CS FOR SPONSOR SUBSTITUTE FOR SENATE BILL NO. 94(FIN) am "An Act relating to the medical use of marijuana; and providing for an effective date." MIKE PAULEY, STAFF, SENATOR LEMAN testified in support of SB 94 on behalf of the sponsor. Senate Bil1 94 proposes several amendments to the Medical Marijuana Act that took effect this year on March 4. The changes address some serious law enforcement and public health concerns with this new statute, and also some practical concerns about how state agencies are going to implement what the voters have asked them to implement. In crafting this legislation, we have worked closely with the Department of Law, the Department of Public Safety, and the Department of Health and Social Services. I am pleased to report that these three agencies are in support of the legislation before you. SB 94 is also supported by the Alaska State Advisory Board on Alcoholism & Drug Abuse, the Anchorage Police Department, and the Alaska Association of Chiefs of Police. There are three major changes in the bill. The first area is registration. The marijuana initiative approved last fall by voters establishes a state registry of patients who are entitled to use marijuana for medicinal purposes. However, there is no requirement that a patient register - the initiative still provides legal protection for the use of medical marijuana even if the person is not registered with the state. This creates a problem for law enforcement. Because pharmacies are prohibited by federal law from dispensing marijuana, the drug must be obtained through other channels, and it all looks the same through the eyes of a police officer. To ensure that all patients who need marijuana are protected from needless arrest or unwarranted hassle, SB 94 requires patients and their caregivers to register, and to carry a registry ID card. We modeled this after our successful permit system for those who qualify to carry concealed handguns. This system will help police distinguish between legitimate and illegitimate users of marijuana. The second change deals with possession limits. The marijuana initiative established a presumptively legal possession limit of one ounce in usable form, and six plants. But the initiative also includes a paragraph that allows patients and their caregivers to possess an unlimited amount of marijuana, as long as it can be medically justified. The problem is, there is no definition of what is medically justified. The Department of Law and the Department of Public Safety have urged the Legislature to remove; any ambiguity in this area and set the limit at the same amount identified in the initiative, which is one ounce and six plants. SB 94 implements this change. The third area concerns the role of the primary caregivers for patients who are using medical marijuana. SB 94 establishes some wise precautions to limit abuse. Each patient can have only one primary caregiver, and each primary caregiver can care for only one patient, with very limited exceptions. By creating a "one to one", relationship between the patient and caregiver, we will avoid scenarios such as what cropped up in California, where marijuana clubs sprouted up claiming to be the primary caregivers for 500 or 1000 patients. SB 94 also states that no person who has committed a felony violation of drug laws can be a primary caregiver, and no person who is on probation or parole can be a primary caregiver. Vice-Chair Bunde observed that possession and use of marijuana is still against federal law. Mr. Pauley stated that there is nothing that the state can do to provide protection from federal prosecution. An United States Drug Enforcement Agency administrator stated in response to an inquiry by the Unites States Senate Judiciary Committee regarding initiatives legalizing marijuana passed in Arizona and California that: "The California and Arizona initiatives do nothing to change federal drug enforcement policy. The DEA will continue to target major drug traffickers, including major marijuana growers and distributors. We also can take both administrative and criminal actions against doctors who violate the terms of DEA drug registrations that authorizes them to prescribe controlled substances. Doctors are registered with the DEA to prescribe only Schedule II-IV substances. Technically, those doctors who prescribe or recommend Schedule I substances are violating federal law. Then licenses of over 900 physicians have either been surrendered or revoked in the last two years for fraudulent prescribing practices." Vice-Chair Bunde questioned if $5 thousand dollars in general fund program receipts is the charge for the identification card. Mr. Pauley explained that the fee would be $25 dollars. Vice-Chair Bunde suggested that the recipients should pay for the cost of the program. Representative J. Davies questioned if all 900 cases of fraudulent prescribing practices were related to marijuana. Mr. Pauley clarified that the figure includes all fraudulent prescription charges, not all were related to marijuana. Representative Foster asked how persons living in rural areas would register. Mr. Pauley explained that how a patient legally obtains the substance was not addressed in the initiative or the legislation. The patient would first need to obtain a doctor's recommendation that they have a debilitating medical condition that could be alleviated through the use of medical marijuana. The doctor's recommendation would go with an application to the Department of Health and Social Services. If the application is approved the patient would receive a card. The card would protect the patient from state prosecution. The legislation addresses the card on page 5, line 17. Co-Chair Therriault referred to page 5, line 24. He stated that "card" would be added as a