HB 213 - MEDICAL USE OF MARIJUANA CO-CHAIRMAN DYSON announced the next order of business as House Bill No. 213, "An Act relating to the medical use of marijuana; and providing for an effective date." Number 0060 DUANE UDLAND, Chief of Police, Anchorage Police Department, testified via teleconference from Anchorage. The statewide chiefs of police met, and they support the intent of the public and their efforts to have medical marijuana. The chiefs of police are concerned with the definition of the amount of marijuana that individuals can have, and they support mandatory registration of patients and caregivers so law enforcement knows who is authorized to possess and use medical marijuana or to provide it for patients. Without that registration, the police are in a difficult position. The police officers don't want to be in a position where they have to decide whether or not someone is telling the truth about medical marijuana. MR. UDLAND indicated that the police don't need to know the medical reasons and don't care about the privacy issues; all they want to know is if they have the right person. Not having registration places law enforcement in the position of making some embarrassing arrests that will be reversed later, or possibly letting people go who simply lie. They want to avoid the problems that California has faced. There are some good amendments proposed by the Department of Law, and he hopes the committee takes a look at them. CO-CHAIRMAN DYSON asked Mr. Udland if one ounce of marijuana was a reasonable amount. MR. UDLAND agreed it was a reasonable amount. Today marijuana plants grow to be huge shrubs, and they can yield a lot of marijuana. The definition they have before them will take care of their concern. Number 0358 CO-CHAIRMAN DYSON asked Mr. Udland what is the magnitude of the marijuana busts these days. MR. UDLAND answered they have joined with other law enforcement agencies and done some marijuana grow operations in the Matanuska-Susitna Valley area and Anchorage, which are notoriously large operations. They could do a lot more on marijuana than they actually focus on; it is a matter of resources. CO-CHAIRMAN DYSON asked Mr. Udland for his sense of the marijuana problem. Number 0439 MR. UDLAND commented that if they compare marijuana to alcohol, they will find that people smoking marijuana tend to be more docile. Research shows that non-medical marijuana is a gateway drug, and it does have intoxicating effects. Often marijuana is mixed with alcohol and other drugs. He would not agree with anyone who says it is harmless. CO-CHAIRMAN DYSON asked Mr. Udland if he finds many people in his jurisdiction who get victimized when they are under the influence of marijuana. MR. UDLAND said it would be hard to put a name on it, but anytime people are under the influence of any drug, including alcohol, they are in harm's way. Number 0562 DEAN GUANELI, Chief Assistant Attorney General, Legal Services Section - Juneau, Criminal Division, Department of Law, testified via teleconference from Anchorage saying he hasn't heard any previous testimony but offered to address any areas and answer questions that the committee would like. CO-CHAIRMAN DYSON asked Mr. Guaneli to address what the legislature needs to do to make the initiative work. Number 0646 MR. GUANELI answered that the position of the administration is that the voters have spoken and indicated a desire to provide access to marijuana for medical purposes for certain individuals. The administration has heard that and wants to make this program work. However, they don't believe it will work because there are ambiguities, loopholes and problems with the initiative as enacted. It is subject to abuses and if they occur, there could be a groundswell against the program and result in its repeal. The administration has proposed a number of changes to the initiative that will make the program work. Registration of patients must be mandatory. Unless registration is mandatory, it creates a situation where people will be using marijuana for medical purposes but not registering, and that will be difficult for law enforcement to make decisions about whether or not to arrest someone. MR. GUANELI pointed out that there needs to be a definite limit on the amount of marijuana that can be possessed. The initiative has a limit, but there is a loophole that if people can show they need more, they could possess unlimited amounts, and that could cause problems for the police. A limitation to what was specifically allowed in the initiative is what is needed. One ounce of marijuana will last someone a fair amount of time, but the real flexibility is in the six plants. The average mature marijuana plant that the state troopers confiscated in marijuana growing operations last year amounted to about four ounces of useable marijuana per plant. Number 0937 MR. GUANELI explained that if the other three plants yielded an ounce each, and the three plants yielded four ounces each, then that adds up to 15 ounces, plus the one ounce of useable marijuana, equals one pound of marijuana. It is unreasonable to think that people would need to possess more. MR. GUANELI said there are other aspects of the law that are less obvious. Marijuana is a Schedule VI-A, controlled substance under Alaska law, but the initiative changed that so marijuana for medical use is taken out of the schedule altogether. It is not a controlled substance now, so that means that all the offenses under Alaska law with controlled substances don't apply when dealing with medical marijuana. For example, possession of a firearm while under the influence of a controlled substance is against the law. However, if marijuana for medical purposes is not a controlled substance, then that means someone can be stoned on marijuana for medical purposes and possess a firearm, and nothing could be done in Alaska criminal law in that situation. The