Earlier this month I, along with 10 other District residents, founded the Washington, DC Chapter of Americans For Safe Access, which is America’s largest patient advocacy organization with over 50,000 members. Since Congress had prevented Initiative 59 from becoming law for so long, there has never been the opportunity for the local chapter to form. Over the last couple weeks we’ve met a few times and have deconstructed the amendments to Initiative 59. Below is the official position of the Washington, DC ASA Chapter concerning the amendments:

I did not write this…..

1. The bill instructs the Department of Health to establish a list of qualifying medical conditions:

This is not necessary, as the voters have already decided this matter:

Recommendation:

“All seriously ill individuals have the right to obtain and use marijuana for medical purposes when a licensed physician has found the use of marijuana to be medically necessary and has recommended the use of marijuana for the treatment (or to mitigate the side effects of other treatments such as chemotherapy, including the use of AZT, protease inhibitors, etc., radiotherapy, etc.) or diseases and conditions associated with HIV and AIDS, glaucoma, muscle spasm, cancer and other serious or chronic illnesses for which the recommending physician reasonably believes that marijuana has demonstrated utility. “

2. The bill requires that recommendations be issued by a patient’s primary care physician in DC:

+ The requirement that recommendations issued by a patient’s primary care physician ignores the role of specialists
+ Not everyone has a primary care physician; current trends in the healthcare industry have reduced the role of the primary care physician.
+ Specialists, such as oncologists or neurologists, should have the discretion to issue recommendations.
+ An oncologist, for example, is in a better position to recommend medical marijuana to a cancer patient undergoing chemotherapy than a traditional primary care physician.
+ The law should not abandon patients who have difficulty meeting this requirement through their existing health coverage.
+ The definition of “primary physician” in the bill excludes physicians licensed in neighboring Virginia and Maryland.
+ DC residents receive medical care throughout the DC Metro area. They should not be required to change doctors with which they have had a longstanding relationship in order to receive a recommendation for medical marijuana.
+ Maryland and Virginia physicians can legally recommend marijuana without explicit state approval.
+ This is confirmed by the U.S. Supreme Court case Conant v. McAffrey in which the Court found that doctors could not be penalized for recommending medical marijuana.
+ Allowing Maryland and Virginia physicians to recommend medical marijuana would acknowledge regional realities and respect existing doctor-patient relationships.

Recommendation:

Section 2 (a)

“(3) “Primary physician” means a physician who maintains in good standing a license to practice medicine in the District of Columbia who has primary responsibility for the care and treatment of the qualifying patient.

Change:

“(3)” “Physician” means a physician who maintains in good standing license in the District of Columbia, Maryland or Virginia who has responsibility for the treatment of the qualifying patient.

3. The bill limits patients to only one caregiver:

+ Patients with chronic illnesses who need care 24/7 cannot possibly rely on just one caregiver.
+ Twenty-four hour care requires at least three caregivers; having a fourth available to cope with unforeseen circumstances is certainly not unreasonable.
+ DC voters approved a ballot initiative in 1998 that specified four caregivers.

Recommendation:

“A medical patient may designate or appoint a licensed health care practitioner, parent, sibling, child, or other close relative, domestic partner, case manager/worker, or best friend to serve as a primary caregiver for the purposes of this act. A designation under this act need not be in writing; however, any written designation or appointment shall be prima facie evidence that a person has been so designated. A patient may designate not more than four persons at any one time to serve as a primary caregiver for the purposes of this act. For the purposes of this subsection, the term ‘best friend’ means a close friend who is feeding, nursing, bathing, or otherwise caring for the medical patient while the medical patient is in a weakened condition.”

“Sec. 7. Designation of Primary Caregivers.

Amendment:

“(a) A qualifying patient may designate one licensed health care practitioner, spouse, domestic partner, case manager/worker, or close friend, parent, sibling, child, or other close relative, to serve as a primary caregiver to assist the qualifying patient’s medicinal use of marijuana for the purposes of this act. The qualifying patient must register the primary caregiver with the Department in compliance with the requirements of section 10 of this act.

Change to the original language of Initiative 59:

“(a) A qualifying patient may designate up to 4 licensed health care practitioner, spouse, domestic partner, case manager/worker, or close friend, parent, sibling, child, or other close relative, to serve as a primary caregiver to assist the qualifying patient’s medicinal use of marijuana for the purposes of this act. The qualifying patient must register the primary caregiver with the Department in compliance with the requirements of section 10 of this act.

4. The bill requires patients to pay a registration fee to their designated dispensary, in order to subsidize implementation of the act:

+ With dispensaries paying fees to the District there is no need for addition fees for patients.

Recommendation, strike:

“(M) Set a registration and renewal fees for qualifying patients, as well as a sliding
scale fee system for qualifying patients experiencing financial hardship based on the qualifying patient’s family income. The fees collected shall be applied toward the cost of administering this act.

5. The bill requires dispensaries to track all sales to individual patients, with records of names, dates, and quantity sold:

+ This well-intended language creates privacy concerns that could put patients at risk.
+ To limit abuses, other states with compassionate-use laws have set limits on the amount of medical marijuana that can be purchased at one time.
+ Any patient registries should be voluntary.
+ The Obama administration has lived up to it’s campaign promise to stop medical marijuana raids in states with medical marijuana laws.
+ A change in administration (hopefully not for another seven years!) could put patients whose data is in a registry at great risk if the incoming administration is not as enlightened as the current administration.

