THE SOUTHERN OFFICE OF THE COUNCIL OF STATE GOVERNMENTSPO Box 98129 | Atlanta, Georgia 30359

ph: 404/633-1866 | fx: 404/633-4896 | www.slcatlanta.orgSERVING THE SOUTH

Southern LegiSLative ConferenCe

of

the CounCiL of State governmentS

© Copyright March 2014

Lauren Greer Policy AnalystSouthern Legislative ConferenceMarch 2014

A SPECIAL CONDITION:MEDICAL MARIJUANA IN SLC STATESA REGIONAL RESOURCE FROM THE SLC

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IntroductionGaining traction in a number of state legislatures of The Council of State Governments (CSG), Southern Legisla-tive Conference (SLC) member states, is the legalization of marijuana for medical use. Many SLC lawmakers cite sto-ries of families with children suffering from severe seizure disorders that failed to respond to the more conventional treatments as the impetus for the push toward its legaliza-tion; some of these families have even considered moving to a state that does allow for the medicinal or recreational use of marijuana. Prior to the start of the 2014 legislative session, 21 states and the District of Columbia had legalized marijuana for medical purposes.1,2 Additionally, in 2012, voters in Colorado and Washington approved the recre-ational use of marijuana within their states. Mirroring the rise in states legalizing or decriminalizing marijuana, public support for legalization also is on the rise. A 2010 national survey conducted by the Pew Research Center found that only 41 percent of Americans supported legalizing mari-juana.3 Only three years later, the same Pew survey found that 52 percent of Americans favor legalization.4

Previously Enacted Legislation Georgia, Louisiana, South Carolina, and Virginia already have laws from the 1970s and 1980s that allow for some use of cannabis or cannabis derivatives for medical purposes. However, all of these programs have remained mostly dor-mant since their enactment, mainly due to lack of funding or regulations for implementation. In previous and cur-rent legislation, the terms marijuana and cannabis often are used interchangeably.

Current Legislation As of February 2014, 10 of the 15 SLC member states have introduced legislation for the 2014 session that would al-low for the medical use of marijuana to some extent. Although North Carolina does not reconvene until May, legislation filed in 2013 technically is still available, de-spite an unfavorable committee vote. Oklahoma also introduced medical marijuana legislation in 2013. No leg-islation has been introduced to allow medical marijuana in Arkansas, Texas, or Virginia in the last two years. How-ever, it should be noted that Arkansas only has a short budget session in 2014, and Texas will not reconvene for their next biennial legislative session until 2015. In ad-dition to medical marijuana legislation, some states also have seen legislation that would allow for the recreation-al use of marijuana.

Despite the prevalence of marijuana-related legislation being filed across the Southern states, only a few bills are expected to make their way through the legislative process to achieve enactment. However, as the topic moves further from theoretical and closer to reality, there are some com-mon trends emerging in legislation across the SLC region. This Regional Resource reviews the similarities among these 12 legislative proposals and two ballot proposals.* The anal-ysis was conducted on the February 28, 2014, version of the proposals in SLC member states listed on Table 1.* One Arkansas ballot proposal and the Florida ballot proposal have been included in the comparisons. The Missouri proposals were not included in the analysis because they propose constitutional amend-ments to legalize marijuana for recreational uses.

2 A SPECIAL CONDITION: MEDICAL MARIJUANA IN SLC STATES

Nationally, 10 of the 21 states that already have legalized medical marijuana in some form have done so through tra-ditional legislative means. In 2000, Hawaii became the first state to enact legislation legalizing marijuana for medical use. Between Hawaii in 2000, and most recently Illinois and New Hampshire in 2013, Connecticut, Delaware, New Jer-sey, New Mexico, Rhode Island, and Vermont have enacted similar legislation. In 2013, Maryland enacted legislation that legalized marijuana only for medical research by aca-demic medical centers; however, no regulations have been established to implement the program.

Public Vote Some states offer another means of deciding whether mari-juana will be allowed – public vote. Ballot language has been approved in Arkansas, Florida, and Missouri that will appear on the respective 2014 ballot if petitioners can collect the req-uisite number of signatures before the deadline in each state.

