. Additionally, a federal judge ruled in favor of a medical
cannabis patient who sued a would-be employer for rescinding a job offer due to
her state-legal medical cannabis use.

2015 2016 2017 2018-19

C+ B- B- C+

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 74/100 EASE OF NAVIGATION 83/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 44/50
Affirmative Defense........................................................................................................................ 13/15 Adding New Conditions.............................................................................................................. 10/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 5/5
Employment Protections............................................................................................................ 5/5 Reasonable Access for Minors.............................................................................................. 7/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 5/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 4/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 7/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 4/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 66/100
Allows Distribution Programs................................................................................................ 26/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 77/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 4/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 4/5 Dispensaries or by Cultivation.......................................................................................... 45/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 14/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 3/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 0/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 10/10

Base Categories Points: .....................................................377

Opioid Response Points: ...................................................16.5
Points Total: .............................................................................................341/500
Score Percentage: ........................................................................78.73%
FINAL GRADE C+
62
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 CONNECTICUT

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 77/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 23/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 2.67/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 2/5
– Potency/Compound Identification............................................................................................ 1/1.67 – Is there a veteran discount?.................................................................................................................................. 1/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 2.5/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 19/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 4/5
– Facility and Equipment Sanitary Conditions...................................................................... 0.71/0.71 Background
– Workforce Safety Protocols .......................................................................................................... 0/0.71
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In 2012, Connecticut became the 17th medical cannabis state with the
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 signing of HB 5380, An Act Concerning the Palliative Use of Marijuana.
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71 HB 5389 provides registered patients with protection from arrest when
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71
using or possessing up to a one-month supply of medical cannabis in
Pesticide Guidance.............................................................................................................................. 5/5 accordance with the law and allows them to designate caregivers to
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 assist them. Patients and caregivers registered with the Department of
– Pesticide Labeling................................................................................................................................ 2.5/2.5 Consumer Protection may purchase medical cannabis from state-licensed
Required Testing.................................................................................................................................... 5/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25
dispensaries, but no personal cultivation is allowed. Final regulations were
– Contaminants.......................................................................................................................................... 1.25/1.25 issued in 2013, and dispensaries began offering medicine in September
– Potency....................................................................................................................................................... 1.25/1.25 2014, with six dispensaries opening throughout the state. In 2016, three
– Sample Retention................................................................................................................................. 1.25/1.25 additional dispensaries were licensed, six new conditions were added to
Recall Protocol and Adverse Event Reporting.............................................................. 5/5
the program, and the legislature passed HB 5450, which allows minors to
qualify for the medical cannabis program under some restrictions, creates
Manufacturing 18/25 protections for nurses to administer medical cannabis in health care
Staff Training............................................................................................................................................. 0/5
facilities, and allows dispensaries to provide medical cannabis to medical
Standard Operating Procedures............................................................................................... 4/5
– Facility and Equipment Sanitary Conditions...................................................................... 0/1 facilities serving registered medical cannabis patients. Connecticut did not
– Workforce Safety Protocols .......................................................................................................... 1/1 make any improvements to its program in 2017 through the legislature. As
– Storage Protocols ................................................................................................................................ 1/1 is noted above, a 2018 court case (Noffsinger v. SSC Niantic Operating Co.,
– Reasonable Security Protocols.................................................................................................... 1/1
LLC) reaffirmed employee rights for medical cannabis patients by clarifying
– Batch and Lot Tracking..................................................................................................................... 1/1
Product Labeling................................................................................................................................... 5/5 that federal law does not preclude enforcement of a Connecticut law that
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 prohibits employers from firing or refusing to hire someone who uses
– Allergens..................................................................................................................................................... 1.67/1.67 cannabis for medical purposes.
– Potency and Compound Information ..................................................................................... 1.67/1.67
Required Testing.................................................................................................................................... 4/5
– Active Ingredient Identification.................................................................................................... 1/1
Opioid Response
– Contaminants.......................................................................................................................................... 1/1 It is absolutely critical that Connecticut add chronic pain to its list of
– Potency....................................................................................................................................................... 1/1 qualifying conditions. In early 2019, Connecticut regulators considered
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 1/1 adding chronic pain, but ultimately put off making a decision. There were
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 961 opioid overdose deaths in Connecticut in 2017 and an additional 948 in
2018; as of 2017, Connecticut had the tenth-highest opioid overdose death
Laboratory Operations 17.49/25 rate in the country. Further, Hartford, CT has one of the highest urban
Staff Training............................................................................................................................................. 5/5 overdose rates in the country.
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 5/5 Patient Feedback
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 2.49/5 Patients expressed frustration that there is inconsistent product availability
– Equipment and Instrument Calibration.................................................................................. 0/0.83 and that it is difficult to find the same products that worked for them before
– Sample Tracking.................................................................................................................................... 0.83/0.83 in dispensaries. Medical cannabis is not permitted in any hospitals. Home-
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
bound patients are eager for home delivery to be available to them. Patients
– Storage Protocols................................................................................................................................. 0.83/0.83 report that it is still too expensive to be a medical cannabis patient; in order
– Workforce Safety Protocols .......................................................................................................... 0/0.83 to obtain a medical card, patients must spend more than $100, and taxes on
medical cannabis are too high. Patients are concerned about product and
cultivar scarcity because they have not seen any plans from the state to add
more growers and producers to keep up with demand.

63
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

DELAWARE
2018-2019 IMPROVEMENTS C+
It is estimated that there will be approximately 9,000 patients in Delaware’s program by the
end of the 2019 fiscal year. However, despite these numbers, Delaware only made a few
modest program improvements in 2018-2019. In 2018, HB 374 added glaucoma, chronic
debilitating migraines, pediatric autism spectrum disorder, and pediatric sensory processing
disorder to the state’s list of qualifying conditions. The state also passed a bill that approved
mandatory expungements for certain cannabis offenses. At the end of 2018, a judge
allowed a medical cannabis patient to move forward with a discrimination case against his
employer. In 2019, Delaware approved a bill for the expungement of cannabis offenses that
are now legal under the state’s medical program.

The Delaware medical cannabis program would be greatly improved with an overhaul of
product safety protocols and the issuance of more distribution licenses to increase access
in the state.
2015 2016 2017 2018-19

C+ C+ C+ C+

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 93/100 EASE OF NAVIGATION 85/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 46/50
Affirmative Defense........................................................................................................................ 13/15 Adding New Conditions.............................................................................................................. 8/10
Parental Rights Protections..................................................................................................... 10/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 3/5
Employment Protections............................................................................................................ 5/5 Reasonable Access for Minors.............................................................................................. 8/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... 5/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 7/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 4/5
ACCESS TO MEDICINE 66/100
Allows Distribution Programs................................................................................................ 33/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 78/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 4/5 Dispensaries or by Cultivation.......................................................................................... 42/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 1/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 5/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 5/10
Does Not Impose Bans or Limits on THC..................................................................... 9/10
Does Not Impose Bans on CBD............................................................................................ 9/10
Local Bans/Zoning.......................................................................................................................... 10/10

Base Categories Points: .....................................................377.26

Opioid Response Points: ...................................................14
Points Total: .............................................................................................391.26/500
Score Percentage: ........................................................................78.25%
FINAL GRADE C+
64
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 DELAWARE

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 56.6/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 6/7
Dispensing 16.59/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 2/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 1/2
Standard Operating Procedures............................................................................................... 3.25/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 3/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 3.34/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 1/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 2.5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 18.84/25
Staff Training............................................................................................................................................. 3/5
Standard Operating Procedures............................................................................................... 2.84/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In 2011, the Delaware state legislature approved Senate Bill 17, the
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 Delaware Medical Marijuana Act, making it legal for a patient with
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
a registration identification card to use and possess cannabis for
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 medical purposes and to designate a caregiver. Registered patients and
Pesticide Guidance.............................................................................................................................. 4/5 designated caregivers may possess up to six ounces of usable cannabis,
– Pesticide Guidance.............................................................................................................................. 2/2.5 but no personal cultivation is allowed. Qualifying patients and caregivers
– Pesticide Labeling................................................................................................................................ 2/2.5
are protected from discrimination in employment, education, housing,
Required Testing.................................................................................................................................... 5/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 parental rights, and medical care, including organ transplants. Delaware
– Contaminants.......................................................................................................................................... 1.25/1.25 lawmakers adopted regulations for the Medical Marijuana Program in
– Potency....................................................................................................................................................... 1.25/1.25 2012; however, before the regulations were finalized, the program was
– Sample Retention................................................................................................................................. 1.25/1.25
suspended by Governor Jack Markell as the result of a letter sent to him
Recall Protocol and Adverse Event Reporting.............................................................. 4/5
from the U.S. Attorney for Delaware threatening legal action against state
employees. In August 2013, Governor Markell lifted the suspension, and
Manufacturing 13.34/25
the Department of Health and Social Services completed the process
Staff Training............................................................................................................................................. 3/5
Standard Operating Procedures............................................................................................... 4/5
of implementing regulations. The state’s first compassion center was
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 opened in 2014.
– Workforce Safety Protocols .......................................................................................................... 0/1
– Storage Protocols ................................................................................................................................ 1/1 In 2015, three legislative updates were made to the program. SB 7 made
– Reasonable Security Protocols.................................................................................................... 1/1 technical changes to the oversight commission and SB 138 authorizes
– Batch and Lot Tracking..................................................................................................................... 1/1 research studies in the state. The most notable change was SB 90, which
Product Labeling................................................................................................................................... 3.34/5
– Product Contents, Including Source Material Identification.................................... 1.67/1.67
allows pediatric access to cannabis extract oils with less than 7% THC.
– Allergens..................................................................................................................................................... 0/1.67 In 2017, HB 219 and SB 24 were passed; the former allows minors access
– Potency and Compound Information ..................................................................................... 1.67/1.67 to the same petition process as adults to add qualifying conditions,
Required Testing.................................................................................................................................... 3/5 while the latter removes the requirement that PTSD patients obtain their
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 1/1
medical cannabis recommendations from licensed psychiatrists.
– Potency....................................................................................................................................................... 1/1
– Shelf Life Testing................................................................................................................................... 0/1 Opioid Response
– Sample Retention................................................................................................................................. 0/1
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 Delaware regulator Paul Hyland participated in the kick-off of ASA’s
End Pain, Not Lives campaign, showing a dedication to improving the
Laboratory Operations 7.83/25 Delaware medical cannabis program. While overall prescribing of opioids
Staff Training............................................................................................................................................. 2/5 decreased by about 30%, the rate of overdose deaths nearly doubled
Method Validation in Accordance with AHP Guidelines...................................... 0/5 in 2017. Delaware needs to implement better protocols for integrating
Result Reporting.................................................................................................................................... 0/5 medical cannabis as a tool against the opioid crisis.
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 0.83/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83 Patient Feedback
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83 Patients reported that product labeling varies by dispensary and that
– Disposal/Waste...................................................................................................................................... 0/0.83 labels should be standardized. The high cost of medical cannabis
– Storage Protocols................................................................................................................................. 0.83/0.83 products still keeps many medical cannabis patients from accessing their
– Workforce Safety Protocols .......................................................................................................... 0/0.83 medicine on a regular basis. Popular cultivars are often sold at the gram
price, and there is no price break for purchasing by volume. Patients
reported a desire for states to allow home cultivation for patients to
ensure consistent, affordable access.

65
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

DISTRICT OF COLUMBIA
2018-2019 IMPROVEMENTS
DC currently has 6,015 registered patients. In 2019, legislation was introduced to allow patients to have same-day
B
access to medical cannabis, but as of this writing, the legislation is still under the review of the DC Council. This
legislation would allow patients to access medical cannabis on the day their application is submitted instead of
having to wait weeks for processing. This bill also would allow for on-site consumption spaces for patients at
dispensaries and legalize delivery. Separately in 2019, after reports of Department of Corrections employees being
unlawfully denied from participating in the District’s medical cannabis program, the DC Council introduced a bill
to protect government employees from discrimination based on their status as a patient; it, too, is under review.
To address geographic disparities in access to medical cannabis, the DC Council passed emergency legislation
in December 2016 to expand the number of authorized dispensaries from five to six and to mandate that the sixth
dispensary be located in Ward 7 or Ward 8, which are areas of the District that had been underserved. The sixth
dispensary opened in Ward 8 in January 2019.
Prior to April 6, 2018, DC’s medical cannabis patients had to pick one dispensary from which to obtain medication
and this dispensary was identified on the patients’ medical cannabis cards. Patients now may go to any licensed
dispensary in DC, increasing both patient access to cannabis and the variety of cannabis and cannabis-derived
products available to each patient. Also in 2018, reciprocity was extended to patients from jurisdictions
with medical cannabis programs functionally equivalent to DC’s; as of the time of this writing, patients 2015 2016 2017 2018-19
from 19 states are able to obtain medical cannabis from one of DC’s dispensaries.
C+ B- B B

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 79/100 EASE OF NAVIGATION 93/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 50/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 10/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 5/5
Employment Protections............................................................................................................ 4/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 2/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 8/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 78/100
Allows Distribution Programs................................................................................................ 29/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 81/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 4/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 40/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 15/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 5/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 11/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 10/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 5/7
– Collective Gardening..................................................................................................................... 1/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 8/10

Base Categories Points: .....................................................397.20

Opioid Response Points: ...................................................26
Points Total: .............................................................................................423.2/500
Score Percentage: ........................................................................84.64%
FINAL GRADE B
66
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 DISTRICT OF COLUMBIA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 66.2/100 Is Cannabis Available for Treatment?........................................................................................................... 10/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 5/5
Doctor Education........................................................................................................................................................... 7/7
Dispensing 16/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 2/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 3.34/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 2/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 1/1
Required Testing.................................................................................................................................... 2.67/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 2.5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 17.5/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions...................................................................... 0.71/0.71 Background
– Workforce Safety Protocols .......................................................................................................... 0.71/0.71
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 The voters of Washington, DC first approved medical cannabis in 1998 with the
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 passage of Initiative 59 (I-59), but the law was blocked by Congressional action
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71 through a budget rider that was attached to the District’s budget every year
– Disposal/Waste...................................................................................................................................... 0.71/0.71
– Water Management............................................................................................................................ 0.71/0.71
until 2009. Once Congress dropped its opposition, the DC Council passed B18-
Pesticide Guidance.............................................................................................................................. 3/5 0622: Legalization of Marijuana for Medical Treatment of 2010 Initiative, which
– Pesticide Guidance.............................................................................................................................. 2/2.5 replaced I-59. Initially, registered patients could purchase up to two ounces of
– Pesticide Labeling................................................................................................................................ 1/2.5 usable cannabis or its equivalent in other forms (e.g., edibles, tinctures, topicals,
Required Testing.................................................................................................................................... 2.5/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25
etc.) in a 30-day period; in 2016, the purchase limit was raised to four ounces.
– Contaminants.......................................................................................................................................... 0/1.25 Patients whose income is less than 200% of the federal poverty level are
– Potency....................................................................................................................................................... 1.25/1.25 entitled to purchase medicine at a reduced rate and to pay a lower application
– Sample Retention................................................................................................................................. 0/1.25 fee when obtaining and renewing their medical cannabis cards. Registered
Recall Protocol and Adverse Event Reporting.............................................................. 2/5
cultivation centers supply medical cannabis to dispensaries. In July 2014, the
DC Council passed emergency legislation to allow physicians to recommend
Manufacturing 12.67/25 cannabis for any condition for which treatment with medical cannabis would
Staff Training............................................................................................................................................. 5/5
be beneficial and to increase the cultivation center plant limit from 95 to 500
Standard Operating Procedures............................................................................................... 4/5
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 plants. In 2015, the Council increased the plant limit to 1,000 plants.
– Workforce Safety Protocols .......................................................................................................... 0/1
– Storage Protocols ................................................................................................................................ 1/1 In November 2016, the DC Council passed B21-210, which required the
– Reasonable Security Protocols.................................................................................................... 1/1 Department of Health (DOH) to license independent laboratories for product
– Batch and Lot Tracking..................................................................................................................... 01/1 testing, removed drug conviction restrictions on individuals allowed to
Product Labeling................................................................................................................................... 2.67/5
work in dispensaries, and required the DOH to create the District-wide
– Product Contents, Including Source Material Identification.................................... 1.67/1.67
– Allergens..................................................................................................................................................... 1/1.67 tracking system that enabled the above-mentioned improvements regarding
– Potency and Compound Information ..................................................................................... 0/1.67 reciprocity and dispensary access.
Required Testing.................................................................................................................................... 1/5
– Active Ingredient Identification.................................................................................................... 1/1 Opioid Response
– Contaminants.......................................................................................................................................... 0/1
– Potency....................................................................................................................................................... 0/1 Washington, DC has a very strong program and deserves credit for being
– Shelf Life Testing................................................................................................................................... 0/1 the first jurisdiction to introduce for consideration portions of Americans
– Sample Retention................................................................................................................................. 0/1 for Safe Access’ ACT NOW legislation, which promotes cannabis as an
Recall Protocol and Adverse Event Reporting.............................................................. 0/5
option to fight the opioid crisis. Washington, DC had the third-highest opioid
Laboratory Operations 20/25 overdose death rate in the nation in 2017, underscoring the urgent need for
a comprehensive response. Additionally, the District still needs to overhaul
Staff Training............................................................................................................................................. 5/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5 regulations for manufacturers and provide civil protections for patients in
Result Reporting.................................................................................................................................... 5/5 the areas of employment protections, housing protections, and parental
Independent or Third Party........................................................................................................... 5/5 rights. Unfortunately, ongoing conversations about DC’s efforts to overcome
Standard Operating Procedures and Protocols.......................................................... 5/5 Congressional objection and create a regulated adult-use regime seem to take
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83 up much of the energy of both the Office of the Mayor and the DC Council.
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83 Patient Feedback
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83
Patients reported appreciation of DC’s reciprocity rules for patients who live
in other states. Some patients expressed concern with the quality of medical
cannabis and medical cannabis products sold at dispensaries. Patients
reported the desire for medical cannabis products to be more affordable and
for insurance companies to consider covering cannabis for medical patients.
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

FLORIDA
2018-2019 IMPROVEMENTS
C
After months of litigation and legislative arguing, patients in Florida can
finally smoke medical cannabis. However, shortly after this change,
lawmakers quickly began pushing to put a 10% THC cap on cannabis
flower. While this provision has not become law, it is clear that the Florida
legislature is keen on limiting the diversity of products available to patients.
In a win for patients, a judge in Florida ruled that the cap on dispensaries
was unconstitutional as it created an expensive distribution model which
drove up prices and restricted access. Florida currently has 307,010 total
patients but only 2,132 physicians who meet the state requirements to
recommend cannabis.

2015 2016 2017 2018-19

F C C- C

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 69/100 EASE OF NAVIGATION 75/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 45/50
Affirmative Defense........................................................................................................................ 13/15 Adding New Conditions.............................................................................................................. 7/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 2/5
Employment Protections............................................................................................................ 5/5 Reasonable Access for Minors.............................................................................................. 8/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 0/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 0/2
Does Not Create New Criminal Penalties for Patients...................................... 4/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 5/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 67/100
Allows Distribution Programs................................................................................................ 35/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 71/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 40/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 2/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 5/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 2/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 2/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 0/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 9/10
Does Not Impose Bans or Limits on THC..................................................................... 9/10
Does Not Impose Bans on CBD............................................................................................ 4/10
Local Bans/Zoning.......................................................................................................................... 8/10

Base Categories Points: .....................................................352.83

Opioid Response Points: ...................................................15
Points Total: .............................................................................................367.83/500
Score Percentage: ........................................................................73%
FINAL GRADE C
68
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 FLORIDA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 70.83/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 21.34/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 0/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 0/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 3/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1/1.67 Research............................................................................................................................................................................... 2.5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 21/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0.71/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In 2014, the Florida Legislature passed SB 1030, which created a registry
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 ID card system that would allow patients with cancer, seizure disorders,
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
or severe or persistent muscle spasms to possess and use only cannabis
– Disposal/Waste...................................................................................................................................... 0.71/0.71
– Water Management............................................................................................................................ 0.71/0.71 products rich in CBD and low in THC. SB 1030 also resulted in state
Pesticide Guidance.............................................................................................................................. 4/5 licensure of dispensing organizations. Additionally, the legislature
– Pesticide Guidance.............................................................................................................................. 2/2.5 passed HB 307, which expanded the program to terminally ill patients
– Pesticide Labeling................................................................................................................................ 2/2.5
and allowed dispensing organizations to produce products with higher
Required Testing.................................................................................................................................... 2/5
– Active Ingredient Identification.................................................................................................... 1/1.25 levels of THC than were previously allowed. In November 2016, voters
– Contaminants.......................................................................................................................................... 0/1.25 approved Amendment 2, which created a comprehensive medical
– Potency....................................................................................................................................................... 1/1.25 cannabis program with significantly expanded qualifying conditions. In a
– Sample Retention................................................................................................................................. 0/1.25
2017 emergency session, the legislature passed SB 8A, which provides a
Recall Protocol and Adverse Event Reporting.............................................................. 5/5
framework for patients to access cannabis more quickly. On July 3, 2017,
the Florida Department of Health promulgated rules for implementing
Manufacturing 21/25
SB 8A. Florida passed several improvements to its program in 2017 as
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
it continued to move through the implementation of Amendment 2, but
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 the Florida Legislature adversely changed what voters decided on and
– Workforce Safety Protocols .......................................................................................................... 1/1 should return to language passed in Amendment 2. In addition, the state
– Storage Protocols ................................................................................................................................ 1/1 should implement a financial hardship waiver, which it currently lacks.
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1
Product Labeling................................................................................................................................... 2/5 Opioid Response
– Product Contents, Including Source Material Identification.................................... 1/1.67 Florida had 5,088 opioid overdose deaths in 2017, putting the state
– Allergens..................................................................................................................................................... 0/1.67
slightly above the national average. Florida is one of 13 states that has not
– Potency and Compound Information ..................................................................................... 1/1.67
Required Testing.................................................................................................................................... 4/5 completed a Centers for Disease Control and Prevention (CDC) opioid-
– Active Ingredient Identification.................................................................................................... 1/1 prescribing consultation, which includes a review of the 2016 opioid
– Contaminants.......................................................................................................................................... 1/1 prescribing guidelines that recommend that doctors do not test for THC
– Potency....................................................................................................................................................... 1/1
or other cannabinoids at pain clinics.
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 1/1
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 Patient Feedback
Patients reported that the cost of medical cannabis is a big issue and the
Laboratory Operations 7.49/25 desire to have insurance companies cover the costs of visits to medical
Staff Training............................................................................................................................................. 0/5 providers and of medical cannabis products. Further, patients expressed
Method Validation in Accordance with AHP Guidelines...................................... 0/5 frustration over the fact that insurance companies currently cover opioids
Result Reporting.................................................................................................................................... 5/5
Independent or Third Party........................................................................................................... 0/5 but not medical cannabis products. Some patients also reported concern
Standard Operating Procedures and Protocols.......................................................... 2.49/5 about their loss of 2nd Amendment rights due to their status as medical
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83 cannabis patients. Many patients reported that they want to be able
– Sample Tracking.................................................................................................................................... 0.83/0.83 to grow their own medical cannabis so that their products are free of
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83 pesticides and other chemicals.
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

69
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

GEORGIA
2018-2019 IMPROVEMENTS
F
Georgia had significant improvements to its program over the last year.
Notably, the state added PTSD and intractable pain to its list of qualifying
conditions. In the spring of 2019, Georgia finally passed a bill that allows in-
state cultivation and distribution of low-THC medical cannabis products. Even
so, the state still severely limits what types of products are available to patients
by only allowing for up to 20 ounces of low-THC cannabis oil (containing no
more than 5% THC).

Georgia needs to allow access to forms other than oil, expand access to
products that have varying levels of THC, and allow more people to participate
in the program.

2015 2016 2017 2018-19

F F F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 54/100 EASE OF NAVIGATION 73/100

Arrest Protection.............................................................................................................................. 30/40 Comprehensive Qualifying Conditions.......................................................................... 40/50
Affirmative Defense........................................................................................................................ 10/15 Adding New Conditions.............................................................................................................. 0/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 8/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 1/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 10/10
Reciprocity............................................................................................................................................. 2/3 Allows Multiple-Year Registrations .................................................................................. 2/2
Reasonable Physician Requirements.............................................................................. 4/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 2/5
ACCESS TO MEDICINE 15/100
Allows Distribution Programs................................................................................................ 0/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 55/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 0/5 Dispensaries or by Cultivation.......................................................................................... 30/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 0/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 3/10
Does Not Impose Bans or Limits on THC..................................................................... 5/10
Does Not Impose Bans on CBD............................................................................................ 7/10
Local Bans/Zoning.......................................................................................................................... 0/10

Base Categories Points: .....................................................197

Opioid Response Points: ...................................................12
Points Total: .............................................................................................209/500
Score Percentage: ........................................................................41.80%
FINAL GRADE F
70
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 GEORGIA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 0/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 0/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 0/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 0/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 0/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 0/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 0/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 0/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 0/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 In 2015, the Georgia legislature passed HB1, which created a patient
– Reasonable Security Protocols.................................................................................................... 0/0.71 ID card registry and established a list of eight qualifying conditions
– Batch and Lot Tracking..................................................................................................................... 0/0.71
for which patients could legally possess and use low-THC medical
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 cannabis products. The law places a 5% cap on THC and requires
Pesticide Guidance.............................................................................................................................. 0/5 products to have at least a 1:1 ratio of CBD to THC. The law did not
– Pesticide Guidance.............................................................................................................................. 0/2.5 provide for in-state production or access, but it did create the Georgia
– Pesticide Labeling................................................................................................................................ 0/2.5
Medical Cannabis Commission, which was tasked with investigating
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1.25 other state programs to come up with a legislative proposal. In
– Contaminants.......................................................................................................................................... 0/1.25 December 2015, the commission voted against in-state production of
– Potency....................................................................................................................................................... 0/1.25 cannabis. In May of 2017, SB 16 added six more qualifying conditions to
– Sample Retention................................................................................................................................. 0/1.25
the program and allowed patients in hospice care to possess oil.
Recall Protocol and Adverse Event Reporting.............................................................. 0/5
Patients in Georgia still have great difficulty accessing medicine
Manufacturing 0/25 because the in-state distribution system is not yet operational. In
Staff Training............................................................................................................................................. 0/5 addition to getting the in-state distribution off the ground, Georgia
Standard Operating Procedures............................................................................................... 0/5 could greatly improve its program by strengthening product safety
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
– Workforce Safety Protocols .......................................................................................................... 0/1
standards, increasing the forms of medical cannabis and medical
– Storage Protocols ................................................................................................................................ 0/1 cannabis products available to patients, and removing arbitrary limits
– Reasonable Security Protocols.................................................................................................... 0/1 on products’ THC percentage.
– Batch and Lot Tracking..................................................................................................................... 0/1
Product Labeling...................................................................................................................................
– Product Contents, Including Source Material Identification....................................
0/5
0/1.67
Opioid Response
– Allergens..................................................................................................................................................... 0/1.67 In 2017, there were 1,014 overdose deaths involving opioids in
– Potency and Compound Information ..................................................................................... 0/1.67 Georgia—a rate of 9.7 deaths per 100,000 persons, compared to the
Required Testing.................................................................................................................................... 0/5
national rate of 14.6 deaths per 100,000 persons. While Georgia was
– Active Ingredient Identification.................................................................................................... 0/1
– Contaminants.......................................................................................................................................... 0/1 below the national average, in May of 2019 there was a 17.1% increase in
– Potency....................................................................................................................................................... 0/1 the count of drug overdoses among those aged 35-44 compared to the
– Shelf Life Testing................................................................................................................................... 0/1 same month last year. If Georgia allowed for a more inclusive cannabis
– Sample Retention................................................................................................................................. 0/1
program, it could see a reduction in emergency department visits and
Recall Protocol and Adverse Event Reporting.............................................................. 0/5
opioid overdose deaths.
Laboratory Operations 0/25
Patient Feedback
Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5 Even though there is a medical cannabis program in Georgia, the
Result Reporting.................................................................................................................................... 0/5 program is currently limited to low-THC oil only.
Independent or Third Party........................................................................................................... 0/5
Standard Operating Procedures and Protocols.......................................................... 0/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

71
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

GUAM
2018-2019 IMPROVEMENTS C
Delays in the implementation of the medical program in Guam have frustrated patients. Due
to a slow rollout, former Governor Calvo signed a bill that allows home cultivation for patients,
though this will only apply until dispensaries on the island are operational. Calvo also signed a
bill that provided for independent laboratory testing and allowed non-residents to participate
in the territory’s medical cannabis program. In 2019, Governor Lou Leon Guerrero signed a bill
that legalized cannabis on the island for non-medical use. When signing the bill, the Governor
indicated that she was establishing a Medical Cannabis Regulation Commission to ensure
patients were protected.

Guam deserves credit for allowing physicians to recommend medical cannabis for any
qualifying condition, but, it needs to open dispensaries and address administrative delays
to effectively serve patients. The territory illustrates that a good program on paper does not
necessarily translate to patient access. Guam needs to improve its staff training in cannabis
cultivation, dispensing, and manufacturing and increase civil rights protections in the areas of 2015 2016 2017 2018-19
housing, organ transplants, and employment.
NA NA C- C

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 78/100 EASE OF NAVIGATION 91/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 50/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 10/10
Parental Rights Protections..................................................................................................... 9/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 5/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 8/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 2/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 4/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 7/10
Reciprocity............................................................................................................................................. 3/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 78/100
Allows Distribution Programs................................................................................................ 27/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 57/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 3/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 30/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 7/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 9/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 15/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 0/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 6/10

Base Categories Points: .....................................................368.18

Opioid Response Points: ...................................................10
Points Total: .............................................................................................378.18/500
Score Percentage: ........................................................................75.64%
FINAL GRADE C
72
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 GUAM

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 70.83/100 Is Cannabis Available for Treatment?........................................................................................................... 10/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 5/5
Doctor Education........................................................................................................................................................... 0/7
Dispensing 15/25 – Is doctor education on opioids available through the state’s department of health?...... 0/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 3.75/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 0/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 0/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 3/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 3.34/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 13/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 2.84/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In 2013, Guam passed Public Law 33-220, known as the “Joaquin
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 Concepcion, II Compassionate Use of Cannabis Act,” which allowed
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
for the medical use of cannabis. The Joaquin Concepcion Act has
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 been amended twice since its enactment, once in 2016 and once
Pesticide Guidance.............................................................................................................................. 3.5/5 again in 2017. The 2017 amendments related to the fees and taxation
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 of medical cannabis cultivation, manufacturing, and laboratory
– Pesticide Labeling................................................................................................................................ 1/2.5
facilities and created ownership restrictions for non-residents of
Required Testing.................................................................................................................................... 3.75/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 Guam. Guam requires each of its dispensaries to be certified by
– Contaminants.......................................................................................................................................... 1.25/1.25 Patient Focused Certification, a standards project of Americans
– Potency....................................................................................................................................................... 1.25/1.25 for Safe Access. Patients or caregivers may possess up to 2.5
– Sample Retention................................................................................................................................. 0/1.25
ounces of dried or prepared cannabis from a dispensary. However,
Recall Protocol and Adverse Event Reporting.............................................................. 3/5
administrative barriers and procedural delays have prevented the
program from effectively serving patients.
Manufacturing 16/25
Staff Training.............................................................................................................................................
Standard Operating Procedures...............................................................................................
0/5
4/5
Opioid Response
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 Insufficient data is available to assess Guam’s response to the
– Workforce Safety Protocols .......................................................................................................... 0/1 opioid crisis.
– Storage Protocols ................................................................................................................................ 1/1
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1
Patient Feedback
Product Labeling................................................................................................................................... 5/5 Patients reported frustration by the lack of medical providers who are
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 willing to recommend medical cannabis. Due to this, many patients
– Allergens..................................................................................................................................................... 1.67/1.67
– Potency and Compound Information ..................................................................................... 1.67/1.67 stated they were forced to seek cannabis from the illicit market.
Required Testing.................................................................................................................................... 4/5
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 1/1
– Potency....................................................................................................................................................... 1/1
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 1/1
Recall Protocol and Adverse Event Reporting.............................................................. 3/5

Laboratory Operations 20/25

Staff Training............................................................................................................................................. 5/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 5/5
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 5/5
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83

73
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

HAWAII
2018-2019 IMPROVEMENTS
B+
As of June 1, 2019, Hawaii had 26,125 patients enrolled. Although Hawaii’s
program has been law for nearly 20 years, the state didn’t approve its
first medical cannabis production and dispensary facilities until 2018.
Unfortunately, with Hawaii’s slow rollout, there have also been product
safety problems. An October 2018 report revealed that 20% of products
failed laboratory testing. In 2019, Hawaii announced that registrations could
be valid for up to three years and that out-of-state patients could now
obtain medicine in Hawaii.