only penalty provided for that in the initiative is if someone uses marijuana in a way that endangers others, then their registration can be taken away for one year. That amounts to very little because they don't have to be registered to use marijuana. The person could continue to use marijuana; they just wouldn't have a registry identification card. Some of those subtle provisions in the bill need to be changed. MR. GUANELI noted another provision that sounds good, but really amounts to very little, is the prohibition under the initiative that says people with registry identification cards can't use marijuana in public. Because they don't have to be registered to use marijuana for medical purposes, and because the prohibition in using it in public only applies to those who are registered, that means that people who are not registered can use it in public for medical purposes. Patients who are registered can't use marijuana in public, but people who are not registered can use it in public. Under the law, these two groups are being treated significantly different, and there is a question whether this is constitutional under the equal protection doctrine. That provision in the initiative, therefore, is probably unconstitutional. That means, in his view, marijuana for medical purposes can be used openly. MR. GUANELI said there is another provision that says registered patients can sell or distribute marijuana to another person as long as they don't know that that person is not entitled to use it. In California, marijuana clubs have sprung up to buy and sell marijuana and raked in about $1 million per month. In Alaska there is a specific provision that would allow registered patients to sell to other people as long as that patient doesn't know for certain that the person is not entitled to use marijuana. This demonstrates how the drafters of the initiative didn't realize some of the things that the initiative would do as drafted. Both HB 213 and SB 94 correct all of the problems he identified, as well as others that he hasn't talked about. Number 1293 CO-CHAIRMAN DYSON asked Mr. Guaneli if he said someone can sell to people unless he knows they are disqualified as a medical user. MR. GUANELI answered a registered patient is prohibited from selling or distributing to any person who the patient knows is not registered or is not entitled to be registered. He can sell as long as he does not know that the person is not entitled to use. CO-CHAIRMAN DYSON asked if there is anything in the initiative that requires the seller to verify that he is a qualified buyer. MR. GUANELI answered no there is not. The marijuana clubs that sprung up bought and sold marijuana in a variety of amounts, but they usually sold marijuana in the amount of one-eighth ounce and from that a person could get a few marijuana cigarettes. The one-eighth ounce of marijuana ranged in price from $20 to $120. This demonstrates the danger in allowing some people to profit from others who feel they have a legitimate need for marijuana. Number 1444 CO-CHAIRMAN DYSON asked Mr. Guaneli if his remarks also applied to the caregiver. MR. GUANELI said he believes that the wording in the initiative is limited to the registered patient, so it would not apply to the primary caregiver. The bill before them has a provision that the primary caregiver can distribute to the patient, and the patient can distribute to the primary caregiver, and that is the only distribution that should occur. Number 1497 CO-CHAIRMAN DYSON asked if there is anything in the initiative or HB 213 that limits the profit making on this. MR. GUANELI answered he doesn't believe that there is anything that speaks to that specifically. It is possible that a primary caregiver could charge the patient for the service of providing marijuana. The protection in the current bill is that the primary caregiver can only provide marijuana to one patient at a time. The profit incentive is greatly reduced under HB 213. That will keep the people with a profit motive only out of the business. CO-CHAIRMAN DYSON asked Mr. Guaneli if the misuse of illegal marijuana is significantly impacting the court system. Number 1593 MR. GUANELI answered in terms of small amounts of recreational use of marijuana, the answer is clearly no. Approximately 100 marijuana growing operations are filed in the Matanuska-Susitna valley every year. The state troopers tell him they could probably make one of those cases a day if they put a lot more effort towards it. The troopers have found very sophisticated growing operations in the valley, which include buildings specifically built for growing marijuana and underground cellars that vent the odor of marijuana far away from the building to make it harder to identify the smell with the building location. MR. GUANELI pointed out that people go to great lengths to grow marijuana because of the profit motive. Alaska grows some of the most potent marijuana in the world. The content of THC [tetra-hydro-cannabinol] is 10 to 20 times higher today than 20 years ago. Marijuana is a very powerful hallucinogenic drug and has gotten more expensive. A lot of money can be made on a fairly small growing operation. They have had information from other state law enforcement agencies that marijuana is actually exported from Alaska to other states, and some of the best marijuana is actually traded for cocaine on a pound-for-pound basis. Once that kind of profit motive is involved, there is violence from people who want to take the grower's money. Although marijuana may not cause the same social problems as alcohol, marijuana has its own set of problems. Number 1785 MR. GUANELI mentioned that they can learn from the experience in California where there was no mandatory registration, but many of the counties have found that to make the program work and to solve some of the practical law enforcement problems, the counties