Despite voters rejecting a proposal to legalize medical mar-ijuana in 2012, the Arkansas attorney general has approved two statutory proposals for the ballot in 2014. The largest distinction between The Arkansas Medical Cannabis Act and The Arkansas Medical Marijuana Act is that the lat-ter would not allow for home cultivation. Petitioners have until July 2014 to collect signatures.

In Florida, the required number of signatures has been obtained to put the constitutional question of medical mar-

ijuana legalization before voters in 2014. Although the language was challenged for being too vague and mislead-ing, it was narrowly approved by the Florida Supreme Court in January of this year.

In Missouri, the secretary of state has approved 13 separate petitions for amending the state’s constitution to allow for the use of marijuana. Petitioners have until May to col-lect the requisite number of signatures to have the petitions placed on the 2014 ballot. The petitions propose a range of amendments from allowing the recreational use of mari-juana for anyone 21 years of age or older, to allowing for the medical use of marijuana, to allowing the state to tax and regulate marijuana. Some petitions also call for chang-ing the criminal provisions for marijuana-related offenses and the expunction of these offenses from existing crimi-nal records. Legislation has also been filed in 2014 to enact statutory provisions similar to those in the constitutional ballot proposals.

More than half of the states that currently allow for the medical use of marijuana have legalized it through pub-lic vote. California became the first state in the nation to approve a ballot measure to allow medical marijuana in 1996. Between 1996 in California and most recently Ar-izona in 2010, Alaska, Colorado, Maine, Massachusetts, Michigan, Montana, Nevada, Oregon, and Washington approved medical marijuana ballot measures. The Dis-trict of Colombia approved a ballot measure in 1998, but it

Table 1 Analyzed Medical Marijuana ProposalsAlabama SB 174 (2014) – Carly’s Law

Arkansas Statutory (2014) - The Arkansas Medical Cannabis Act

Florida

Constitutional (2014) - 2014 Ballot Amendment 2HB 859 (2014) – Cathy Jordan Medical Cannabis Act

Georgia HB 885 (2014) – Haleigh’s Hope Act

Kentucky SB 43 (2014) – Cannabis Compassion Act

Louisiana SB 541 (2014) – Louisiana Therapeutic Use of Marijuana Act

Mississippi SB 2763 (2014) – No title Missouri HB 1324 (2014) – Compassionate Use of Medical Cannabis Pilot Program Act

North Carolina HB 84 (2013) – North Carolina Medical Cannabis Act

Oklahoma SB 710 (2013) – Compassionate Use Act of 2013

South Carolina SB 1035 (2014) – South Carolina Medical Cannabis Therapeutic Treatment Research Act

Tennessee HB 1385 (2014) – Koozer-Kuhn Medical Cannabis Act

Texas NoneVirginia NoneWest Virginia HB 4264 (2014) – The Compassionate Use Act for Medical Cannabis

Note: This is not an exhaustive list of medical marijuana proposals in each state.

A SPECIAL CONDITION: MEDICAL MARIJUANA IN SLC STATES 3

was not implemented until District Council members ap-proved legislation in 2010, which the U.S. Congress then allowed to become law.

Drugs Approved for Medical UseProposals in SLC member states vary on the form of marijuana being approved for medical use. Most of the proposals would allow all forms of cannabis or marijuana, while three proposals only would allow limited cannabis derivatives or extracts.

» The Alabama proposal is limited to nonpsychoactive can-nabidiol (CBD) with a tetrahydrocannabinol (THC) level of no more than 3 percent.†

» The Georgia and South Carolina proposals are limited to “medical cannabis,” which is cannabis extracts and com-pounds of cannabis, including, but not limited to, CBD a nonpsychoactive cannabinoid, that is delivered to pa-tients in a nonsmoking delivery system.