technical correction. In response to a question by Representative Grussendorf, Mr. Pauley explained that the medical patient or their primary care giver would be expected to grow their own marijuana. Vice-Chair Bunde observed that an illegal act must be committed before the legal use of marijuana occurs. Mr. Pauley noted that there have not been federal prosecutions of patients in the states that have passed medical marijuana initiatives. Vice-Chair Bunde expressed further concern that the fee was not sufficient to support the program. ELMER LINDSTROM, SPECIAL ASSISTANT, DEPARTMENT OF HEALTH AND SOCIAL SERVICES testified in support of SB 94. He explained that page 7; line 26 allows the department to adjust the fee. The Bureau of Vital Statistic will administer the program. The fee was based on comparisons to other services by the bureau. Co-Chair Therriault questioned if the language would allow the department to charge for other services. Mr. Pauley clarified that the legislation only refers to AS 17.37, relating to medical marijuana. JERRY LUCKHAUPT, LEGISLATIVE LEGAL COUNSEL, LEGISLATIVE AFFAIRS AGENCY observed that the department could theoretically extend the program to include other public health areas. The legislation allows a fee to be administered. The language was placed in statute by the initiative. In response to a question by Representative Foster, Mr. Pauley noted that the initiative stated that individuals suffering from cancer, glaucoma, positive HIV, and AIDS would qualify for medical marijuana use. He added that the use of marijuana has been discredited by a recent Institute of Medicine Report of the Office of National Drug Control Policy. The Alaska State Board of Examiners and Optometry adopted a statement in December 1998 opposing the use of marijuana as a treatment for glaucoma on the grounds that it is not as effective as other treatment. Representative Foster noted that rural Alaskans might have difficulty with the quantity allowable under the legislation. Mr. Pauley pointed out that one-ounce lasting ten days is based on a very high rate scenario. He added that the terminally ill person would also be allowed 6 plants. He did not imagine that terminally ill persons would be working in fish camps. Representative Foster questioned if marijuana could not be shipped by mail. Mr. Pauley did not think that it would be legal to ship marijuana. Co-Chair Therriault explained that the initiative is non- specific. Mr. Luckhaupt pointed out that possession of marijuana is still a crime under federal law. It cannot be transported. Co-Chair Therriault observed that the initiative could not affect federal law. Mr. Lindstrom noted that law enforcement agencies identified difficulties with the initiative. He observed that the intent is to meet the law enforcement concerns without interfering with the underlying patient doctor relationship or making the administration cumbersome. The Administration supports the bill. He assured Representative Foster that the Administration is committed to making the program work in rural Alaska. Mr. Lindstrom discussed the fiscal note. He explained that the legislation changes the program from permissive registration to mandated registration. Registration would be run thorough the Bureau of Vital Statistics for a reasonable amount of money. The additional funds would allow the Department to provide law enforcement agencies with a nightly updated registration. There is a $25 dollar initial registration fee annual fee of $15 or $20 dollars. Co-Chair Therriault questioned if a full time position is needed to take care of 200 permits. Mr. Lindstrom stressed that it is a new program. Staff will have to verify registration information. In response to a question by Representative Foster, Mr. Lindstrom stated that confidentiality laws would prohibit state employees from sharing the information with federal law enforcement agents. Mr. Pauley added that page 2, line 25 addresses confidentiality. The information can only be shared with state or local law enforcement agencies in order to verify registration. Mr. Luckhaupt noted that state statutes protect the caregiver. The state receives some immunity through the tenth amendment. He noted that the federal government started a federal marijuana program in the 1970's. He acknowledged that a state employee could be required to give up the information if subpoenaed by the federal government. Representative J. Davies pointed out that the legislation does not create a new program. It only modifies a program created by the initiative. Mr. Pauley responded that there is no money in the budget to implement any registration without the legislation. Co-Chair Therriault MOVED to ADOPT Amendment replace "and" with "card" on 1 page 5, line 24. There being NO OBJECTION, it was so ordered. Representative J. Davies MOVED to ADOPT Amendment 2 (copy on file). Amendment 2 would change "one-year" to 16-month". Co- Chair Mulder OBJECTED for the purpose of discussion. (Tape Change, HFC 99 - 142, Side 2) SENATOR LOREN LEMAN, SPONSOR stated that he would not oppose the amendment in the spirit of compromise. He did not think that the 12-month requirement was unreasonable. Co-Chair Mulder WITHDREW his objection. There being NO OBJECTION, Amendment 2 was adopted. Co-Chair Therriault clarified that the original request by the Department of Health and Social Services in the operating budget was higher. Senator Leman pointed out that it is still illegal to posses or use marijuana under federal law. Protection is only granted under the state law. Co-Chair Mulder ADOPT HCS CS SB 94 (FIN) HCS SSSB 94(FIN) was REPORTED out of Committee with a "do pass" recommendation and with a published fiscal impact note by the Department of Health and Social Services dated 5/4/99.