2015 2016 2017 2018-19

B B B+ B+

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 94/100 EASE OF NAVIGATION 94/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 48/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 9/10
Parental Rights Protections..................................................................................................... 10/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 4/5
Employment Protections............................................................................................................ 5/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 5/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 4/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 9/10
Reciprocity............................................................................................................................................. 3/3 Allows Multiple-Year Registrations .................................................................................. 2/2
Reasonable Physician Requirements.............................................................................. 4/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 82/100
Allows Distribution Programs................................................................................................ 27/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 83/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 4/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 45/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 14/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 7/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 18/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 4/7
– Collective Gardening..................................................................................................................... 3/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 7/10

Base Categories Points: .....................................................431.18

Opioid Response Points: ...................................................17
Points Total: .............................................................................................448.18/500
Score Percentage: ........................................................................89.64%
FINAL GRADE B+
74
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 HAWAII

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 78.18/100 Is Cannabis Available for Treatment?........................................................................................................... 15/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 18.34/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 3.34/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 2.5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 01.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 18.5/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions...................................................................... 0.71/0.71
Background
– Workforce Safety Protocols .......................................................................................................... 0.71/0.71 In 2000, Hawaii passed SB 862/HD 1, making it the first state to legalize medical
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 cannabis via the legislative (rather than the voter-initiated) process. The
– Reasonable Security Protocols.................................................................................................... 0.71/0.71
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
legislature amended the law in 2013 with two bills. HB 668 moved the medical
– Disposal/Waste...................................................................................................................................... 0.71/0.71 cannabis program from the Department of Public Safety to the Department
– Water Management............................................................................................................................ 0.71/0.71 of Health and established a medical marijuana registry special fund. SB 642
Pesticide Guidance.............................................................................................................................. 3.5/5 defined “adequate supply,” “medical use,” “primary caregiver,” “usable marijuana,”
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 and “written certification,” amended registration requirements, and created a
– Pesticide Labeling................................................................................................................................ 1/2.5
Required Testing.................................................................................................................................... 5/5
mechanism for law enforcement to immediately verify registration status 24
– Active Ingredient Identification.................................................................................................... 1.25/1.25 hours a day, seven days a week. Prior to the effective date of SB 642, “adequate
– Contaminants.......................................................................................................................................... 1.25/1.25 supply” was defined as up to seven plants (no more than three of which could
– Potency....................................................................................................................................................... 1.25/1.25 be mature) and one ounce of usable cannabis per each mature plant; after the
– Sample Retention................................................................................................................................. 1.25/1.25 legislation took effect on January 2, 2015, registered medical cannabis patients
Recall Protocol and Adverse Event Reporting.............................................................. 0/5
and their registered caregivers could possess up to four ounces of usable
cannabis and cultivate up to seven plants, whether mature or immature.
Manufacturing 17.34/25
In 2015, the legislature passed two more bills that improved the medical
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
cannabis program. HB 321 created a program allowing eight medical
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 marijuana dispensaries with two cultivation licenses each and allowing
– Workforce Safety Protocols .......................................................................................................... 1/1 more dispensaries to be licensed after October 1, 2017. SB 1291 clarified anti-
– Storage Protocols ................................................................................................................................ 1/1 discrimination protections for patients.
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1 In 2016, the legislature passed HB 2707, which created a legislative oversight
Product Labeling................................................................................................................................... 3.34/5 group to monitor the program and report back to the legislature before the
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 2018 session. The bill also expanded the allowed delivery methods and
– Allergens..................................................................................................................................................... 0/1.67 protections for medical cannabis paraphernalia.
– Potency and Compound Information ..................................................................................... 1.67/1.67
Required Testing.................................................................................................................................... 4/5 2017 brought significant improvements for Hawaii’s medical cannabis program,
– Active Ingredient Identification.................................................................................................... 1/1 including legislation that expanded the number of plants an individual
– Contaminants.......................................................................................................................................... 1/1 can grow (from seven to 10 at any stage of growth), amended laboratory
– Potency....................................................................................................................................................... 1/1 certification standards, and added four new qualifying conditions. Hawaii
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 1/1
also improved its petition process for adding qualifying conditions, provided
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 clarifications about patient privacy, and developed a state-sanctioned cashless
purchasing system for medical cannabis. The state also deserves credit for
Laboratory Operations 24/25 making technical changes to its program by replacing the word “marijuana”
Staff Training............................................................................................................................................. 5/5 with “cannabis” in their statutes.
Method Validation in Accordance with AHP Guidelines...................................... 5/5
Result Reporting.................................................................................................................................... 4/5 Opioid Response
Independent or Third Party........................................................................................................... 5/5 A major problem in Hawaii’s program is that chronic pain is not a qualifying
Standard Operating Procedures and Protocols.......................................................... 5/5
condition. While Hawaii allows for medical cannabis to be used to treat severe
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83 pain, the state needs to not overly limit the definition as it may exclude certain
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83 patients. However, Hawaii has one of the lowest rates of opioid overdose
– Disposal/Waste...................................................................................................................................... 0.83/0.83 deaths in the nation at a rate of 3.4 per 100,000 persons.
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83
Patient Feedback
Patients reported that because there are only a handful of dispensaries in the
state, and some islands do not have any dispensaries, some patients must grow
their own cannabis. Some growers also indicated that they were unhappy with
the quality of the medical cannabis seeds to which they have access.
75
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

IDAHO
F

2015 2016 2017 2018-19

F F F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 0/100 EASE OF NAVIGATION 0/100

Arrest Protection.............................................................................................................................. 0/40 Comprehensive Qualifying Conditions.......................................................................... 0/50
Affirmative Defense........................................................................................................................ 0/15 Adding New Conditions.............................................................................................................. 0/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 0/10
Explicit Privacy Standards........................................................................................................ 0/7 Reasonable Caregiver Background Checks.............................................................. 0/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 0/2
Does Not Create New Criminal Penalties for Patients...................................... 0/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 0/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 0/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 0/5
ACCESS TO MEDICINE 0/100
Allows Distribution Programs................................................................................................ 0/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 0/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 0/5 Dispensaries or by Cultivation.......................................................................................... 0/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 0/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 0/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 0/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 0/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 0/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 0/10
Does Not Impose Bans or Limits on THC..................................................................... 0/10
Does Not Impose Bans on CBD............................................................................................ 0/10
Local Bans/Zoning.......................................................................................................................... 0/10

Base Categories Points: .....................................................0

Opioid Response Points: ...................................................5
Points Total: .............................................................................................5/500
Score Percentage: ........................................................................1%
FINAL GRADE F
76
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 IDAHO

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 0/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 0/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 0/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 0/2
– Storage Protocols................................................................................................................................. 0/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 0/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 0/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 0/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 0/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 0/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 0/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 Idaho is one of three remaining states without any type of medical
– Reasonable Security Protocols.................................................................................................... 0/0.71 cannabis program. Activists are currently working on gathering
– Batch and Lot Tracking..................................................................................................................... 0/0.71
signatures to get a medical cannabis ballot initiative question on the
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 2020 ballot. However, the state has recently made it more difficult to
Pesticide Guidance.............................................................................................................................. 0/5 certify citizen initiatives.
– Pesticide Guidance.............................................................................................................................. 0/2.5
– Pesticide Labeling................................................................................................................................ 0/2.5 Opioid Response
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1.25 In 2017, Idaho providers wrote 70.3 opioid prescriptions for every 100
– Contaminants.......................................................................................................................................... 0/1.25 persons. While this is the lowest number for the state in 10 years,
– Potency....................................................................................................................................................... 0/1.25 it remains well above the national average. In addition to legalizing
– Sample Retention................................................................................................................................. 0/1.25
Recall Protocol and Adverse Event Reporting.............................................................. 0/5
cannabis in any form, the state needs to increase access to publicly
funded medication-assisted treatment programs.
Manufacturing 0/25
Patient Feedback
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5 Patients report that it is unacceptable for medical cannabis to be
– Facility and Equipment Sanitary Conditions...................................................................... 0/1 illegal in Idaho.
– Workforce Safety Protocols .......................................................................................................... 0/1
– Storage Protocols ................................................................................................................................ 0/1
– Reasonable Security Protocols.................................................................................................... 0/1
– Batch and Lot Tracking..................................................................................................................... 0/1
Product Labeling................................................................................................................................... 0/5
– Product Contents, Including Source Material Identification.................................... 0/1.67
– Allergens..................................................................................................................................................... 0/1.67
– Potency and Compound Information ..................................................................................... 0/1.67
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1
– Contaminants.......................................................................................................................................... 0/1
– Potency....................................................................................................................................................... 0/1
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 0/1
Recall Protocol and Adverse Event Reporting.............................................................. 0/5

Laboratory Operations 0/25

Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 0/5
Standard Operating Procedures and Protocols.......................................................... 0/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

77
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

ILLINOIS
2018-2019 IMPROVEMENTS A-
As of June 2019, Illinois had approximately 65,000 patients. Illinois is making a case
to be recognized as the strongest medical cannabis program in the country. In 2018,
the state began to allow medical cannabis in schools and allowed for anyone with
a prescription for opioids to trade in that prescription for medical cannabis. In 2019,
Illinois became the first state to legalize the non-medical use of cannabis through
the legislature. This legislation allows patients to cultivate up to five plants at home
and will exempt patients from taxes once Illinois’ adult-use market is in place. The
Illinois legislature also made the medical program permanent, added new qualifying
conditions, and allowed nurse practitioners and physician assistants to issue
recommendations. As of February 1, 2019, patients who submit Medical Cannabis
Registry Card applications online receive provisional access to a licensed dispensary
within 24 hours of completing the application process.

2015 2016 2017 2018-19

B+ B+ B+ A-

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 94/100 EASE OF NAVIGATION 92/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 48/50
Affirmative Defense........................................................................................................................ 13/15 Adding New Conditions.............................................................................................................. 10/10
Parental Rights Protections..................................................................................................... 10/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 5/5 – System Works for Adding New Conditions.................................................................... 5/5
Employment Protections............................................................................................................ 5/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... 5/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 4/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 7/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 2/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 4/5
ACCESS TO MEDICINE 85/100
Allows Distribution Programs................................................................................................ 32/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 75/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 40/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 2/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 2/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 15/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 5/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 8/10

Base Categories Points: .....................................................434.83

Opioid Response Points: ...................................................26.5
Points Total: .............................................................................................461.33/500
Score Percentage: ........................................................................92.27%
FINAL GRADE A-
78
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 ILLINOIS

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 89/100 Is Cannabis Available for Treatment?........................................................................................................... 15/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 5/5
– Does the state allow for opioid use disorder?........................................................................................... 5/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 23/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 3/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 2.5/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 2/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 1/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 25/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0.71/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In 2013, the Compassionate Use of Medical Cannabis Pilot Program
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 Act (HB 1) was enacted to create a temporary statewide distribution
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
program for qualifying patients. HB 1 specifies 35 qualifying conditions,
– Disposal/Waste...................................................................................................................................... 0.71/0.71
– Water Management............................................................................................................................ 0.71/0.71 but excludes chronic pain, the leading indication for the use of medical
Pesticide Guidance.............................................................................................................................. 5/5 cannabis. HB 1 allows patients to purchase up to 2.5 ounces of
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 cannabis every two weeks from a dispensing organization. Cultivation
– Pesticide Labeling................................................................................................................................ 2.5/2.5
by patients or their caregivers of up to five plants will be permitted
Required Testing.................................................................................................................................... 5/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 beginning January 1, 2020. Public safety officials, school bus and
– Contaminants.......................................................................................................................................... 1.25/1.25 commercial drivers, police and correctional officers, firefighters, and
– Potency....................................................................................................................................................... 1.25/1.25 those convicted of a drug-related felony are not eligible for the program.
– Sample Retention................................................................................................................................. 1.25/1.25
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 The Joint Committee on Administrative Rules approved final rules for
the pilot program on July 15, 2014 with input from the Departments
Manufacturing 25/25 of Agriculture, Financial and Professional Regulation, Public Health,
Staff Training............................................................................................................................................. 5/5 and Revenue. The state’s first dispensaries began serving patients in
Standard Operating Procedures............................................................................................... 5/5 November 2015. In 2016, the legislature passed SB 10, which extended
– Facility and Equipment Sanitary Conditions...................................................................... 1/1
– Workforce Safety Protocols .......................................................................................................... 1/1
the sunset clause for the program to 2020, added PTSD and terminal
– Storage Protocols ................................................................................................................................ 1/1 illness as qualifying conditions, established a petition process for
– Reasonable Security Protocols.................................................................................................... 1/1 adding new conditions, amended the process by which physicians
– Batch and Lot Tracking..................................................................................................................... 1/1 certify patients, and extended the registration identification card validity
Product Labeling................................................................................................................................... 5/5
– Product Contents, Including Source Material Identification.................................... 1.67/1.67
period from one year to three years.
– Allergens..................................................................................................................................................... 1.67/1.67
– Potency and Compound Information ..................................................................................... 1.67/1.67 Opioid Response
Required Testing.................................................................................................................................... 5/5
Illinois should be seen as a leader for having passed SB 336 in 2018.
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 1/1 It allows those who have been or could be prescribed an opioid
– Potency....................................................................................................................................................... 1/1 medication to exchange the prescription for a medical cannabis
– Shelf Life Testing................................................................................................................................... 1/1 card that is valid for 90 days and renewable. This is a model that
– Sample Retention................................................................................................................................. 1/1
ASA proposes be adopted nationally. In 2017, there were 2,202 drug
Recall Protocol and Adverse Event Reporting.............................................................. 5/5
overdose deaths involving opioids in Illinois—a rate of 17.2 deaths per
Laboratory Operations 15.83/25 100,000 persons, which is higher than the national rate of 14.6 deaths
per 100,000 persons.
Staff Training............................................................................................................................................. 5/5
Method Validation in Accordance with AHP Guidelines...................................... 5/5
Result Reporting.................................................................................................................................... 0/5 Patient Feedback
Independent or Third Party........................................................................................................... 5/5 Illinois patient’s reported that many of them still struggle to get patients
Standard Operating Procedures and Protocols.......................................................... 0.83/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83 ID cards in a timely manner. Patients reported being frustrated that
– Sample Tracking.................................................................................................................................... 0.83/0.83 medical cannabis products are expensive and assert that insurance
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83 companies should get involved to cover the costs for patients. Patients
– Disposal/Waste...................................................................................................................................... 0/0.83 pointed out a need for more medical providers to recommend medical
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83 cannabis and that there should be better training of dispensary staff.
Patients reported struggling to find consistent products available and
the same products that worked for them before in dispensaries.

79
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

INDIANA
2018-2019 IMPROVEMENTS F
In March of 2018, after nearly a year of confusion, Governor Holcomb signed a law
that allows low-THC hemp extract to be used and purchased by any person, so
long as the product contains not more than 0.3% THC. While the bill remains silent
on in-state manufacturing, the 2018 Farm Bill likely will address the issue of patient
access; one potentially complicating factor is the bill’s requirement that each product
have a QR code that links to product information. Indiana’s Study Committee on
Public Health, Behavioral Health, and Human Services is currently studying medical
cannabis, but little detail about this commission has been made public. Governor
Holcomb has publicly stated that he is opposed to medical cannabis.

2015 2016 2017 2018-19

NA NA F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 23/100 EASE OF NAVIGATION 51/100

Arrest Protection.............................................................................................................................. 0/40 Comprehensive Qualifying Conditions.......................................................................... 25/50
Affirmative Defense........................................................................................................................ 12/15 Adding New Conditions.............................................................................................................. 0/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 2/5 Reasonable Access for Minors.............................................................................................. 7/10
Explicit Privacy Standards........................................................................................................ 4/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 1/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 10/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 3/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 1/5
ACCESS TO MEDICINE 9/100
Allows Distribution Programs................................................................................................ 0/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 23/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 0/5 Dispensaries or by Cultivation.......................................................................................... 0/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 0/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 7/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 3/10
Does Not Impose Bans or Limits on THC..................................................................... 1/10
Does Not Impose Bans on CBD............................................................................................ 5/10
Local Bans/Zoning.......................................................................................................................... 0/10

Base Categories Points: .....................................................116

Opioid Response Points: ...................................................5
Points Total: .............................................................................................121/500
Score Percentage: ........................................................................24.20%
FINAL GRADE F
80
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 INDIANA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 10/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 5/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 0/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 0/2
– Storage Protocols................................................................................................................................. 0/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 0/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 0/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 0/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 In April 2017, Governor Eric Holcomb signed a bill into law that
– Reasonable Security Protocols.................................................................................................... 0/0.71 allowed patients who were suffering from treatment resistant
– Batch and Lot Tracking..................................................................................................................... 0/0.71
epilepsy to enroll in the state’s medical cannabis program with
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 approval from their neurologist. The Indiana program limits
Pesticide Guidance.............................................................................................................................. 0/5 patients to cannabidiol preparations with 0.3% or less THC. After
– Pesticide Guidance.............................................................................................................................. 0/2.5 the law was passed, Indiana State Excise Police confiscated over
– Pesticide Labeling................................................................................................................................ 0/2.5
3,500 CBD items from 57 stores across the state, creating access
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1.25 problems that were even more significant than those that existed
– Contaminants.......................................................................................................................................... 0/1.25 before the law passed.
– Potency....................................................................................................................................................... 0/1.25
– Sample Retention................................................................................................................................. 0/1.25 Despite bordering three states with fairly effective programs, Indiana
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 did not provide any access at all to medical cannabis until the spring
of 2017. If Indiana wants to get on par with neighboring states like
Manufacturing 5/25 Michigan, Illinois, and Ohio, the program needs to include more
Staff Training............................................................................................................................................. 0/5 qualifying conditions, remove the cap on THC, expand the allowable
Standard Operating Procedures............................................................................................... 0/5 forms of medical cannabis, and increase access points.
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
– Workforce Safety Protocols .......................................................................................................... 0/1
– Storage Protocols ................................................................................................................................ 0/1 Opioid Response
– Reasonable Security Protocols.................................................................................................... 0/1 Opioid overdoses in Indiana increased 22.5% between 2016 and 2017
– Batch and Lot Tracking..................................................................................................................... 0/1
and are expected to continue to increase. Further, since 1999, opioid
Product Labeling................................................................................................................................... 5/5
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 poisoning deaths have increased by 500%. With Governor Holcomb’s
– Allergens..................................................................................................................................................... 1.67/1.67 staunch opposition to medical cannabis reform and a steadily
– Potency and Compound Information ..................................................................................... 1.67/1.67 worsening opioid crisis, the state must change course quickly to
Required Testing.................................................................................................................................... 0/5
prevent more overdose deaths.
– Active Ingredient Identification.................................................................................................... 0/1
– Contaminants.......................................................................................................................................... 0/1
– Potency....................................................................................................................................................... 0/1 Patient Feedback
– Shelf Life Testing................................................................................................................................... 0/1 Patients report that it is unacceptable for medical cannabis, except
– Sample Retention................................................................................................................................. 0/1
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 for very limited amounts of CBD products, to be illegal in Indiana.

Laboratory Operations 0/25

Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 0/5
Standard Operating Procedures and Protocols.......................................................... 0/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

81
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

IOWA
2018-2019 IMPROVEMENTS F
As of June 1, 2019 there were 2,787 patients registered in Iowa’s low THC
cannabis program, and 752 medical providers. In 2018, the state issued five
licenses for CBD dispensaries, and sales of medical cannabis products (capped
at 3% THC) began in December of 2018. During 2018-2019 Iowa regulators
added autism spectrum disorders and ulcerative colitis as qualifying conditions
and moved to allow inhaled forms of cannabis for patients.

In 2019, a bill (HF 732) to remove the state’s THC cap, to increase possession
limits, allow for more practitioners to recommend cannabis, and change the
definition of untreatable pain to severe and chronic pain was introduced. The
bill also allowed certain individuals with criminal convictions to participate in
the program. Unfortunately, despite significant support in the legislature, the bill
was ultimately vetoed by Governor Kim Reynolds.
2015 2016 2017 2018-19

F F F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 55/100 EASE OF NAVIGATION 81/100

Arrest Protection.............................................................................................................................. 20/40 Comprehensive Qualifying Conditions.......................................................................... 46/50
Affirmative Defense........................................................................................................................ 12/15 Adding New Conditions.............................................................................................................. 5/10
Parental Rights Protections..................................................................................................... 8/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 6/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 10/10
Reciprocity............................................................................................................................................. 3/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 3/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 3/5
ACCESS TO MEDICINE 24/100
Allows Distribution Programs................................................................................................ 8/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 71/100
– Allows Delivery.................................................................................................................................. 3/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 35/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 12/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 5/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 7/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 3/10
Does Not Impose Bans or Limits on THC..................................................................... 3/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 0/10

Base Categories Points: .....................................................249.09

Opioid Response Points: ...................................................10.5
Points Total: .............................................................................................259.59/500
Score Percentage: ........................................................................51.92%
FINAL GRADE F
82
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 IOWA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 18/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 8/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 4.75/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 3.34/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 1/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 2.5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 5/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 In 2014, the Iowa legislature passed the “Medical Cannabidiol Act”
– Reasonable Security Protocols.................................................................................................... 0/0.71 which allows licensed neurologists and other health care practitioners
– Batch and Lot Tracking..................................................................................................................... 0/0.71
to certify patients with intractable epilepsy to use CBD with 3% or
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 less THC content. Qualifying patients must obtain a registry card to be
Pesticide Guidance.............................................................................................................................. 0/5 eligible to receive legal protection; patients may designate a caregiver
– Pesticide Guidance.............................................................................................................................. 0/2.5 to assist them. The law does not impose a minimum amount of CBD,
– Pesticide Labeling................................................................................................................................ 0/2.5
but does not extend legal protections to those with products that have
Required Testing.................................................................................................................................... 5/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 more than 3% THC.
– Contaminants.......................................................................................................................................... 1.25/1.25
– Potency....................................................................................................................................................... 1.25/1.25 While Iowa’s program remains limited, 2017 showed an improvement.
– Sample Retention................................................................................................................................. 1.25/1.25 House File 524, which was signed into law, expanded access to those
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 with Parkinson’s, cancer, multiple sclerosis, seizures, HIV/AIDS, Crohn’s
disease, ALS, most terminal illnesses with life expectancy less than
Manufacturing 5/25 one year, and untreatable pain. Adding untreatable pain is a step in the
Staff Training............................................................................................................................................. 0/5 right direction for those affected by the opioid crisis, but the definition
Standard Operating Procedures............................................................................................... 0/5 of pain remains limited. The law also allows for the production of low-
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
– Workforce Safety Protocols .......................................................................................................... 0/1
THC cannabis products in the state creating a framework for growing,
– Storage Protocols ................................................................................................................................ 0/1 manufacturing, and distribution companies to submit proposals to the
– Reasonable Security Protocols.................................................................................................... 0/1 state. Iowa could still vastly improve on developing robust product
– Batch and Lot Tracking..................................................................................................................... 0/1 safety regulations and increasing accessibility to medicine.
Product Labeling................................................................................................................................... 0/5
– Product Contents, Including Source Material Identification.................................... 0/1.67
– Allergens..................................................................................................................................................... 0/1.67 Opioid Response
– Potency and Compound Information ..................................................................................... 0/1.67 Pain patients in Iowa would have been greatly benefited by a change
Required Testing.................................................................................................................................... 5/5
in the definition of pain as a qualifying condition. Currently the
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 1/1 definition of untreatable pain only allows patients to use cannabis as a
– Potency....................................................................................................................................................... 1/1 last resort instead of as a first choice. There were 206 opioid overdoses
– Shelf Life Testing................................................................................................................................... 1/1 in Iowa in 2017. While this is below the national average, providers in
– Sample Retention................................................................................................................................. 1/1
Iowa receive little formal training on opioid prescribing, and continuing
Recall Protocol and Adverse Event Reporting.............................................................. 0/5
medical education in chronic pain management is only required
Laboratory Operations 0/25 for two hours every five years. The state’s Prescription Monitoring
Program is not mandatory. Pain agreements in Iowa are not only
Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5 allowed for providers but are encouraged.
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 0/5 Patient Feedback
Standard Operating Procedures and Protocols.......................................................... 0/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83 Patients reported major problems in obtaining a medical cannabis
– Sample Tracking.................................................................................................................................... 0/0.83 patient card and felt that the list of qualifying conditions for medical
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83 cannabis is too narrow. Some patients expressed a need for a higher
– Disposal/Waste...................................................................................................................................... 0/0.83 THC content than is allowed in the state. Patients reported that there
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83 are very few dispensaries in the state causing problems with access to
medical cannabis.

83
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

KANSAS
2018-2019 IMPROVEMENTS
F
Kansas did not have any program to speak of prior to 2018. In May of that year,
cannabidiol was exempted from the Kansas Controlled Act. In 2019, Governor
Laura Kelley signed a bill (SB 28) that allows for an affirmative defense for the
possession of CBD medical cannabis oils. This affirmative defense extends
to both criminal proceedings and proceedings dealing with child custody.
Governor Kelly has indicated support for broader medical cannabis reform.

2015 2016 2017 2018-19

NA F F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 20/100 EASE OF NAVIGATION 40/100

Arrest Protection.............................................................................................................................. 8/40 Comprehensive Qualifying Conditions.......................................................................... 30/50
Affirmative Defense........................................................................................................................ 5/15 Adding New Conditions.............................................................................................................. 0/10
Parental Rights Protections..................................................................................................... 7/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 5/10
Explicit Privacy Standards........................................................................................................ 0/7 Reasonable Caregiver Background Checks.............................................................. 0/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 0/2
Does Not Create New Criminal Penalties for Patients...................................... 0/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 0/10
Reciprocity............................................................................................................................................. 2/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 2/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 3/5
ACCESS TO MEDICINE 2/100
Allows Distribution Programs................................................................................................ 0/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 4/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 0/5 Dispensaries or by Cultivation.......................................................................................... 0/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 0/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 4/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 0/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 0/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 0/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 0/10
Does Not Impose Bans or Limits on THC..................................................................... 0/10
Does Not Impose Bans on CBD............................................................................................ 2/10
Local Bans/Zoning.......................................................................................................................... 0/10

Base Categories Points: .....................................................66

Opioid Response Points: ...................................................7
Points Total: .............................................................................................73/500
Score Percentage: ........................................................................14.60%
FINAL GRADE F
84
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 ALABAMA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 0/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 0/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 0/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 0/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 0/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 0/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 0/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 0/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 0/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 Kansas was one of the last holdout states before allowing an
– Reasonable Security Protocols.................................................................................................... 0/0.71 affirmative defense for medical cannabis oil in 2019.
– Batch and Lot Tracking..................................................................................................................... 0/0.71
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71
Opioid Response
Pesticide Guidance.............................................................................................................................. 0/5 Kansas deserves credit for prominently displaying the 2016 CDC
– Pesticide Guidance.............................................................................................................................. 0/2.5 Opioid Prescribing guidelines (including the recommendation that
– Pesticide Labeling................................................................................................................................ 0/2.5
Required Testing.................................................................................................................................... 0/5
pain providers do not test for THC metabolites) on its Department
– Active Ingredient Identification.................................................................................................... 0/1.25 of Health Website. However, the state providers wrote 69.8 opioid
– Contaminants.......................................................................................................................................... 0/1.25 prescriptions for every 100 persons compared to the average U.S.
– Potency....................................................................................................................................................... 0/1.25 rate of 58.7 prescriptions for every 100 persons.
– Sample Retention................................................................................................................................. 0/1.25
Recall Protocol and Adverse Event Reporting.............................................................. 0/5
Patient Feedback
Manufacturing 0/25 Patients report that it is unacceptable for medical cannabis to be
Staff Training............................................................................................................................................. 0/5 illegal in Kansas, as the state only provides an affirmative defense
Standard Operating Procedures............................................................................................... 0/5 for CBD oils.
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
– Workforce Safety Protocols .......................................................................................................... 0/1
– Storage Protocols ................................................................................................................................ 0/1
– Reasonable Security Protocols.................................................................................................... 0/1
– Batch and Lot Tracking..................................................................................................................... 0/1
Product Labeling................................................................................................................................... 0/5
– Product Contents, Including Source Material Identification.................................... 0/1.67
– Allergens..................................................................................................................................................... 0/1.67
– Potency and Compound Information ..................................................................................... 0/1.67
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1
– Contaminants.......................................................................................................................................... 0/1
– Potency....................................................................................................................................................... 0/1
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 0/1
Recall Protocol and Adverse Event Reporting.............................................................. 0/5

Laboratory Operations 0/25

Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 0/5
Standard Operating Procedures and Protocols.......................................................... 0/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

85
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

KENTUCKY
2018-2019 IMPROVEMENTS F
Another year for Kentucky has gone by without positive movement to
the state’s medical cannabis program. In 2019, the Kentucky Court of
Appeals dismissed a lawsuit challenging the state’s ban on medical
cannabis, stating that it was an issue that must be decided by the
legislature. Unfortunately, the legislature has been reluctant to act on
expanding the state’s incredibly limited CBD program.

2015 2016 2017 2018-19

F F F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 41/100 EASE OF NAVIGATION 77/100

Arrest Protection.............................................................................................................................. 20/40 Comprehensive Qualifying Conditions.......................................................................... 50/50
Affirmative Defense........................................................................................................................ 9/15 Adding New Conditions.............................................................................................................. 0/10
Parental Rights Protections..................................................................................................... 8/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 10/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 0/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 0/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 10/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 2/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 3/5
ACCESS TO MEDICINE 10/100
Allows Distribution Programs................................................................................................ 0/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 28/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 0/5 Dispensaries or by Cultivation.......................................................................................... 0/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 10/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 0/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 0/10
Does Not Impose Bans or Limits on THC..................................................................... 0/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 0/10

Base Categories Points: .....................................................156

Opioid Response Points: ...................................................5
Points Total: .............................................................................................161/500
Score Percentage: ........................................................................32.20%
FINAL GRADE F
86
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 KENTUCKY

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 0/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 0/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 0/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 0/2
– Storage Protocols................................................................................................................................. 0/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 0/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 0/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 0/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 0/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 0/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 0/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 In 2014, the Kentucky legislature revised the definition of marijuana
– Reasonable Security Protocols.................................................................................................... 0/0.71 under state law to create legal protections for patients who use
– Batch and Lot Tracking..................................................................................................................... 0/0.71
CBD as part of an approved clinical trial or on the written order of
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 “a physician practicing at a hospital or affiliated with a Kentucky
Pesticide Guidance.............................................................................................................................. 0/5 public university having a college or a school of medicine.” Although
– Pesticide Guidance.............................................................................................................................. 0/2.5 the law does not limit the use of CBD to one particular condition,
– Pesticide Labeling................................................................................................................................ 0/2.5
rather letting physicians recommend to anyone where the benefits
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1.25 outweigh the risks, Kentucky fails to provide any production or
– Contaminants.......................................................................................................................................... 0/1.25 distribution system making the program completely ineffective.
– Potency....................................................................................................................................................... 0/1.25
– Sample Retention................................................................................................................................. 0/1.25 In September 2017, a Kentucky judge ruled that Kentucky has a good
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 reason to “curtail citizens’ possession of a narcotic, hallucinogenic
drug.” (Seum et. al, v. Bevin) On the other hand, Kentucky Secretary
Manufacturing 0/25 of State Alison Lundergan Grimes has called for a taskforce to look
Staff Training............................................................................................................................................. 0/5 into possible medical cannabis legalization, but the task force itself
Standard Operating Procedures............................................................................................... 0/5 has no legislative authority.
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
– Workforce Safety Protocols .......................................................................................................... 0/1
– Storage Protocols ................................................................................................................................ 0/1 Opioid Response
– Reasonable Security Protocols.................................................................................................... 0/1 Kentucky has one of the highest opioid overdose rates in the country
– Batch and Lot Tracking..................................................................................................................... 0/1
at a rate of 29.9 per 100,000, and the state’s population could be
Product Labeling................................................................................................................................... 0/5
– Product Contents, Including Source Material Identification.................................... 0/1.67 tremendously helped by a medical cannabis program that included
– Allergens..................................................................................................................................................... 0/1.67 chronic pain. Kentucky needs to expand its limited program and
– Potency and Compound Information ..................................................................................... 0/1.67 increase the availability of medicine.
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1
– Contaminants.......................................................................................................................................... 0/1
Patient Feedback
– Potency....................................................................................................................................................... 0/1 Patients report that it is unacceptable for medical cannabis to be
– Shelf Life Testing................................................................................................................................... 0/1 illegal in Kentucky, except for low-THC CBD products.
– Sample Retention................................................................................................................................. 0/1
Recall Protocol and Adverse Event Reporting.............................................................. 0/5

Laboratory Operations 0/25

Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 0/5
Standard Operating Procedures and Protocols.......................................................... 0/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

87
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

LOUISIANA
2018-2019 IMPROVEMENTS D
After years of delay, Louisiana had its first harvest of medical cannabis,
though due to a hold up with testing regulations the state missed a May 2019
deadline as to when it had promised to have medical cannabis available for
purchase. As of June 2019, both Louisiana State University and Southern
University had been deemed suitable to grow cannabis by the state
Department of Agriculture. Separately, a law was signed by Governor John
Bel Edwards which allows for the inhalation of medical cannabis, and the
state added PTSD, Parkinson’s Disease and Autism as qualifying conditions.
Additionally, regulators removed the cap on how many patients could be
seen by individual doctors, and the requirement that patients had to renew
their certifications every 90 days was rescinded.

Cannabis is expected to be available in Louisiana at the time this report

goes to print. 2015 2016 2017 2018-19

F F D- D

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 62/100 EASE OF NAVIGATION 69/100

Arrest Protection.............................................................................................................................. 35/40 Comprehensive Qualifying Conditions.......................................................................... 42/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 2/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 2/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 10/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 0/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 0/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 7/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 3/5
ACCESS TO MEDICINE 63/100
Allows Distribution Programs................................................................................................ 15/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 63/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 3/5 Dispensaries or by Cultivation.......................................................................................... 35/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 5/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 5/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 0/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 7/10
Does Not Impose Bans or Limits on THC..................................................................... 3/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 10/10

Base Categories Points: .....................................................317.05

Opioid Response Points: ...................................................14.5
Points Total: .............................................................................................331.55/500
Score Percentage: ........................................................................66.31%
FINAL GRADE D
88
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 LOUISIANA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 60/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 14.59/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 3.25/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 3/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 3.34/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 2.5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 12.46/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0.71/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 The state first passed medical cannabis legislation in 1978; however, the
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 program has never functioned. The state tried to resuscitate it with the
– Batch and Lot Tracking..................................................................................................................... 0/0.71
passage of SB 143. While this was a good step for the state it did not do
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 anything to help patients access cannabis in a safe and legal way. The
Pesticide Guidance.............................................................................................................................. 4/5 original bill used the term “prescribe” rather than “recommend,” but due
– Pesticide Guidance.............................................................................................................................. 2/2.5 to its classification as a Schedule I controlled substance, no physician
– Pesticide Labeling................................................................................................................................ 2/2.5
can currently write prescriptions for cannabis. In 2016, the state
Required Testing.................................................................................................................................... 3.75/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 passed and signed a pair of bills, SB 271 and SB 180 which fixed the
– Contaminants.......................................................................................................................................... 1.25/1.25 “prescription” language issue, established legal protections for patients,
– Potency....................................................................................................................................................... 1.25/1.25 and expanded the qualifying conditions. In June of 2017, Governor
– Sample Retention................................................................................................................................. 0/1.25
John Bel Edwards signed SB 35 into law which extended arrest
Recall Protocol and Adverse Event Reporting.............................................................. 4/5
protections to employees of the medical cannabis industry, including
those who would be dispensing at pharmacies, research facilities, and
Manufacturing 17/25
laboratories, moving the program one step closer to serving patients.
Staff Training............................................................................................................................................. 3/5
Standard Operating Procedures............................................................................................... 3/5 Due to the limited number of access points, many patients are left
– Facility and Equipment Sanitary Conditions...................................................................... 1/1
– Workforce Safety Protocols .......................................................................................................... 0/1
without an opportunity to obtain medicine. Louisiana’s program did see
– Storage Protocols ................................................................................................................................ 1/1 a significant boost due to the Department of Agriculture promulgating
– Reasonable Security Protocols.................................................................................................... 1/1 consumer safety and provider regulations. The state’s restriction of only
– Batch and Lot Tracking..................................................................................................................... 0/1 allowing two state universities to dispense medical cannabis is overly
Product Labeling................................................................................................................................... 5/5
– Product Contents, Including Source Material Identification.................................... 1.67/1.67
restrictive and patients continue to not have access in Louisiana.
– Allergens..................................................................................................................................................... 1.67/1.67
– Potency and Compound Information ..................................................................................... 1.67/1.67 Opioid Response
Required Testing.................................................................................................................................... 3/5
Louisiana had 401 opioid overdose deaths in 2017, and increase
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 1/1 of 12.4% from 2016. While Louisiana’s program allows for medical
– Potency....................................................................................................................................................... 1/1 cannabis to be used for chronic pain, the program’s operational
– Shelf Life Testing................................................................................................................................... 0/1 and administrative delays have prevented researchers from making
– Sample Retention................................................................................................................................. 0/1
an effective determination of whether or not the medical cannabis
Recall Protocol and Adverse Event Reporting.............................................................. 3/5
program has helped reduce opioid deaths in the state.
Laboratory Operations 16/25
Patient Feedback
Staff Training............................................................................................................................................. 3/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5 When this survey was filled out by patients, there were no dispensaries
Result Reporting.................................................................................................................................... 5/5 open in Louisiana despite the fact that the state legalized medical
Independent or Third Party........................................................................................................... 3/5 cannabis.
Standard Operating Procedures and Protocols.......................................................... 5/5
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83

89
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

MAINE
2018-2019 IMPROVEMENTS
At the end of 2018, there were 45,940 patients in the state’s program. In a nation first, Maine’s
B+
legislature had a hearing on a bill (HP0747) to require insurance companies to cover medical
cannabis, however the bill did not advance. In December of 2018, a medical cannabis
omnibus bill went into effect (over Governor Lepage’s veto) which removed the qualifying
condition list leaving the decision up to a doctor, eliminated the requirement that a patient
designate a caregiver or particular dispensary allowing for more patient choice, added two
more dispensaries to the existing eight and allowed caregivers to open storefront businesses.
In 2019, Governor Mills signed a bill improving out of state patient reciprocity.
Maine lawmakers continue to grapple with how to implement non-medical use of cannabis
regulations and the state also had a few setbacks in the courts, where the Maine Supreme
Court ruled that employers don’t need to pay for medical cannabis under the state workers’
compensation system. In another case, the Maine Supreme Court upheld the eviction of a
man form public housing who grew medical cannabis.
Maine provides a strong program for patients and was an early leader in implementing
product safety guidelines. However, Maine could improve its program by further expanding 2015 2016 2017 2018-19
its product safety regulations in the areas of dispensing and manufacturing.
B- B B B+

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 88/100 EASE OF NAVIGATION 91/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 50/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 7/10
Parental Rights Protections..................................................................................................... 10/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 2/5
Employment Protections............................................................................................................ 4/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 4/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 9/10
Reciprocity............................................................................................................................................. 3/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 89/100
Allows Distribution Programs................................................................................................ 33/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 92/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 50/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 14/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 9/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 18/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 7/7
– Collective Gardening..................................................................................................................... 3/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 8/10

Base Categories Points: .....................................................420.56

Opioid Response Points: ...................................................23.5
Points Total: .............................................................................................444.06/500
Score Percentage: ........................................................................ 88.81%
FINAL GRADE B+
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MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 MAINE

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 60.56/100 Is Cannabis Available for Treatment?........................................................................................................... 10/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 5/5
Doctor Education........................................................................................................................................................... 7/7
Dispensing 14.42/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 4/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 2/2
Standard Operating Procedures............................................................................................... 3.75/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 3/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 1/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 3.67/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 1/1.67 Affordability........................................................................................................................................................................ 1/5
– Potency/Compound Identification............................................................................................ 1/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 3/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 1/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 14.14/25
Staff Training............................................................................................................................................. 3/5
Standard Operating Procedures............................................................................................... 2/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In 1998, voters enacted the Maine Medical Marijuana Act to protect
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 patients who use medical cannabis at the advice of their doctor. In 2002,
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
the Maine legislature approved SB 611, which increased the medical
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 cannabis possession limit for those who could legally acquire medicine
Pesticide Guidance.............................................................................................................................. 3/5 under the 1998 act. In 2009, the voters of Maine modified the 1998
– Pesticide Guidance.............................................................................................................................. 2/2.5 act with the initiative Question 5. Question 5 added several qualifying
– Pesticide Labeling................................................................................................................................ 1/2.5
conditions and created a statewide distribution program and registry
Required Testing.................................................................................................................................... 3/5
– Active Ingredient Identification.................................................................................................... 1/1.25 system. In 2012, the Maine legislature amended the law to provide better
– Contaminants.......................................................................................................................................... 1/1.25 patient privacy. Registered patients, or their designated caregivers, may
– Potency....................................................................................................................................................... 1/1.25 possess up to 2.5 ounces of usable cannabis and cultivate up to six
– Sample Retention................................................................................................................................. 1/1.25
mature plants. In 2013, the Maine legislature passed HP755/LD 1062,
Recall Protocol and Adverse Event Reporting.............................................................. 3/5
which added PTSD to the list of qualifying conditions. In 2016, LD 726
was passed, which authorized 3rd party testing labs. In 2016, voters
Manufacturing 11/25
approved an adult-use program, but disagreements between Governor
Staff Training............................................................................................................................................. 3/5
Standard Operating Procedures............................................................................................... 3/5
LePage and the legislature delayed implementation. Maine has approved
– Facility and Equipment Sanitary Conditions...................................................................... 0/1 regulations that will allow physicians to diagnose conditions through
– Workforce Safety Protocols .......................................................................................................... 0/1 telemedicine beginning in 2018.
– Storage Protocols ................................................................................................................................ 1/1
– Reasonable Security Protocols.................................................................................................... 1/1 In spring of 2018, the state promulgated regulations for the state’s adult-
– Batch and Lot Tracking..................................................................................................................... 1/1 use program.
Product Labeling................................................................................................................................... 2/5
– Product Contents, Including Source Material Identification.................................... 1/1.67
– Allergens..................................................................................................................................................... 0/1.67 Opioid Response
– Potency and Compound Information ..................................................................................... 1/1.67 In July of 2019, Governor Mills will be holding an Opioid Summit that
Required Testing.................................................................................................................................... 3/5
provides continuing education credit to various professionals. As of this
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 1/1 writing, medical cannabis is not specifically present on the agenda, but
– Potency....................................................................................................................................................... 1/1 the Summit will explore alternatives to opioids for pain management.
– Shelf Life Testing................................................................................................................................... 0/1 Maine had 417 opioid overdose deaths in 2017, putting the state in the
– Sample Retention................................................................................................................................. 0/1
top ten deadliest for overdose deaths. Maine made a significant step by
Recall Protocol and Adverse Event Reporting.............................................................. 0/5
allowing medical cannabis to be recommended for any condition and
Laboratory Operations 21/25 having open and robust discussions about testing positive for cannabis in
the workplace without that test meaning automatic termination.
Staff Training............................................................................................................................................. 5/5
Method Validation in Accordance with AHP Guidelines...................................... 5/5
Result Reporting.................................................................................................................................... 1/5 Patient Feedback
Independent or Third Party........................................................................................................... 5/5 Patients reported that there is inconsistent product availability and that
Standard Operating Procedures and Protocols.......................................................... 5/5
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83 it is difficult to find the same products that worked for them before. In
– Sample Tracking.................................................................................................................................... 0.83/0.83 addition, they noted that medical cannabis products are very expensive.
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83

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 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

MARYLAND
2018-2019 IMPROVEMENTS
B
Over the last year, Maryland’s program has continued to expand. The
program currently has 99,240 patients, about ⅔ of which have been
certified. In July of 2018 the state approved eight new dispensaries, and
is currently accepting applications for more cultivation facilities and
other cannabis businesses. In 2019 Governor Larry Hogan signed a law
that allowed medical cannabis edibles.