Required Medical ConditionAll of the proposals require an individual to have an exist-ing medical condition before being considered as a potential patient who qualifies for the use of medical marijuana as a † THC is the chemical in marijuana that is responsible for most of its psychological effects. Comparatively, some of the most po-tent products derived from cannabis can have THC levels as high as 30 percent.

form of treatment. In order to receive a registry identifica-tion card, most of the proposals would require a patient to have some type of written certification recommending the use of marijuana for medical purposes from a doctor in their state with whom they have a “bona fide” physician-patient relationship. However, the proposals vary widely on what classifies as a “qualifying” or “debilitating” medical condition. South Carolina provides the narrowest qualification by only allowing patients who suffer from seizures to participate in the research-only program. Similarly, Georgia only would allow patients who suffer from severe side effects of cancer treatment, nonresponsive glaucoma, or seizure disorders to participate in its research-only program.

The most common conditions found among the medical condition proposals are seizures, cancer, glaucoma, HIV/AIDS, and Crohn’s Disease. Table 2 provides a more com-prehensive list of some of the more common and unique conditions included in the proposals as a qualifying or debilitating medical condition; however, it is not an ex-haustive list of the proposed conditions:

The proposals in Florida (ballot and legislation), Alabama, North Carolina, Oklahoma, and Tennessee would allow doctors some discretion in recommending the use of med-ical marijuana for additional qualifying conditions not listed in law. Likewise, the proposals in Arkansas, Ken-tucky, Mississippi, Missouri, and West Virginia would

Figure 1 Legalization of Marijuana by State and Method

Legislation

Public Vote

Illegal

4 A SPECIAL CONDITION: MEDICAL MARIJUANA IN SLC STATES

Table 2Most Common and Unique Qualifying Medical Conditions Proposed for Medical Marijuana Treatment

Ala

ba

ma

SB

17

4

Ar

ka

nsa

s

Ba

llo

t

Flo

rid

a

Ba

llo

t

Flo

rid

a

HB

8

59

Ge

ro

gia

HB

8

85

Ke

ntu

ck

y

SB

4

3

Lo

uisia

na

SB

5

41

Mississip

pi

SB

2

76

3

Misso

ur

i

HB

13

24

No

rth

C

ar

olin

a

HB

8

4

Ok

la

ho

ma

SB

7

10

So

uth

C

ao

rlin

a

SB

10

35

Te

nn

esse

e

HB

13

85

We

st V

ir

gin

ia

HB

4

26

4

Alzheimer’s • • • • • • •

Amyotrophic Lateral Sclerosis • • • • • • • • •

Anorexia • • • •

Autism •

Cachexia or Wasting Syndrome • • • • • • • • • •

Cancer • • • • • • • • • • •

Celiac Disease •

Chronic Pain • • • • • • • • • •

Crohn’s Disease • • • • • • • • • •

Depression or Anxiety • •

Diabetes • •

Fibromyalgia • • • • • •

Glaucoma • • • • • • • • • • •

Hepatitis C • • • • • • • •

HIV/AIDS • • • • • • • • • •

Hypertension •

Incontinence •

Lupus •

Multiple Sclerosis • • • • • • • • •

Muscle Spasms • • • • • • •

Narcolepsy •

Opiate Addiction •

Organ Transplantation • •

Osteoporosis •

Post-Traumatic Stress Disorder • • • • •

Rheumatoid Arthritis • • •

Seizures, including Epilepsy • • • • • • • • • • • •

Severe Migraines • •

Severe Nausea • • • • • • • • • •

Sleep Apnea •

A SPECIAL CONDITION: MEDICAL MARIJUANA IN SLC STATES 5

allow the regulating department to add additional quali-fying conditions after public petition and comment. The Louisiana proposal would allow the Therapeutic Mari-juana Utilization Review Board, a new entity created by the proposal within the state’s Department of Health and Hospitals, to review and recommend additional qualifying medical conditions.

Research Beyond staying apprised of research on the medical uses of marijuana, seven states specifically have included research provisions in their legislation.

» Georgia and South Carolina only would allow for the medical use of cannabis by patients enrolled in a research program conducted by academic medical centers and ap-proved pediatric neurologists.

» North Carolina would direct the University of North Carolina System to undertake research regarding the efficacy and safety of administering cannabis as part of medical treatment.