enacted ordinances that require the registration in the county. That seems to be working very well. CO-CHAIRMAN DYSON asked Mr. Guaneli if it would solve many of their problems if the federal government changed the list on which medical marijuana is on and allowed doctors to prescribe it. MR. GUANELI agreed that providing a national standard, backed up by national research and specific criteria that the doctors can follow, would be beneficial. This is a national issue. There are agencies on the federal level working on that, but it may not happen soon. Number 2103 DAVID KENDRICK, Lieutenant, Fairbanks Police Department (FPD), testified via teleconference from Fairbanks. He has been with FPD over 22 years and has worked with various drug units in Fairbanks. Law enforcement has some compassion for people in medical need of marijuana to reduce their pain, but they are concerned with the potential for abuse with the amount of marijuana patients can possess. It has been his experience that three plants could grow very large and produce between two and three pounds of marijuana per plant. During an investigation of a marijuana conspiracy in Fairbanks, the officers seized several hundred pounds of marijuana: plants in full maturity ranging from eight to nine feet tall and three to four feet wide and producing up to two or three pounds of marijuana. The average is four or five ounces per plant, but the plants can grow larger than that. MR. KENDRICK told the committee that due to the ability of the growers in Alaska, the THC content of the marijuana plants is now up in the 20 to 30 percent range, which makes for an extremely potent plant. In the investigation in Fairbanks, some people involved stated it was so potent that they would go into convulsions and vomit if they smoked too much of this marijuana. The person growing the marijuana said he doesn't smoke his own marijuana; he purchases marijuana from friends whose marijuana is less potent. He pointed out that six plants could produce a very large quantity of marijuana. Mr. Kendrick concludes that law enforcement in Fairbanks supports this amendment to the medical marijuana act tightening up the language and taking care of any loopholes. Number 2304 DEL SMITH, Deputy Commissioner, Department of Public Safety, came forward to testify saying that the amendments that were added to SB 94 addressed many of the department's concerns which include the mandatory registration, the listing of the primary caregiver and the amount of marijuana a patient can possess. TAPE 99-50, SIDE B Number 2357 MR. SMITH noted that the department supports the right based upon the citizens' vote for people to use medical marijuana. REPRESENTATIVE BRICE asked Mr. Smith how they would limit the quantity of plants. MR. SMITH answered he isn't entirely sure how they might, or if they should, change the six plant amount. Number 2272 CO-CHAIRMAN DYSON asked if it is fair to say that the DPS is comfortable with SB 94 as amended. MR. SMITH said the administration, including the DPS and the DHSS and the Department of Law, are in agreement on the package of amendments adopted into the committee substitute for SB 94, and if HB 213 is the same, they would support that also. Number 2216 DR. ANDY EMBICK testified via teleconference from Valdez saying just since the ballot measure was passed, he has become familiar with the kinds of complaints that patients mention as being helped by marijuana. Of course they didn't mention this before, but now they indicate that they want a letter from him. In general, the complaints mentioned are not life-threatening conditions; they are not immediately fatal; they are not the dramatic sorts of things that were listed in the original bill, but rather chronic problems that one might refer to as relatively non-life-threatening, maybe even minor. However, they aren't minor to the person who is in pain. Most of the patients that a physician is likely to see, who ask for a letter for registration and use of medical marijuana, are likely to be in this category. DR. EMBICK agreed that they should not limit the conditions that patients can receive medical marijuana; use of marijuana as a drug appears to be considerably safer than many drugs which physicians normally prescribe. It is certainly safer than chemotherapy. The narcotics that doctors prescribe on a regular basis seem more dangerous than marijuana, and marijuana is vastly safer than alcohol. In twenty years, he has not seen a patient who said their problem was from marijuana or could he attribute their complaint to marijuana. Whereas in twenty years, alcohol has been the cause in thousands of cases. Because marijuana counts as a relatively minor drug when compared to others, it shouldn't be singled out as one which requires the physician to specify what condition is being treated. Number 2014 CO-CHAIRMAN DYSON asked Dr. Embick to comment on whether smoking marijuana is more dangerous than smoking cigarettes. DR. EMBICK noted that he tells patients that the hazards of marijuana are likely to be seven times as dangerous as cigarettes, but they can only guess at that by looking at the content in the smoke of tars and particulates, rather than using epidemiologic data twenty or thirty years down the line to see the relative frequency of emphysema or lung cancer. They are probably looking at the composition of the smoke and not the final public health effect. The cigarette makers have been doing some research to retain the nicotine content but reduce the tars and particulates so the smoke looks safer, even though it is just as addictive, whereas, the same kind of research probably has not been going on with marijuana cigarettes. There could be room for improvement there. Number 1933 MATTHEW FAGNANI, President, Worksafe, Incorporated, testified via teleconference from Anchorage. Worksafe provides drug and alcohol testing program assistance