Recommendation:

(I) Require dispensaries to maintain detailed and accurate medical records that specify at least the following:
(i) The quantity of marijuana the dispensary sold, to whom, and on what date;

Change:

(i) Patient records necessary to demonstrate patient eligibility under the law for every collective member, including (1) a copy of a driver’s license or Department of Motor Vehicle identification card, (2) a patient registration form, (3) a valid and unexpired letter of recommendation for the use of medical marijuana written by a doctor licensed practice medicine in the District of Columbia, VA or MD. All patient records shall be kept in a secure location and regarded as strictly confidential.

6. The bill does not have provisions for Police training and procedures.

+ Lack of police training has been a huge problem in localities where law enforcement resisted the passage of medical marijuana laws and refused to honor them after passage.
+ We would like to work closely with the Police Department to make sure everyone is on the same page, police resources are used wisely, and patients are protected.

Recommendation:

(1) Within six months of the date that this chapter becomes effective, the training materials handbooks, and printed procedures of the Police Department shall be updated to reflect its provisions. These updated materials shall be made available to police officers in the regular course of their training and service.

(2) Medical cannabis-related activities shall be the lowest possible priority of the Police Department.

(3) Qualified patients, their caregivers, and medical cannabis dispensing collectives who come into contact with law enforcement will not be cited or arrested and dried cannabis or cannabis plants in their possession will not be seized if they are in compliance with the provisions under the law.

(4) Qualified patients, their caregivers, and medical cannabis dispensing collectives who come into contact with law enforcement and cannot establish or demonstrate their status as a qualified patient, primary caregiver, or medical cannabis dispensing collective, but are otherwise in compliance with the provisions of this chapter, will not be cited or arrested and dried cannabis or cannabis plants in their possession will not be seized if (1) based on the activity and circumstances, the officer determines that there is no evidence of criminal activity; (2) the claim to be a qualified patient, caregiver, or medical cannabis dispensing collective is credible; and (3) proof of status as a qualified patient, primary caregiver, or medical cannabis dispensing collective can be provided to the Police Department within three business days of the date of contact with law enforcement.

7. The bill excludes anyone with a misdemeanor drug conviction or any felony conviction from owning or working at a dispensary:

+ This patient unfairly penalizes people who have been unfairly treated by marijuana laws, including DC residents who may have qualified for medical marijuana recommendations in the 11 years since the passage of Initiative 59.
+ Some of the people most qualified to cultivate medicinal quality marijuana unfortunately have been convicted of drug-related offenses. That is the reality of marijuana cultivation.
+ We recommend that only persons with convictions for violent offenses be banned from owing or working in dispensaries.

Recommendation:

Sec 10. Rulemaking

(B) Require each dispensary to register with the Department, provided that:
(ii) No person with a misdemeanor conviction for a violent crime drug-related offense or felony conviction shall own or work for a registered dispensary; and

Change:

(ii) No person with a misdemeanor or felony conviction for a violent crime shall own or work for a registered dispensary; and

8. The bill prohibits dispensaries 1,000 feet from a school or youth center:

+ Few if any, locations in the city can meet these criteria.
+ Restrictions on proximity to schools and youth centers should be re-evaluated based on practical considerations.
+ DC zoning just passed a 300 ft buffer zone around schools and youth centers for gun stores.
+ We hope we can all agree that guns pose a greater threat than marijuana plants.

9. The bill establishes a limit of five dispensaries with no review process:

+ We recommend limiting the number of dispensaries to five in the first year with a requirement that the Department of Health conduct hearings twice a year to determine if the number is appropriate to meet the needs of qualified patients in the District.

Recommendation:

(i) No more than 5 dispensaries may register to conduct business in the District;

Change:

(i) No less than 5 dispensaries may register to conduct business in the District in the first year: the Medical Marijuana Advisory Committee will conduct hearings annually to determine if the number is appropriate to meet the needs of qualified patients in the District.

10. The bill prohibits patients from registering with more than one dispensary:

+ Patients should be allowed to visit any of the five dispensaries, so that patients can make informed choices regarding which products and services best meet their medical needs

11. Create a medical marijuana taskforce to make recommendations for cultivation, ID cards, dispensary regulations and selection process.

Recommendation:

MEDICAL MARIJUANA ADVISORY COMITTEE–DUTIES.–The council shall establish a Medical Marijuana Advisory consisting of eight members consisting of 2 healthcare professionals, 3 patient advocates, 2 representatives from non-profit patient advocacy organizations and 1 caregiver. The members shall be chosen for appointment by the Council from recommendations from citizens of the District of Columbia. A quorum of the advisory board shall consist of five members. The advisory board shall:

A. make recommends to the council for a process for selecting dispensary applications;
B. make recommendations to the council for dispensary operational guidelines and oversight;
C. convene at least once per year to conduct public input process on the implementation of 1 59 and to evaluate the number of dispensaries needed to serve the District;
D. issue recommendations concerning rules to be promulgated for the issuance of the registry identification cards; and
E. recommend quantities of cannabis that are necessary to constitute an adequate supply for qualified patients, caregivers and dispensaries.