» Kentucky and West Virginia would allow registered safety compliance centers to conduct research related to medi-cal marijuana, but patients are not required to participate. However, the application for qualifying patients shall ask whether the patient would like to be notified of any clini-cal studies conducted in the Unites States needing human subjects for research on the medical use of marijuana.

» Florida legislation would direct the Department of Busi-ness and Professional Regulation (DBPR) to specify persons who will be exempt from possession laws for the purposes of teaching, research, or testing, but it does not set any specifications for the research to be conducted.

» Oklahoma would direct the State Board of Health to promulgate rules to authorize and license medical can-nabis laboratories to analyze dried, extracted, cured, food-based, or any other forms of cannabis. Testing would be voluntary and may include the analysis of con-taminants and chemical composition and other methods of investigation intended to advance the understanding of the therapeutic benefits of cannabis.

Cultivation Language in six of the proposed laws would allow a qualifying patient or his or her designated caregiver to cultivate cannabis.

» Arkansas would require the patient or caregiver to ob-tain a Hardship Cultivation Certificate, but only if it is determined that the patient lacks access to a nonprof-it dispensary. The certificate only would be issued if the patient, based on physical incapacity, lacks reasonable

transportation to a dispensary, a caregiver with access to reasonable transportation, or a dispensary that will deliv-er to the patient’s residence.

» Oklahoma would require a patient or caregiver to ei-ther obtain a patient grower’s license, which is separate from the identification card, or require membership in a licensed collective, which may have no more than 75 members.

» The legislation in Florida, Kentucky, Mississippi, and West Virginia explicitly would allow patients or care-givers to cultivate their own cannabis.

Ten of the proposals would require an entity to register or be licensed for the purpose of growing medical canna-bis; however, only the legislation in West Virginia and the ballot proposals in Arkansas and Florida would allow the cultivator to sell directly to the patient or caregiver. The other proposals that would require a license for cultivation include the legislation in Florida, Kentucky, Louisiana, Missouri, North Carolina, Oklahoma, Tennessee, and West Virginia. In most cases, being registered or licensed as a cultivation center only allows for selling, processing, or delivering the cultivated cannabis to a separate licensed entity for dispensing.

One of the more unique cultivator-related provisions is in the Florida legislation, which would allow medical canna-bis farms permitted by the DBPR to cultivate, manufacture, sell, deliver, and possess with the intent to sell, cannabis, cannabis-based products, and cannabis plants for wholesale to a licensed dispensary. Before applying for the permit, all of the necessary agricultural classifications must be ob-tained to indicate that the land on which the farm is located is primarily for bona fide agricultural purposes.

Some states, like North Carolina and Oklahoma, would require a separate license to produce marijuana-related products or paraphernalia.

Dispensing Most of the proposals would require a separate license or registration for dispensaries, which serve as the interme-diary between the cultivator and qualifying patient. Some proposals require a chain of three or four licensed entities before the product would reach the patient.

» In Louisiana, a license to dispense therapeutic marijua-na only would be issued to pharmacists who are either employed by or the owner of a therapeutic marijua-na treatment center. A license to operate a therapeutic marijuana treatment facility only will be granted to phar-

6 A SPECIAL CONDITION: MEDICAL MARIJUANA IN SLC STATES

macies that employ a pharmacist who holds a therapeutic marijuana dispensing license.

» In Oklahoma, medical cannabis dispensing centers would have to be licensed to dispense cannabis and cannabis products through a storefront for medical use to mem-ber patients and caregivers. A separate license is required for a medical cannabis delivery service for cannabis and cannabis products to patients, designated caregivers, cannabis laboratories, manufacturers, cultivators, and dispensing centers.

» In Tennessee, a licensed producer would be able to possess, cultivate, harvest, and deliver cannabis or related prod-ucts to a licensed processor. A licensed processor would be able to possess, process, package, and deliver canna-bis and related products to participating pharmacies and regulated dispensaries, which then would distribute the cannabis or products to program participants.