2015 2016 2017 2018-19

B C B B

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 63/100 EASE OF NAVIGATION 89/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 44/50
Affirmative Defense........................................................................................................................ 10/15 Adding New Conditions.............................................................................................................. 9/10
Parental Rights Protections..................................................................................................... 13/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 4/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 0/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 9/10
Reciprocity............................................................................................................................................. 3/3 Allows Multiple-Year Registrations .................................................................................. 2/2
Reasonable Physician Requirements.............................................................................. 4/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 76/100
Allows Distribution Programs................................................................................................ 39/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 81/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 45/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 12/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 2/2 Reasonable Time Frame of Doctor’s Recommendation............................... 9/10
– Environmental Impact Regulations...................................................................................... 2/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 3/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 7/10

Base Categories Points: .....................................................409

Opioid Response Points: ...................................................13
Points Total: .............................................................................................422/500
Score Percentage: ........................................................................84.40%
FINAL GRADE B
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MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 MARYLAND

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 100/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 6/7
Dispensing 25/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 1/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 25/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions...................................................................... 0.71/0.71
Background
– Workforce Safety Protocols .......................................................................................................... 0.71/0.71 Maryland’s first legal protections for patients were established in 2003 with the
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 Darrell Putman Compassionate Use Act, which created an affirmative defense for
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 patients possessing less than one ounce of cannabis that reduced convictions
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
to a misdemeanor offense with a maximum $100 fine. In 2011, Maryland passed
– Disposal/Waste...................................................................................................................................... 0.71/0.71
– Water Management............................................................................................................................ 0.71/0.71 SB 308 to recognize specific medical conditions and remove the misdemeanor
Pesticide Guidance.............................................................................................................................. 5/5 penalty but not the $100 fine. In 2013, HB 180 expanded the affirmative defense to
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 caregivers, while HB 1101 allowed “Academic Medical Centers” to conduct medical
– Pesticide Labeling................................................................................................................................ 2.5/2.5 cannabis research studies and established the Natalie M. LaPrade Medical
Required Testing.................................................................................................................................... 5/5 Marijuana Commission to create regulations.
– Active Ingredient Identification.................................................................................................... 1.25/1.25
– Contaminants.......................................................................................................................................... 1.25/1.25 In 2014, the Maryland Legislature approved HB 881/SB 923, a comprehensive
– Potency....................................................................................................................................................... 1.25/1.25 medical cannabis program that expanded and clarified legal protections for patients,
– Sample Retention................................................................................................................................. 1.25/1.25 caregivers, and physicians and created a distribution system. Registered patients
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 and their designated caregivers are allowed to obtain and possess a 30-day supply
of cannabis, but personal cultivation is prohibited. There are no explicit qualifying
Manufacturing 25/25 conditions in Maryland under HB 881; instead, physicians must apply for permission
Staff Training............................................................................................................................................. 5/5 to write recommendations for conditions they specify, though the Commission may
Standard Operating Procedures............................................................................................... 5/5 add conditions through rulemaking. In 2016, HB 104 was passed which expanded
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 the type of healthcare practitioners that could recommend cannabis. In 2017, certain
– Workforce Safety Protocols .......................................................................................................... 1/1 dispensaries began distributing medicine, but quickly ran into supply shortages.
– Storage Protocols ................................................................................................................................ 1/1
– Reasonable Security Protocols.................................................................................................... 1/1 After nearly 4 years of waiting, patients in Maryland finally had access to
– Batch and Lot Tracking..................................................................................................................... 1/1 medicine through a total of 21 dispensaries in December 2017. Maryland has
Product Labeling................................................................................................................................... 5/5 been thoughtful in their adoption of consumer safety and provider requirements,
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 earning them a perfect score in this category, but still needs to provide civil
– Allergens..................................................................................................................................................... 1.67/1.67
protections for patients including parental rights, employment protections, and
– Potency and Compound Information ..................................................................................... 1.67/1.67
Required Testing.................................................................................................................................... 5/5
organ transplants. While Maryland’s affirmative defense provision has been used
– Active Ingredient Identification.................................................................................................... 1/1 in limited instances to protect patients growing their own medicine, the state
– Contaminants.......................................................................................................................................... 1/1 should explicitly provide for patients and caregivers to grow their own medicine.
– Potency....................................................................................................................................................... 1/1
– Shelf Life Testing................................................................................................................................... 1/1 Opioid Response
– Sample Retention................................................................................................................................. 1/1
For the first time in 10 years, the opioid overdose rate in Maryland has declined.
Recall Protocol and Adverse Event Reporting.............................................................. 5/5
Despite this, the number of drug- and alcohol-related intoxication deaths
occurring in Maryland increased in 2017 for the seventh year in a row, reaching
Laboratory Operations 25/25 an all-time high of 2,282 deaths. In a report, Maryland regulators found that there
Staff Training............................................................................................................................................. 5/5 is “mounting anecdotal evidence “ that cannabis may “offer an effective tool for
Method Validation in Accordance with AHP Guidelines...................................... 5/5
lowering” opioid cravings and addressing withdrawal symptoms. Maryland needs
Result Reporting.................................................................................................................................... 5/5
Independent or Third Party........................................................................................................... 5/5 to improve the efficiency of its program in getting patients certified, as well as
Standard Operating Procedures and Protocols.......................................................... 5/5 increasing doctor education on opioids and cannabis.
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83 Patient Feedback
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83 Some patients reported having to use the black market despite Maryland having a
– Storage Protocols................................................................................................................................. 0.83/0.83 medical cannabis program because the prices are too high and the dispensaries are
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83 too far from their homes. They contend that medical cannabis is still more expensive
than doctor prescribed opioids, and costs around the same as the black market
products. Patients expressed the desire for insurance companies to get involved
to help cover the costs of medical cannabis products. Many patients also urge
Maryland legislators to allow firefighters and state workers to use medical cannabis.

93
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

MASSACHUSETTS
2018-2019 IMPROVEMENTS B+
As of March 2019, Massachusetts had 66,945 in its program. Massachusetts
has done well maintaining a strong medical cannabis program during its
roll-out of non-medical cannabis despite the state’s Medical Use of Marijuana
Program office merging into the State’s Cannabis Control Commission. In
March 2018, the Cannabis Control Commission approved regulations for the
non-medical use of cannabis, with retail operations opening in November of
2018. In September 2018, the state Attorney General said that municipalities
cannot ban medical dispensaries. Beginning July 1, 2019 patients and
caregivers can get same day access to cannabis after seeing a clinician,
allowing them to obtain up to 2.5 ounces per 14 day period. Patients will still
need to complete the remaining registration process to obtain their card. If a
patient presents their card, they will not be subject to tax.

2015 2016 2017 2018-19

B B- B B+

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 80/100 EASE OF NAVIGATION 90/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 50/50
Affirmative Defense........................................................................................................................ 13/15 Adding New Conditions.............................................................................................................. 10/10
Parental Rights Protections..................................................................................................... 10/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 5/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 8/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 8/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 4/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 86/100
Allows Distribution Programs................................................................................................ 36/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 83/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 45/50
– Does Not Require Vertical Integration............................................................................... 1/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 2/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 5/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 10/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 10/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 6/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 10/10

Base Categories Points: .....................................................418

Opioid Response Points: ...................................................25
Points Total: .............................................................................................443/500
Score Percentage: ........................................................................88.66%
FINAL GRADE B+
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MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 MASSACHUSETTS

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 79/100 Is Cannabis Available for Treatment?........................................................................................................... 10/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 5/5
Doctor Education........................................................................................................................................................... 7/7
Dispensing 25/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 2/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 1/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 1/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 2.5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 23/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions...................................................................... 0.71/0.71 Background
– Workforce Safety Protocols .......................................................................................................... 0.71/0.71 In 2012, 63% of Massachusetts voters approved Question 3, “An Initiative
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71
– Reasonable Security Protocols.................................................................................................... 0.71/0.71
Petition for a Law for the Humanitarian Medical Use of Marijuana”,
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71 establishing legal protection for patients, caregivers, physicians, medical
– Disposal/Waste...................................................................................................................................... 0.71/0.71 professionals, cultivators, and providers. Registered patients and their
– Water Management............................................................................................................................ 0.71/0.71 designated caregivers may possess up to a 60-day supply of usable
Pesticide Guidance.............................................................................................................................. 3/5
– Pesticide Guidance.............................................................................................................................. 2/2.5
cannabis, defined as 10 ounces. Some protections for patients began
– Pesticide Labeling................................................................................................................................ 01/2.5 January 1, 2013, including limited rights to cultivate their own medicine. In
Required Testing.................................................................................................................................... 5/5 2014, the Department of Health (DOH) began issuing ID cards for patients
– Active Ingredient Identification.................................................................................................... 1.25/1.25 and granting licenses for dispensaries. “Registered Marijuana Dispensaries”
– Contaminants.......................................................................................................................................... 1.25/1.25
are licensed to both grow and sell medical cannabis and are required to
– Potency....................................................................................................................................................... 1.25/1.25
– Sample Retention................................................................................................................................. 1.25/1.25 provide medicine at discounted rates for low income residents. DOH issues
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 hardship cultivation licenses to patients who qualify.
In 2016, DOH announced it will accept applications for dispensaries on a
Manufacturing 23/25 rolling basis. Voters in Massachusetts have passed Question 4, an adult-use
Staff Training............................................................................................................................................. 5/5 initiative which added some rights for patients including parental rights and
Standard Operating Procedures............................................................................................... 5/5 organ transplant rights.
– Facility and Equipment Sanitary Conditions...................................................................... 1/1
– Workforce Safety Protocols .......................................................................................................... 1/1 After nearly a year long delay, Massachusetts implemented a number of
– Storage Protocols ................................................................................................................................ 1/1 regulations that improve patient access. Under the new rules, certified
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1
nurse practitioners can apply for permission to issue medical cannabis
Product Labeling................................................................................................................................... 5/5 recommendations. The new rules also allow for employees of nursing
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 homes, hospice centers, and other medical facilities to administer medical
– Allergens..................................................................................................................................................... 1.67/1.67 cannabis. In addition, the regulations fixed some supply issues by allowing
– Potency and Compound Information ..................................................................................... 1.67/1.67 dispensaries to grow cannabis from clippings instead of just seeds, which
Required Testing.................................................................................................................................... 3/5
– Active Ingredient Identification.................................................................................................... 1/1
could boost plant yields and ensure that cultivars stay consistent over
– Contaminants.......................................................................................................................................... 1/1 multiple harvests. Despite these improvements, Massachusetts still needs
– Potency....................................................................................................................................................... 1/1 to protect patients in the areas of housing and employment discrimination.
– Shelf Life Testing................................................................................................................................... 0/1 The Department of Health also needs to strengthen laboratory testing
– Sample Retention................................................................................................................................. 0/1
Recall Protocol and Adverse Event Reporting.............................................................. 5/5
regulations, and expedite the process for dispensary licensing.

Opioid Response
Laboratory Operations 8.32/25
Staff Training............................................................................................................................................. 5/5
Massachusetts does an admirable job of tracking opioid overdoses each
Method Validation in Accordance with AHP Guidelines...................................... 0/5 month. In 2018 there were 2,033 opioid overdose deaths, 120 more than
Result Reporting.................................................................................................................................... 0/5 2017, and a rate over-double the national average. While Massachusetts
Independent or Third Party........................................................................................................... 0/5 has a strong medical cannabis program it is not being fully used to fight the
Standard Operating Procedures and Protocols.......................................................... 3.32/5
opioid crisis, though allowing patients same day access to medical cannabis
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83 is a big improvement. Massacuhsetts has adopted the 2016 CDC opioid
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83 prescribing guidelines.
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83 Patient Feedback
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83
Patients reported concern over the high prices of medical cannabis products.
Some patients report that they have experienced dispensaries ignoring doctor’s
recommendations and have tried to upsell patients into other high margin
products. Patient’s also expressed concern over product quality.

95
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

MICHIGAN
2018-2019 IMPROVEMENTS
As of March 2019, Michigan had approximately 284,000 patients enrolled in the state’s program,
B+
with 52,363 joining the program in between October 1, 2018 and March 31, 2019. In July of 2018, Michigan
regulators added chronic pain, autism, arthritis, colitis and IBS, obsessive compulsive disorder, Parkinson’s, spinal
cord injury and Tourette’s syndrome, and added cerebral palsy in 2019. Shortly after the approval of these conditions,
the state approved licenses for the first medical cannabis businesses in the state. Also in July, the Michigan Court of
Appeals ruled that local governments can’t restrict where medical cannabis growers can operate.
In October of 2018 a medical dispensary was raided by the DEA. This serves as a reminder that even though the CJS amend-
ment remains in place, raids still occur when the DEA suspects businesses of unlawful activity. In November 2018, the state
issued new regulations that set max THC concentrations for edibles (50 mg per dose for edible products, 200 mg max per
container) and approved delivery from medical dispensaries. Voters also approved the adult-use of cannabis in November.
In 2019, regulators issued updated detailed guidance about sampling and testing, guidance about reciprocity for patients,
reduced patient fees from $60 to $40, and issued a number of recalls for unsafe products (something that would not have
happened absent a well regulated program).
In March of 2019, Governor Gretchen Whitmer signed an executive order eliminating the current medical
cannabis licensing board in favor of creating a new cannabis regulatory agency. After shutting down nearly
50 unlicensed medical cannabis businesses, the state set a deadline of July 1 for businesses to become
licensed. Finally, regulators approved waste and processing rules for cannabis and updated procedure to 2015 2016 2017 2018-19
allow patients to immediately participate in the state’s program by registering on-line and using their
confirmation email before receiving a registry card. C+ B+ B+ B+

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 82/100 EASE OF NAVIGATION 90/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 48/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 9/10
Parental Rights Protections..................................................................................................... 8/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 4/5 – System Works for Adding New Conditions.................................................................... 4/5
Employment Protections............................................................................................................ 2/5 Reasonable Access for Minors.............................................................................................. 8/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 3/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 8/10
Reciprocity............................................................................................................................................. 3/3 Allows Multiple-Year Registrations .................................................................................. 2/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 87/100
Allows Distribution Programs................................................................................................ 35/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 81/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 45/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 10/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 15/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 4/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 7/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 10/10

Base Categories Points: .....................................................424

Opioid Response Points: ...................................................17
Points Total: .............................................................................................441/500
Score Percentage: ........................................................................88.14%
FINAL GRADE B+
96
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 MICHIGAN

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 84/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 22/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 4/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 2/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 3.34/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 1/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 1/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 2.5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 23/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0.71/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In 2008, Michigan voters passed the Michigan Medical Marihuana
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 Act, which allows qualifying patients or their designated caregivers
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
to cultivate up to 12 cannabis plants and possess up to 2.5 ounces of
– Disposal/Waste...................................................................................................................................... 0.71/0.71
– Water Management............................................................................................................................ 0.71/0.71 usable cannabis. Patients certified by their doctor and registered with
Pesticide Guidance.............................................................................................................................. 3/5 the Department of Licensing and Regulatory Affairs (LARA) are not
– Pesticide Guidance.............................................................................................................................. 1/2.5 subject to arrest or prosecution and are protected from civil penalty or
– Pesticide Labeling................................................................................................................................ 2/2.5
disciplinary action by a business, occupational, or professional licensing
Required Testing.................................................................................................................................... 5/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 board or bureau. Although dispensaries were not expressly permitted
– Contaminants.......................................................................................................................................... 1.25/1.25 by law, several local jurisdictions have allowed them to provide access
– Potency....................................................................................................................................................... 1.25/1.25 to patients. In September 2016, the governor signed three bills to
– Sample Retention................................................................................................................................. 1.25/1.25
improve the medical cannabis program. HB 4210, which went into effect
Recall Protocol and Adverse Event Reporting.............................................................. 5/5
immediately, clarified that patients may possess cannabis extracts and
infused products. The Medical Marihuana Facilities Licensing Act creates
Manufacturing 22.34/25
a program to license and regulate the cultivation, processing, transport,
Staff Training............................................................................................................................................. 4/5
Standard Operating Procedures............................................................................................... 5/5
and distribution of medical cannabis. The Medical Marihuana Licensing
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 Board and LARA issued emergency rules in December 2017, which were
– Workforce Safety Protocols .......................................................................................................... 1/1 in place for six months until final rules were approved.
– Storage Protocols ................................................................................................................................ 1/1
– Reasonable Security Protocols....................................................................................................
– Batch and Lot Tracking.....................................................................................................................
1/1
1/1
Opioid Response
Product Labeling................................................................................................................................... 3.34/5 Michigan had 2,033 opioid overdoses in 2017. However, the number of
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 opioid prescriptions has declined by 25% since 2013. It is possible that
– Allergens..................................................................................................................................................... 0/1.67
this downward trend will continue now that Michigan allows for chronic
– Potency and Compound Information ..................................................................................... 1.67/1.67
Required Testing.................................................................................................................................... 5/5 pain patients to use cannabis. Despite this decline, Michigan, as shown
– Active Ingredient Identification.................................................................................................... 1/1 in ASA’s opioid state policy blueprint, still has hundreds of thousands
– Contaminants.......................................................................................................................................... 1/1 of potential patients that are barred from access. Michigan still needs
– Potency....................................................................................................................................................... 1/1
to provide civil discrimination protections in the areas of housing,
– Shelf Life Testing................................................................................................................................... 1/1
– Sample Retention................................................................................................................................. 1/1 employment, and organ transplants and create stronger regulations for
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 laboratory testing.

Laboratory Operations 16/25 Patient Feedback

Staff Training............................................................................................................................................. 3/5 Patients reported that the licensing process in the state is slow and that
Method Validation in Accordance with AHP Guidelines...................................... 0/5 dispensaries are still not available in certain counties and cities.
Result Reporting.................................................................................................................................... 3/5
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 5/5
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83

97
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

MINNESOTA
2018-2019 IMPROVEMENTS C-
As of June 2019, there were 17,005 patients actively enrolled in Minnesota’s
program. Minnesota did not make any legislative changes to its medical
cannabis program in 2018-2019. However, the Department of Health
did approve sleep apnea, autism and Alzheimer’s to be added to the
list of qualifying conditions. The Minnesota Department of Corrections
moved to allow people on supervised release to use medical cannabis.
Unfortunately, during 2018, the state denied a petition to add Opioid Use
Disorder. Further, chronic pain is not a stand-alone condition in the state
(only intractable pain).

Increasing the number of cultivators and dispensaries as well as lifting the

restriction on methods of delivery would ensure more patients being able
to access medicine.
2015 2016 2017 2018-19

C C- C- C-

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 84/100 EASE OF NAVIGATION 85/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 47/50
Affirmative Defense........................................................................................................................ 12/15 Adding New Conditions.............................................................................................................. 8/10
Parental Rights Protections..................................................................................................... 10/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 3/5
Employment Protections............................................................................................................ 5/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... 5/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 0/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 7/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 3/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 4/5
ACCESS TO MEDICINE 48/100
Allows Distribution Programs................................................................................................ 13/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 72/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 3/5 Dispensaries or by Cultivation.......................................................................................... 35/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 12/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 2/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 5/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 5/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 7/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 8/10

Base Categories Points: .....................................................349

Opioid Response Points: ...................................................9
Points Total: .............................................................................................358/500
Score Percentage: ........................................................................71.58%
FINAL GRADE C-
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MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 MINNESOTA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 60/100 Is Cannabis Available for Treatment?........................................................................................................... 3/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 3/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 21/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 3/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 0/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 0/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 2.67/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 1/5
– Potency/Compound Identification............................................................................................ 1/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 12.25/25
Staff Training............................................................................................................................................. 3/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 In 2014, the Minnesota legislature passed SF 2470, which provides
– Reasonable Security Protocols.................................................................................................... 0/0.71 legal protections for patients with certain debilitating medical
– Batch and Lot Tracking..................................................................................................................... 0/0.71
conditions who obtain a physician’s recommendation for the use of
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 medical cannabis products. Minnesota law does not provide access
Pesticide Guidance.............................................................................................................................. 3/5 to medical cannabis in its most common form, dried flower. Patients
– Pesticide Guidance.............................................................................................................................. 2/2.5 may only legally obtain and use medical cannabis products such as
– Pesticide Labeling................................................................................................................................ 1/2.5
oils, pills, or liquids which may be consumed by any means other than
Required Testing.................................................................................................................................... 1.25/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 smoking. The law does not impose concentration requirements for
– Contaminants.......................................................................................................................................... 0/1.25 THC or CBD. The law contains strong privacy protections for patients,
– Potency....................................................................................................................................................... 0/1.25 though they do collect medical data from physicians on the patients
– Sample Retention................................................................................................................................. 0/1.25
for whom they recommend medical cannabis. In 2016, intractable
Recall Protocol and Adverse Event Reporting.............................................................. 5/5
pain and PTSD were officially added as qualifying conditions through
HF 3142, which also improved transportation laws for testing and
Manufacturing 18.67/25
disposal, and allowed pharmacists to video-conference with patients.
Staff Training............................................................................................................................................. 3/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 Opioid Response
– Workforce Safety Protocols .......................................................................................................... 1/1 There were 422 opioid overdose deaths in Minnesota in 2017. The
– Storage Protocols ................................................................................................................................ 1/1
state has a broad campaign on reducing opioid overdoses, but
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1 medical cannabis is not directly tied to this campaign. State regulators
Product Labeling................................................................................................................................... 2.67/5 heard a petition in October 2018 on Opioid Use Disorder, but declined
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 to add it as a qualifying condition However, a Minnesota Department
– Allergens..................................................................................................................................................... 0/1.67
of Health Survey indicated that, of patients who entered the medical
– Potency and Compound Information ..................................................................................... 1/1.67
Required Testing.................................................................................................................................... 3/5 cannabis program, 64% were able to reduce their opioid intake or
– Active Ingredient Identification.................................................................................................... 1/1 wean off within six months.
– Contaminants.......................................................................................................................................... 1/1
– Potency....................................................................................................................................................... 1/1 Patient Feedback
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 0/1 Patients reported concern over the high cost of medical cannabis
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 products and that the qualifying conditions are very restrictive.
Patients also reported that medical providers need better training on
Laboratory Operations 8.32/25 medical cannabis efficacy.
Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 3.32/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

99
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

MISSISSIPPI
2018-2019 IMPROVEMENTS F
While there was no legislative or regulatory effort to improve Mississippi’s
limited program, activists have indicated that as of May 2019 they have
collected over 90,000 signatures. If all these signatures are valid, and
appropriately distributed through the state, a question about the legalization of
medical cannabis will appear on the 2020 ballot as a constitutional amendment.
Individuals with debilitating medical conditions (including chronic pain and pain
refractory to appropriate opioid management) could possess up to 2.5 ounces
of medical cannabis with a doctor’s certification. The deadline for signature
collection is October 9, 2019.

2015 2016 2017 2018-19

F F F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 62/100 EASE OF NAVIGATION 31/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 5/50
Affirmative Defense........................................................................................................................ 9/15 Adding New Conditions.............................................................................................................. 0/10
Parental Rights Protections..................................................................................................... 8/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 6/10
Explicit Privacy Standards........................................................................................................ 0/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 1/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 10/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 2/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 3/5
ACCESS TO MEDICINE 7/100
Allows Distribution Programs................................................................................................ 0/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 29/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 0/5 Dispensaries or by Cultivation.......................................................................................... 1/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 2/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 3/10
Does Not Impose Bans or Limits on THC..................................................................... 1/10
Does Not Impose Bans on CBD............................................................................................ 3z/10
Local Bans/Zoning.......................................................................................................................... 0/10

Base Categories Points: .....................................................129

Opioid Response Points: ...................................................2
Points Total: .............................................................................................131/500
Score Percentage: ........................................................................26.20%
FINAL GRADE F
100
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 MISSISSIPPI

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 0/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 0/7
Dispensing 0/25 – Is doctor education on opioids available through the state’s department of health?...... 0/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 0/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 0/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 0/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 0/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 0/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 0/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 0/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 In 2014, Mississippi passed HB 1231, which creates an affirmative
– Reasonable Security Protocols.................................................................................................... 0/0.71 defense for the possession and use of CBD oil in very limited
– Batch and Lot Tracking..................................................................................................................... 0/0.71
circumstances. Known as “Harper Grace’s Law,” the bill only provides
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 legal protections to patients diagnosed with a debilitating epileptic
Pesticide Guidance.............................................................................................................................. 0/5 condition, and only if the CBD oil was either obtained from or tested by
– Pesticide Guidance.............................................................................................................................. 0/2.5 the National Center for Natural Products Research at the University of
– Pesticide Labeling................................................................................................................................ 0/2.5
Mississippi and dispensed by the Department of Pharmacy Services
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1.25 at the University of Mississippi Medical Center. The law requires that
– Contaminants.......................................................................................................................................... 0/1.25 CBD oil must have at least 15% CBD and no more than 0.5% THC.
– Potency....................................................................................................................................................... 0/1.25 Patients with conditions other than a debilitating epileptic condition are
– Sample Retention................................................................................................................................. 0/1.25
not entitled to any legal protections, nor are there any legal protections
Recall Protocol and Adverse Event Reporting.............................................................. 0/5
for the possession and use of any other type of cannabis. In 2017, the
legislature passed SB 2610 which clarifies the use of CBD in research
Manufacturing 0/25
for the treatment of seizures.
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5 Despite being the home of the National Institute on Drug Abuse’s only
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
– Workforce Safety Protocols .......................................................................................................... 0/1
facility where cannabis is grown by the federal government, patients
– Storage Protocols ................................................................................................................................ 0/1 in Mississippi still face tremendous access problems. While the state
– Reasonable Security Protocols.................................................................................................... 0/1 deserves credit for including parental rights protections, the program
– Batch and Lot Tracking..................................................................................................................... 0/1 fails to help patients on nearly all other fronts. Until a robust set of
Product Labeling................................................................................................................................... 0/5
– Product Contents, Including Source Material Identification.................................... 0/1.67
qualifying conditions, including chronic pain, and strong product safety
– Allergens..................................................................................................................................................... 0/1.67 guidelines are developed the patients of Mississippi will be denied a
– Potency and Compound Information ..................................................................................... 0/1.67 functional medical cannabis program.
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification....................................................................................................
– Contaminants..........................................................................................................................................
0/1
0/1
Patient Feedback
– Potency....................................................................................................................................................... 0/1 Patients report that it is unacceptable for medical cannabis other than
– Shelf Life Testing................................................................................................................................... 0/1 CBD oil to be illegal in Mississippi and are turning to the black market
– Sample Retention................................................................................................................................. 0/1
for medicine.
Recall Protocol and Adverse Event Reporting.............................................................. 0/5

Laboratory Operations 0/25

Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 0/5
Standard Operating Procedures and Protocols.......................................................... 0/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

101
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

MISSOURI
2018-2019 IMPROVEMENTS C
In November of 2018 Missouri voters approved an initiative that legalized medical
cannabis. The measure is sweeping and allows home cultivation, allows for a
possession limit of up to four ounces for a 30 day period with more allowed with
medical necessity, and while the measure contains a condition list, it also allows
doctors to use their professional judgement as to whether or not medical cannabis
may assist a patient. Medical cannabis rules have already been released and the state
will begin accepting patient identification card applications on June 28, 2019. 301
dispensaries have prefiled application forms and the state anticipates cannabis will be
purchasable sometime after January 2020.

Unfortunately, the news out of Missouri for the past year is not completely positive. In
a video that got national attention, Missouri police were recorded rifling through the
bag of a patient with stage four pancreatic cancer at a hospital. Despite the law having
changed at the time of this video, it shows the critical need for programs to launch 2015 2016 2017 2018-19
quickly without delay.
F F F C

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 67/100 EASE OF NAVIGATION 90/100

Arrest Protection.............................................................................................................................. 35/40 Comprehensive Qualifying Conditions.......................................................................... 50/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 10/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 5/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 8/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 8/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 3/5
ACCESS TO MEDICINE 82/100
Allows Distribution Programs................................................................................................ 30/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 34/100
– Allows Delivery.................................................................................................................................. 3/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 3/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 0/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 7/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 5/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 15/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 4/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 7/10

Base Categories Points: .....................................................359

Opioid Response Points: ...................................................20.5
Points Total: .............................................................................................379.5/500
Score Percentage: ........................................................................75.90%
FINAL GRADE C
102
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 MISSOURI

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 86/100 Is Cannabis Available for Treatment?........................................................................................................... 10/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 5/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 22/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 4/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 3/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 1/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 1/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 2.5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 21/25
Staff Training............................................................................................................................................. 4/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0.71/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In 2014, Missouri passed HB 2238, which created a legal right for
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 certain patients to obtain, possess, and use “hemp extracts” in limited
– Batch and Lot Tracking..................................................................................................................... 0.71/0.7
circumstances. The law defines a “hemp extract” as a preparation of
– Disposal/Waste...................................................................................................................................... 0.71/0.71
– Water Management............................................................................................................................ 0.71/0.71 cannabis that contains at least 5% CBD and no more than 0.3% THC.
Pesticide Guidance.............................................................................................................................. 3/5 Only patients with a seizure disorder and a recommendation from
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 a neurologist can obtain a “hemp registration card,” which entitles
– Pesticide Labeling................................................................................................................................ 0/2.5
them to access and limited legal protections. Patients are allowed to
Required Testing.................................................................................................................................... 5/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 purchase hemp extracts from two state-regulated “cannabidiol oil care
– Contaminants.......................................................................................................................................... 1.25/1.25 centers.” in 2015, the Department of Agriculture granted two licenses,
– Potency....................................................................................................................................................... 1.25/1.25 and in 2016, the centers began serving patients.
– Sample Retention................................................................................................................................. 1.25/1.25
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 In November 2018, the state approved a ballot initiative that set up a
comprehensive medical cannabis framework. Once medical cannabis
Manufacturing 21/25 is available in the state, Missouri’s score will undoubtedly improve.
Staff Training............................................................................................................................................. 4/5
Standard Operating Procedures............................................................................................... 4/5 Opioid Response
– Facility and Equipment Sanitary Conditions...................................................................... 1/1
– Workforce Safety Protocols .......................................................................................................... 0/1 As medical cannabis is not available for purchase it is difficult to
– Storage Protocols ................................................................................................................................ 1/1 assess how the new program will affect Missouri’s opioid crisis. In
– Reasonable Security Protocols.................................................................................................... 1/1 2017, there were 952 overdose deaths in Missouri, a rate higher than
– Batch and Lot Tracking..................................................................................................................... 1/1
the national average. Missouri has implemented federal grant funding,
Product Labeling................................................................................................................................... 3/5
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 and has implemented a state targeted response. The Missouri Hospital
– Allergens..................................................................................................................................................... 0/1.67 Association has issued their own guidelines for Opioid Prescribing
– Potency and Compound Information ..................................................................................... 1.67/1.67 in addition to the 2016 CDC Guidelines, but their guidelines do not
Required Testing.................................................................................................................................... 5/5
mention the cessation of testing for THC or other cannabis metabolites
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 1/1 at pain clinics.
– Potency....................................................................................................................................................... 1/1
– Shelf Life Testing................................................................................................................................... 1/1 Patient Feedback
– Sample Retention................................................................................................................................. 1/1
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 Even though a medical cannabis law was passed, patients do not
currently have access to medical cannabis as there are no dispensaries
Laboratory Operations 21/25 open at this time.
Staff Training............................................................................................................................................. 4/5
Method Validation in Accordance with AHP Guidelines...................................... 5/5
Result Reporting.................................................................................................................................... 3/5
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 4.2/5
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

103
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

MONTANA
2018-2019 IMPROVEMENTS
As of March 2019, there were 32,240 patients in Montana. However, in many
B
counties there are still no active providers. In February 2018, new rules were
adopted dealing with quality assurance testing, waste management, and other
technical changes. In 2019, SB265 was signed into law which created much needed
detailed regulations for the program. The bill included improvements to laboratory
testing, telemedicine and removes the requirement that patients must decide
between choosing a provider or whether they will cultivate their own, allowing them
greater flexibility. The bill also modestly raised the excise tax rate on producers.