The proposals in Georgia and South Carolina only would allow the academic medical centers conducting the re-search to act as dispensaries. The Alabama legislation is silent regarding the source of the drug.

Limitations on Amount in Possession Nine of the proposals would limit the amount of medical cannabis a patient or caregiver could possess at one time. The caregiver possession limitations generally are collec-tive or in lieu of patient possession. Table 3 provides the patient and caregiver possession limits for each proposal.

Caregivers and Assistance LimitsWith one exception, all of the proposals would extend the protections provided to a qualifying patient to his or her designated caregiver. Like patients, caregivers also would be required to have a registry identification card provid-ed by the regulating agency. Seven of the proposals limit the number of patients a caregiver may assist at one time. The numbers range from one patient in Missouri, two pa-tients in North Carolina, three patients under the Florida legislation, and five patients in Arkansas, Kentucky, and West Virginia. The largest number of patients allowed is in Oklahoma, in which a single caregiver could assist up to 25 qualifying patients simultaneously; however, the limit is reduced to 10 patients if operating within 1,000 feet of a

Patient Possession Limit Caregiver Possession Limit

Usable Cannabis Plants Usable Cannabis Plants

Arkansas 2.5 ounces

6 marijuana plants - only 3 may be more than 12 inches in height or diameter

2.5 ounces, per patient6 marijuana plants per patient, not to exceed 30 plants total

Florida

Legislation

250 grams 8 mature plants and 8 immature plants

250 grams, per patient8 mature plants and 8 immature plants, per patient

Kentucky

12 ounces at the site where cultivated or 3 ounces elsewhere

12 mature plants and 12 seedlings at the site where cultivated

12 ounces at site where cultivated or 3 ounces elsewhere, per patient

12 mature plants and 12 seedlings at the site where cultivated, per patient

Mississippi 30 grams per mature plant3 mature plants and 4 immature plants

30 grams per mature plant collectively with patient

3 mature plants and 4 immature plants collectively with patient

Missouri

2.5 ounces during a 14-day period

None 2.5 ounces None

North Carolina

Varies by recommended delivery method

Varies by recommended delivery method

Oklahoma 8 ounces 12 plants 8 ounces, per patient 12 plants, per patient

Tennessee 1 month supply None 1 month supply None

West Virginia 6 ounces12 mature plants and 12 seedlings, if no caregiver designated for cultivation

6 ounces, per patient12 mature plants and 12 seedlings, per patient

Table 3 Maximum Possession Amounts

A SPECIAL CONDITION: MEDICAL MARIJUANA IN SLC STATES 7

jail, correctional facility, public or private primary school, church, or daycare facility. Louisiana has the only propos-al that does not mention patient caregivers.

Other Notable Provisions Some of the proposals include a breakdown of how the funds collected from the sale of medical cannabis should be distributed.

» Under the Arkansas proposal, any sales tax reve-nue remaining after covering the state Department of Health’s cost of administering the program would be distributed as follows: 50 percent for the Newborn Umbilical Cord Blood Initiative Fund and 50 percent for drug education programs administered by the De-partment of Human Services.

» Under the Oklahoma proposal, sales tax would be re-mitted to the state’s general fund and license fees would be distributed as follows: 30 percent for the department where operational expenses were incurred; 30 percent for general state, county, and city tax funds; 20 percent for drug rehabilitation and prevention programs spon-sored or organized by the Oklahoma Department of Mental Health and Substance Abuse; 10 percent for the Oklahoma Department of Agriculture, Food, and Forest-ry; and 10 percent for law enforcement entities.

References1) “Medical marijuana gains traction in the Deep South,” The Atlanta Journal-Constitution, February 9, 2014.

http://www.ajc.com/ap/ap/legislative/medical-marijuana-gains-traction-in-the-deep-south/ndJGG/.

2) “Medical marijuana still beyond reach in Maryland,” The Baltimore Sun, January 28, 2014. http://articles.baltimoresun.com/2014-01-28/health/bs-md-medical-marijuana-20140118_1_medical-marijuana-morhaim-biker-bar.

3) “Majority Now Supports Legalizing Marijuana,” Pew Research Center, April 4, 2013. http://www.people-press.org/2013/04/04/majority-now-supports-legalizing-marijuana/.

4) Ibid.

» Under the Louisiana proposal, a physician would be re-quired to have a separate license to prescribe therapeutic marijuana. However, only certified neurologists, oncolo-gists, and ophthalmologists would be eligible for the license.

» Tennessee has one of only two proposals that would in-clude existing pharmacies in any context (Louisiana has the other). Under the proposed Tennessee Safe Access pro-gram, patients and caregivers would have to enroll in a Safe Access program at a participating pharmacy or regulated dispensary to receive their identification card in order to obtain cannabis for medical use from these sources.

ConclusionWhile the legalization or decriminalization of marijuana use for medicinal or recreational purposes has been on the legislative agenda in many states outside the SLC region for a number of years, it is only within the past few years that Southern state legislatures have begun to grapple with the complexities of this issue.

For a number of Southern states, crafting legislation that addresses the use of medical marijuana has been the focal point in this mostly uncharted area. To that end, as the possibility of legalizing medical marijuana becomes more plausible, there are many issues policymakers will need to address, including, but not limited to: determining which department will regulate its cultivation, distribution, and use; issuing licenses to cultivators and distributors; regis-tering qualifying patients; determining whether a patient must designate caregivers; establishing a tax structure to determine which products will be taxed and at what rate they will be taxed; determining the cost of medical mari-juana and its related products; setting limitations on where medical marijuana can be consumed (i.e. work or school); and determining whether insurance will cover the cost of medical marijuana.

Although it is not an exhaustive analysis of medical mari-juana-related proposals in the SLC states, as of February 28, 2014, this SLC Regional Resource demonstrates that the idea of legalization is spreading in the Southern region.

Table 4Maximum Number of Patients Assisted by a Caregiver

State

Maximum Number of

Patients

Arkansas 5

Florida 3

Kentucky 5

Missouri 1

North Carolina 2

Oklahoma 10 or 25

West Virginia 5

THE SOUTHERN OFFICE OF THE COUNCIL OF STATE GOVERNMENTSPO Box 98129 | Atlanta, Georgia 30359

ph: 404/633-1866 | fx: 404/633-4896 | www.slcatlanta.orgSERVING THE SOUTH

THE SOUTHERN OFFICE OF THE COUNCIL OF STATE GOVERNMENTS

REGIONAL VIEW NATIONAL REACH

This report was prepared by Policy Analyst

Lauren Greer for the Human Services & Public Safety Committee of the Southern Legislative Conference (SLC) of The Council of State Gov-

ernments (CSG), under the chairmanship of state Senator

Emmett W. Hanger, Jr. of Virginia

The mission of The Council of State Governments’ Southern Legislative Conference is to foster and en-courage intergovernmental cooperation among its 15-member states. In large measure, this is achieved through the ongoing work of the Conference’s six standing committees and supporting groups. Through member outreach in state capitols, policy research, member delegations to points of interest, meetings and fly-ins, staff support state policymakers in their work to build a stronger region.

Founded in 1947, the Southern Legislative Conference is a member-driven organization and the largest of four region-al legislative groups operating under The Council of State Governments and comprises the states of Alabama, Ar-

kansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, Missouri, North Carolina, Oklahoma, South Carolina, Ten-nessee, Texas, Virginia and West Virginia.

The SLC’s six standing committees provide a forum which allows policymakers to share knowledge in their area of ex-pertise with colleagues from across the  South. By working together within the SLC and participating on its commit-tees, Southern state legislative leaders are able to speak in a distinctive, unified voice while addressing issues that affect their states and the entire region.

The Southern Office was opened in Atlanta in 1959. Ini-tially charged with serving all three branches of state government, the duties of the Office have evolved to pro-viding services primarily to the more than 2,400 legislative members and staff of its 15-state region. SLC members are appointed by the leadership of the 30 legislative chambers in the South. The SLC Annual Meeting has grown to be-come the largest regional gathering of state legislators in the country and attracts the largest audience of any of the CSG regional conferences.