Montana does well in serving patients and has moved through its implementation
of its medical cannabis program quickly. However, Montana needs a better system
for adding qualifying conditions, or should allow physicians to recommend cannabis
for any condition. Montana also should create strong civil protections for patients
including employment protections, protections for parents, housing protections, and 2015 2016 2017 2018-19
organ transplants.
C- D- B- B

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 65/100 EASE OF NAVIGATION 84/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 47/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 6/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 3/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 3/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 3/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 0/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 8/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 3/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 82/100
Allows Distribution Programs................................................................................................ 30/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 85/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 4/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 45/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 13/15
– Ownership/Employment Restrictions................................................................................ 2/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 10/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 3/5
Reasonable Purchase Limits.................................................................................................. 5/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 5/5
Noncommercial Cultivation..................................................................................................... 15/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 4/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 7/10

Base Categories Points: .....................................................403

Opioid Response Points: ...................................................20.5
Points Total: .............................................................................................417/500
Score Percentage: ........................................................................83.44%
FINAL GRADE B
104
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 MONTANA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 87/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 22/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 4/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 3.34/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 24/25
Staff Training............................................................................................................................................. 4/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0.71/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In 2004, 62% of Montana voters passed initiative I-148, allowing
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 registered patients to use, possess, and cultivate medical cannabis and
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
designate a caregiver to assist them. Currently, registered patients and
– Disposal/Waste...................................................................................................................................... 0.71/0.71
– Water Management............................................................................................................................ 0.71/0.71 their designated caregivers may possess up to one ounce of usable
Pesticide Guidance.............................................................................................................................. 5/5 cannabis and cultivate up to four mature plants and 12 immature. In 2011,
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 the Montana legislature introduced several laws to create regulations
– Pesticide Labeling................................................................................................................................ 2.5/2.5
for a statewide licensing program, but instead the legislature passed SB
Required Testing.................................................................................................................................... 5/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 423 that repealed much of the rights granted under I-148. SB 423 was
– Contaminants.......................................................................................................................................... 1.25/1.25 challenged in state court blocking many of the worst provisions before
– Potency....................................................................................................................................................... 1.25/1.25 it could be implemented. Following a lengthy court battle, the Montana
– Sample Retention................................................................................................................................. 1.25/1.25
Supreme Court ruled in favor of allowing SB 423 to be implemented in
Recall Protocol and Adverse Event Reporting.............................................................. 5/5
early 2016, which cut off almost all access for patients.
Manufacturing 20.34/25 In November 2016, Montana voters passed I-182 which not only restored
Staff Training............................................................................................................................................. 4/5 many of the rights granted to patients in I-148, but also added PTSD and
Standard Operating Procedures............................................................................................... 4/5 removed restrictions on chronic pain for qualifying conditions. In 2017,
– Facility and Equipment Sanitary Conditions...................................................................... 1/1
– Workforce Safety Protocols .......................................................................................................... 0/1
the legislature passed SB 333 which created detailed regulations and
– Storage Protocols ................................................................................................................................ 1/1 allowed for the additional manufacture of cannabis products.
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1 Patient Feedback
Product Labeling................................................................................................................................... 3.34/5
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 The reported that the state is slow on renewing medical cannabis cards
– Allergens..................................................................................................................................................... 0/1.67 and dispensaries run out of certain products patients need. Patients also
– Potency and Compound Information ..................................................................................... 1.67/1.67 reported a desire for more follow up required with medical providers on
Required Testing.................................................................................................................................... 5/5
how medical cannabis is helping with their ailments and illnesses.
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 1/1
– Potency....................................................................................................................................................... 1/1
– Shelf Life Testing................................................................................................................................... 1/1
– Sample Retention................................................................................................................................. 1/1
Recall Protocol and Adverse Event Reporting.............................................................. 4/5

Laboratory Operations 20/25

Staff Training............................................................................................................................................. 5/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 5/5
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 5/5
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83

105
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

NEBRASKA
2018-2019 IMPROVEMENTS F
Nebraska is one of three remaining states that has no form of medical
cannabis access. After legislators tried to move forward a medical cannabis bill
and ultimately failed, Governor Pete Ricketts joined with prohibitionist groups
to prevent reform in the state.

In hopes of changing the state policy, activists are circulating an initiative

amendment that would allow those with serious health conditions to use
medical cannabis as recommended by their physicians. The initiative also
creates a regulated system for testing laboratories, dispensaries, and a variety
of medical cannabis products, and does not create a limited list of qualifying
conditions. As of June 2019, the initiative has approximately 10,000 signatures
of the 130,000 needed by July 2, 2020.

2015 2016 2017 2018-19

F F F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 0/100 EASE OF NAVIGATION 0/100

Arrest Protection.............................................................................................................................. 0/40 Comprehensive Qualifying Conditions.......................................................................... 0/50
Affirmative Defense........................................................................................................................ 0/15 Adding New Conditions.............................................................................................................. 0/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 0/10
Explicit Privacy Standards........................................................................................................ 0/7 Reasonable Caregiver Background Checks.............................................................. 0/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 0/2
Does Not Create New Criminal Penalties for Patients...................................... 0/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 0/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 0/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 0/5
ACCESS TO MEDICINE 0/100
Allows Distribution Programs................................................................................................ 0/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 0/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 0/5 Dispensaries or by Cultivation.......................................................................................... 0/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 0/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 0/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 0/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 0/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 0/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 0/10
Does Not Impose Bans or Limits on THC..................................................................... 0/10
Does Not Impose Bans on CBD............................................................................................ 0/10
Local Bans/Zoning.......................................................................................................................... 0/10

Base Categories Points: .....................................................0

Opioid Response Points: ...................................................7
Points Total: .............................................................................................7/500
Score Percentage: ........................................................................1.4%
FINAL GRADE F
106
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 NEBRASKA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 0/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 0/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 0/2
– Storage Protocols................................................................................................................................. 0/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 0/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 0/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 0/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 0/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 0/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 0/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 Cannabis was decriminalized in Nebraska in 1979. Since then the
– Reasonable Security Protocols.................................................................................................... 0/0.71 state has made no progress in further improving access for patients.
– Batch and Lot Tracking..................................................................................................................... 0/0.71
In 2014, Nebraska sued Colorado for that states implementation of
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 legalization, but this case was ultimately denied to proceed by the
Pesticide Guidance.............................................................................................................................. 0/5 Supreme Court. In 2015, the Cannabis Compassion and Care Act was
– Pesticide Guidance.............................................................................................................................. 0/2.5 introduced, but the bill did not successfully move through the state’s
– Pesticide Labeling................................................................................................................................ 0/2.5
unicameral legislature.
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1.25
– Contaminants.......................................................................................................................................... 0/1.25 Opioid Response
– Potency....................................................................................................................................................... 0/1.25 Nebraska’s opioid overdose death count and number of opioid
– Sample Retention................................................................................................................................. 0/1.25
Recall Protocol and Adverse Event Reporting.............................................................. 0/5
prescriptions both fall below the national average. Nebraska has
adopted the CDC opioid prescribing guidelines, and was the first state
Manufacturing 0/25 to enact a prescription drug monitoring program. Nebraska needs to
explore developing a medical cannabis program to further help those
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5 struggling with pain find an alternative treatment.
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
– Workforce Safety Protocols .......................................................................................................... 0/1 Patient Feedback
– Storage Protocols ................................................................................................................................ 0/1
– Reasonable Security Protocols.................................................................................................... 0/1 Patients reported frustration that medical cannabis is illegal in
– Batch and Lot Tracking..................................................................................................................... 0/1 Nebraska.
Product Labeling................................................................................................................................... 0/5
– Product Contents, Including Source Material Identification.................................... 0/1.67
– Allergens..................................................................................................................................................... 0/1.67
– Potency and Compound Information ..................................................................................... 0/1.67
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1
– Contaminants.......................................................................................................................................... 0/1
– Potency....................................................................................................................................................... 0/1
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 0/1
Recall Protocol and Adverse Event Reporting.............................................................. 0/5

Laboratory Operations 0/25

Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 0/5
Standard Operating Procedures and Protocols.......................................................... 0/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

107
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

NEVADA
2018-2019 IMPROVEMENTS B+
As of May 2019, there were 17,623 active patient cardholders in Nevada, over 86%
of which are severe pain patients. Nevada is one of the strongest programs in the
country and demonstrates the value of keeping medical and adult-use programs
legislatively separate. In February 2018, the state promulgated permanent regulations
for the adult use of cannabis which predominantly kept the state’s medical program
in tact though did allow adult-use and medical cannabis establishments to be
co-located and operated with the same license. The regulations also strengthened
testing protocols for medical cannabis.

In 2019, Governor Steve Sisolak signed a bill baring employers from refusing to hire
someone over a positive cannabis test. Beyond these employment protections,
Nevada needs to provide civil protections for cannabis patients receiving organ
transplants, protecting parental rights, and improve housing protections.
2015 2016 2017 2018-19

B+ B B+ B+

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 76/100 EASE OF NAVIGATION 89/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 46/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 7/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 2/5 – System Works for Adding New Conditions.................................................................... 2/5
Employment Protections............................................................................................................ 5/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 4/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 1/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 9/10
Reciprocity............................................................................................................................................. 3/3 Allows Multiple-Year Registrations .................................................................................. 1/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 89/100
Allows Distribution Programs................................................................................................ 36/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 84/100
– Allows Delivery.................................................................................................................................. 4/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 45/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 15/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 2/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 15/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 4/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 8/10

Base Categories Points: .....................................................427.5

Opioid Response Points: ...................................................12.5
Points Total: .............................................................................................440/500
Score Percentage: ........................................................................87.90%
FINAL GRADE B+
108
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 NEVADA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 89/100 Is Cannabis Available for Treatment?........................................................................................................... 3/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 3/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 23/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 3/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 23/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0.71/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In 2000, 65% of Nevada voters approved Question 9, amending the
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 state constitution to allow use, possession, and cultivation of cannabis
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
by qualifying patients who participate in a confidential state run registry
– Disposal/Waste...................................................................................................................................... 0.71/0.71
– Water Management............................................................................................................................ 0.71/0.71 that issues identification cards. Patients may possess up to 2.5 ounces
Pesticide Guidance.............................................................................................................................. 5/5 of cannabis in a single 14 day period, cultivate up to 12 plants (if they
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 are more than 25 miles away from a dispensary), and present a medical
– Pesticide Labeling................................................................................................................................ 2.5/2.5
necessity defense in court if they possessed over the legal limit. In April
Required Testing.................................................................................................................................... 5/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 2014, Senate Bill 374 was enacted, establishing a statewide medical
– Contaminants.......................................................................................................................................... 1.25/1.25 cannabis distribution system. The law allows for the creation of up
– Potency....................................................................................................................................................... 1.25/1.25 to 66 dispensaries and 200 production facilities as regulated by the
– Sample Retention................................................................................................................................. 1.25/1.25
Department of Health and Human Services (DHHS). The law added
Recall Protocol and Adverse Event Reporting.............................................................. 3/5
the 25 mile restriction but also increased patient possession limits and
allowed out of state patients to register and participate in the state
Manufacturing 23/25
program. In 2016, DHHS put patient applications online and began
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
issuing temporary cards allowing patients to enroll and access medicine
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 more quickly. In November of 2016, voters approved an adult-use market
– Workforce Safety Protocols .......................................................................................................... 1/1 in Nevada. As Nevada adopted regulations surrounding the state’s adult-
– Storage Protocols ................................................................................................................................ 1/1 use market in 2017, employment protections were increased and sales tax
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1
on medical cannabis was removed. Governor Sisolak created a Cannabis
Product Labeling................................................................................................................................... 5/5 Compliance Board in 2019.
– Product Contents, Including Source Material Identification.................................... 1.67/1.67
– Allergens..................................................................................................................................................... 1.67/1.67 Opioid Response
– Potency and Compound Information ..................................................................................... 1.67/1.67
Required Testing.................................................................................................................................... 5/5 In 2017 there were 412 opioid overdoses in Nevada, a rate of 13.3 deaths
– Active Ingredient Identification.................................................................................................... 1/1 per 100,000 persons, dropping below the national average for the first
– Contaminants.......................................................................................................................................... 1/1 time since 1999. However, the majority of overdoses in 2017 (276) came
– Potency....................................................................................................................................................... 1/1
from prescription opioids. Nevada allows for severe pain, but not opioid
– Shelf Life Testing................................................................................................................................... 1/1
– Sample Retention................................................................................................................................. 1/1 use disorder. The state could also improve its doctor education program.
Recall Protocol and Adverse Event Reporting.............................................................. 3/5
Patient Feedback
Laboratory Operations 20/25 Patients reported being frustrated that medical cannabis costs as much
Staff Training............................................................................................................................................. 5/5 as the black market and they are not able to access as many of the
Method Validation in Accordance with AHP Guidelines...................................... 0/5 cultivars in Nevada for chronic pain as some of the other states. They
Result Reporting.................................................................................................................................... 5/5
Independent or Third Party........................................................................................................... 5/5 also reported wanting medical providers to be better trained in the use of
Standard Operating Procedures and Protocols.......................................................... 5/5 cannabis for medical purposes.
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83

109
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

NEW HAMPSHIRE
2018-2019 IMPROVEMENTS
B
At the end of 2018, there were 7,120 patients enrolled in the state’s program. During
the 2018 legislative sessions, the number of dispensaries (Alternative Treatment
Centers) in the state doubled. In July of 2018, Governor Chris Sununu created a
medical cannabis oversight board.

In March of 2019, the state removed the requirement that patients to have an existing
three month relationship with a provider for patients in hospice care. In June of 2019,
the NH legislature sent the governor a bil (HB 364) that would allow patients to
home cultivate. As of this writing, it is unclear whether or not the Governor will sign.
Separately, in 2019, the New Hampshire Supreme Court ruled that a labor appeals
board incorrectly decided that workers’ compensation insurance can’t reimburse
employees for medical cannabis costs, leaving the issue open.
2015 2016 2017 2018-19

C+ B- B B

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 86/100 EASE OF NAVIGATION 87/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 45/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 8/10
Parental Rights Protections..................................................................................................... 10/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 3/5
Employment Protections............................................................................................................ 2/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 4/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 8/10
Reciprocity............................................................................................................................................. 3/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 66/100
Allows Distribution Programs................................................................................................ 29/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 88/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 50/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 13/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 1/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 5/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 7/10

Base Categories Points: .....................................................420.5

Opioid Response Points: ...................................................14.5
Points Total: .............................................................................................435/500
Score Percentage: ........................................................................86.90%
FINAL GRADE B
110
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 NEW HAMPSHIRE

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 93/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 25/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 23/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions...................................................................... 0.71/0.71
Background
– Workforce Safety Protocols .......................................................................................................... 0.71/0.71 In 2013, New Hampshire became the 19th medical cannabis state with the
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 passage of HB 573, Use of Cannabis for Therapeutic Purposes, after similar
– Reasonable Security Protocols.................................................................................................... 0.71/0.71
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71 bills had been vetoed twice before. Patients and caregivers registered
– Disposal/Waste...................................................................................................................................... 0.71/0.71 with the New Hampshire Department of Health and Human Services’
– Water Management............................................................................................................................ 0.71/0.71 (DHHS) medical cannabis program, in possession of a registry ID card, who
Pesticide Guidance.............................................................................................................................. 3/5 possess no more than two ounces of cannabis, are protected from arrest
– Pesticide Guidance.............................................................................................................................. 2/2.5
– Pesticide Labeling................................................................................................................................ 1/2.5
or prosecution. If charged, registration provides an affirmative defense for
Required Testing.................................................................................................................................... 5/5 patients or caregivers in compliance with the law. Patients and caregivers
– Active Ingredient Identification.................................................................................................... 1.25/1.25 may not be denied any right or privilege based on their status. Medicine may
– Contaminants.......................................................................................................................................... 1.25/1.25 be obtained by the patient, a registered caregiver, or in some cases a “support
– Potency....................................................................................................................................................... 1.25/1.25
person” from one of the state’s Alternative Treatment Centers. Up to two
– Sample Retention................................................................................................................................. 1.25/1.25
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 ounces may be purchased every 10 days. A patient may only designate one
caregiver, but a caregiver may assist up to five patients. In November 2015,
Manufacturing 25/25 DHHS began issuing ID cards and licensing businesses. In 2016, dispensaries
began serving patients.
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5 New Hampshire’s program saw several small but significant changes to its
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 program in 2017. A change in regulations allowed a “support person” who is
– Workforce Safety Protocols .......................................................................................................... 1/1 not necessarily a caregiver to enter a dispensary and obtain medicine for a
– Storage Protocols ................................................................................................................................ 1/1
– Reasonable Security Protocols.................................................................................................... 1/1
qualifying patient. New Hampshire’s program also added chronic pain, PTSD,
– Batch and Lot Tracking..................................................................................................................... 1/1 Ehlers-Danlos Syndrome, and Hepatitis C. New Hampshire also added a
Product Labeling................................................................................................................................... 5/5 more effective petition process for adding new qualifying conditions. New
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 Hampshire could improve its program by adding employment discrimination
– Allergens..................................................................................................................................................... 1.67/1.67 protections, allow delivery and/or home cultivation, and allow for patients to
– Potency and Compound Information ..................................................................................... 1.67/1.67
Required Testing.................................................................................................................................... 5/5
have multiple year registrations. There were no recalls in 2018 and only one
– Active Ingredient Identification.................................................................................................... 1/1 reportable incident. Low Income and Veteran discounts are provided at the
– Contaminants.......................................................................................................................................... 1/1 discretion of each Alternative Treatment Center.
– Potency....................................................................................................................................................... 1/1
– Shelf Life Testing................................................................................................................................... 1/1 Opioid Response
– Sample Retention................................................................................................................................. 1/1
Recall Protocol and Adverse Event Reporting.............................................................. 5/5
In 2017 there were 424 opioid overdose deaths putting the state in the top
five deadliest. The overdose rate for New Hampshire is more than double
Laboratory Operations 20/25 the national average. Since approving chronic pain, the patient count has
Staff Training............................................................................................................................................. 5/5
increased by over 33%. Moderate to severe chronic pain is the most prevalent
Method Validation in Accordance with AHP Guidelines...................................... 0/5 condition in New Hampshire’s program.
Result Reporting.................................................................................................................................... 5/5
Independent or Third Party........................................................................................................... 5/5 Patient Feedback
Standard Operating Procedures and Protocols.......................................................... 5/5
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83 Many patients reported frustration with the cumbersome process to renew
– Sample Tracking.................................................................................................................................... 0.83/0.83 a card, and do not like to have to select only one ATC. Patients also reported
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83 that the prices are very high compared to other states and wish there was a
– Disposal/Waste...................................................................................................................................... 0.83/0.83
home grown option. Other concerns reported were over the small number
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83 of dispensaries in the state, that patients are assigned to a state dispensary
and cannot switch dispensaries easily, and that the number of cultivars in
dispensaries are very limited making it difficult to find the cultivar(s) that work
best for their ailments. Patients indicated a desire for dispensary staff to be
better trained. In addition, some patients reported frustration that they cannot
be a medical cannabis user and also own guns.
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 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

NEW JERSEY
2018-2019 IMPROVEMENTS
As of March 2019, New Jersey served 49,018 medical cannabis patients. The New Jersey program saw great
improvements over the last year under Governor Phil Murphy. While much of the legislative session was spent
B
debating an adult-use measure that never passed there were significant victories for patients. In March of
2018, Murphy added five new categories of qualifying conditions, including chronic pain, and reduced patient
and caregiver fees from $200 to $100, and added an additional $20 dollar discount for seniors and veterans.
Opioid Use Disorder was added separately. These regulations also removed the cap of one caregiver per
patient and allowed for Alternative Treatment Centers to open up satellite locations. Further, Governor Murphy
and Regulators announced they plan to license up to 108 new medical cannabis businesses.
Regulations in May 2018 also expanded the forms of available cannabis to include oil based formulations
like vape cartridges, streamlined the process to add new qualifying conditions, and removed the
requirement of a psychiatric evaluation for minor patients. It also removed the requirement that physicians
had to list their information online to participate in the program. Further, a NJ Workers compensation judge
ordered a town to cover the cost of a town employee’s medical cannabis, setting a precedent for potential
future coverage in other workers’ compensation cases.
While the cutoff for inclusion in this report was June 1, 2019, it is worth mentioning that in July 2019 a
significant piece of medical cannabis reform legislation, the “Jake Honig Compassionate Use Medical 2015 2016 2017 2018-19
Marijuana Act” which increases patient purchase limits, allows hospices to buy cannabis for patients,
grants reciprocity and allows for home delivery, was signed into law. C C C B

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 77/100 EASE OF NAVIGATION 98/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 48/50
Affirmative Defense........................................................................................................................ 13/15 Adding New Conditions.............................................................................................................. 10/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 5/5
Employment Protections............................................................................................................ 5/5 Reasonable Access for Minors.............................................................................................. 10/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 4/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 10/10
Reciprocity............................................................................................................................................. 3/3 Allows Multiple-Year Registrations .................................................................................. 2/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 68/100
Allows Distribution Programs................................................................................................ 33/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 88/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 4/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 45/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 14/15
– Ownership/Employment Restrictions................................................................................ 2/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 5/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 1/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 7/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 7/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 8/10

Base Categories Points: .....................................................407.43

Opioid Response Points: ...................................................20.5
Points Total: .............................................................................................427.93/500
Score Percentage: ........................................................................85.59%
FINAL GRADE B
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MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 NEW JERSEY

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 76.43/100 Is Cannabis Available for Treatment?........................................................................................................... 10/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 5/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 19.67/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 2.67/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 1/5
– Potency/Compound Identification............................................................................................ 1/1.67 – Is there a veteran discount?.................................................................................................................................. 1/1
Required Testing.................................................................................................................................... 2/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 20/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 2.84/5 Background
– Facility and Equipment Sanitary Conditions...................................................................... 0.71/0.71
– Workforce Safety Protocols .......................................................................................................... 0/0.71 On January 18, 2010, Governor Jon Corzine signed the New Jersey
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 Compassionate Use Marijuana Act, SB 119, into law on his last day in office.
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 Governor Chris Christie subsequently made several attempts to delay the
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
– Disposal/Waste...................................................................................................................................... 0/0.71 program. After a series of legislative and bureaucratic battles, the New
– Water Management............................................................................................................................ 0/0.71 Jersey Department of Health (DOH) adopted rules for the program in
Pesticide Guidance.............................................................................................................................. 4/5 2011. These rules included changes to the licensing process for cultivators
– Pesticide Guidance.............................................................................................................................. 2/2.5 and distributors, prohibited home delivery, and required a recommending
– Pesticide Labeling................................................................................................................................ 2/2.5
Required Testing.................................................................................................................................... 3.25/5 physician to certify that a patient’s qualifying condition is “resistant to
– Active Ingredient Identification.................................................................................................... 1.25/1.25 conventional medical therapy” and must be recertified every 90 days.
– Contaminants.......................................................................................................................................... 1/1.25 Patients must obtain medicine from one of six Alternative Treatment
– Potency....................................................................................................................................................... 1/1.25 Centers. The certifying physician must indicate the quantity a registered
– Sample Retention................................................................................................................................. 0/1.25
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 patient can obtain, not to exceed two ounces in a 30-day period.
The first patient registrations were accepted in August 2012, and the first
Manufacturing 19.67/25 Alternative Treatment Center (ATC) opened in December 2012, with the
Staff Training............................................................................................................................................. 5/5 most recent ATC opening in Secaucus in 2017. In August 2013, SB 2842
Standard Operating Procedures............................................................................................... 5/5 lifted the limits on the number of cannabis cultivars that may be cultivated
– Facility and Equipment Sanitary Conditions...................................................................... 1/1
– Workforce Safety Protocols .......................................................................................................... 1/1
and allowed for the manufacture and distribution of edible cannabis
– Storage Protocols ................................................................................................................................ 1/1 solely to minors. In 2016, the legislature passed AB 457 adding PTSD as a
– Reasonable Security Protocols.................................................................................................... 1/1 qualifying condition, and the DOH finally appointed a panel of physicians
– Batch and Lot Tracking..................................................................................................................... 1/1 and health professionals with the authority to add more conditions.
Product Labeling................................................................................................................................... 2.67/5
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 The state still needs to improve its production and supply base so more
– Allergens..................................................................................................................................................... 0/1.67 patients can benefit from the program, but with Governor Murphy’s
– Potency and Compound Information ..................................................................................... 1/1.67
Required Testing.................................................................................................................................... 2/5
expansion this may happen sooner rather than later. New Jersey also needs
– Active Ingredient Identification.................................................................................................... 1/1 to add civil discrimination protections in the areas of housing, employment,
– Contaminants.......................................................................................................................................... 0/1 parental rights and organ transplants.
– Potency....................................................................................................................................................... 1/1
– Shelf Life Testing................................................................................................................................... 0/1 Opioid Response
– Sample Retention................................................................................................................................. 0/1
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 New Jersey allows for both opioid use disorder and chronic pain. Governor
Murphy’s move to increase the number of dispensaries will greatly increase
Laboratory Operations 17/25 patient access points. The Governor specifically includes the use of medical
Staff Training............................................................................................................................................. 3/5 cannabis in his plan to fight the opioid epidemic by allowing all individuals
Method Validation in Accordance with AHP Guidelines...................................... 0/5 in medication assisted treatment programs to use medical cannabis,
Result Reporting.................................................................................................................................... 5/5 not just those with chronic pain. The opioid overdose rate in New Jersey
Independent or Third Party........................................................................................................... 4/5
Standard Operating Procedures and Protocols.......................................................... 5/5
increased by 29.3% from 2016 to 2017, so hopefully the expansion of the
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83 state’s cannabis program will assist in reducing overdose deaths.
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83 Patient Feedback
– Disposal/Waste...................................................................................................................................... 0.83/0.83
Patients reported that the prices are very high and there is a lack of variety
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83 of medical cannabis products available. Patients also wanted more medical
providers available to recommend medical cannabis products. Some
patients reported that medical providers are overcharging them for regular
visits for medical cannabis recommendations. In addition, some patients
reported wanting access to edibles.

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 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

NEW MEXICO
2018-2019 IMPROVEMENTS
As of June 1, New Mexico had 73,350 active patients in the state program. New Mexico had several
B+
improvements during 2018-2019. In March of 2018, New Mexico made it easier for patients to
apply for the medical cannabis program by shortening the application process. In October of 2018
regulators added two additional medical dispensaries, and a court ruled that the 450 plant cap at
dispensaries was arbitrary, enabling regulators to enact a rule that allowed producers to grow up
to 2,500 plants, greatly increasing the supply of medicine.

Governor Lujan Girsham signed a bill to allow cannabis in schools as well as a bill (SB 406) that
broadly expanded the state’s program by providing exemptions from criminal and civil liability
for all patients, caregivers, and employees; established civil rights protections in the area of child
custody and medical care including organ transplant; creates employment protections preventing
employers from taking adverse actions; creates a 3-year registry card; requires the DOH to publish
an annual report on the affordability and accessibility to medical cannabis including access for
those in rural areas and living in subsidized housing; allows DOH to license on-site consumption
of cannabis; and requires DOH to create product safety and quality rules by December 2019.

Regulators also added opioid use disorder, sleep apnea, Alzhiemer’s disease, autism spectrum 2015 2016 2017 2018-19
disorder, and three degenerative neurological disorders as medical cannabis qualifying conditions.
B+ B B B+

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 82/100 EASE OF NAVIGATION 88/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 46/50
Affirmative Defense........................................................................................................................ 13/15 Adding New Conditions.............................................................................................................. 10/10
Parental Rights Protections..................................................................................................... 8/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 5/5
Employment Protections............................................................................................................ 4/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 9/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 2/2
Reasonable Physician Requirements.............................................................................. 4/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 3/5
ACCESS TO MEDICINE 90/100
Allows Distribution Programs................................................................................................ 34/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 78/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 4/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 40/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 11/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 2/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 18/20
Covered by Insurance/State Health Aid........................................................................ 2/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 4/7
– Collective Gardening..................................................................................................................... 3/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 9/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 9/10

Base Categories Points: .....................................................426.34

Opioid Response Points: ...................................................23
Points Total: .............................................................................................449.34/500
Score Percentage: ........................................................................89.67%
FINAL GRADE B+
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MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 NEW MEXICO

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 88.34/100 Is Cannabis Available for Treatment?........................................................................................................... 10/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 5/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 22.67/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 2.67/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 1/5
– Potency/Compound Identification............................................................................................ 1/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 2.5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 23/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0.71/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In March 2007, the New Mexico legislature passed SB 523, the “Lynn
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 and Erin Compassionate Use Act.” The law allowed patients and their
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
caregivers to collectively possess up to six ounces of usable cannabis
– Disposal/Waste...................................................................................................................................... 0.71/0.71
– Water Management............................................................................................................................ 0.71/0.71 and, after obtaining a separate permit, cultivate up to four mature plants
Pesticide Guidance.............................................................................................................................. 3/5 and 12 seedlings. The Department of Health (DOH) oversees the rules
– Pesticide Guidance.............................................................................................................................. 2/2.5 and regulations for patient and caregiver IDs and Personal Production
– Pesticide Labeling................................................................................................................................ 1/2.5
Licenses (PPLs) for patients or caregivers to grow medical cannabis for
Required Testing.................................................................................................................................... 5/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 personal use. Thirty-nine licensed non-profit producers serving medical
– Contaminants.......................................................................................................................................... 1.25/1.25 cannabis patients were relicensed for 2018. The DOH has updated
– Potency....................................................................................................................................................... 1.25/1.25 the regulations several times to expand plant numbers and clarify
– Sample Retention................................................................................................................................. 1.25/1.25
requirements. New Mexico’s program includes a Medical Advisory Board
Recall Protocol and Adverse Event Reporting.............................................................. 5/5
that can approve new qualifying conditions and was the first to approve
PTSD. The Board also removed restrictions on chronic pain patients from
Manufacturing 22.67/25
qualifying for the program. In 2016, the DOH extended the expiration date
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
for many patients so they could improve their ability to turn around more
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 applications more quickly. This period of extension ended in April of 2017
– Workforce Safety Protocols .......................................................................................................... 1/1 after the DOH believed it sufficiently addressed its backlog.
– Storage Protocols ................................................................................................................................ 1/1
– Reasonable Security Protocols....................................................................................................
– Batch and Lot Tracking.....................................................................................................................
1/1
1/1
Opioid Response
Product Labeling................................................................................................................................... 2.67/5 New Mexico has adopted many sound policies that can help combat
– Product Contents, Including Source Material Identification.................................... 0/1.67 the opioid crisis including adding opioid use disorder, adding civil
– Allergens..................................................................................................................................................... 1/1.67
rights protections and mandating an accessibility report. In 2017, 491
– Potency and Compound Information ..................................................................................... 1/1.67
Required Testing.................................................................................................................................... 5/5 individuals in New Mexico died of opioid overdose with over ⅔ of the
– Active Ingredient Identification.................................................................................................... 1/1 deaths resulting from prescription opioids. The state should improve
– Contaminants.......................................................................................................................................... 1/1 doctor education and could further improve by making medical cannabis
– Potency....................................................................................................................................................... 1/1
available to patients on the same day that they register.
– Shelf Life Testing................................................................................................................................... 1/1
– Sample Retention................................................................................................................................. 1/1
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 Patient Feedback
Patients reported that the prices are very high and there are concerns
Laboratory Operations 20/25 with product quality. Inconsistent product availability in dispensaries
Staff Training............................................................................................................................................. 5/5 makes it difficult for patients to find the same products that worked for
Method Validation in Accordance with AHP Guidelines...................................... 0/5 them before. Employees stated that they want the state to do away with
Result Reporting.................................................................................................................................... 5/5
Independent or Third Party........................................................................................................... 5/5 random drug screenings for cannabis as many patients do not want to
Standard Operating Procedures and Protocols.......................................................... 5/5 choose between their employment and their health care. Rural patients
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83 reported frustration that dispensaries are far away from them and they
– Sample Tracking.................................................................................................................................... 0.83/0.83 wish there were more dispensaries in their areas.
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83

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 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

NEW YORK
2018-2019 IMPROVEMENTS B-
New York currently has a patient population of 102,978 participating in
the state’s program. New York made a great improvement by allowing
cannabis to be used for any condition for which an opioid would have been
prescribed, including acute pain management. The state also added opioid
use disorder in June of 2018.

New York joined the ranks of states that fiercely debated legislation
establishing the adult-use of cannabis. Lawmakers settled on a bill that
decriminalized cannabis use and allowed for expungements of many
previous cannabis offenses.

2015 2016 2017 2018-19

C C C+ B-

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 72/100 EASE OF NAVIGATION 91/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 48/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 10/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 5/5
Employment Protections............................................................................................................ 5/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 9/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 60/100
Allows Distribution Programs................................................................................................ 25/40
– Allows Access to Dried Flowers............................................................................................ 8/15 FUNCTIONALITY 75/100
– Allows Delivery.................................................................................................................................. 3/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 3/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 4/5 Dispensaries or by Cultivation.......................................................................................... 40/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 12/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 2/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 2/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 3/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 5/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 7/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 8/10

Base Categories Points: .....................................................327.67

Opioid Response Points: ...................................................27.5
Points Total: .............................................................................................400.17/500
Score Percentage: ........................................................................80.03%
FINAL GRADE B-
116
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 NEW YORK

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 74.67/100 Is Cannabis Available for Treatment?........................................................................................................... 15/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 5/5
– Does the state allow for opioid use disorder?........................................................................................... 5/5
Doctor Education........................................................................................................................................................... 7/7
Dispensing 20.67/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 3/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 2/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 2.67/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 1/5
– Potency/Compound Identification............................................................................................ 1/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 01.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 21/25
Staff Training............................................................................................................................................. 3/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions...................................................................... 0.71/0.71 Background
– Workforce Safety Protocols .......................................................................................................... 0.71/0.71
In June 2014, the New York Assembly passed S7923, which created legal
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 protections for patients and caregivers and authorized the Department of
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71 Health (DOH) to license and regulate “registered organizations” to cultivate
– Disposal/Waste...................................................................................................................................... 0.71/0.71 and sell medical cannabis to patients. Upon receiving written certification
– Water Management............................................................................................................................ 0.71/0.71
from their physician, patients must obtain a registration identification card.
Pesticide Guidance.............................................................................................................................. 3/5
– Pesticide Guidance.............................................................................................................................. 2/2.5 The law requires physicians to complete educational requirements and
– Pesticide Labeling................................................................................................................................ 1/2.5 state the “dosage” patients should use, which then is used to determine the
Required Testing.................................................................................................................................... 5/5 amount that constitutes a 30-day supply of medicine that the patient may
– Active Ingredient Identification.................................................................................................... 1.25/1.25
possess. The law forbids the smoking of cannabis but does not explicitly ban
– Contaminants.......................................................................................................................................... 1.25/1.25
– Potency....................................................................................................................................................... 1.25/1.25 patients from access to cannabis in its dried flower form.
– Sample Retention................................................................................................................................. 1.25/1.25
The DOH granted five licenses in July 2015, and began issuing patient
Recall Protocol and Adverse Event Reporting.............................................................. 5/5
ID cards in December 2015. In January 2016, dispensaries began serving
medical cannabis patients. In 2016, the DOH added chronic pain as
Manufacturing 23/25
a qualifying condition and updated the regulations to allow nurse
Staff Training............................................................................................................................................. 3/5
Standard Operating Procedures............................................................................................... 5/5
practitioners to recommend medical cannabis, home delivery, and registered
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 organizations to sell “wholesale” products to other registered organizations
– Workforce Safety Protocols .......................................................................................................... 1/1 to prevent shortages. The program was improved again in 2017 with the
– Storage Protocols ................................................................................................................................ 1/1 addition of PTSD and chronic pain as well more registered organizations and
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1
an increased variety of products.
Product Labeling................................................................................................................................... 5/5
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 Opioid Response
– Allergens..................................................................................................................................................... 1.67/1.67 In 2017, there were 3,224 overdose deaths­­­involving opioids in New York—a
– Potency and Compound Information ..................................................................................... 1.67/1.67
Required Testing.................................................................................................................................... 5/5
rate of 16.1 deaths per 100,000 persons compared to the average national
– Active Ingredient Identification.................................................................................................... 1/1 rate of 14.6 deaths per 100,000 persons. In 2018, the New York Senate Task
– Contaminants.......................................................................................................................................... 1/1 Force on Heroin and Opioid Addiction recommended expanding health
– Potency....................................................................................................................................................... 1/1 insurance coverage to include medical cannabis, though it is unclear if this
– Shelf Life Testing................................................................................................................................... 1/1
– Sample Retention................................................................................................................................. 1/1
recommendation will be implemented. New York deserves credit for allowing
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 any condition for which opioids would be prescribed to be replaced with
medical cannabis. However, the state could increase the number of access
Laboratory Operations 10/25 points to better serve patients.
Staff Training............................................................................................................................................. 5/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5 Patient Feedback
Result Reporting.................................................................................................................................... 0/5 Patients reported that the prices are very high and there are concerns
Independent or Third Party........................................................................................................... 0/5
with product quality. Patients also reported wanting insurance companies
Standard Operating Procedures and Protocols.......................................................... 5/5
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83 involved for covering the costs of medical cannabis products. Patients
– Sample Tracking.................................................................................................................................... 0.83/0.83 expressed wanting greater access to the whole flower and are frustrated
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83 that they must use highly processed products of indeterminate origin and
– Disposal/Waste...................................................................................................................................... 00.83/0.83
makeup. Patients noted that inconsistent product availability in dispensaries
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83 makes it difficult for patients to find the same products that worked for them
before. Patients also reported wanting more dispensaries as the nearest
dispensaries are still very far away from them. Patients also expressed living
in fear of arrest and eviction because they live in federal housing and use
medical cannabis.

117
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

NORTH CAROLINA
2018-2019 IMPROVEMENTS
F
No improvements happened in North Carolina. In fact, not a single
lawmaker showed up to the first scheduled meeting of the North Carolina
Cannabis Caucus.

2015 2016 2017 2018-19

F F F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 37/100 EASE OF NAVIGATION 46/100

Arrest Protection.............................................................................................................................. 20/40 Comprehensive Qualifying Conditions.......................................................................... 20/50
Affirmative Defense........................................................................................................................ 7/15 Adding New Conditions.............................................................................................................. 0/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 6/10
Explicit Privacy Standards........................................................................................................ 5/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 1/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 9/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 3/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 3/5
ACCESS TO MEDICINE 11/100
Allows Distribution Programs................................................................................................ 0/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 25/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 0/5 Dispensaries or by Cultivation.......................................................................................... 0/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 8/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 7/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 0/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 3/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 7/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 3/10
Does Not Impose Bans or Limits on THC..................................................................... 1/10
Does Not Impose Bans on CBD............................................................................................ 7/10
Local Bans/Zoning.......................................................................................................................... 0/10

Base Categories Points: .....................................................143.34

Opioid Response Points: ...................................................7
Points Total: .............................................................................................150.34/500
Score Percentage: ........................................................................30.07%
FINAL GRADE F
118
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 NORTH CAROLINA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 24.34/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 5.67/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 0/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 0/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 0/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 2.67/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 3/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 8/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.71
Background
– Workforce Safety Protocols .......................................................................................................... 0/0.71 In July 2014, North Carolina enacted HB 1220, known as North Carolina
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 Epilepsy Alternative Treatment Act, creating a pilot program that allows
– Reasonable Security Protocols.................................................................................................... 0/0.71
– Batch and Lot Tracking..................................................................................................................... 0/0.71
medical use of CBD-rich oil only for registered patients diagnosed by a
– Disposal/Waste...................................................................................................................................... 0/0.71 neurologist at one of four universities as having intractable epilepsy (that
– Water Management............................................................................................................................ 0/0.71 has not been responsive to at least three other treatment options). Access
Pesticide Guidance.............................................................................................................................. 0/5 is only through a registered caregiver who must be a parent, guardian, or
– Pesticide Guidance.............................................................................................................................. 0/2.5
– Pesticide Labeling................................................................................................................................ 0/2.5
legal custodian, and who must obtain the CBD oil in a state with reciprocity
Required Testing.................................................................................................................................... 3/5 to purchase medical cannabis products. Most medical cannabis jurisdictions
– Active Ingredient Identification.................................................................................................... 1/1.25 that honor reciprocity for other state registration cards do not allow patients/
– Contaminants.......................................................................................................................................... 1/1.25 caregivers from out of state to purchase any medical cannabis products. The
– Potency....................................................................................................................................................... 1/1.25
– Sample Retention................................................................................................................................. 0/1.25
CBD-rich oil must contain at least 10% CBD, no more than 0.3% THC, and
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 must have no other psychoactive components.
In July of 2015, House Bill 766 was signed by Governor McCory, amending HB
Manufacturing 10.67/25 1220 to expand qualified physicians to include any board certified physician
Staff Training............................................................................................................................................. 0/5 certified in neurology and affiliated with any state-licensed hospital. The bill
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
also changed the required THC/CBD percentages for medical cannabis from
– Workforce Safety Protocols .......................................................................................................... 0/1 greater than 10% CBD and less than 0.3% THC to greater than 5% CBD and
– Storage Protocols ................................................................................................................................ 0/1 less than 0.9% THC. There were also changes to enhance patient privacy as
– Reasonable Security Protocols.................................................................................................... 0/1 well as the addition of a sunset clause, ending the medical cannabis program
– Batch and Lot Tracking..................................................................................................................... 0/1
Product Labeling................................................................................................................................... 2.67/5
in 2021 if studies fail to show therapeutic relief from CBD.
– Product Contents, Including Source Material Identification.................................... 1.67/1.67
– Allergens..................................................................................................................................................... 0/1.67 Opioid Response
– Potency and Compound Information ..................................................................................... 1/1.67 In 2017, there were 1,953 overdose deaths­­­involving opioids in North
Required Testing.................................................................................................................................... 3/5
Carolina—a rate of 19.8 deaths per 100,000 persons compared to the average
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 1/1 national rate of 14.6 deaths per 100,000 persons. Governor Cooper served on
– Potency....................................................................................................................................................... 1/1 the President’s Commission on Opioids and Drug Dependence, a commission
– Shelf Life Testing................................................................................................................................... 1/1 which indicated that cannabis may be linked to an increase in opioid use
– Sample Retention................................................................................................................................. 0/1
disorder. The only doctor in the North Carolina Legislature recognized the
Recall Protocol and Adverse Event Reporting.............................................................. 5/5
value of medical cannabis in reducing the opioid crisis, but did not introduce
Laboratory Operations 0/25 any legislation as follow up. North Carolina still lacks many of the components
that make a state medical cannabis program effective, including in-state
Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5 production and dispensing systems. North Carolina’s Department of Health
Result Reporting.................................................................................................................................... 0/5 has issued an Opioid Action Plan to reduce opioid overdose deaths by 20%
Independent or Third Party........................................................................................................... 0/5 by the year 2021, but this plan does not include using medical cannabis
Standard Operating Procedures and Protocols.......................................................... 0/5
as a tool. There are no civil protections for patients included in the areas
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0/0.83 of housing, organ transplants, employment rights, and parental rights. The
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83 program could benefit by expanding the list of qualifying conditions and
– Disposal/Waste...................................................................................................................................... 0/0.83 removing the arbitrary limits on THC and CBD. North Carolina also needs to
– Storage Protocols................................................................................................................................. 0/0.83
develop rigorous product safety regulations.
– Workforce Safety Protocols .......................................................................................................... 0/0.83
Patient Feedback
Patients reported being frustrated that medical cannabis is illegal in North
Carolina, except for the state’s limited CBD program.

119
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

NORTH DAKOTA
2018-2019 IMPROVEMENTS
As of June 2019, 683 patient registration cards had been issued to qualifying patients, with two open
C+
dispensaries (an additional two locations are anticipated to open in July 2019, with four more opening later
in 2019). The state began accepting patient applications in October 2018. North Dakota has done well at
implementing it’s program fairly quickly. Medical cannabis sales began in March of 2019. In April of 2019,
the state made significant changes through a series of bills (HB 1119, HB 1283, HB 1417, HB 1519, SB 2200,
SB 2210), including easing the burden of minor patient registration, allowing caregivers to live out of state,
furthering privacy protections for patients, and adding physician assistants to the list of providers.
The state also removed the requirement that healthcare providers had to state on the certification that
the patient was likely to receive a benefit form medical cannabis, allowed a process for veterans to submit medical
records and discharge documentation instead of a certification, removed the requirement for patients to indicate
whether or not they possessed a firearm by including a disclosure about further violations of federal law.
Certain qualifying patients were also allowed an increased possession limit of up to 7.5 ounces in a 30 day period (up
from 2.5 ounces), the maximum amount of THC in a cannabinoid concentrate or cannabinoid product was increased
from 2,000 to 4,000 mg, and the requirement that a health care provider must authorize use of dried flowers was
removed. However, minors (under 19) are not eligible for dried flower. The state also added 12 qualifying
conditions and improved the process for adding additional conditions. Lastly, manufacturing facilities
2015 2016 2017 2018-19
can now grow to meet patient demands instead of being arbitrarily capped.
NA D+ C C+

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 52/100 EASE OF NAVIGATION 86/100

Arrest Protection.............................................................................................................................. 30/40 Comprehensive Qualifying Conditions.......................................................................... 45/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 8/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 3/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 8/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 1/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 8/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 1/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 81/100
Allows Distribution Programs................................................................................................ 34/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 78/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 45/50
– Does Not Require Vertical Integration............................................................................... 1/2 No Significant Administrative or Supply Problems.............................................. 12/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 7/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 5/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 10/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 10/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 0/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 7/10

Base Categories Points: .....................................................383

Opioid Response Points: ...................................................5
Points Total: .............................................................................................388/500
Score Percentage: ........................................................................77.62%
FINAL GRADE C+
120
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 NORTH DAKOTA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 86.11/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 19.25/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 3.25/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 0/3
– Facility Sanitary Conditions........................................................................................................... 1/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 0/2
– Storage Protocols................................................................................................................................. 1/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 0/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 2.67/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 3/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 23/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 3/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In 2016, 64% of North Dakotans voted in favor of the North Dakota
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 Medical Marijuana Legalization initiative, creating a comprehensive
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
cannabis program for patients of the state. The program allows access
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 for patients at retail dispensaries, but also allows patients to grow up to
Pesticide Guidance.............................................................................................................................. 5/5 8 plants if they live 40 or more miles away from the nearest dispensary.
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 The program is one of the strictest in the nation as it allows the ND
– Pesticide Labeling................................................................................................................................ 2.5/2.5
Department of Health to conduct in person interviews in order to
Required Testing.................................................................................................................................... 5/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 determine eligibility. Implementation legislation for this program became
– Contaminants.......................................................................................................................................... 1.25/1.25 effective on April 18, 2017.
– Potency....................................................................................................................................................... 1.25/1.25
– Sample Retention................................................................................................................................. 1.25/1.25 North Dakota appears to be moving at a good pace in implementing their
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 medical cannabis program. As North Dakota continues to implement
its medical cannabis program, adopting the proposed rules would lead
Manufacturing 24/25 to the implementation of strong product safety protocols. North Dakota
Staff Training............................................................................................................................................. 5/5 could also improve its program by adding affirmative defense as well
Standard Operating Procedures............................................................................................... 4/5 as civil discrimination protections in the areas of housing, employment,
– Facility and Equipment Sanitary Conditions...................................................................... 1/1
– Workforce Safety Protocols .......................................................................................................... 0/1
organ transplants, and parental rights.
– Storage Protocols ................................................................................................................................ 1/1
– Reasonable Security Protocols.................................................................................................... 1/1 Opioid Response
– Batch and Lot Tracking..................................................................................................................... 1/1
North Dakota needs to add chronic pain and opioid use disorder to its
Product Labeling................................................................................................................................... 5/5
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 program. North Dakota’s overdose rate and prescribing rates are both
– Allergens..................................................................................................................................................... 1.67/1.67 below the national average, but the state still had a rate of 9.2 overdose
– Potency and Compound Information ..................................................................................... 1.67/1.67 deaths per 100,000. However, the state needs to increase its access
Required Testing.................................................................................................................................... 5/5
points to better serve the patient population.
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 1/1
– Potency....................................................................................................................................................... 1/1 Patient Feedback
– Shelf Life Testing................................................................................................................................... 1/1 No patient feedback was received from North Dakota patients.
– Sample Retention................................................................................................................................. 1/1
Recall Protocol and Adverse Event Reporting.............................................................. 5/5

Laboratory Operations 20/25

Staff Training............................................................................................................................................. 5/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 5/5
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 5/5
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83

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 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

OHIO
2018-2019 IMPROVEMENTS B
As of June 1, 2019 Ohio had 35,162 patients with recommendations in the program.
After a slow start in 2016 and 2017, Ohio’s program is finally starting to get off the
ground. Medical cannabis sales began in January 2019, and 56 dispensaries have
been issued provisional licenses (19 are operational). The vast majority of medical
cannabis recommendations are being made by doctors at cannabis clinics, rather
than primary care facilities. Further, the Ohio Medical Board denied adding opioid
addiction, depression and insomnia as qualifying conditions and delayed a decision
on autism and anxiety. The state’s first testing lab was approved in 2019.

2015 2016 2017 2018-19

NA B B+ B

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 84/100 EASE OF NAVIGATION 83/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 44/50
Affirmative Defense........................................................................................................................ 10/15 Adding New Conditions.............................................................................................................. 8/10
Parental Rights Protections..................................................................................................... 10/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 5/5 – System Works for Adding New Conditions.................................................................... 3/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 4/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 4/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 7/10
Reciprocity............................................................................................................................................. 1/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 2/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 63/100
Allows Distribution Programs................................................................................................ 30/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 84/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 40/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 15/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 7/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 5/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 5/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 7/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 9/10
Does Not Impose Bans or Limits on THC..................................................................... 9/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 5/10

Base Categories Points: .....................................................409.01

Opioid Response Points: ...................................................16.5
Points Total: .............................................................................................425.51/500
Score Percentage: ........................................................................85.10%
FINAL GRADE B
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MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 OHIO

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 95/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 7/7
Dispensing 23/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 2/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 0/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 0/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 2/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 1/1
Required Testing.................................................................................................................................... 3/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 1/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 22/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0.71/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 Ohio’s medical cannabis program was created by HB 523 (2016),
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 which went into effect on September 8, 2016. The law allows patients
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
in Ohio to obtain legal protections to possess and use medical
– Disposal/Waste...................................................................................................................................... 0.71/0.71
– Water Management............................................................................................................................ 0.71/0.71 cannabis. The Ohio Medical Marijuana Control Program is comprised
Pesticide Guidance.............................................................................................................................. 4/5 of several state agencies that regulate the program. Patients who
– Pesticide Guidance.............................................................................................................................. 2/2.5 meet certain requirements are eligible for an affirmative defense
– Pesticide Labeling................................................................................................................................ 2/2.5
for possession and use of medical cannabis. Ohio promulgated
Required Testing.................................................................................................................................... 3/5
– Active Ingredient Identification.................................................................................................... 1/1.25 rules for a variety of areas in 2017, including dispensing, cultivation,
– Contaminants.......................................................................................................................................... 1/1.25 manufacturing, and laboratory standards.
– Potency....................................................................................................................................................... 1/1.25
– Sample Retention................................................................................................................................. 01/1.25 Opioid Response
Recall Protocol and Adverse Event Reporting.............................................................. 5/5
Ohio has moved well through the implementation process, but the
Manufacturing 25/25 state’s program is still a long way from being fully functional and
serving patients. In 2017, Ohio had the second highest rate of opioid
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5 overdose deaths in the United States (4293 in 2017). It is disappointing
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 to see the Ohio Medical Board deny a petition for opioid addiction,
– Workforce Safety Protocols .......................................................................................................... 1/1 when it is clearly devastating the state. Patients are also forced to
– Storage Protocols ................................................................................................................................ 1/1
deal with the worst employment language in the country, making
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1 employment discrimination against patients lawful and explicitly
Product Labeling................................................................................................................................... 5/5 denying patients a cause of action in court to challenge employment
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 discrimination cases. Cannabis and opioid education is available
– Allergens..................................................................................................................................................... 1.67/1.67
through the Ohio State Medical Society but not directly through the
– Potency and Compound Information ..................................................................................... 1.67/1.67
Required Testing.................................................................................................................................... 5/5 State Department of Health.
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 1/1 Patient Feedback
– Potency....................................................................................................................................................... 1/1
– Shelf Life Testing................................................................................................................................... 1/1 Ohio patients reported frustration with the slow rollout of the state’s
– Sample Retention................................................................................................................................. 1/1 program.
Recall Protocol and Adverse Event Reporting.............................................................. 5/5

Laboratory Operations 25/25

Staff Training............................................................................................................................................. 5/5
Method Validation in Accordance with AHP Guidelines...................................... 5/5
Result Reporting.................................................................................................................................... 5/5
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 5/5
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83

123
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

OKLAHOMA
2018-2019 IMPROVEMENTS
As of June 1, there are over 140,000 patients registered in Oklahoma. This number is almost certainly
B
attributable to the state’s lack of qualifying conditions list and the large number of access points.
Oklahoma saw a massive improvement in 2018 when voters passed a comprehensive medical cannabis
initiative. The Oklahoma Medical Program was able to get up and running and grow rapidly as there was
no caps on how many dispensaries could be opened, with nearly 1,500 already in the state. Patients may
possess up to 3 ounces at a time. The state has reduced fees for low income patients.
In 2018, regulations that were passed in response to the initiative removed the ban on smoking, and the
requirement that all dispensaries have a pharmacist on staff. In December of 2018, The Oklahoma Court
of Civil Appeals ruled that the presence of an intoxicating substance in the blood does not automatically
mean impairment, which is a victory for those patients who may be drug tested in the workplace.
The state has approved rules for edibles and Governor Kevin Stitt has signed laws that expand the
pool of physicians that can recommend medical cannabis (SB 162) and a bill (HB 2612) that sets up
guidelines for inventory testing and tracking, advertising, packing and labeling. HB 2612 also sets
up a Medical Marijuana Authority within the state Department of Health, creates a patient registry,
outlines the rights of patients who are firearm owners, allows patients to have 2-year registrations 2015 2016 2017 2018-19
and for veterans to participate in the program and creates medical cannabis research licenses. Other
implementation bills passed in 2019 include SB 882, HB 2613, HB 2601, SB 1030, and HB 2601. F F F B

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 86/100 EASE OF NAVIGATION 94/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 50/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 10/10
Parental Rights Protections..................................................................................................... 10/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 5/5
Employment Protections............................................................................................................ 4/5 Reasonable Access for Minors.............................................................................................. 7/10
Explicit Privacy Standards........................................................................................................ 4/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 4/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 4/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 10/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 4/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 74/100
Allows Distribution Programs................................................................................................ 23/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 90/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 1/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 50/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 14/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 7/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 5/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 15/20
Covered by Insurance/State Health Aid........................................................................ 1/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 5/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 8/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 8/10

Base Categories Points: .....................................................399

Opioid Response Points: ...................................................28.5
Points Total: .............................................................................................427.5/500
Score Percentage: ........................................................................85.10%
FINAL GRADE B
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MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 OKLAHOMA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 55/100 Is Cannabis Available for Treatment?........................................................................................................... 10/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 5/5
Doctor Education........................................................................................................................................................... 7/7
Dispensing 17/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 1/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 2/2
Standard Operating Procedures............................................................................................... 2.5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 0/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 3/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 2/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 1/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 2.5/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 14/25
Staff Training............................................................................................................................................. 1/5
Standard Operating Procedures............................................................................................... 3/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 In April of 2015, Governor Fallin signed HB 2154, Katie and Cayman’s
– Reasonable Security Protocols.................................................................................................... 0.71/0.7 Law, which allows physicians in Oklahoma to recommend a high-CBD
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
cannabis oil (less than 0.3%) to minors suffering from a severe epilepsy
– Disposal/Waste...................................................................................................................................... 0.71/0.71
– Water Management............................................................................................................................ 0.71/0.71 disorder like Lennox-Gastaut or Dravet Syndrome. In 2016, the state
Pesticide Guidance.............................................................................................................................. 2.5/5 adopted HB 2835, which expanded legal protections to patients of all
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 ages and added several new qualifying conditions including spasticity
– Pesticide Labeling................................................................................................................................ 0/2.5
due to Multiple Sclerosis or paraplegia, intractable nausea and vomiting,
Required Testing.................................................................................................................................... 5/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 and appetite stimulation with chronic wasting diseases. In March of 2017,
– Contaminants.......................................................................................................................................... 1.25/1.25 a lawsuit was resolved that allowed question 788, the “Medical Marijuana
– Potency....................................................................................................................................................... 1.25/1.25 Legalization Initiative” to appear on the June 2018 Ballot. Question 788
– Sample Retention................................................................................................................................. 1.25/1.25
passed in 2018 and the state quickly implemented regulations to help the
Recall Protocol and Adverse Event Reporting.............................................................. 3/5
program thrive.
Manufacturing 16/25 Opioid Response
Staff Training............................................................................................................................................. 1/5
Standard Operating Procedures............................................................................................... 3/5 In 2017, Oklahoma had 388 overdose deaths. At a rate of 10.2 per
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 100,000 persons, this is below the national average. With so many
– Workforce Safety Protocols .......................................................................................................... 0/1 already participating in the medical cannabis program, it should be very
– Storage Protocols ................................................................................................................................ 0/1
interesting to see how this impacts Oklahoma’s overdose rates. Medical
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1 cannabis and opioid education is available through the Oklahoma Board
Product Labeling................................................................................................................................... 5/5 of Medical Licensure and Supervision.
– Product Contents, Including Source Material Identification.................................... 1.67/1.67
– Allergens..................................................................................................................................................... 1.67/1.67 Patient Feedback
– Potency and Compound Information ..................................................................................... 1.67/1.67
Required Testing.................................................................................................................................... 4/5 Many Oklahoma patients reported being worried about the adverse
– Active Ingredient Identification.................................................................................................... 1/1 impact of cannabis use on their employment and would like to see
– Contaminants.......................................................................................................................................... 1/1 stronger protections.
– Potency....................................................................................................................................................... 1/1
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 1/1
Recall Protocol and Adverse Event Reporting.............................................................. 3/5

Laboratory Operations 8/25

Staff Training............................................................................................................................................. 1/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 2/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

125
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

OREGON
2018-2019 IMPROVEMENTS A-
As of April 2019, Oregon had 28,177 patients registered in its program. In 2018,
Oregon developed new rules about waste disposal, packaging and labeling, and
pesticides. In August of 2018, the state temporarily restricted patient purchase
limits, in an attempt to restrict diversion. Qualified card holders were allowed to
purchase up to 24 ounces per day. In December of 2018, regulators allowed rules
that provided for medical cannabis delivery to municipalities that banned store
fonts. In 2019, Governor Kate Brown signed a bill that prevented landlords from
denying housing to prospective tenants for medical cannabis use or past low-level
cannabis convictions.

A report from November 2018 revealed that patient counts in Oregon are down
41% since the state legalized cannabis for non-medical uses. This shows the state
could better incentivize patients to participate in the program.
2015 2016 2017 2018-19

B B B+ A-

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 80/100 EASE OF NAVIGATION 85/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 47/50
Affirmative Defense........................................................................................................................ 10/15 Adding New Conditions.............................................................................................................. 7/10
Parental Rights Protections..................................................................................................... 15/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 2/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 5/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 4/10
Reciprocity............................................................................................................................................. 3/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 90/100
Allows Distribution Programs................................................................................................ 37/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 89/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 50/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 12/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 2/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 3/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 5/5
Noncommercial Cultivation..................................................................................................... 17/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 6/7
– Collective Gardening..................................................................................................................... 2/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 9/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 7/10

Base Categories Points: .....................................................435.43

Opioid Response Points: ...................................................22
Points Total: .............................................................................................457.43/500
Score Percentage: ........................................................................91.49%
FINAL GRADE A-
126
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 OREGON

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 91.43/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 7/7
Dispensing 23/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 2/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 3/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 1/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 3/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 2/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 1/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 2.5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 22.26/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 4.26/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In 1998, Oregon voters approved the Oregon Medical Marijuana Act
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 (OMMA), allowing a patient with a valid ID to use, possess, and cultivate
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
cannabis for medical purposes, and designate a primary caregiver to
– Disposal/Waste...................................................................................................................................... 0.71/0.71
– Water Management............................................................................................................................ 0.71/0.71 assist them. Qualifying patients may possess up to twenty-four ounces
Pesticide Guidance.............................................................................................................................. 5/5 of usable cannabis, and individuals may cultivate up to six mature plants
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 and twelve immature plants or four plants if they belong to a non-OMMP
– Pesticide Labeling................................................................................................................................ 2.5/2.5
cardholder. To be protected from arrest, patients must enroll in the
Required Testing.................................................................................................................................... 5/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 Oregon Health Authority patient registry and possess a valid Oregon
– Contaminants.......................................................................................................................................... 1.25/1.25 Medical Marijuana Program (OMMP) identification card. Non-registered
– Potency....................................................................................................................................................... 1.25/1.25 patients with a valid recommendation who are within the possession or
– Sample Retention................................................................................................................................. 1.25/1.25
cultivation limits set by the OMMA are entitled to an affirmative defense.
Recall Protocol and Adverse Event Reporting.............................................................. 3/5
In August 2013, HB 3460 established regulations for state-licensed
medical cannabis facilities. In March 2014, SB 1531 granted cities and
Manufacturing 22/25
counties the right to pass moratoriums on the opening of medical
Staff Training............................................................................................................................................. 4/5
Standard Operating Procedures............................................................................................... 5/5
marijuana facilities until May 1, 2015. There are currently over 300 state
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 licensed dispensaries serving patients. In 2016 the legislature passed HB
– Workforce Safety Protocols .......................................................................................................... 0/1 1404 allowing out of state ownership/investment in medical cannabis
– Storage Protocols ................................................................................................................................ 1/1 businesses. Also passed was SB 1524 which reduces the paperwork
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1
requirement for veterans. New rules in Oregon became effective January
Product Labeling................................................................................................................................... 5/5 1, 2018 due to the passage of SB 56, SB 1057 and HB 2198 in 2017. These
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 rules changed the plant limits to twelve at grow sites, introduced new
– Allergens..................................................................................................................................................... 1.67/1.67 testing procedures and environmental and zoning regulations, and
– Potency and Compound Information ..................................................................................... 1.67/1.67
Required Testing.................................................................................................................................... 5/5
allowed for caregivers to assist patients with the production of cannabis
– Active Ingredient Identification.................................................................................................... 1/1 or processing of concentrates.
– Contaminants.......................................................................................................................................... 1/1
– Potency....................................................................................................................................................... 1/1 Opioid Response
– Shelf Life Testing................................................................................................................................... 1/1
– Sample Retention................................................................................................................................. 1/1 In 2017, there were 344 opioid overdoses in Oregon, a rate well below
Recall Protocol and Adverse Event Reporting.............................................................. 3/5 the national average. Despite this, an average of three Oregonians die
every week from prescription opioids, so there is still room for growth in
Laboratory Operations 24/25 using medical cannabis as an option for pain. While Oregon improved
Staff Training............................................................................................................................................. 5/5 testing procedures, it still needs to develop better recall and adverse
Method Validation in Accordance with AHP Guidelines...................................... 5/5 event reporting protocols. Additionally, Oregon needs to provide patients
Result Reporting.................................................................................................................................... 5/5
additional civil protections including in the area of employment.
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 4.15/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83 Patient Feedback
– Sample Tracking.................................................................................................................................... 0.83/0.83 Some patients reported that they have been able to eliminate many of
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83 their daily medications by using medical cannabis, but cannot afford the
– Storage Protocols................................................................................................................................. 0.83/0.83 high prices of medical cannabis and are, therefore, growing their own.
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83 These patients are frustrated that they must pay a fee to grow medical
cannabis while there are no taxes or fees associated with using opiates
and would prefer that medical cannabis be covered by insurance.

127
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

PENNSYLVANIA
2018-2019 IMPROVEMENTS C+
As of April 2019, Pennsylvania has approximately 131,000 patients who participate in the
state’s program. Since coming into office Governor Wolf has been laser focused on expanding
the state’s medical cannabis program. In January 2018, the Commonwealth indicated that it
would not confiscate firearms from patients and the state adopted new regulations for testing.
In April of 2018, the Medical Marijuana Advisory Board recommended that flower be available,
broaden the definition of pain, add other qualifying conditions, as well as expand research.

Late in 2018 Pennsylvania certified eight medical schools as official research centers and
approved several more dispensary facilities. The state also streamlined the process to add
new qualifying conditions.
Pennsylvania does need to remove some of its program’s bureaucracy. Recommendations are
first proposed by the State Medical Marijuna Advisory Board, then voted on by the advisory
board, then approved by the Secretary of Health. This red tape showed its face when the
Advisory board recommended and approved adding opioid use disorder but the Health 2015 2016 2017 2018-19
Secretary ultimately rejected it.
NA C- C C+

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 71/100 EASE OF NAVIGATION 84/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 46/50
Affirmative Defense........................................................................................................................ 7/15 Adding New Conditions.............................................................................................................. 9/10
Parental Rights Protections..................................................................................................... 10/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 4/5
Employment Protections............................................................................................................ 5/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 2/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 0/2
Does Not Create New Criminal Penalties for Patients...................................... 2/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 9/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 3/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 4/5
ACCESS TO MEDICINE 67/100
Allows Distribution Programs................................................................................................ 31/40
– Allows Access to Dried Flowers............................................................................................ 12/15 FUNCTIONALITY 84/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 4/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 05/5 Dispensaries or by Cultivation.......................................................................................... 45/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 14/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 7/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 5/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 5/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 9/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 7/10

Base Categories Points: .....................................................375.32

Opioid Response Points: ...................................................24
Points Total: .............................................................................................399.32/500
Score Percentage: ........................................................................79.86%
FINAL GRADE C+
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MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 PENNSYLVANIA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 69.32/100 Is Cannabis Available for Treatment?........................................................................................................... 8/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 3/5
Doctor Education........................................................................................................................................................... 7/7
Dispensing 15.67/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 3/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 2/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 1.67/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 2/5
– Potency/Compound Identification............................................................................................ 0/1.67 – Is there a veteran discount?.................................................................................................................................. 1/1
Required Testing.................................................................................................................................... 1/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 1/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 2.5/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 18/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0.71/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 The Pennsylvania Medical Marijuana Act (Act 16, 2016), signed on April
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 17, 2016, created the state’s medical marijuana program. The program
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
will ultimately allow patients to obtain medical cannabis from state-
– Disposal/Waste...................................................................................................................................... 0.71/0.71
– Water Management............................................................................................................................ 0.71/0.71 licensed dispensaries. The program initially included 17 qualifying
Pesticide Guidance.............................................................................................................................. 5/5 conditions. Prior to the opening of dispensaries, pediatric patients
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 and the parent/legal guardian caregivers could apply for safe harbor
– Pesticide Labeling................................................................................................................................ 2.5/2.5
exemptions from possessing and using medical cannabis. The state
Required Testing.................................................................................................................................... 3/5
– Active Ingredient Identification.................................................................................................... 1/1.25 Department of Health (DOH) has provided guidelines for patients
– Contaminants.......................................................................................................................................... 1/1.25 seeking safe harbor. Physicians must take a training course before
– Potency....................................................................................................................................................... 1/1.25 being eligible to recommend medical cannabis under Act 16.
– Sample Retention................................................................................................................................. 0/1.25
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 Pennsylvania adopted temporary regulations in early 2017, and these
show the state’s dedication to developing a robust program that is
Manufacturing 15.67/25 effective for patients. There is still room for improvement. Pennsylvania
Staff Training............................................................................................................................................. 0/5 should add housing and organ transplant protections, allow patients to
Standard Operating Procedures............................................................................................... 4/5 participate in personal cultivation, and improve the training of staff at
– Facility and Equipment Sanitary Conditions...................................................................... 1/1
– Workforce Safety Protocols .......................................................................................................... 1/1
medical cannabis facilities.
– Storage Protocols ................................................................................................................................ 0/1
– Reasonable Security Protocols.................................................................................................... 1/1 Opioid Response
– Batch and Lot Tracking..................................................................................................................... 1/1
As a result of the program’s bureaucracy, opioid use disorder was
Product Labeling................................................................................................................................... 2.67/5
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 delayed from being added to the state’s program. Now, the condition
– Allergens..................................................................................................................................................... 0/1.67 qualifies, but only in extremely limited scenarios “where conventional
– Potency and Compound Information ..................................................................................... 1/1.67 therapeutic therapies are contraindicated or ineffective.” In 2017, drug
Required Testing.................................................................................................................................... 4/5
overdose deaths increased significantly in Pennsylvania by 16.9 percent
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 1/1 from 2016. Hopefully, as the state continues to grow its program, and
– Potency....................................................................................................................................................... 1/1 as the academic research centers become operational, Pennsylvania’s
– Shelf Life Testing................................................................................................................................... 1/1 medical cannabis program will continue to assist those most affected
– Sample Retention................................................................................................................................. 0/1
by the opioid crisis.
Recall Protocol and Adverse Event Reporting.............................................................. 5/5

Laboratory Operations 19.98/25 Patient Feedback

Staff Training............................................................................................................................................. 0/5 Patients reported that the list of qualifying conditions for medical
Method Validation in Accordance with AHP Guidelines...................................... 5/5 cannabis is too limited and the prices are very high. Patients want
Result Reporting.................................................................................................................................... 5/5 access to edibles and are frustrated with a lack of dispensaries in rural
Independent or Third Party........................................................................................................... 5/5 areas. Patients also reported wanting medical providers to have more
Standard Operating Procedures and Protocols.......................................................... 4.98/5
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83 training on medical cannabis and for dispensaries to do a better job
– Sample Tracking.................................................................................................................................... 0.83/0.83 with product labeling.
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83

129
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

PUERTO RICO
2018-2019 IMPROVEMENTS
C-
In 2018, Puerto Rico released comprehensive medical cannabis
regulations and launched an online portal for patients with information
about the Island’s program. Governor Ricardo Rossello announced
that he would waive patient fees for the first 125,000 patients to enroll.
The Governor also appointed the director of a Medicinal Cannabis
Regulatory Board.

2015 2016 2017 2018-19

NA NA C- C-

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 61/100 EASE OF NAVIGATION 79/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 40/50
Affirmative Defense........................................................................................................................ 8/15 Adding New Conditions.............................................................................................................. 5/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 7/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 1/2
Does Not Create New Criminal Penalties for Patients...................................... 3/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 10/10
Reciprocity............................................................................................................................................. 3/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 59/100
Allows Distribution Programs................................................................................................ 22/40
– Allows Access to Dried Flowers............................................................................................ 8/15 FUNCTIONALITY 71/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 45/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 1/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 3/5
Reasonable Purchase Limits.................................................................................................. 2/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 0/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 7/10

Base Categories Points: .....................................................338

Opioid Response Points: ...................................................13
Points Total: .............................................................................................351/500
Score Percentage: ........................................................................70.17%
FINAL GRADE C-
130
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 PUERTO RICO

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 68/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 7/7
Dispensing 17/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 3/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 2/2
Standard Operating Procedures............................................................................................... 3/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 0/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 0/2
– Storage Protocols................................................................................................................................. 1/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 1/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 1/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 16.84/25
Staff Training............................................................................................................................................. 3/5
Standard Operating Procedures............................................................................................... 2.84/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0.71/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 Puerto Rico’s program was first passed in 2015; however, due to
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 administrative delays, it hasn’t been functioning until this year. On July 8,
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
2016, Reglamento 8766 (Regulation 8766) was adopted, which outlines
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 the rules and regulations for Puerto Rico’s medical cannabis program.
Pesticide Guidance.............................................................................................................................. 5/5 Reglamento 8766 repealed Reglamento 155 of 2015. Reglamento 8766
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 removed restrictions on individuals with prior convictions from serving
– Pesticide Labeling................................................................................................................................ 2.5/2.5
as medical cannabis employees. Reglamento 8766 also allows for
Required Testing.................................................................................................................................... 3/5
– Active Ingredient Identification.................................................................................................... 1/1.25 reciprocity for patients who do not permanently reside on the island.
– Contaminants.......................................................................................................................................... 1/1.25 On July 9, 2017, the Governor of Puerto Rico signed into law the Act
– Potency....................................................................................................................................................... 1/1.25 to Manage the Study, Development and Investigation of Cannabis for
– Sample Retention................................................................................................................................. 0/1.25
Innovation, and Applicable Norms and Limitations (Ley 42-2017) which
Recall Protocol and Adverse Event Reporting.............................................................. 3/5
set up a framework for dealing with medical cannabis, establishing
research protocols, and creating a Regulatory Board. In July 2018,
Manufacturing 18/25
the Governor signed Reglamento 9038 which focuses on the study,
Staff Training............................................................................................................................................. 3/5
Standard Operating Procedures............................................................................................... 5/5
development and investigation of cannabis for research purposes.
– Facility and Equipment Sanitary Conditions...................................................................... 1/1
– Workforce Safety Protocols .......................................................................................................... 1/1 Opioid Response
– Storage Protocols ................................................................................................................................ 1/1
Insufficient data is available to assess Puerto Rico’s response to the
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1 opioid crisis beyond the state’s inclusion of pain as a qualifying condition,
Product Labeling................................................................................................................................... 5/5 reduced patient fees, and doctor education.
– Product Contents, Including Source Material Identification.................................... 1.67/1.67
– Allergens..................................................................................................................................................... 1.67/1.67 Patient Feedback
– Potency and Compound Information ..................................................................................... 1.67/1.67
Required Testing.................................................................................................................................... 2/5 No Puerto Rico patient feedback was received.
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 0/1
– Potency....................................................................................................................................................... 1/1
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 0/1
Recall Protocol and Adverse Event Reporting.............................................................. 3/5

Laboratory Operations 16/25

Staff Training............................................................................................................................................. 3/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 3/5
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 5/5
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83

131
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

RHODE ISLAND
2018-2019 IMPROVEMENTS C-
Rhode Island currently has 18,728 patients in its program. While Rhode Island
had some improvements such as an expungement bill, allowing reciprocity,
accepting applications for testing labs, and adding autism spectrum disorder
as a qualifying condition, the state was plagued with civil rights problems. In
August of 2018, the Rhode Island Office of the Child Advocate issued guidance
saying that medical cannabis use by a caretaker should be treated as a risk
factor regardless of legality. Further, a community living center for veterans
came under fire for banning medical cannabis use on the premises.

Finally, although regulators had a hearing on adding opioid dependency as a

qualifying condition, this petition was ultimately rejected because regulators
said that chronic pain was already a condition in the State’s program.

2015 2016 2017 2018-19

C- C+ C C-

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 64/100 EASE OF NAVIGATION 85/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 45/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 6/10
Parental Rights Protections..................................................................................................... -5/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 1/5
Employment Protections............................................................................................................ 4/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... -5/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 8/10
Reciprocity............................................................................................................................................. 3/3 Allows Multiple-Year Registrations .................................................................................. 2/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 81/100
Allows Distribution Programs................................................................................................ 28/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 83/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 4/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 3/5 Dispensaries or by Cultivation.......................................................................................... 45/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 11/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 9/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 16/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 6/7
– Collective Gardening..................................................................................................................... 1/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 9/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 8/10

Base Categories Points: .....................................................348.13

Opioid Response Points: ...................................................16.5
Points Total: .............................................................................................364.63/500
Score Percentage: ........................................................................72.93%
FINAL GRADE C-
132
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 RHODE ISLAND

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 35.13/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 10/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 3/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 1/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 1/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 2/5
– Potency/Compound Identification............................................................................................ 0/1.67 – Is there a veteran discount?.................................................................................................................................. 1/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 1/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 9.13/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 2.13/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In 2006, the Edward O. Hawkins and Thomas C. Slater Medical Marijuana
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 Act was enacted, allowing patients with a Rhode Island registry ID
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
card to use, possess, and cultivate cannabis. Registered patients may
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 possess up to 2.5 ounces of usable cannabis and may cultivate up to 12
Pesticide Guidance.............................................................................................................................. 0/5 plants. Patients may currently appoint up to two primary caregivers for
– Pesticide Guidance.............................................................................................................................. 0/2.5 assistance or designate a compassion center as one of the caregivers.
– Pesticide Labeling................................................................................................................................ 0/2.5
Qualified patients and caregivers are entitled to an affirmative defense at
Required Testing.................................................................................................................................... 2/5
– Active Ingredient Identification.................................................................................................... 1/1.25 trial or dismissal of charges.
– Contaminants.......................................................................................................................................... 0/1.25
– Potency....................................................................................................................................................... 1/1.25 In 2009, the Department of Health (DOH) was authorized to license
– Sample Retention................................................................................................................................. 0/1.25 not-for-profit compassion centers to distribute medical cannabis. In 2011,
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 Governor Lincoln Chafee suspended licensing of compassion centers
in response to threats from federal prosecutors; he then resumed the
Manufacturing 12/25 program in January 2012 after background checks and additional plant
Staff Training............................................................................................................................................. 5/5 limits were added to the licensing requirements. By 2013, compassion
Standard Operating Procedures............................................................................................... 3/5 centers were serving patients. In 2014, the legislature passed laws
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
– Workforce Safety Protocols .......................................................................................................... 0/1
removing caps on cultivation for compassion centers. Patients and
– Storage Protocols ................................................................................................................................ 1/1 caregivers may also sell excess medical cannabis to compassion centers.
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1 In 2016, the DOH made several positive changes to the program,
Product Labeling................................................................................................................................... 2/5 including creating a new cultivator license to help deal with product
– Product Contents, Including Source Material Identification.................................... 1/1.67 shortages. The legislature passed H 7412 which added PTSD as a
– Allergens..................................................................................................................................................... 0/1.67
– Potency and Compound Information ..................................................................................... 1/1.67
qualifying condition. Rhode Island deserves credit for protecting
Required Testing.................................................................................................................................... 2/5 employee rights through the courts in Callaghan v. Darlington Fabrics
– Active Ingredient Identification.................................................................................................... 1/1 Co. et. al., (R.I. Super. Ct. 2017).
– Contaminants.......................................................................................................................................... 0/1
– Potency.......................................................................................................................................................
– Shelf Life Testing...................................................................................................................................
1/1
0/1
Opioid Response
– Sample Retention................................................................................................................................. 0/1 Rhode Island had 277 opioid overdose deaths in 2017, which was just
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 under double the national average per capita. Although regulators said
that there was no need to add opioid use disorder because chronic
Laboratory Operations 4/25 pain was already a condition, it is clear that the state needs to improve
Staff Training............................................................................................................................................. 2/5 its response to the opioid epidemic. Rhode Island could also improve
Method Validation in Accordance with AHP Guidelines...................................... 0/5
its program greatly by adopting strict consumer and product safety
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 2/5 requirements, particularly in the area of laboratory testing.
Standard Operating Procedures and Protocols.......................................................... 0/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83 Patient Feedback
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83 No Rhode Island patient feedback was received.
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

133
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

SOUTH CAROLINA
2018-2019 IMPROVEMENTS
F
The 2018-2019 legislative session came with another disappointment.
Although the SC Compassionate Care Act had bi-partisan support, and
the state’s Medical Affairs Committee had several hearings on the bill,
there was not any vote of consequence and the bill was not passed.
The issue may be taken up again in 2020, but it may continue to be
postponed due to other priorities.

2015 2016 2017 2018-19

F F F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 47/100 EASE OF NAVIGATION 52/100

Arrest Protection.............................................................................................................................. 30/40 Comprehensive Qualifying Conditions.......................................................................... 20/50
Affirmative Defense........................................................................................................................ 12/15 Adding New Conditions.............................................................................................................. 0/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 0/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 1/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 10/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 3/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 3/5
ACCESS TO MEDICINE 10/100
Allows Distribution Programs................................................................................................ 3/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 35/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 3/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 0/5 Dispensaries or by Cultivation.......................................................................................... 10/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 0/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 2/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 3/10
Does Not Impose Bans or Limits on THC..................................................................... 1/10
Does Not Impose Bans on CBD............................................................................................ 3/10
Local Bans/Zoning.......................................................................................................................... 0/10

Base Categories Points: .....................................................144

Opioid Response Points: ...................................................5
Points Total: .............................................................................................149/500
Score Percentage: ........................................................................29.80%
FINAL GRADE F
134
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 SOUTH CAROLINA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 0/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 0/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 0/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 0/2
– Storage Protocols................................................................................................................................. 0/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 0/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 0/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 0/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 0/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 0/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 0/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 The state’s current law provides very limited protection for only a select
– Reasonable Security Protocols.................................................................................................... 0/0.71 few patients. When adopting a comprehensive program, the state
– Batch and Lot Tracking..................................................................................................................... 0/0.71
should include a system for in-state production and distribution, civil
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 discrimination protections for patients, expand the list of qualifying
Pesticide Guidance.............................................................................................................................. 0/5 conditions or simply let doctors recommend for any condition, and
– Pesticide Guidance.............................................................................................................................. 0/2.5 develop strict product safety standards.
– Pesticide Labeling................................................................................................................................ 0/2.5
Required Testing.................................................................................................................................... 0/5 In 2014, the South Carolina legislature passed S1035 which is also
– Active Ingredient Identification.................................................................................................... 0/1.25
known as “Julian’s Law.” The law creates an exemption for the
– Contaminants.......................................................................................................................................... 0/1.25
– Potency....................................................................................................................................................... 0/1.25 possession and use of CBD from the criminal definition of marijuana
– Sample Retention................................................................................................................................. 0/1.25 in limited circumstances. Only patients with severe forms of seizure
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 disorders are eligible for legal protections after the patient obtains a
recommendation for CBD oil from a physician. The law requires that
Manufacturing 0/25 the CBD oil be at least 15% CBD and no more than 0.9% THC. The
Staff Training............................................................................................................................................. 0/5 law also creates the ability for physicians to apply to take part in a
Standard Operating Procedures............................................................................................... 0/5 statewide medical study of CBD oil for other conditions; however, the
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
– Workforce Safety Protocols .......................................................................................................... 0/1
CBD oil for these studies must be at least 98% CBD and must come
– Storage Protocols ................................................................................................................................ 0/1 from a USDA-approved source. Several legislative proposals to create
– Reasonable Security Protocols.................................................................................................... 0/1 comprehensive programs have failed in the state.
– Batch and Lot Tracking..................................................................................................................... 0/1
Product Labeling...................................................................................................................................
– Product Contents, Including Source Material Identification....................................
0/5
0/1.67
Opioid Response
– Allergens..................................................................................................................................................... 0/1.67 In 2017, there were 749 opioid overdoses in South Carolina, placing the
– Potency and Compound Information ..................................................................................... 0/1.67 state slightly above the national average. Aside from implementing a
Required Testing.................................................................................................................................... 0/5
medical cannabis program, the state needs to overcome a significant
– Active Ingredient Identification.................................................................................................... 0/1
– Contaminants.......................................................................................................................................... 0/1 education gap with lawmakers, healthcare practitioners and
– Potency....................................................................................................................................................... 0/1 government officials. The state has adopted its own opioid guidelines,
– Shelf Life Testing................................................................................................................................... 0/1 without adopting the 2016 CDC opioid prescribing guidelines which
– Sample Retention................................................................................................................................. 0/1
include the recommendation to not test for THC at pain clinics.
Recall Protocol and Adverse Event Reporting.............................................................. 0/5

Laboratory Operations 0/25 Patient Feedback

Staff Training............................................................................................................................................. 0/5 Patients reported being frustrated that medical cannabis is illegal in
Method Validation in Accordance with AHP Guidelines...................................... 0/5 South Carolina, except for the limited CBD program that is run through
Result Reporting.................................................................................................................................... 0/5 state universities.
Independent or Third Party........................................................................................................... 0/5
Standard Operating Procedures and Protocols.......................................................... 0/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

135
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

SOUTH DAKOTA
It appears though medical cannabis may be out of reach in South
F
Dakota anytime in the near future. In 2018, the South Dakota
Secretary of State rejected a medical cannabis ballot because it
lacked valid signatures. In 2019, after the 2018 Farm Bill had passed,
South Dakota’s Attorney General released a statement that both
hemp and CBD remain illegal under state law.

2015 2016 2017 2018-19

F F F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 0/100 EASE OF NAVIGATION 0/100

Arrest Protection.............................................................................................................................. 0/40 Comprehensive Qualifying Conditions.......................................................................... 0/50
Affirmative Defense........................................................................................................................ 0/15 Adding New Conditions.............................................................................................................. 0/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 0/10
Explicit Privacy Standards........................................................................................................ 0/7 Reasonable Caregiver Background Checks.............................................................. 0/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 0/2
Does Not Create New Criminal Penalties for Patients...................................... 0/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 0/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 0/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 0/5
ACCESS TO MEDICINE 0/100
Allows Distribution Programs................................................................................................ 0/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 0/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 0/5 Dispensaries or by Cultivation.......................................................................................... 0/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 0/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 0/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 0/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 0/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 0/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 0/10
Does Not Impose Bans or Limits on THC..................................................................... 0/10
Does Not Impose Bans on CBD............................................................................................ 0/10
Local Bans/Zoning.......................................................................................................................... 0/10

Base Categories Points: .....................................................0

Opioid Response Points: ...................................................5
Points Total: .............................................................................................5/500
Score Percentage: ........................................................................1%
FINAL GRADE F
136
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 SOUTH DAKOTA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 0/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 0/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 0/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 0/2
– Storage Protocols................................................................................................................................. 0/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 0/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 0/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 0/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 0/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 0/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 0/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 South Dakota is one of three states that has no form of medical
– Reasonable Security Protocols.................................................................................................... 0/0.71 cannabis access.
– Batch and Lot Tracking..................................................................................................................... 0/0.71
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71
Opioid Response
Pesticide Guidance.............................................................................................................................. 0/5 Over the last 5 years opioid overdoses have increased significantly
– Pesticide Guidance.............................................................................................................................. 0/2.5 in South Dakota. While the overdose rate is well below the national
– Pesticide Labeling................................................................................................................................ 0/2.5
Required Testing.................................................................................................................................... 0/5
average, it remains a problem that can’t be ignored. The fact that the
– Active Ingredient Identification.................................................................................................... 0/1.25 Governor has chosen to vilify both hemp and CBD puts in question
– Contaminants.......................................................................................................................................... 0/1.25 the health and safety of patients.
– Potency....................................................................................................................................................... 0/1.25
– Sample Retention.................................................................................................................................
Recall Protocol and Adverse Event Reporting..............................................................
0/1.25
0/5
Patient Feedback
No patient feedback was received from South Dakota, but medical
Manufacturing 0/25 cannabis in all forms remains illegal.
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
– Workforce Safety Protocols .......................................................................................................... 0/1
– Storage Protocols ................................................................................................................................ 0/1
– Reasonable Security Protocols.................................................................................................... 0/1
– Batch and Lot Tracking..................................................................................................................... 0/1
Product Labeling................................................................................................................................... 0/5
– Product Contents, Including Source Material Identification.................................... 0/1.67
– Allergens..................................................................................................................................................... 0/1.67
– Potency and Compound Information ..................................................................................... 0/1.67
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1
– Contaminants.......................................................................................................................................... 0/1
– Potency....................................................................................................................................................... 0/1
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 0/1
Recall Protocol and Adverse Event Reporting.............................................................. 0/5

Laboratory Operations 0/25

Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 0/5
Standard Operating Procedures and Protocols.......................................................... 0/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

137
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

TENNESSEE
2018-2019 IMPROVEMENTS
F
Tennessee went another year without improvements to its program,
although medical cannabis bills did make their way through some
committees at the Tennessee statehouse. Unfortunately, these proposals
were met with strong opposition from Governor Bill Lee who urged
lawmakers to “explore alternatives” before legalizing medical cannabis.
In 2018, Tennessee regulators issued a health advisory about cannabis
products, which contained much of the misinformation previously
published by the DEA. Tennessee police also raided nearly two dozen
stores accused of illegally selling CBD products.

2015 2016 2017 2018-19

F F F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 34/100 EASE OF NAVIGATION 40/100

Arrest Protection.............................................................................................................................. 20/40 Comprehensive Qualifying Conditions.......................................................................... 20/50
Affirmative Defense........................................................................................................................ 9/15 Adding New Conditions.............................................................................................................. 0/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 6/10
Explicit Privacy Standards........................................................................................................ 0/7 Reasonable Caregiver Background Checks.............................................................. 0/4
Housing Protections...................................................................................................................... 5/5 Number of Caregivers.................................................................................................................. 0/2
Does Not Create New Criminal Penalties for Patients...................................... 0/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 6/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 3/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 3/5
ACCESS TO MEDICINE 9/100
Allows Distribution Programs................................................................................................ 0/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 33/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 0/5 Dispensaries or by Cultivation.......................................................................................... 10/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 5/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 2/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 3/10
Does Not Impose Bans or Limits on THC..................................................................... 1/10
Does Not Impose Bans on CBD............................................................................................ 5/10
Local Bans/Zoning.......................................................................................................................... 0/10

Base Categories Points: .....................................................116

Opioid Response Points: ...................................................5
Points Total: .............................................................................................121/500
Score Percentage: ........................................................................24.20%
FINAL GRADE F
138
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 TENNESSEE

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 0/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 0/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 0/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 0/2
– Storage Protocols................................................................................................................................. 0/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 0/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 0/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 0/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 0/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 0/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 0/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 In 2014, Tennessee legislators passed SB 2531, which changed the
– Reasonable Security Protocols.................................................................................................... 0/0.71 definition of marijuana to create a legal exception for the possession
– Batch and Lot Tracking..................................................................................................................... 0/0.71
and use of low-THC, CBD-rich cannabis oil solely by patients with
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 intractable seizures. The law authorizes a state university to grow
Pesticide Guidance.............................................................................................................................. 0/5 and manufacture the oil, which can have no more than 0.9% THC.
– Pesticide Guidance.............................................................................................................................. 0/2.5 Minor revisions were made to the law in 2016. In 2017, House Speaker
– Pesticide Labeling................................................................................................................................ 0/2.5
Beth Harwell and Lt. Governor Randy McNally ordered the formation
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1.25 of a study committee to review the impact of medical cannabis in
– Contaminants.......................................................................................................................................... 0/1.25 Tennessee. The committee had its first meeting in September of 2017.
– Potency....................................................................................................................................................... 0/1.25 Unfortunately, it seems as though this committee has been disbanded
– Sample Retention................................................................................................................................. 0/1.25
with a new gubernatorial administration.
Recall Protocol and Adverse Event Reporting.............................................................. 0/5
Despite some minor changes in 2016, Tennessee has failed to make
Manufacturing 0/25 any significant changes to its program since the passage of a 2014
Staff Training............................................................................................................................................. 0/5 CBD bill. Unfortunately, Tennessee still lacks a system for in-state
Standard Operating Procedures............................................................................................... 0/5 production and dispensing, civil protections for patients, and product
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
– Workforce Safety Protocols .......................................................................................................... 0/1
safety guidelines. Additionally, in 2016, Tennessee had 1,631 individuals
– Storage Protocols ................................................................................................................................ 0/1 die from opioid overdose which could be mitigated by the state offering
– Reasonable Security Protocols.................................................................................................... 0/1 a comprehensive medical cannabis program that included chronic
– Batch and Lot Tracking..................................................................................................................... 0/1 pain. Tennessee could also improve its medical cannabis program by
Product Labeling................................................................................................................................... 0/5
– Product Contents, Including Source Material Identification.................................... 0/1.67
avoiding arbitrary limits on THC.
– Allergens..................................................................................................................................................... 0/1.67
– Potency and Compound Information ..................................................................................... 0/1.67 Opioid Response
Required Testing.................................................................................................................................... 0/5
In 2017, there were 1,269 overdose deaths in Tennessee. While this
– Active Ingredient Identification.................................................................................................... 0/1
– Contaminants.......................................................................................................................................... 0/1 was a decrease from 2016, Tennessee has one of the highest opioid
– Potency....................................................................................................................................................... 0/1 prescribing rates in the country, at a rate of 94.4 opioid prescriptions per
– Shelf Life Testing................................................................................................................................... 0/1 100 persons. Tennessee has opted to restrict opioids to patients from
– Sample Retention................................................................................................................................. 0/1
initial dosing, which is not necessarily an effective way to manage pain.
Recall Protocol and Adverse Event Reporting.............................................................. 0/5

Laboratory Operations 0/25 Patient Feedback

Staff Training............................................................................................................................................. 0/5 Patients reported being frustrated that medical cannabis is illegal in
Method Validation in Accordance with AHP Guidelines...................................... 0/5 Tennessee, except CBD oil.
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 0/5
Standard Operating Procedures and Protocols.......................................................... 0/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

139
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

TEXAS
2018-2019 IMPROVEMENTS
F
While Texas is still a far cry from a functioning medical cannabis
program, the State did expand access to the state’s low-THC cannabis
program. In May of 2019, Governor Abbott signed a bill that adds several
conditions including epilepsy, multiple sclerosis, terminal cancer, autism,
and spasticity. Before this bill the only condition allowed was intractable
epilepsy. Unfortunately, this bill did not correct technical challenges
where the statute says prescription.

2015 2016 2017 2018-19

F F F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 38/100 EASE OF NAVIGATION 64/100

Arrest Protection.............................................................................................................................. 20/40 Comprehensive Qualifying Conditions.......................................................................... 35/50
Affirmative Defense........................................................................................................................ 9/15 Adding New Conditions.............................................................................................................. 0/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 8/10
Explicit Privacy Standards........................................................................................................ 4/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 5/5 Number of Caregivers.................................................................................................................. 1/2
Does Not Create New Criminal Penalties for Patients...................................... 0/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 10/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 2/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 4/5
ACCESS TO MEDICINE 26/100
Allows Distribution Programs................................................................................................ 6/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 55/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 4/5 Dispensaries or by Cultivation.......................................................................................... 30/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 0/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 5/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 2/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 6/10
Does Not Impose Bans or Limits on THC..................................................................... 2/10
Does Not Impose Bans on CBD............................................................................................ 5/10
Local Bans/Zoning.......................................................................................................................... 7/10

Base Categories Points: .....................................................223.21

Opioid Response Points: ...................................................7.5
Points Total: .............................................................................................230.71/500
Score Percentage: ........................................................................46.14%
FINAL GRADE F
140
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 TEXAS

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 40.21/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 3/7
Dispensing 12.67/25 – Is doctor education on opioids available through the state’s department of health?...... 3/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 3/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 2.67/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 2/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 2.5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 13.38/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 2.13/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In June of 2015, Governor Abbott signed SB 399, the Texas
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 Compassionate Use Act. This law allows access for some patients
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
to “low-THC cannabis.” Unlike many other “CBD Laws,” this act also
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 allows for “dispensing organizations” to cultivate, process, and distribute
Pesticide Guidance.............................................................................................................................. 3/5 this medical cannabis. Another significant difference between Texas
– Pesticide Guidance.............................................................................................................................. 2/2.5 and other state programs is that SB 399 establishes a type of parallel
– Pesticide Labeling................................................................................................................................ 1/2.5
prescription system in which registered physicians record information
Required Testing.................................................................................................................................... 3.25/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 such as patient dosage and amounts. This “prescription” would be taken
– Contaminants.......................................................................................................................................... 1/1.25 to a dispensing organization to be filled.
– Potency....................................................................................................................................................... 1/1.25
– Sample Retention................................................................................................................................. 0/1.25 Texas deserves credit for actually licensing and opening cultivation
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 facilities. On September 1, 2017, the first cultivation facility was licensed.
Despite the beginning of in-state production, Texas still has to make
Manufacturing 11.67/25 many improvements to its program before it can adequately serve
Staff Training............................................................................................................................................. 0/5 patients. However, the Texas law still uses the word “prescription”
Standard Operating Procedures............................................................................................... 2/5 instead of “recommendation,” so it may be impossible for physicians to
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
– Workforce Safety Protocols .......................................................................................................... 0/1
incorporate the program into their practices, thereby denying access.
– Storage Protocols ................................................................................................................................ 1/1 Even with a proper “recommendation,” the low number of production and
– Reasonable Security Protocols.................................................................................................... 0/1 dispensing organizations will all but ensure shortages of medicine and
– Batch and Lot Tracking..................................................................................................................... 1/1 further complications obtaining it. In addition to fixing these problems,
Product Labeling................................................................................................................................... 2.67/5
– Product Contents, Including Source Material Identification.................................... 1.67/1.67
the state must add on civil protections for housing, employment, organ
– Allergens..................................................................................................................................................... 0/1.67 transplants, and parental rights, expand the list of qualifying conditions,
– Potency and Compound Information ..................................................................................... 1/1.67 and remove arbitrary limits on THC.
Required Testing.................................................................................................................................... 2/5
– Active Ingredient Identification....................................................................................................
– Contaminants..........................................................................................................................................
1/1
0/1
Opioid Response
– Potency....................................................................................................................................................... 1/1 In 2017, there were 1,458 overdose deaths involving opioids in Texas—a
– Shelf Life Testing................................................................................................................................... 0/1 rate of 5.1 deaths per 100,000 persons, compared to the national rate
– Sample Retention................................................................................................................................. 0/1
of 14.6 deaths per 100,000 persons. Texas has adopted the 2016 Opioid
Recall Protocol and Adverse Event Reporting.............................................................. 5/5
Prescribing Conference.
Laboratory Operations 2.49/25
Patient Feedback
Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5 Patients reported being frustrated that only CBD and low THC forms of
Result Reporting.................................................................................................................................... 0/5 cannabis are available in Texas.
Independent or Third Party........................................................................................................... 0/5
Standard Operating Procedures and Protocols.......................................................... 2.49/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

141
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

UTAH
2018-2019 IMPROVEMENTS
Although Utah now has a significantly more robust program than it did in 2017, to call what
D-
happened in 2018-2019 to Utah’s program anything other than a colossal mess would be a
mischaracterization. In March of 2018, Governor Hebert signed a bill (HB 197) that would have
allowed the State of Utah, not private or non-profit entities, to grow medical cannabis for terminally
ill patients as part of a right to try program. This bill did not come close to appropriately serving the
state’s patient population.
In November of 2018, Utah voters approved Proposition 2. After months of political attacks on the
initiative, Utah lawmakers almost immediately began working on a ‘compromise bill’ that would
usurp the provisions of Prop. 2. The compromise bill was conducted behind closed doors with
lawmakers, the Mormon Church, and a few advocates. The compromise bill is currently being
challenged in court as it is against the will of the voters. Cards will begin to be issued on March
1, 2020. Prior to January 2021, Utah patients with qualifying conditions may possess medical
cannabis in certain forms without a card, including flower, but only if it is in a state made blister
pack. Patients may possess up to 113 grams, with some exceptions. The state intends to distribute
cannabis through state-run pharmacies, a model that has resulted in exceptional delays and
challenges in other states. 2015 2016 2017 2018-19
In 2019, Herbert signed a bill that would provide employment protections for state employees and F F F D-
prevent courts from discriminating against parents.

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 68/100 EASE OF NAVIGATION 61/100

Arrest Protection.............................................................................................................................. 30/40 Comprehensive Qualifying Conditions.......................................................................... 35/50
Affirmative Defense........................................................................................................................ 10/15 Adding New Conditions.............................................................................................................. 5/10
Parental Rights Protections..................................................................................................... 8/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 3/5 Reasonable Access for Minors.............................................................................................. 6/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 1/2
Does Not Create New Criminal Penalties for Patients...................................... 3/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 5/10
Reciprocity............................................................................................................................................. 2/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 3/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 1/5
ACCESS TO MEDICINE 51/100
Allows Distribution Programs................................................................................................ 19/40
– Allows Access to Dried Flowers............................................................................................ 7/15 FUNCTIONALITY 29/100
– Allows Delivery.................................................................................................................................. 2/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 1/5 Dispensaries or by Cultivation.......................................................................................... 0/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 7/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 3/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 5/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 7/10

Base Categories Points: .....................................................296

Opioid Response Points: ...................................................12
Points Total: .............................................................................................308/500
Score Percentage: ........................................................................61.59%
FINAL GRADE D-
142
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 UTAH

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 87/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 24/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 4/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 2.5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 23/25
Staff Training............................................................................................................................................. 4/5
Standard Operating Procedures............................................................................................... 4/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 Utah deserves credit for becoming the first state to pass CBD focused
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 legislation, but patients with many medical conditions have been left
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
out. In addition to expanding the number of qualifying conditions, Utah
– Disposal/Waste...................................................................................................................................... 0.71/0.71
– Water Management............................................................................................................................ 0.71/0.71 should add a functional in-state distribution and production system for
Pesticide Guidance.............................................................................................................................. 5/5 medical cannabis, add civil discrimination protections, remove arbitrary
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 caps on THC, and add more strict product safety guidelines.
– Pesticide Labeling................................................................................................................................ 2.5/2.5
Required Testing.................................................................................................................................... 0/5 In 2014, Utah passed HB 105, which creates a legal right to possess
– Active Ingredient Identification.................................................................................................... 1.25/1.25
and use CBD-rich extracts of the cannabis plant for patients diagnosed
– Contaminants.......................................................................................................................................... 1.25/1.25
– Potency....................................................................................................................................................... 1.25/1.25 by a neurologist with intractable epilepsy who obtain a registration ID
– Sample Retention................................................................................................................................. 1.25/1.25 from the state. The state requires that extracts must contain at least 15%
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 CBD, have no more than 0.3% THC, and be free of other psychoactive
substances. There is only an extremely limited framework, through an
Manufacturing 22/25 Institutional Review Board approved study, for patients to obtain these
Staff Training............................................................................................................................................. 4/5 products created through HB 130, which passed in 2017.
Standard Operating Procedures............................................................................................... 4/5
– Facility and Equipment Sanitary Conditions...................................................................... 1/1 After several years of limited action by the Utah State legislature,
– Workforce Safety Protocols .......................................................................................................... 0/1 momentum built for a medical cannabis ballot initiative for 2018 in Utah.
– Storage Protocols ................................................................................................................................ 1/1
– Reasonable Security Protocols.................................................................................................... 1/1
This initiative was overridden by HB 3001.
– Batch and Lot Tracking..................................................................................................................... 1/1
Product Labeling................................................................................................................................... 5/5 Opioid Response
– Product Contents, Including Source Material Identification.................................... 1.67/1.67
One of the policy positions of the Utah Department of health is “Opioids
– Allergens..................................................................................................................................................... 1.67/1.67
– Potency and Compound Information ..................................................................................... 1.67/1.67 should not be chosen first to treat pain, alternatives such as physical
Required Testing.................................................................................................................................... 4/5 therapy, non-narcotic medication, and acupuncture can treat pain and
– Active Ingredient Identification.................................................................................................... 1/1 increase functionality/mobility better than opioids.” Yet when the state’s
– Contaminants.......................................................................................................................................... 1/1
medical cannabis program becomes operational it will penalize pain
– Potency....................................................................................................................................................... 1/1
– Shelf Life Testing................................................................................................................................... 0/1 patients by making them try opioids for a minimum of two weeks before
– Sample Retention................................................................................................................................. 1/1 being able to use medical cannabis. In 2017, there were 456 opioid
Recall Protocol and Adverse Event Reporting.............................................................. 5/5 overdoses deaths in Utah, at a rate of 15.5 per 100,000 persons.

Laboratory Operations 18/25 Patient Feedback

Staff Training............................................................................................................................................. 3/5 Patients reported being extremely upset that the legislature completely
Method Validation in Accordance with AHP Guidelines...................................... 3/5
Result Reporting.................................................................................................................................... 5/5 gutted the will of the voters by passing a bill to replace Prop 2.
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 2/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

143
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

VERMONT
2018-2019 IMPROVEMENTS
C
On July 1, 2018, a law that allowed adults to possess cannabis and home
cultivate went into effect. Lawmakers debated a bill that would create
a regulatory framework to tax and regulate the sale of non-medical
cannabis, but this has been delayed. Further in 2018, regulators reported
that the number of medical cannabis patients in the program has dropped
significantly since the legalization of possession of non-medical cannabis.

2015 2016 2017 2018-19

D+ C- C C

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 55/100 EASE OF NAVIGATION 87/100

Arrest Protection.............................................................................................................................. 30/40 Comprehensive Qualifying Conditions.......................................................................... 48/50
Affirmative Defense........................................................................................................................ 13/15 Adding New Conditions.............................................................................................................. 8/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 3/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 9/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 8/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 4/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 3/5
ACCESS TO MEDICINE 86/100
Allows Distribution Programs................................................................................................ 34/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 88/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 50/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 13/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 1/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 15/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 5/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 7/10

Base Categories Points: .....................................................359

Opioid Response Points: ...................................................12
Points Total: .............................................................................................371/500
Score Percentage: ........................................................................74.29%
FINAL GRADE C
144
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 VERMONT

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 43/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 12.67/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 3/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 2.67/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 2/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 13.13/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 2.13/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In 2004, Vermont Senate Bill 76 established a patient registry that
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 provided legal protections for qualifying patients and their primary
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
caregivers who possess or cultivate small amounts of medical cannabis.
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 Patients and their designated caregivers may possess up to two ounces
Pesticide Guidance.............................................................................................................................. 3/5 of usable cannabis. In 2007, Senate Bill 7 increased the cultivation
– Pesticide Guidance.............................................................................................................................. 2/2.5 limits to two mature and seven immature plants, and allowed licensed
– Pesticide Labeling................................................................................................................................ 1/2.5
physicians in neighboring states to recommend cannabis for Vermont
Required Testing.................................................................................................................................... 3/5
– Active Ingredient Identification.................................................................................................... 1/1.25 residents. SB7 also expanded the qualifying conditions to include any
– Contaminants.......................................................................................................................................... 1/1.25 chronic, debilitating condition or its treatment that produces cachexia or
– Potency....................................................................................................................................................... 1/1.25 wasting syndrome, severe pain, severe nausea, or seizures. In June 2011,
– Sample Retention................................................................................................................................. 0/1.25
Senate Bill 17 authorized up to four state-licensed distribution facilities
Recall Protocol and Adverse Event Reporting.............................................................. 0/5
and allowed physician assistants and advanced practice registered
nurses to write recommendations. Dispensaries opened in the spring
Manufacturing 12.67/25
of 2013. In 2014, the program was expanded with the passage of S. 247,
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 3/5
which added delivery programs to existing dispensaries and granted
– Facility and Equipment Sanitary Conditions...................................................................... 0/1 naturopathic physicians the right to recommend medical cannabis. In
– Workforce Safety Protocols .......................................................................................................... 0/1 2016, S. 14 was passed which changed the qualifying condition of severe
– Storage Protocols ................................................................................................................................ 1/1 pain to the less restrictive condition of chronic pain.
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 1/1 In 2017, Governor Scott signed a bill improving the program by allowing
Product Labeling................................................................................................................................... 2.67/5
– Product Contents, Including Source Material Identification.................................... 1.67/1.67
patients to have access to a designated dispensary and to cultivate
– Allergens..................................................................................................................................................... 0/1.67 at home. Prior to this bill, patients had to choose between the two.
– Potency and Compound Information ..................................................................................... 1/1.67 Dispensaries will also be able to open second locations based on patient
Required Testing.................................................................................................................................... 2/5 needs. Vermont also improved its program by adding Crohn’s disease,
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 0/1
Parkinson’s disease, and PTSD. Despite these improvements, Vermont
– Potency....................................................................................................................................................... 1/1 still needs to add civil discrimination protections for patients in the areas
– Shelf Life Testing................................................................................................................................... 0/1 of parental rights, housing, and organ transplants. Vermont’s program
– Sample Retention................................................................................................................................. 0/1 could also be greatly improved by adopting strong consumer safety and
Recall Protocol and Adverse Event Reporting.............................................................. 0/5
provider requirements.
Laboratory Operations 5/25 Opioid Response
Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5 Vermont had 114 opioid overdose deaths in 2017, at a rate of 20.0 per
Result Reporting.................................................................................................................................... 0/5 100,000 persons. Vermont follows the 2016 CDC guidelines and has
Independent or Third Party........................................................................................................... 5/5 created extensive medical education guidelines on the prescribing of
Standard Operating Procedures and Protocols.......................................................... 0/5
opioids, however this education does not include cannabis.
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83 Patient Feedback
– Disposal/Waste...................................................................................................................................... 0/0.83 Patients reported that the prices are very high and some are turning to
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83 the black market. Patients also expressed a desire for insurance to help
pay for medical cannabis.

145
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

VIRGINIA
2018-2019 IMPROVEMENTS
As of July 1, approximately 600 people had registered for Virginia’s program. This is expected
F
to increase once processors are up and running and medical cannabis products are available.
Virginia made significant strides in 2018-2019 on its way to becoming a better functioning
program. In March of 2018, lawmakers removed the states qualifying condition list to allow
THCA and CBD products for any condition that a doctor deemed appropriate. In the fall of
2018, the state gave approval to CBD processors to begin operating in the state, with the
expected timeline that these facilities will be operational in late 2019.

In March 2019, Virginia passed a law that allowed full therapeutic (15% CBD or THCA, 5%
THC) strength creams and lozenges, a law that allowed the use of CBD/THCA in schools
and a law that allows registered agents to procure CBD or THCA products for patients.
Currently, any doctor who is licensed to practice medicine or osteopathy in Virginia may issue
certifications. Effective July 1, 2019, a physician’s assistant licensed by the Board of Medicine
or a nurse practitioner jointly licensed by the Board of Medicine and Board of Nursing may
also issue certifications. However, unlike other states, medical cannabis isn’t fully legalized 2015 2016 2017 2018-19
but rather, classes of people are provided affirmative defenses.
F F F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 27/100 EASE OF NAVIGATION 87/100

Arrest Protection.............................................................................................................................. 0/40 Comprehensive Qualifying Conditions.......................................................................... 50/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 10/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 5/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 6/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 2/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 1/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 10/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 3/5
ACCESS TO MEDICINE 44/100
Allows Distribution Programs................................................................................................ 13/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 59/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 5/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 3/5 Dispensaries or by Cultivation.......................................................................................... 20/50
– Does Not Require Vertical Integration............................................................................... 1/2 No Significant Administrative or Supply Problems.............................................. 15/15
– Ownership/Employment Restrictions................................................................................ 2/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 10/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 3/5
Reasonable Purchase Limits.................................................................................................. 3/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 5/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 5/10
Does Not Impose Bans or Limits on THC..................................................................... 7/10
Does Not Impose Bans on CBD............................................................................................ 9/10
Local Bans/Zoning.......................................................................................................................... 10/10

Base Categories Points: .....................................................264.59

Opioid Response Points: ...................................................17
Points Total: .............................................................................................281.59/500
Score Percentage: ........................................................................56.32%
FINAL GRADE F
146
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 VIRGINIA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 47.59/100 Is Cannabis Available for Treatment?........................................................................................................... 10/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 5/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 13.34/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 4/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 3/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 1/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 2.67/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 2.67/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 9.09/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 2.84/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 February of 2015 marked the signing of HB 1445 and SB 1235, extending
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 some legal protections to patients using CBD or THCA extracts. This
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
law protects patients using those specific medicines from prosecution
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 but not arrest. The bills failed to develop any kind of cultivation,
Pesticide Guidance.............................................................................................................................. 3/5 production, or distribution system thereby forcing Virginians to travel to
– Pesticide Guidance.............................................................................................................................. 2/2.5 another state that extends medical access to non-residents.
– Pesticide Labeling................................................................................................................................ 1/2.5
Required Testing.................................................................................................................................... 2.25/5 In 2017, Virginia passed SB 1027, which permits “pharmaceutical
– Active Ingredient Identification.................................................................................................... 1.25/1.25
processors” to produce low-THC cannabis oils for patients suffering
– Contaminants.......................................................................................................................................... 0/1.25
– Potency....................................................................................................................................................... 1/1.25 from intractable epilepsy. This extremely narrow law will eventually
– Sample Retention................................................................................................................................. 0/1.25 provide for in-state production and distribution of the oils, and patients
Recall Protocol and Adverse Event Reporting.............................................................. 1/5 will be able to enroll in a program with their doctors’ certifications. The
Board of Pharmacy adopted regulations establishing health and safety
Manufacturing 12.67/25 in August 2017.
Staff Training............................................................................................................................................. 4/5
Standard Operating Procedures............................................................................................... 3/5 Opioid Response
– Facility and Equipment Sanitary Conditions...................................................................... 1/1
– Workforce Safety Protocols .......................................................................................................... 0/1 In Virginia there were 1,241 drug overdose deaths involving opioids at a
– Storage Protocols ................................................................................................................................ 1/1 rate consistent with the national average. Virginia’s move to eliminate
– Reasonable Security Protocols.................................................................................................... 1/1 a qualifying condition list should be applauded, however, the diversity
– Batch and Lot Tracking..................................................................................................................... 0/1
and strength of products that will be available in Virginia should be
Product Labeling................................................................................................................................... 2.67/5
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 increased to better manage the opioid crisis. The state also needs to
– Allergens..................................................................................................................................................... 0/1.67 improve on how it educates its providers.
– Potency and Compound Information ..................................................................................... 1/1.67
Required Testing.................................................................................................................................... 2/5 Patient Feedback
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 0/1 Patients reported frustration by the lack of dried flower and the caps on
– Potency....................................................................................................................................................... 1/1 THCA and CBD.
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 0/1
Recall Protocol and Adverse Event Reporting.............................................................. 1/5

Laboratory Operations 12.49/25

Staff Training............................................................................................................................................. 2/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 3/5
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 2.49/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

147
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

UNITED STATES
VIRGIN ISLANDS D
2018-2019 IMPROVEMENTS
In early 2019, the Governor of the U.S. Virgin Islands signed the Virgin
Islands Medicinal Cannabis Care Act to allow qualifying patients to
possess and obtain cannabis for medical purposes. The program
includes chronic pain and home cultivation (up to 12 plants with an
ID card) Patients may possess up to four ounces at a time with a
certification from a healthcare practitioner. The program offers strong civil
rights protections for patients.

2015 2016 2017 2018-19

F F F D

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 91/100 EASE OF NAVIGATION 83/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 45/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 5/10
Parental Rights Protections..................................................................................................... 8/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 5/5 Reasonable Access for Minors.............................................................................................. 6/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 3/4
Housing Protections...................................................................................................................... 5/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 3/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 2/2
Organ Transplants........................................................................................................................... 3/5 Reasonable Fees (Patients and Caregivers)............................................................. 10/10
Reciprocity............................................................................................................................................. 3/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 75/100
Allows Distribution Programs................................................................................................ 26/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 41/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 3/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 3/5 Dispensaries or by Cultivation.......................................................................................... 0/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 15/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 5/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 15/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 4/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 7/10
Does Not Impose Bans on CBD............................................................................................ 9/10
Local Bans/Zoning.......................................................................................................................... 8/10

Base Categories Points: .....................................................312.01

Opioid Response Points: ...................................................12.5
Points Total: .............................................................................................324.51/500
Score Percentage: ........................................................................64.90%
FINAL GRADE D
148
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 U.S. VIRGIN ISLANDS

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 22/100 Is Cannabis Available for Treatment?........................................................................................................... 10/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 5/5
Doctor Education........................................................................................................................................................... 0/7
Dispensing 3/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 3/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 0/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 0/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 0/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 2.5/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 0/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 2.5/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 3/25
Staff Training............................................................................................................................................. 3/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 USVI did not have a medical cannabis program before 2019, although
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 voters did approve a non-binding referendum supporting medical
– Batch and Lot Tracking..................................................................................................................... 0/0.71
cannabis in 2014.
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71
Pesticide Guidance.............................................................................................................................. 0/5 Opioid Response
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 Data on opioid overdoses in the USVI is scarce, but the island did
– Pesticide Labeling................................................................................................................................ 0/2.5
Required Testing.................................................................................................................................... 0/5
partner with the Red Cross to develop an online opioid overdose
– Active Ingredient Identification.................................................................................................... 0/1.25 training course. As the medical cannabis program is in its infancy,
– Contaminants.......................................................................................................................................... 0/1.25 we have not yet seen if access to medical cannabis will improve the
– Potency....................................................................................................................................................... 0/1.25 Island’s opioid crisis.
– Sample Retention................................................................................................................................. 0/1.25
Recall Protocol and Adverse Event Reporting.............................................................. 0/5
Patient Feedback
Manufacturing 8/25 No comments were received from the US Virgin Islands.
Staff Training............................................................................................................................................. 3/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
– Workforce Safety Protocols .......................................................................................................... 0/1
– Storage Protocols ................................................................................................................................ 1/1
– Reasonable Security Protocols.................................................................................................... 1/1
– Batch and Lot Tracking..................................................................................................................... 0/1
Product Labeling................................................................................................................................... 5/5
– Product Contents, Including Source Material Identification.................................... 1.67/1.67
– Allergens..................................................................................................................................................... 1.67/1.67
– Potency and Compound Information ..................................................................................... 1.67/1.67
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1
– Contaminants.......................................................................................................................................... 0/1
– Potency....................................................................................................................................................... 0/1
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 0/1
Recall Protocol and Adverse Event Reporting.............................................................. 0/5

Laboratory Operations 8/25

Staff Training............................................................................................................................................. 3/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 5/5
Standard Operating Procedures and Protocols.......................................................... 0/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

149
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

WASHINGTON
2018-2019 IMPROVEMENTS
B-
As of June 2019, there are 39,331 patients in Washington State. Washington
continues to deal with the consequences of collapsing it’s medical market and
its adult-use market into one. In 2018, regulators released new packaging and
labeling requirements, as well as the state’s first research license. In November
of 2018, the state’s attorney general issued an opinion that local boards which
oversee first responder programs can approve payments for medical cannabis,
although they do not have to.

In 2019, the state temporarily suspended the requirement that cannabis products
be tested for heavy metal because there were no labs certified to do so. A lack
of laboratory testing creates a big safety problem for patients. While there was
only a temporary period where heavy metal testing was suspended, any time
where untested products are on the market is too long. In 2019, Washington also 2015 2016 2017 2018-19
approved the use of medical cannabis in schools.
B C- C+ B-

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 87/100 EASE OF NAVIGATION 77/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 46/50
Affirmative Defense........................................................................................................................ 15/15 Adding New Conditions.............................................................................................................. 0/10
Parental Rights Protections..................................................................................................... 10/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 2/5 Reasonable Access for Minors.............................................................................................. 7/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 3/5 Number of Caregivers.................................................................................................................. 2/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 5/5 Reasonable Fees (Patients and Caregivers)............................................................. 8/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 5/5
ACCESS TO MEDICINE 77/100
Allows Distribution Programs................................................................................................ 29/40
– Allows Access to Dried Flowers............................................................................................ 15/15 FUNCTIONALITY 61/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 1/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 3/5 Dispensaries or by Cultivation.......................................................................................... 30/50
– Does Not Require Vertical Integration............................................................................... 2/2 No Significant Administrative or Supply Problems.............................................. 7/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 17/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 15/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 4/7
– Collective Gardening..................................................................................................................... 2/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 8/10
Does Not Impose Bans or Limits on THC..................................................................... 8/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 5/10

Base Categories Points: .....................................................395

Opioid Response Points: ...................................................13
Points Total: .............................................................................................408/500
Score Percentage: ........................................................................81.60%
FINAL GRADE B-
150
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 WASHINGTON

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 93/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 6/7
Dispensing 22/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 5/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 1/2
Standard Operating Procedures............................................................................................... 4/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 3/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 5/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1.67/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 1.67/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1.67/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 5/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1.67/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 1.67/1.67 Research............................................................................................................................................................................... 5/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1.67/1.67
tax breaks for medical cannabis?...................................................................................................................... 2.5/2.5
– Does the state promote research?.................................................................................................................... 2.5/2.5
Grow/Cultivation 23/25
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0.71/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 In 1998, Washington voters approved state Initiative Measure No. 692,
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 allowing a qualifying patient or designated provider to have a 60-day
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
supply of medical cannabis, later defined as 24 ounces and 15 plants.
– Disposal/Waste...................................................................................................................................... 0.71/0.71
– Water Management............................................................................................................................ 0.71/0.71 Qualifying patients and caregivers within those limits are protected from
Pesticide Guidance.............................................................................................................................. 5/5 arrest and prosecution; a patient who exceeds those limits is entitled to a
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 medical defense of medical necessity. Designated providers must be 18
– Pesticide Labeling................................................................................................................................ 2.5/2.5
years of age or older. Dispensaries are not permitted under Washington
Required Testing.................................................................................................................................... 5/5
– Active Ingredient Identification.................................................................................................... 1.25/1.25 law but the Washington Department of Health has issued a list of
– Contaminants.......................................................................................................................................... 1.25/1.25 retail stores with a certified medical cannabis consultant on staff on its
– Potency....................................................................................................................................................... 1.25/1.25 website. Washington also allows cooperatives for growing. In 2011, the
– Sample Retention................................................................................................................................. 1.25/1.25
state legislature changed the requirements for recommending cannabis
Recall Protocol and Adverse Event Reporting.............................................................. 3/5
to patients. Currently, recommendations must be on tamper resistant
paper and include an original signature by the healthcare provider, a
Manufacturing 23/25
date, and a statement that the patient may benefit from the medical use
Staff Training............................................................................................................................................. 5/5
Standard Operating Procedures............................................................................................... 5/5
of cannabis.
– Facility and Equipment Sanitary Conditions...................................................................... 1/1
– Workforce Safety Protocols .......................................................................................................... 1/1
In November 2012, voters passed I-502, adding retail stores and making
– Storage Protocols ................................................................................................................................ 1/1 significant changes to patient cultivation rights. Collective gardening is
– Reasonable Security Protocols.................................................................................................... 1/1 no longer allowed as of July 2016, and patients are encouraged to apply
– Batch and Lot Tracking..................................................................................................................... 1/1 to form non-commercial cooperatives to provide alternative access to
Product Labeling................................................................................................................................... 5/5
– Product Contents, Including Source Material Identification.................................... 1.67/1.67
retail stores.
– Allergens..................................................................................................................................................... 1.67/1.67
– Potency and Compound Information ..................................................................................... 1.67/1.67
In 2017, Washington passed SB 5131, which provided a slight
Required Testing.................................................................................................................................... 5/5 improvement to Washington’s market. It allows qualifying medical card
– Active Ingredient Identification.................................................................................................... 1/1 holders in the state database to purchase immature plants, clones,
– Contaminants.......................................................................................................................................... 1/1 and seeds for the purposes of growing cannabis at home. SB 5131
– Potency....................................................................................................................................................... 1/1
– Shelf Life Testing................................................................................................................................... 1/1
also created a few technical changes, including provisions related
– Sample Retention................................................................................................................................. 1/1 to consulting agreements, advertising restrictions, research, and
Recall Protocol and Adverse Event Reporting.............................................................. 3/5 qualifications for organic cannabis. Washington is one of the few states
that continues to allow cooperative gardens.
Laboratory Operations 25/25
Staff Training............................................................................................................................................. 5/5 Opioid Response
Method Validation in Accordance with AHP Guidelines...................................... 5/5
In 2017, there were 742 opioid overdoses in Washington State, a rate of 9.6
Result Reporting.................................................................................................................................... 5/5
Independent or Third Party........................................................................................................... 5/5 deaths per 100,000 persons. This rate is well below the national average,
Standard Operating Procedures and Protocols.......................................................... 5/5 but the state could work better at using its medical cannabis program to
– Equipment and Instrument Calibration.................................................................................. 0.83/0.83 reduce preventable opioid overdose deaths. Patients can buy medicine
– Sample Tracking.................................................................................................................................... 0.83/0.83
tax free and purchase up to 3 times the non-medical possession limits.
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0.83/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83 Patient Feedback
– Workforce Safety Protocols .......................................................................................................... 0.83/0.83 Patients reported wanting more dispensaries available and are frustrated
that cannabis has become too expensive due to high taxes on medical
cannabis products.

151
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

WEST VIRGINIA
2018-2019 IMPROVEMENTS F
Some have been frustrated by West Virginia’s slow rollout of its medical
cannabis program, which lawmakers have equated to a lack of banking access.
In February 2018, the West Virginia Medical Cannabis board recommend that
smokable forms of cannabis be available. In March 2019, Governor Jim Justice
signed a medical cannabis banking bill into law, which goes as far as to say that
the state will help defend any official prosecuted by the federal government for
handling cannabis proceeds. Governor Justice also vetoed a bill that would have
allowed vertical integration in the medical cannabis industry. Medical cannabis
was supposed to be available in the state by July 2019, but regulators failed to
make that a reality by the beginning of the month, and a spokeswoman for the
State Department of Health & Human Resources says it could be another two
to three years after a banking vendor is in place before sales begin, a delay of
which would be devastating to patients.
2015 2016 2017 2018-19

NA NA D- F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 62/100 EASE OF NAVIGATION 72/100

Arrest Protection.............................................................................................................................. 40/40 Comprehensive Qualifying Conditions.......................................................................... 40/50
Affirmative Defense........................................................................................................................ 10/15 Adding New Conditions.............................................................................................................. 5/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 5/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 5/5 Reasonable Access for Minors.............................................................................................. 8/10
Explicit Privacy Standards........................................................................................................ 5/7 Reasonable Caregiver Background Checks.............................................................. 2/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 0/2
Does Not Create New Criminal Penalties for Patients...................................... 1/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 1/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 8/10
Reciprocity............................................................................................................................................. 1/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 3/5
ACCESS TO MEDICINE 65/100
Allows Distribution Programs................................................................................................ 27/40
– Allows Access to Dried Flowers............................................................................................ 10/15 FUNCTIONALITY 32/100
– Allows Delivery.................................................................................................................................. 5/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 4/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 5/5 Dispensaries or by Cultivation.......................................................................................... 0/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 7/15
– Ownership/Employment Restrictions................................................................................ 1/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 8/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 4/5
Reasonable Purchase Limits.................................................................................................. 4/5
– Choice of Dispensary Without Restrictions................................................................... 2/2
Allows Patients to Medicate Where They Choose................................................ 4/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 5/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 10/10
Does Not Impose Bans or Limits on THC..................................................................... 10/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 8/10

Base Categories Points: .....................................................282.16

Opioid Response Points: ...................................................12
Points Total: .............................................................................................294.16/500
Score Percentage: ........................................................................58.83%
FINAL GRADE F
152
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 WEST VIRGINIA

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 51.16/100 Is Cannabis Available for Treatment?........................................................................................................... 5/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 5/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 15/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 3/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 5/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 1.25/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 1.25/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 1.25/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 1.25/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 3/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 2/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 1/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 1/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 2/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 1/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 1/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 14/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 4/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0.71/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0.71/0.71 On April 19, 2017, Governor Jim Justice signed SB 386, the West Virginia
– Reasonable Security Protocols.................................................................................................... 0.71/0.71 Medical Cannabis Act that allows for cannabis to be used by West
– Batch and Lot Tracking..................................................................................................................... 0.71/0.71
Virginia residents that have a serious medical condition. The law only
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 provides for the use of cannabis in the form of oils, pills, topicals,
Pesticide Guidance.............................................................................................................................. 5/5 vaporization (but not of dry flower), tinctures, liquids and dermal patches.
– Pesticide Guidance.............................................................................................................................. 2.5/2.5 The West Virginia Department of Health is currently facilitating the
– Pesticide Labeling................................................................................................................................ 2.5/2.5
rulemaking process.
Required Testing.................................................................................................................................... 2/5
– Active Ingredient Identification.................................................................................................... 1/1.25
– Contaminants.......................................................................................................................................... 0/1.25 Opioid Response
– Potency....................................................................................................................................................... 1/1.25 In 2017, West Virginia had the highest rate of opioid overdose deaths
– Sample Retention................................................................................................................................. 0/1.25
Recall Protocol and Adverse Event Reporting.............................................................. 3/5
in the nation at 49.6 per 100,000 persons. One of the key reasons for
West Virginia’s program was how adversely it has been impacted by the
Manufacturing 11.67/25 opioid crisis. The state needs to swiftly move through implementation
of the medical cannabis program to avoid the catastrophic opioid crisis
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 4/5 continuing at the rate it is in West Virginia.
– Facility and Equipment Sanitary Conditions...................................................................... 1/1
– Workforce Safety Protocols .......................................................................................................... 0/1 Patient Feedback
– Storage Protocols ................................................................................................................................ 1/1
– Reasonable Security Protocols.................................................................................................... 1/1 Patients reportedbeing upset that the state has not met the July 1, 2019
– Batch and Lot Tracking..................................................................................................................... 1/1 deadline that was in the statute, and will likely have to wait several more
Product Labeling................................................................................................................................... 2.67/5 years before receiving access.
– Product Contents, Including Source Material Identification.................................... 1.67/1.67
– Allergens..................................................................................................................................................... 0/1.67
– Potency and Compound Information ..................................................................................... 1/1.67
Required Testing.................................................................................................................................... 2/5
– Active Ingredient Identification.................................................................................................... 1/1
– Contaminants.......................................................................................................................................... 0/1
– Potency....................................................................................................................................................... 1/1
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 0/1
Recall Protocol and Adverse Event Reporting.............................................................. 3/5

Laboratory Operations 10.49/25

Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 5/5
Independent or Third Party........................................................................................................... 3/5
Standard Operating Procedures and Protocols.......................................................... 2.49/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0.83/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0.83/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0.83/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

153
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

WISCONSIN
2018-2019 IMPROVEMENTS F
In October of 2018, Wisconsin approved a bill that allows the use of FDA
approved cannabis medicines, which at this point is limited to Epidiolex,
Marinol and Cessamet. While advocates were hopeful that Democratic
Governor Tony Evers could bring a medical cannabis proposal into
fruition (the Governor included it in his budget), he has been unable to
convince the state’s legislative body to act yet.

2015 2016 2017 2018-19

F F F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 34/100 EASE OF NAVIGATION 40/100

Arrest Protection.............................................................................................................................. 20/40 Comprehensive Qualifying Conditions.......................................................................... 20/50
Affirmative Defense........................................................................................................................ 10/15 Adding New Conditions.............................................................................................................. 0/10
Parental Rights Protections..................................................................................................... 9/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 6/10
Explicit Privacy Standards........................................................................................................ 0/7 Reasonable Caregiver Background Checks.............................................................. 0/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 0/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 6/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 2/5
ACCESS TO MEDICINE 13/100
Allows Distribution Programs................................................................................................ 0/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 20/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 0/5 Dispensaries or by Cultivation.......................................................................................... 0/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 0/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 10/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 2/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 3/10
Does Not Impose Bans or Limits on THC..................................................................... 0/10
Does Not Impose Bans on CBD............................................................................................ 10/10
Local Bans/Zoning.......................................................................................................................... 0/10

Base Categories Points: .....................................................107

Opioid Response Points: ...................................................7
Points Total: .............................................................................................114/500
Score Percentage: ........................................................................22.80%
FINAL GRADE F
154
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 WISCONSIN

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 0/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 0/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 0/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 0/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 0/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 0/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 0/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 0/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 0/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 In 2014, Wisconsin passed what was known as Lydia’s Law, which
– Reasonable Security Protocols.................................................................................................... 0/0.71 created a legal right for patients with seizure disorders, and was
– Batch and Lot Tracking..................................................................................................................... 0/0.71
expanded to any medical condition under Act 4, to possess and use
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 CBD-rich medicines if they have a written recommendation. The law
Pesticide Guidance.............................................................................................................................. 0/5 allows medical practitioners to dispense CBD, but provides no guidance
– Pesticide Guidance.............................................................................................................................. 0/2.5 on how to obtain it, nor does the law address production or distribution.
– Pesticide Labeling................................................................................................................................ 0/2.5
The law only removes criminal penalties for CBD and does not authorize
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1.25 the possession or use of THC. Nearly all CBD-rich products have at least
– Contaminants.......................................................................................................................................... 0/1.25 trace amounts of THC, making the production of qualifying medicine
– Potency....................................................................................................................................................... 0/1.25 practically impossible.
– Sample Retention................................................................................................................................. 0/1.25
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 In 2017, Act 4 removed the requirement that CBD was only to be used
to treat seizure disorders. Now CBD may be used to treat any medical
Manufacturing 0/25 condition. However, despite the expansion of qualifying conditions,
Staff Training............................................................................................................................................. 0/5 Wisconsin’s medical cannabis law is so limited that many patients do not
Standard Operating Procedures............................................................................................... 0/5 qualify. There is no in-state production or distribution system of medical
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
– Workforce Safety Protocols .......................................................................................................... 0/1
cannabis nor does the state have any product safety protocols.
– Storage Protocols ................................................................................................................................ 0/1
– Reasonable Security Protocols.................................................................................................... 0/1 Opioid Response
– Batch and Lot Tracking..................................................................................................................... 0/1
In 2017 Wisconsin had 926 opioid overdose deaths at a rate of 16.9 per
Product Labeling................................................................................................................................... 0/5
– Product Contents, Including Source Material Identification.................................... 0/1.67 100,000 persons. While the state provides opioid education for healthcare
– Allergens..................................................................................................................................................... 0/1.67 providers, the state could do far more in mitigating the crisis.
– Potency and Compound Information ..................................................................................... 0/1.67
Required Testing.................................................................................................................................... 0/5 Patient Feedback
– Active Ingredient Identification.................................................................................................... 0/1
– Contaminants.......................................................................................................................................... 0/1 Patients reported being frustrated that medical cannabis is illegal in
– Potency....................................................................................................................................................... 0/1 Wisconsin, except for CBD oil.
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 0/1
Recall Protocol and Adverse Event Reporting.............................................................. 0/5

Laboratory Operations 0/25

Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 0/5
Standard Operating Procedures and Protocols.......................................................... 0/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

155
 MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019

WYOMING
2018-2019 IMPROVEMENTS
F
Wyoming did not show any improvement to its limited program over the
last year.

2015 2016 2017 2018-19

F F F F

ISSUE POINTS ISSUE POINTS

PATIENT RIGHTS AND CIVIL PROTECTIONS 45/100 EASE OF NAVIGATION 44/100

Arrest Protection.............................................................................................................................. 24/40 Comprehensive Qualifying Conditions.......................................................................... 20/50
Affirmative Defense........................................................................................................................ 9/15 Adding New Conditions.............................................................................................................. 0/10
Parental Rights Protections..................................................................................................... 0/10 – Law/Regulations Allow for New Conditions ................................................................ 0/5
DUI Protections.................................................................................................................................. 0/5 – System Works for Adding New Conditions.................................................................... 0/5
Employment Protections............................................................................................................ 0/5 Reasonable Access for Minors.............................................................................................. 6/10
Explicit Privacy Standards........................................................................................................ 7/7 Reasonable Caregiver Background Checks.............................................................. 4/4
Housing Protections...................................................................................................................... 0/5 Number of Caregivers.................................................................................................................. 1/2
Does Not Create New Criminal Penalties for Patients...................................... 5/5 Patient/Practitioner-Focused Task Force or Advisory Board..................... 0/2
Organ Transplants........................................................................................................................... 0/5 Reasonable Fees (Patients and Caregivers)............................................................. 6/10
Reciprocity............................................................................................................................................. 0/3 Allows Multiple-Year Registrations .................................................................................. 0/2
Reasonable Physician Requirements.............................................................................. 5/5
Does Not Classify Cannabis as a Medicine of Last Resort............................ 2/5
ACCESS TO MEDICINE 9/100
Allows Distribution Programs................................................................................................ 0/40
– Allows Access to Dried Flowers............................................................................................ 0/15 FUNCTIONALITY 27/100
– Allows Delivery.................................................................................................................................. 0/5
– No Sales Tax or Reasonable Sales Tax.............................................................................. 0/5 Patients Able to Access Medicine at
– Allows for a Reasonable Number of Dispensaries.................................................... 0/5 Dispensaries or by Cultivation.......................................................................................... 0/50
– Does Not Require Vertical Integration............................................................................... 0/2 No Significant Administrative or Supply Problems.............................................. 10/15
– Ownership/Employment Restrictions................................................................................ 0/2 Patients Can Receive Legal Protections Within
– Provisions for Labor Standards.............................................................................................. 0/2 Reasonable Time Frame of Doctor’s Recommendation............................... 7/10
– Environmental Impact Regulations...................................................................................... 0/2 Reasonable Possession Limits............................................................................................. 5/5
Reasonable Purchase Limits.................................................................................................. 0/5
– Choice of Dispensary Without Restrictions................................................................... 0/2
Allows Patients to Medicate Where They Choose................................................ 3/5
Noncommercial Cultivation..................................................................................................... 0/20
Covered by Insurance/State Health Aid........................................................................ 0/3
– Personal Cultivation....................................................................................................................... 0/15
Financial Hardship (Fee Waivers/Discount Medicine)..................................... 2/7
– Collective Gardening..................................................................................................................... 0/5
Explicit Right to Edibles/Concentrates/Other Forms....................................... 3/10
Does Not Impose Bans or Limits on THC..................................................................... 1/10
Does Not Impose Bans on CBD............................................................................................ 5/10
Local Bans/Zoning.......................................................................................................................... 0/10

Base Categories Points: .....................................................125

Opioid Response Points: ...................................................7
Points Total: .............................................................................................132/500
Score Percentage: ........................................................................26.40%
FINAL GRADE F
156
MEDICAL CANNABIS ACCESS STATE REPORT CARD 2019 PAGE 2/2 WYOMING

ISSUE POINTS OPIOID RESPONSE POINTS

CONSUMER SAFETY AND 0/100 Is Cannabis Available for Treatment?........................................................................................................... 0/15

– Does the state broadly allow chronic pain as a condition without restrictions?................ 0/5
PROVIDER REQUIREMENTS – Does the state allow cannabis to be issued instead of opioid prescriptions?...................... 0/5
– Does the state allow for opioid use disorder?........................................................................................... 0/5
Doctor Education........................................................................................................................................................... 5/7
Dispensing 0/25 – Is doctor education on opioids available through the state’s department of health?...... 5/5
Staff Training............................................................................................................................................. 0/5 – Is opioid-cannabis education part of the state’s curriculum?.......................................................... 0/2
Standard Operating Procedures............................................................................................... 0/5 Can Pain Patients Use Medical Cannabis?.............................................................................................. 2/3
– Facility Sanitary Conditions........................................................................................................... 0/1.25 – Has the state acknowledged 2016 CDC guidelines on not testing for THC?....................... 2/2
– Storage Protocols................................................................................................................................. 0/1.25 – Has the state issued specific guidance about testing for THC and other
– Reasonable Security Protocols.................................................................................................... 0/1.25 cannabinoids in pain patients?............................................................................................................................ 0/1
– Inventory Control.................................................................................................................................. 0/1.25 Can Pain Patients Access Medical Cannabis?...................................................................................... 0/5
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 – Is there same-day access with a doctor’s recommendation?........................................................ 0/2.5
Product Labeling................................................................................................................................... 0/5 – Can patients use medical cannabis in home health facilities, hospice, and
– Product Contents, Including Source Material Identification.................................... 0/1.67 treatment centers?....................................................................................................................................................... 0/2.5
– Allergens..................................................................................................................................................... 0/1.67 Affordability........................................................................................................................................................................ 0/5
– Potency/Compound Identification............................................................................................ 0/1.67 – Is there a veteran discount?.................................................................................................................................. 0/1
Required Testing.................................................................................................................................... 0/5 – Is there a low-income discount?........................................................................................................................ 0/1
– Active Compound Identification................................................................................................. 0/1.67 – Is medicine affordable based on patient feedback?.............................................................................. 0/3
– Contaminants.......................................................................................................................................... 0/1.67 Research............................................................................................................................................................................... 0/5
– Are there state-specific research licenses or research and development
– Potency....................................................................................................................................................... 0/1.67
tax breaks for medical cannabis?...................................................................................................................... 0/2.5
– Does the state promote research?.................................................................................................................... 0/2.5
Grow/Cultivation 0/25
Staff Training............................................................................................................................................. 0/5
Standard Operating Procedures............................................................................................... 0/5
– Facility and Equipment Sanitary Conditions......................................................................
– Workforce Safety Protocols ..........................................................................................................
0/0.71
0/0.71
Background
– Storage Protocols (Short-Term and Long-Term Storage).......................................... 0/0.71 In 2015, Wyoming passed HB 32, which created a legal right for patients
– Reasonable Security Protocols.................................................................................................... 0/0.71 with intractable epilepsy to obtain registry ID cards and possess and use
– Batch and Lot Tracking..................................................................................................................... 0/0.71
low-THC extracts. The law does not allow for the in-state production or
– Disposal/Waste...................................................................................................................................... 0/0.71
– Water Management............................................................................................................................ 0/0.71 dispensing of medical cannabis. The Wyoming Department of Health
Pesticide Guidance.............................................................................................................................. 0/5 currently issues patient ID cards to those who qualify.
– Pesticide Guidance.............................................................................................................................. 0/2.5
– Pesticide Labeling................................................................................................................................ 0/2.5 Wyoming does allow patients to obtain certain low-THC products from
Required Testing.................................................................................................................................... 0/5 other jurisdictions, but does not have any method for production or
– Active Ingredient Identification.................................................................................................... 0/1.25
distribution within the state. Wyoming also places arbitrary caps on levels
– Contaminants.......................................................................................................................................... 0/1.25
– Potency....................................................................................................................................................... 0/1.25 of THC and fails to protect patients from civil discrimination including
– Sample Retention................................................................................................................................. 0/1.25 housing, employment, organ transplants, and parental rights. The state
Recall Protocol and Adverse Event Reporting.............................................................. 0/5 should also expand the number of eligible conditions and include product
safety regulations.
Manufacturing 0/25
Staff Training............................................................................................................................................. 0/5 Opioid Response
Standard Operating Procedures............................................................................................... 0/5
In 2017, Wyoming providers wrote 64.8 opioid prescriptions for every 100
– Facility and Equipment Sanitary Conditions...................................................................... 0/1
– Workforce Safety Protocols .......................................................................................................... 0/1 persons. The average U.S. rate in the same year was 58.7 prescriptions
– Storage Protocols ................................................................................................................................ 0/1 per 100 person. While the state provides opioid education for healthcare
– Reasonable Security Protocols.................................................................................................... 0/1 providers, the state could do far more in mitigating the crisis.
– Batch and Lot Tracking..................................................................................................................... 0/1
Product Labeling................................................................................................................................... 0/5
– Product Contents, Including Source Material Identification.................................... 0/1.67
Patient Feedback
– Allergens..................................................................................................................................................... 0/1.67 Patients reported being frustrated that medical cannabis, except for low-
– Potency and Compound Information ..................................................................................... 0/1.67 THC extracts, is illegal in Wyoming.
Required Testing.................................................................................................................................... 0/5
– Active Ingredient Identification.................................................................................................... 0/1
– Contaminants.......................................................................................................................................... 0/1
– Potency....................................................................................................................................................... 0/1
– Shelf Life Testing................................................................................................................................... 0/1
– Sample Retention................................................................................................................................. 0/1
Recall Protocol and Adverse Event Reporting.............................................................. 0/5

Laboratory Operations 0/25

Staff Training............................................................................................................................................. 0/5
Method Validation in Accordance with AHP Guidelines...................................... 0/5
Result Reporting.................................................................................................................................... 0/5
Independent or Third Party........................................................................................................... 0/5
Standard Operating Procedures and Protocols.......................................................... 0/5
– Equipment and Instrument Calibration.................................................................................. 0/0.83
– Sample Tracking.................................................................................................................................... 0/0.83
– Facility and Equipment Sanitary Conditions...................................................................... 0/0.83
– Disposal/Waste...................................................................................................................................... 0/0.83
– Storage Protocols................................................................................................................................. 0/0.83
– Workforce Safety Protocols .......................................................................................................... 0/0.83

157
 Conclusion

158
 CONCLUSION

Since 1996 states have developed medical cannabis States are recognizing the value of developing robust
programs through citizen initiatives, piecemeal medical cannabis program that serve a variety of
legislation, and regulations. Somewhat surprisingly, patients. A growing trend across the United States is
while the majority of medical cannabis programs an interest in developing “adult-use” cannabis laws in
continue to adapt to the needs of patients, there addition to medical programs. The results of this year’s
is not one in the country that perfectly meets the report shows that medical cannabis programs and adult-
needs of patients. However, 2018-2019 brought many use frameworks can coexist effectively, and at times
encouraging changes for more than three million can even improve medical access. Additionally, there
patients around the country. is evidence that many people who purchase cannabis
from a non-medical dispensary are seeking relief for a
Medical Cannabis Patient Population medical condition. In a survey of 1,000 Coloradans who
Concentration in the United States were not medical cannabis card holders, 65% said they
used cannabis to relieve pain and 82% reported taking
fewer over the counter
medications.1 With
so many individuals
using cannabis for
medical purposes
who are not registered
card holders, it begs the
question of why patients are
choosing not to enroll in the state’s
medical program. States must
encourage these individuals to enroll
in the medical program and show that
becoming a medical patient in an adult-use
state is worthwhile.

However, just because these dual

frameworks can coexist, does not mean that they always
do so for the benefit of patients. States like Alaska and
Washington show the pitfalls that can happen when
*Note: This chart is based on data available as of patients’ needs are ignored for adult-use legalization. As
June 1, 2019 based on patient registry ID card data. states move forward with cannabis policy in the coming
Americans for Safe Access estimates there are at least years, it is critical for these states to first rectify the
3,125,987 medical cannabis patients in the United issues with their existing medical program, and if they
States. For perspective, there are 1.9 million patients do move towards an adult use framework, to effectively
with an ID card not including the State of California protect the interest of patients.
or Maryland as these states do not require ID cards.
This estimate also does not include patients who will
be participating in Utah, Missouri, or West Virginia’s
programs as those states have not begun the process
to start issuing ID cards. This estimate also does not
include the hundreds of thousands of patients who
must continue to medicate illegally in states without
robust medical cannabis programs.

1 https://www.eurekalert.org/pub_releases/2019-07/tfg-cmb062819.php

159
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

Grading Summary half letter or full letter grade and an additional four states
(Georgia, Iowa, Texas, and Virgina) showing significant
improvement in their CBD programs. Nineteen states
When ASA evaluates state medical cannabis programs
remained unchanged or did not change in a statistically
it grades these programs in both in isolation and
significant way. Only five states saw a decrease in their
against other state programs and our model legislation.
programs. Some of these decreases came from an
We recognize what is possible in one state may be
adjustment to the ASA scoring rubric by including Opioid
near impossible in another state’s political landscape, Response rather than bonus. However, the decrease of
however, the goal of this report is to show states what Rhode Island and West Virginia were emblematic of more
specific legislative areas they need to improve in. Just substantive problems in the states’ programs. Several
because a state received a high grade does not mean court decisions in Rhode Island weakened civil rights
the state has finished improving their program. There protections of patients, including through guidance from
is always room for improvement in providing medical the state’s Office of the Child Advocate that stated medical
cannabis to those who need it. cannabis use by a caretaker should be treated as a risk
factor regardless of legality.
In addition to highlighting areas for improvement, this
report also contains the anonymized results of a patient This marks the first year since 2014 (the inaugural year of
survey that received feedback from over 500 patients this report) that states have broken into the “A-” category.
across the country. This feedback is perhaps more Illinois and Oregon both received a grade of A- in 2019.
important than any analysis ASA can perform. Patients Illinois received the highest percentage due to the states
who interact with medical cannabis programs (or lack already strong medical cannabis program being improved
thereof) every day are the ones best suited to assess by passing a law that allowed individuals with opioid
whether or not access to medical cannabis in a state prescriptions to exchange these prescriptions to a medical
is a reality. While every piece of patient feedback is not cannabis card. Additionally, the Illinois passed HB1438
captured in our grading matrix, if a lawmaker is looking which allows individuals 21 years and older to purchase
for mechanisms to improve their state’s program, this is cannabis without a medical card. What is significant about
an excellent place to start. this bill is the great lengths the state’s legislative body
went through to protect the existing medical program and
Each year ASA assigns a grade to a medical cannabis offer additional benefits to patients like the ability to home
program on a A-F scale. There were several trends cultivate, and medicine becoming tax exempt once adult
consistent previous versions of this report. The first
use sales go into effect. Meanwhile Oregon achieved an
is that no state with a CBD only program received a
A- grade by improving packaging, labeling and pesticide
passing grade. Patients have not found these programs
regulations, ending housing discrimination against
meet their needs. While it still received a failing grade,
patients and allowing medical deliveries to munipalites
Virginia’s program (which is limited to only THCA and
that had banned store fronts.
CBD products) received 56.32%, due largely to the state
removing the qualifying condition list for
the program and approved distributors for
medical cannabis products. Conversely, West
Virginia, the only state to have passed a
comprehensive medical cannabis program
and receive a failing grade, received
58.83%. West Virginia’s program is scant
on product safety regulations, lacks civil
rights protections, and will miss a July 1, 2019
deadline of having the program be operational
by months if not years.

In more positive news, a welcome trend is the

majority of states showed improvement, with
twenty-three states or territories increasing a

160
 CONCLUSION

2018-19 2018-19 2017 2017 2016 2016 2015 2015

Jurisdiction Percentage Grade Percentage Grade Percentage Grade Percentage Grade

Alabama 28.8% F 27.4 F 30.4 F 30 F

Alaska 73.8% C 74.2 C 60.6 D- 72 D-
Arizona 86.34% B 79.6 C+ 80 B- 79.8 C+
Arkansas 79.00% C+ 82.2 B- 80 B- N/A N/A
California 89.75% B+ 89.6 B+ 87 B+ 87.8 B+
Colorado 82.8% B 80.33 B- 80.8 B- 84.2 B
Northern Mariana Islands 68.6% D+ No Program F No Program F No Program No Grade
Connecticut 78.73% C+ 80.03 B- 80.4 B- 77.8 C+
Delaware 78.39% C+ 77.25 C+ 77.4 C+ 77 C+
District of Columbia 84.64% B 83.24 B 81.2 B- 77.4 C+
Florida 73.97% C 71.00 C- 75.6 C 53 F
Georgia 41.80% F 37.40 F 32.8 F 47.25 F
Guam 75.64% C 71.44 C- N/A N/A N/A N/A
Hawaii 89.64% B+ 87.84 B+ 86 B 84.4 B
Idaho 1.00% F No Grade F No Grade F Not Scored F
Illinois 92.27% A- 87.77 B+ 89.8 B+ 87.6 B+
Indiana 24.20% F 21.2 F N/A N/A N/A N/A
Iowa 51.92% F 50.62 F 26.4 F 35.5 F
Kansas 14.60% F No Program F No Program F No Program
Kentucky 32.20% F 31.2 F 30.8 F 38.5 F
Louisiana 66.31% D 62.56 D- 46.2 F 34.75 F
Maine 88.81% B+ 85.31 B 86.2 B 81.6 B-
Maryland 84.40% B 83.8 B 75 C 84 B
Massachusetts 88.66% B+ 84.66 B 80 B- 85.4 B
Michigan 88.14% B+ 87.74 B+ 88.75 B+ 77.5 C+
Minnesota 71.58% C- 71.78 C- 72.6 C- 76 C
Mississippi 26.20% F 30.6 F 30.6 F 38.25 F
Missouri 75.90% C 26 F 24.8 F 31 F
Montana 83.44% B 80.14 B- 67 D+ 70 C-
Nevada 87.90% B+ 87.4 B+ 84.6 B 87.2 B+
New Hampshire 86.90% B 85.6 B 82.6 B- 77 C+
New Jersey 85.59% B 76 C 76.6 C 73.8 C
New Mexico 89.67% B+ 84.87 B 85.8 B 88 B+
New York 80.03% B- 77.93 C+ 76 C 73.6 C
North Carolina 30.07% F 29.87 F 28 F 37.5 F
North Dakota 77.62% C+ 75.2 C 69.2 D+ N/A N/A
Ohio 85.10% B 87.4 B+ 83.75 B N/A N/A
Oklahoma 85.41% B 28.2 F 31.2 F 34.5 F
Oregon 91.49% A- 88.1 B+ 86.2 B 85.2 B
Pennsylvania 78.20% C+ 76 C 71.8 C- N/A N/A
Puerto Rico 70.17% C- 70.17 C- N/A N/A N/A N/A
Rhode Island 72.93% C- 75.63 C 77.2 C+ 70.6 C-
South Carolina 29.80% F 28.8 F 28.8 F 42.25 F
South Dakota 1.00% F No Program F No Program F No Program F
Tennessee 24.20% F 24.2 F 23.8 F 32.25 F
Texas 46.14% F 43.04 F 38.2 F 43.2 F
Utah 61.59% D- 25.67 F 25.8 F 30.5 F
Vermont 74.29% C 73.89 C 70 C- 69.4 D+
Virginia 52.32% F 49.72 F 35 F 32.75 F
US Virgin Islands 64.90% D No Program F No Program F No Program F
Washington 81.60% B- 79.4 C+ 72.6 C- 85.2 B
West Virginia 58.83% F 62.43 D- N/A N/A N/A N/A
Wisconsin 22.80% F 23.4 F 21.4 F 26.75 F
Wyoming 26.40% F 25 F 26.8 F 36 F

161
MEDICAL CANNABIS ACCESS IN THE UNITED STATES

ASA’s Role in Shaping and possess dried flower. These changes resulted in the
state’s grade changing from a ‘C-’ to a ‘C’.
Legislation
Georgia
Since its founding in 2002, ASA has been instrumental in
One of the critical flaws in Georgia’s program in 2017 was
shaping state medical cannabis policy. We know that law-
that patients and their caregivers had no way to lawfully
makers trust and rely on this report as they are crafting poli-
obtain medicine within the state, forcing many to become
cy, and we are grateful for the states that use this report as a
medical cannabis refugees. Through the dedicated efforts
blueprint to address legislative problems in their state. Below
of chapters and members in Georgia, the state passed HB
are a few highlights of legislation implemented this past year
324 which allows in-state cultivation and distribution of
as a direct result of ASA input and patient advocacy. low-THC medical cannabis products. While the state still
has a failing grade, the program improved by over four
Arizona
percentage points.
In the 2017 version of this report, ASA noted that the
single greatest way for Arizona to improve its program Maine
would be to develop product safety regulations and
Lawmakers in Maine followed ASA’s recommendation to
enhance laboratory testing standards. In response, the
remove the list of qualifying conditions and let healthcare
state passed SB 1494 which greatly improves the testing
practitioners decide when the use of medical cannabis
standards for medical cannabis and medical cannabis
is appropriate. This change among other improvements
products and reduce patient fees. Mandatory independent
increased the state’s grade from a ‘B’ to a ‘B+’.
testing will begin on November 1, 2020. As a result of this
change Arizona’s grade increased from a ‘C+’ to a ‘B”. Maryland
ASA patients succeeded in passing HB 17, a bill that
California
allows medical cannabis edibles in the state. However,
Year after year, ASA has highlighted the high costs of
this change did not alter the state’s grade.
medicine in California, due largely to a significant excise
tax that is passed along to patients. As the state did New Mexico
not do anything to alleviate the prices patients pay, the
New Mexico directly implemented several changes
state’s grade remained at a B+. In 2019, medical cannabis
highlighted by ASA’s 2017 report thanks to ASA members
cooperatives became illegal under state law, which is a
in the state. In 2017, we highlighted New Mexico’s need
devastating blow to low- or fixed-income patients. If it was
to add civil rights protections for employees and parents,
not for the state’s strong protections in other areas and
multiyear registrations and better use the state’s program
response to the opioid crisis, California’s grade would likely
to combat the opioid epidemic. SB 406 added civil rights
have dropped due to affordability issues. protections in the area of child custody and medical
care including organ transplant; created employment
Colorado
protections preventing employers from taking adverse
In the 2017 version of this report, ASA informed states that
actions; and created a 3-year registry card. Separately,
we would be assessing how they used medical cannabis
regulators added opioid use disorder through an ASA
as a tool for the opioid crisis. In direct response to this
member petition.
guidance and pressure from ASA activists, Colorado
passed a law allowing medical cannabis to be used for Missouri, Oklahoma & Utah
any condition for which an opioid would be prescribed.
ASA worked closely with grassroots advocates to help
This goes further than many states because it covers
in the passage of ballot initiatives in Missouri, Oklahoma
both chronic and acute pain. The state also developed a
and Utah. While these initiatives are far from perfect they
research grant program for cannabis research. As a result
increased each state’s grade from an ‘F’ to a ‘C’, a ‘B’ and a
of direct engagement by ASA members, Colorado’s grade
‘D-’ respectively.
improved from a ‘B-’ to a ‘B’.
In addition to the states and actions listed above ASA
Florida
served as an informational resource for many lawmakers,
When assessing the functionality of programs, ASA
and urges readers of this report to contact our staff for
looks to see if dried flower is available to patients, and if
assistance in drafting specific pieces of legislation to
smoking is available as a delivery method for patients.
improve your state’s program.
ASA members fought in court and won the right to
consume their medicine through smoking and purchase

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Appendix 1
UNIVERSAL
IMPROVEMENTS &
MODEL LEGISLATION
 APPENDIX 1 / UNIVERSAL IMPROVEMENTS & MODEL LEGISLATION

Universal Improvements & A carrier offering a health plan in this State shall
provide coverage for cannabis for medical use for
Model Legislation an enrollee who has received certification for the
medical use of cannabis from a medical provider
While each medical cannabis program is currently under [State Law]
different due to a lack of federal uniform oversight, there
are some universal steps that every state can take to Let Healthcare Practitioners Decide
improve their respective programs. Too many states limit which patients can qualify for
Insurance Coverage medical cannabis by arbitrarily listing conditions while
excluding others. Recommending cannabis for medical
When looking at the 2019 state data in the aggregate,
purposes should be left to the discretion of physicians
one of the clearest issues in every single state is the
or other healthcare providers. Healthcare providers are
affordability of medical cannabis. One of the most
in the best position to review a patient’s medical history,
consistent critiques of these state-based programs is
symptoms, and physiological responses to medicine. A
affordability. ASA conducted a survey in 2018 revealing
patient does not need to have failed other medications
that 88.5% of medical cannabis patients believe that
before being recommended cannabis, but rather a
their medicine is not affordable, with over a quarter of
healthcare practitioner should be able to recommend
patients surveyed indicating that their medicine is often
medical cannabis simply if they believe their patient will
so cost prohibitive that they must go without treatment.
benefit. ASA urges all policymakers to work to make
medical cannabis accessible in their state by adopting
legislation with the following language:

“Debilitating medical condition” means:

A. 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, nail-patella syndrome or the
treatment of these conditions;
B. A chronic or debilitating disease or medical
condition or its treatment that produces acute,
chronic or intractable pain;
Some states have worked to clarify the role of insurance
C. A chronic or debilitating disease or medical
and insurance companies when it comes to medical
condition or its treatment that produces one
cannabis. New York has indicated that insurance
or more of the following: cachexia or wasting
coverage must apply for visits to physicians’ offices
syndrome; severe nausea; seizures, including but
relating to medical cannabis as long as obtaining a
not limited to those characteristic of epilepsy; or
recommendation is not the sole reason for the visit.
severe and persistent muscle spasms, including
Denial of coverage of visits where medical cannabis
but not limited to those characteristic of multiple
is discussed is unlawful under New York State law.
sclerosis;
However, insurers are currently under no obligation to
E. Post-traumatic stress disorder;
pay for actual medical cannabis or medical cannabis
F. O pioid use disorder or pharmaceutical drug
products. Other states have approved Workers’
addiction and recovery; or
compensation to cover medical cannabis. ASA urges
G. Any other medical condition or its treatment as
all policymakers to work to make medical cannabis
determined by a physician.
affordable in their state by adopting legislation with the
following language:

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MEDICAL CANNABIS ACCESS IN THE UNITED STATES

Opioid Prescription Trade-In (iv) Opioid use disorder, as defined under

Everyday, more than 131 individuals lose their lives [State law]
to the opioid crisis. Beyond the human toll, this crisis (v) Additional requirements as defined in
wastes billions of dollars and other resources. In looking [states medical cannabis law, section on
to mitigate this tragedy practitioners and state health requirements for written certifications]
departments should have as many treatment options
available to them as possible. 2018-2019 was the first ASA also urges lawmakers to adopt accompanying
year that ASA assessed each state on how it used legislation:
medical cannabis as a tool to combat the opioid crisis.
Based on our criteria California (29/40 points) and Be it enacted by the State of [State]:
New York (27.5/40) had the best response to the opioid
epidemic, but there is still much more they can do.
SEC. 1. Short title.
This act may be referred to as the Alternatives to
Research has shown that medical cannabis has been
Opioids Act of 2019
an effective treatment option for pain. In a 2017 report,
the National Academies of Sciences, Engineering
and Medicines conclusively found that cannabis and SEC. 2 Findings
cannabinoids are effective for treating chronic pain in (a) T
 he recorded use of cannabis as medicine goes
adults. States with medical cannabis programs have back nearly 5,000 years. Modern medical research
demonstrated 5.88 percent lower prescribing rates for has confirmed the beneficial uses of cannabis in
opioids, with a nearly 30 percent reduction in Schedule treating or alleviating the pain, nausea, and other
III opioid prescriptions for Medicaid enrollees between symptoms associated with a variety of debilitating
1993 and 2014. ASA urges lawmakers to provide an medical conditions including cancer, multiple
alternative for pain by adopting the below regulation: sclerosis, and HIV/AIDS, as found by the National
Academy of Sciences’ Institute of Medicine in
Pursuant to the authority vested in the [State March 1999.
Department of Health] the rules and regulations
of the State of [State] are hereby amended, to be (b) Studies published since the 1999 Institute of
immediately effective upon filing with the Secretary of Medicine study, including a subsequent report
State, to read as follows; issued by the National Academies of Sciences
continue to show the therapeutic value of
1. A
 healthcare practitioner who is licensed in cannabis in treating a wide array of debilitating
accordance with the laws of [State] may issue a medical conditions include the relief of chronic
recommendation or written certification for the pain neuropathic pain caused by multiple
approved use of medical cannabis by a qualifying sclerosis, HIV/AIDS, and other illnesses that
patient. Such certification/recommendation shall often fail to respond to conventional treatments
contain: and relief of nausea, vomiting and other side
(i) The patient’s diagnosis of having a qualifying effects of drugs used to treat HIV/AIDS and
condition as defined under [state’s medical Hepatitis C, increasing the chances of patients
cannabis law, section on qualifying continuing on life-saving treatment regimens.
conditions] or;
(ii) Any condition for which an opioid could be (c) C
 annabis or its derivatives have accepted
prescribed, provided that the underlying medical uses in 47 states of the United States and
condition is expressly stated on the patient’s several territories, and has been recommended
certification or recommendation; or by thousands of licensed physicians to over
(iii) Any condition where the practitioner 1,900,000 patients in states with medical
believes that the benefits of using cannabis cannabis laws. The utility of medical cannabis is
to treat the condition will outweigh risks; or recognized by a wide range of medical and public

166
 APPENDIX 1 / UNIVERSAL IMPROVEMENTS & MODEL LEGISLATION

health organizations including the American

Academy of HIV Medicine, the American College
SEC. 3 Definitions
of Physicians, the American Public Health
Association, the Leukemia & Lymphoma Society, If a state law has any provisions in their definition
the U.S. Pain Foundation, the Michael J. Fox section related to “excluded offenses” barring a
Foundation and many others. patient from enrolling in a program, these should be
stricken, particuldarly if the offenses related to the
(d) D
 ata from the Federal Bureau of Investigation’s use of cannabis.
Uniform Crime Reports and the Compendium of
Federal Justice Statistics show that approximately (A) “Bona fide physician-patient relationship”
99 out of every 100 cannabis arrests in the U.S. means a relationship established at a hospital,
are made under state law, rather than federal physicians office or other health care facility in
law. Consequently, states are best suited to make which a physician has an ongoing responsibility
decisions about cannabis policy and changing for the assessment, care and treatment of a
state law will have the practical effect of protecting patient’s qualifying condition or symptom of
from arrest the vast majority of ill patients who patients qualifying condition. A veteran who has
have a medical need to use cannabis received treatment at a Veterans Affairs hospital
shall be deemed to have a bona fide patient
(e) A ccording to the Centers for Disease Control, drug physician relationship with a VA physician if the
overdoses, fueled by the opioid epidemic, have patient has been seen for his or her debilitating
become the leading cause of death nationwide for condition at the VA medical hospital in
people under the age of 50. accordance with VA Hospital Protocols.
(i) It is estimated that nearly 60,000 people die a
year from the opioid crisis; (B) “Opioid Alternative Program Participant”
(ii) Research from the Journal of the American means an individual who has received a valid
Medical Association has shown that states with written certification to participate in the Opioid
medical cannabis laws have seen up to a 25% Alternative Program for a medical condition for
reduction in opioid overdose deaths; further which an opioid has been or could be prescribed
(iii) In states with medical cannabis dispensaries the by a physician based on generally accepted
reduction in deaths from opioids is nearly 40%; standards of care.
(iv) Beyond the deaths of thousands from the
opioid crisis, states are plagued with high (C) “Provisional Registration” means a document
emergency room costs, hospital stays, and issued by the Department of Public Health [or
pain suffered by individuals, families, and other relevant issuing authority in state] to a
communities. qualifying patient who has submitted: (1) an
(f) States are not required to enforce federal law online application and paid any relevant fee
or prosecute people for engaging in activities to participate in the state’s medical cannabis
prohibited by federal law. Therefore, compliance program pending approval or denial of the
with this Act does not put the state of [State] in patient’s application. If a patient is unable to
violation of federal law. submit an application online, they or a caregiver
may also submit in person at the Department; (2)
(g) S
 ince 2014, the United States Congress has or a completed application for terminal illness.
restricted the Department of Justice from
spending any funds to prosecute those who are (D) “Qualifying Patient” means a person who has
implementing state medical cannabis programs. been diagnosed by a healthcare practitioner
Appellate courts have extended these protections as having a debilitating medical condition as
to individual patients. defined in sec. --- [where state defines qualifying
conditions], including enrolment in the Opioid
Alternative Program or for opioid use disorder

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MEDICAL CANNABIS ACCESS IN THE UNITED STATES

SEC. 5 Provisional Certification

(E) “ Written certification/Recommendation” means (a) Notwithstanding any other provision of this
a document dated and signed by a healthcare Act, a person provided a written certification
practitioner stating: for a debilitating condition who has submitted
(1) that the qualifying patient has a qualifying a completed application whether online or in
condition and specifying the qualifying person shall receive a provisional registration and
condition the patient has if so needed under be entitled to purchase medical cannabis from a
state law; and specified dispensing organization for a period of
(2) that (A) the healthcare practitioner is 90 days or until his or her application has been
treating or managing the patient’s qualifying denied or he or she receives a confirmation of
condition or (B) an Opioid Alternative Program enrollment in the medical cannabis program.
participant has a medical condition for which However, a person may obtain an additional
opioids could have been prescribed. A written provisional registration after the expiration
certification/recommendation shall only be of 90 days after the date of application if the
made in the course of a bona fide healthcare Department of Health does not provide the
practitioner-patient relationship, after the individual with a registry identification card, or
healthcare practitioner has completed an confirmation of enrollment, or deny the individual’s
assessment of either a qualifying patient’s application within those 90 days.
medical history or Opioid Alternative Program (b) The provisional registration may not be extended if
participant, reviewed records related to the the individual does not respond to the Department
patient’s debilitating condition. of Health’s request for additional information or
corrections to required application documentation.
(c) In order for an individual to receive medical
SEC. 4 W
 ritten Certification/Recommendation
cannabis under this subsection, a person
(A) A certification confirming the patient’s eligibility
must present his or her provisional registration
to participate in the Opioid Alternative Program
along with valid identification to the dispensing
shall be written on a form provided by the
organization. The dispensing organization shall
Department of Health and shall include the
verify the provisional registration through the
(i) participants name and date of birth
Department of Health’s verification system.
(ii) the physician’s name, address, medical
(d) Persons with provisional registrations must
license number and active controlled
keep their provisional registration in his or her
substances registration
possession at all times when transporting or
(B) t he physician’s’ signature and date;
engaging in the use of medical cannabis.
(C) t he length of participation in the Opioid
Alternative Program, which shall be limited to no
more than 90 days; SEC. 6 F
 ees Charged for Applications
(D) a statement identifying the patient has been Prohibited
diagnosed with and is currently undergoing (a) No person or business shall charge a fee for
treatment for a medical condition where an assistance in the preparation, compilation
opioid has been or could be prescribed; and or submission of an application to the [State
(E) a statement that a participant in possession Medical Cannabis Program] or to the Opioid
of a written certification indicating eligibility Alternative Program. A violation of this subsection
to participate in the Opioid Alternative is a [applicable section] misdemeanor, for
Program shall not be considered an unlawful which restitution to the applicant and a fine of
user, particularly at pain clinics, or addicted up to $1,500 may be imposed. All fines shall be
to narcotics solely as a result of his or her deposited in the state’s medical cannabis fund
participation in the program after restitution has been made to the applicant

168
 APPENDIX 1 / UNIVERSAL IMPROVEMENTS & MODEL LEGISLATION

(b) the Department of Health shall refer individuals Delivery

making complaints against a person or business A recent report from The Gerald R. Ford School of Public
under this section to the [State] State Police, who Policy at the University of Michigan indicates that 75% of
shall enforce violations of this provision. Michigan cities, villages, and townships statewide report
(c) A
 ll application forms issued by the Department they have chosen to prohibit medical cannabis facilities,
shall state that no business or person may charge while just 8% report “opting in” to allow such facilities
a fee for assistance in the preparation, compilation in their jurisdiction.1 Similar problems exist in California
or admission of an application to the state medical where local bans on medical cannabis facilities have
cannabis program created areas where it is extremely difficult for patients to
access. While under many state laws it is the prerogative
of local jurisdictions to put these bans in place under the
SEC. 7 Opioid Alternative Program
existing medical cannabis laws and regulations, a lack of
(a) T he Department of Health shall establish
local participation makes access even more challenging
the Opioid Alternative Program. Licensed
for medical cannabis patients, and highlights the need for
dispensing facilities shall allow persons with a
well crafted regulations when it comes to delivery. Having
written certification from a licensed healthcare
a functioning delivery system is critically important to
professional to purchase medical cannabis upon
providing patients with medicine, particularly those with
enrollment in the Opioid Alternative Program.
medical conditions that impact mobility. ASA urges all
For a person to receive medical cannabis under
policymakers to work to make medical cannabis accessible
this section the person must present the written
in their state by adopting legislation with the following
certification along with a valid form of identification
language (note: dispensary is used as a placeholder for
to the dispensing organization.
how the state defines cannabis businesses):
(b) T  he dispensing organization shall verify the
person’s status as an Opioid Alternative Program
Definitions
Participant through the Department of Health’s
verification system
“Delivery” means the transportation of usable
(c) E ach dispensing organization shall retain a copy of
marijuana and related supplies to a consumer.
the Opioid Alternative Pilot Program certification
“Delivery” also includes the use by a [dispensary]
and other identifying information as necessary in
of any third party technology platform to receive,
a cannabis tracking system. The cannabis tracking
process, and fulfill orders by legal consumers,
system shall be accessible by the Department of
provided that any physical acts in connection with
Health, and relevant law enforcement agencies.
filling the order and delivery shall be accomplished
(d) The cannabis tracking system shall be capable of
by an employee of the [dispensary].
providing verification of a person’s enrollment in

the Opioid Alternative Program at any time.
“Delivery employee” means an individual employed
(e) U pon verification of an individual’s valid
by a [dispensary] who delivers marijuana and related
certification and enrollment in the Opioid
supplies from the dispensary premises to a legal
Alternative Program, the dispensing organization
consumer at a physical address.
may dispense medical cannabis, in amounts
not exceeding [ounces] per 14 day period to the
“Transport” means the transportation of marijuana
participant. The dispensing organization shall
from a cultivation, processing, manufacturing or
verify that the participant in the Opioid Alternative
distribution site to a dispensing site approved, and the
Program is not already a participant in the [State]
transportation of marijuana among and between sites,
Medical cannabis program.
but does not include delivery of marijuana to consumers
(f) An Opioid Alternative Program participant shall
be registered as a medical cannabis cardholder
and be afforded the same rights and privileges
that a medical card holder has as defined in [State
medical cannabis law] 1 http://closup.umich.edu/files/mpps-spring-2018-marijuana.pdf

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MEDICAL CANNABIS ACCESS IN THE UNITED STATES

Statutory Language (11) A

 [dispensary]shall, upon request provide the
(1) Deliveries may only be made by a licensed regulatory authority with information regarding
[dispensary]. any motor vehicles used for delivery, including the
(2) Deliveries shall be made only to a legal consumer vehicle’s make, model, color, Vehicle Identification
by an employee of the [dispensary]. Number, license plate number and Department of
(3) A [dispensary] shall not deliver to an address Motor Vehicles’ registration.
located on land owned by the federal government (12) A [dispensary] shall ensure that vehicles used
or any address on land or in a building leased by to deliver cannabis bear no markings that would
the federal government. either identify or indicate that the vehicle is used
(4) A [dispensary] shall staff each delivery vehicle with to deliver marijuana.
an employee who shall be at least 21 years of age. (13) A [dispensary] shall ensure that deliveries are
(5) Each delivery employee shall carry a copy of completed in a timely and efficient manner.
the [dispensary] employee identification card. (14) A [dispensary] delivery employee, while making
The employee shall present the [dispensary] deliveries, shall not carry cannabis goods valued
employee identification card upon request to in excess of $10,000 at any time. This value shall
state and local law enforcement, employees of be determined using the current retail price of all
regulatory authorities, and other state and local cannabis goods carried by the delivery employee.
agencies enforcing these rules. (15) A delivery employee, while making deliveries, shall
(6) Each delivery employee shall have access only travel from the [dispensary] licensed premises
to a secure form of communication with the to the delivery address; from one delivery address
dispensary [dispensary], such as a cellular to another delivery address; or from a delivery
telephone, at all times that the vehicle contains address back to the [dispensary]’s licensed prem-
medicinal marijuana. ises. A delivery employee shall not deviate from the
(7) A delivery employee, during a delivery, shall delivery path described in this section, except in the
maintain a physical or electronic copy of the event of emergency or as necessary for rest, fuel,
delivery request and shall make it available or vehicle repair stops, or because road conditions
upon request of the licensing authority and law make continued use of the route or operation of the
enforcement officers. vehicle unsafe, impossible, or impracticable.
(8) A delivery vehicle must be equipped with a secure (16) A [dispensary] shall maintain a record of each
lockbox, container, or cage in a secured cargo delivery of cannabis in a delivery log, which may
area, which shall be used for the sanitary and be written or electronic.
secure transport of marijuana. (17) A [dispensary] shall report any vehicle accidents,
(9) A delivery employee shall not leave cannabis diversions, losses, or other reportable events that
goods in an unattended motor vehicle unless the occur during delivery to the appropriate authorities.
motor vehicle is locked and equipped with an (18) A [dispensary] employees shall not consume
active vehicle alarm system. cannabis goods while delivering cannabis goods
(10) A delivery vehicle shall contain a Global to customers.
Positioning System (GPS) device for identifying
Civil Rights Protections
the geographic location of the delivery vehicle.
While a state may have a functioning medical cannabis
The device shall be either permanently or
program that protects patients from criminal penalties,
temporarily affixed to the delivery vehicle while
people may be hesitant to participate in a medical
the delivery vehicle is in operation, and the device
cannabis program if they could lose their housing,
shall remain active and in the possession of the
jobs, family or other rights. Every state with a medical
delivery employee at all times during delivery. At
cannabis program would be benefited by adopting the
all times, the [dispensary] shall be able to identify
below language that relates to the protection of civil
the geographic location of all delivery vehicles
rights, as these provisions relieve some of the concerns
that are making deliveries for the [dispensary]
that patients face when dealing with the implied costs of
and shall provide that information to the Division
being a medical cannabis patient
upon request.

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 APPENDIX 1 / UNIVERSAL IMPROVEMENTS & MODEL LEGISLATION

(A) Unless a failure to do so would cause the Increasing Cannabis Education

employer to lose a monetary or licensing-related Education for healthcare providers as well as staff at
benefit under federal law or federal regulations, medical cannabis businesses is not required in every
an employer may not discriminate against a state. Having strong training programs mandated
person in hiring, termination, or any term or or accessible improves the overall understanding of
condition of employment, or otherwise penalize a cannabis as a medicine. ASA urges lawmakers to adopt
person, based upon either of the following: education standards through partnering with ASA’s
1. The person’s status as a qualifying patient, Patient Focused Certification (PFC) and Cannabis Care
caregiver, cardholder, or employee at a Certification (CCC) programs.
cannabis business; or
2. A qualifying patient, caregiver, or cardholder The PFC program prepares individuals to understand
tests positive for cannabis components or state and local regulations and to learn required safety
metabolites, unless the individual was impaired and operational protocols, while teaching them the
by cannabis on the premises of the place of basics of cannabis as medicine and common therapeutic
employment or during the hours of employment. uses of cannabis. PFC trainings are available to anyone
(B) Unless required by federal law or required to interested in learning more about medical cannabis.
obtain federal funding, no landlord may refuse Training is available from single discipline certification to
to rent a dwelling unit to a person or take multi-discipline certification in 4 disciplines: Cultivation,
action against a tenant solely on the basis of Manufacturing, Distribution, and Laboratory. Trainings
an individual’s status of a qualifying patient or are available in-person or online.
cardholder under this act.
(C) For the purposes of medical care, including organ The CCC program offers patient and caregiver
transplants, a qualifying patient’s medical use of education as well as continuing medical education
cannabis does not constitute the use of an illicit (CME) credits for medical professionals through
substance or otherwise disqualify a qualifying our partnership with The Answer Page, Inc. (TAP).
patient from medical care. The medical professional course offering created for
(D) Neither the presence of cannabinoid components medical professionals was approved under the latest
or metabolites in a person’s bodily fluids, nor rules for dealing with controversial subjects in CME
conduct related to the medical use of cannabis by programs and provides physicians, pharmacists,
a custodial or noncustodial parent, grandparent, nurse practitioners, nurses, and psychologists with
pregnant woman, legal guardian, or other person the highest quality peer-reviewed and accredited
charged with the well-being of a child, shall educational content focused on medical marijuana and
form the sole or primary basis for any action or the endocannabinoid system. The content provides
proceeding by a child welfare agency or a family Accreditation Council for Continuing Medical Education
or juvenile court. This subsection shall apply only (ACCME), Accreditation Council for Pharmacy Education
to conduct in compliance with this chapter. (ACPE), American Association of Nurse Practitioners
(E) Health care practitioners shall not disqualify (AANP), American Nurses Credentialing Center (ANCC),
or refuse to provide care for a patient due to and American Psychological Association (APA) credits.
positive urinary or blood test results indicating For more information on PFC and CCC, visit
the presence of cannabis or cannabis metabolites www.PatientFocusedCertification.org and
including tetrahydrocannabinol, nor shall the www.CannabisCareCertification.org.
presence of compounds of cannabis or cannabis
metabolites be a reason for the cessation of care.
Additional Model Legislation
(F) A medical cannabis patient or caregiver licensee
For further policy recommendations and the full text of
shall not be denied the right to own, purchase
ASA’s model legislation, please visit
or possess a firearm, ammunition, or firearm
https://www.safeaccessnow.org/model_legislation
accessories based solely on his or her status as a
medical cannabis patient or caregiver licensee.

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MEDICAL CANNABIS ACCESS IN THE UNITED STATES

Appendix 2
RECOMMENDATION
TO REGULATORS

172
 APPENDIX 2 / RECOMMENDATIONS FOR REGULATOS

Recommendations smoked cannabis. These results were produced

under the good laboratory practice (GLP) guidelines
for Regulators included in the AHPA standards, and have helped
shape safety criteria for cannabis products. Regulators
Since the release of the American Herbal Products continue to rely on PFC laboratories and their data to
Association (AHPA) and American Herbal guide public policy and ensure patient safety.
Pharmacopoeia (AHP) guidelines, more than 16 states
have used them as legislative and regulatory tools The PFC government relations team is currently
to create comprehensive product safety rules and negotiating with several states for education, training,
regulations. However, these new regulations will and regulatory compliance contracts.
only be effective with proper oversight and
enforcement. To aid government agencies in these
efforts, Americans for Safe Access (ASA) created the
Patient Focused Certification (PFC) program. PFC is
a non-profit, third party certification program for the
cannabis industry and the nation’s only certification
program for the AHPA and AHP standards. PFC is
available to companies cultivating, manufacturing, or
distributing cannabis and hemp products, as well as to
laboratories providing cannabis analytic services.

As with other industries, oversight of cannabis and

cannabis products is constantly evolving. PFC verifies
compliance with state and local laws as well as the
AHPA and AHP standards. In order to ensure ongoing
compliance, PFC requires comprehensive state training,
annual inspections, unannounced random inspections,
and product testing to ensure that certified companies
continue to meet all program standards. PFC is similar
to other nationally recognized certification programs
including United States Pharmacopeia (USP), Good
Housekeeping, NSF International, and the International
Organization for Standardization (ISO). PFC has a
partnership with the leading ISO accreditation body
in the United States, the American Association for
Laboratory Accreditation (A2LA), to conduct dual PFC
and ISO/IEC 17025 accreditations.

PFC is a unique international program offered by ASA.

It is unlike other training and certifications schemes
for the cannabis industry because their standards are
public documents, their accreditation partner is a global
leader in the field, and the companies that are in the
PFC program are supporting public health efforts. For
example, one PFC certified laboratory has published
two outstanding research articles, on the labeling
accuracy of cannabis products and pesticides in

173
Appendix 3
THE FEDERAL
GOVERNMENT’S ROLE
 APPENDIX 3 / THE FEDERAL GOVERNMENT’S ROLE

The Federal WHEREAS thirty-three states, the District of

Columbia, and four of five U.S. territories have
Government’s Role comprehensive medical cannabis legislation, with
an additional fourteen states having cannabidiol
When looking at state data in the aggregate, it is clear legislation.
that nationwide medical cannabis programs need to be
stronger. Programs ranged from 0% (South Dakota) to WHEREAS oversight authority of medical cannabis
92.27% (Illinois), however, when the fifty-four programs has been handled on the state and local level, rather
were averaged, medical cannabis access in the United than through the federal government, putting the
States only received 64.54%, or a “D” on ASA’s grading United States at odds with the 1961 Single Convention
scale. Even this grade does not paint the true picture on Narcotic Drugs, as amended by the 1972 Protocol,
as many still struggle to access medical cannabis. This which requires a singular medical cannabis oversight
shows the challenging nature of having a patchwork body under Article 28.
approach to state laws. On the state level ASA urges
states to adopt the policies outlined in the above WHEREAS the United States and its territories have
universal improvements section. ASA urges states to fully created a patchwork of licensing, regulation, and
adopt its model legislation2 and implement the strategies enforcement laws that lack uniformity.
outlined in ASA’s 2017 Medical Cannabis to Combat Pain
and Opioid Crisis: A Blueprint for State Policy.3 WHEREAS local level oversight of medical cannabis
has led to greatly differing regulations on product
While states continue to develop policy one critical safety, laboratory operations, taxation, pesticide use,
piece of the legislative puzzle is missing: the role civil rights and other areas where federal guidance
of the Federal Government. Over the last few years exists in other industries.
interest in federal reform has grown exponentially, with
dozens of lawmakers introducing solutions to resolve WHEREAS current federal oversight from the Drug
the federal-state conflict of cannabis laws. However, Enforcement Administration (DEA) and the National
while many of these bills focus on important topics like Institute on Drug Abuse focuses on punitive measures
criminal justice reform and descheduling cannabis, and the harms of cannabis, rather than the expansion
few envision any regulatory or oversight role for the of therapeutic outcomes, which is inconsistent with
federal government. As federal lawmakers grapple with the WHO’s recommendations.
cannabis proposal, it is critical that state governments
ask for federal oversight that is effective and provides WHEREAS due to resource constraints and political
for safe cannabis, without being overly burdensome on ideations, the DEA has failed to act on over two dozen
existing state regulatory frameworks. State lawmakers legitimate requests for research licenses.
can introduce the following resolution calling on the
Federal Government to develop clear standards for safe WHEREAS Schedule I researchers in our State who
medicine in a post-descheduling or rescheduling world. do obtain the proper license may be forced to import
cannabis from other countries or obtain cannabis that
Expressing the sense of the people of [State] that a new does not mirror what is otherwise available in [State’s]
federal agency, the Office of Medical Cannabis Control, markets to patients.
would be beneficial to public and individual health.
WHEREAS administrators of the Food and Drug
WHEREAS there are over three million medical Administration and other agencies have called on
cannabis patients and over 20,000 cannabis Congress to resolve the conflict between state and
businesses in the United States. federal laws and [State] is ready to work with all
relevant Federal agencies.
2 https://www.safeaccessnow.org/model_legislation
3 https://www.safeaccessnow.org/opioidblueprint

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WHEREAS research in the Journal of the American Be it further resolved that as the Federal Government
Medical Association has shown cannabis can play a develops regulations for medical cannabis it should
critical role in reducing opioid overdose deaths, up work with the various states with robust programs
to 25%, when compared to states without medical to develop federal product safety standards which
cannabis programs, and cannabis is widely used for shall act as the minimum allowing states to set more
alleviating the symptoms of numerous other medical stringent standards.
conditions.
For further insight on what a Federal regulatory
Now, therefore, be it Resolved by the people of framework might look like, please refer to Chapter 7 of
[state] that it is the sense of [State] that a new federal ASA’s publication:The Medical Cannabis Briefing Book,
oversight agency for medical cannabis or federal input 116th Congress 4
on medical cannabis regulations would be beneficial to
public and individual health.

4 https://www.safeaccessnow.org/briefingbook116

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