to 2,500 private businesses and public sector organizations in Alaska. Their objective is to improve workplace safety and reduce their customers exposure to liability from employee legal drug use. He will focus his comments on the concerns of many Alaskan businesses about the potential workplace impact of the marijuana initiative as evidenced by a letter distributed to committee members from several major Alaskan employers. They appreciate the efforts of the House Health, Education and Social Services Standing Committee in tightening the language of ballot measure approved by the voters to prevent manipulation of the law by those who do not suffer from terminal illness. The majority of voters approved the ballot measure out of compassion for the terminally ill. MR. FAGNANI said unfortunately, the numerous loopholes in the initiative language provide ample opportunity for abuses in the law. House Bill 213 has corrected some of these flaws in the legislation, and it provides more oversight by the Department of Health and Social Services and law enforcement agencies and makes physicians, patients and primary caregivers more accountable for their involvement with medical marijuana. Furthermore, HB 213 requires physicians to consider other means of alleviating their patients' conditions, besides marijuana, before recommending use. These changes are significant improvements to the current law, which is also consistent with the recent report by the Institute of Medicine released in March 1999. However, Worksafe, Incorporated supports further revising the definition of debilitating medical conditions in the statute to exclude those who do not suffer from terminal illness. Narrowing even more the scope of individuals who can obtain a recommendation for marijuana is the primary objective of employers. MR. FAGNANI noted that in most cases, a terminally ill person will not be interfacing with the workplace. However, the broad definition of "debilitating medical conditions" in the current law will potentially enable other persons suffering from severe pain, nausea, seizures and other muscle spasms to obtain a recommendation for use. Persons with these conditions may be in the workplace. Even the recent accident by Senator Leman, caused by falling off a ladder, might have qualified him for medical recommendation according to the current definition of who can legally use the drug; it is that broad. Although he commends the changes to the law in HB 213 requiring physicians to evaluate other means of alleviating symptoms of pain, in his view, it would be wise to incorporate the requirements of a three physician review panel to review the decision of a physician who recommends marijuana and ensures that other means of alleviating pain have been explored. MR. FAGNANI indicated that the other disturbing aspect of the current statute is the loophole allowing for patients and primary caregivers to sell or distribute marijuana to each other. It is difficult for law enforcement to confront the sale of a Schedule I drug when it is authorized in statute. Marijuana is a very dangerous drug in general, especially in the workplace. Marijuana impairs coordination and judgement which makes it the major cause of accidents. Use of marijuana, even off the job, has long-term residual effects which are of concern to employers. Even more concern to employers is the position of the Alaska Human Rights Commission, which is the state equivalent of the Americans with Disabilities Act (ADA). They understand that the commission has informally indicated that they will view a medical recommendation for marijuana the same as a prescription for drugs. This means that employers will have to make reasonable accommodation for this condition in the workplace, even though the federal ADA standard does not recognize medical marijuana as a disability. MR. FAGNANI said although the statute does not require accommodation in the workplace, it also does not prohibit workplace accommodation. Use of marijuana as medicine should be severely restricted. The recent Institute of Medicine's study conducted by the drug czar McCaffrey, a report which many committee members are familiar, recognized the medicinal benefits of marijuana, but not in the smoked form. There is valid scientific evidence that does not support the use of marijuana as a medicine in the smoked form. This study supported further research of an alternative delivery system. Marijuana is not a pure substance but is an unstable, very complex mixture of over 400 chemicals, many of which are harmful substances. When smoked, marijuana produces over 2,000 chemicals, many of which cause cancer, and are present in higher concentrations than in tobacco smoke. The Federal Food and Drug Administration has not approved the medicinal use of smoked marijuana because of great risks associated with smoking. Broad use of marijuana as is granted under the existing law is very dangerous, not only to the workplace but to society in general. Number 1684 CO-CHAIRMAN DYSON asked Mr. Fagnani if there are any records of accidents in the workplace due to marijuana use. MR. FAGNANI answered that they have plenty of positive test results that demonstrate that marijuana is used on the job. They do not have any data that says the person was actually intoxicated at the time of an accident or had a positive test. It is the general scientific community's opinion that the affects of marijuana does affect the workplace. Number 1641 DON DAPCEVICH, Governor's Advisory Board on Alcoholism and Drug Abuse, came forward to testify. The advisory board was opposed to the marijuana initiative on the ballot, however, the Alaskans have spoken through the process and have determined that they favor the use of medical marijuana, and therefore, the board must support that. The concern of the board is that they provide medical marijuana where it is appropriate, while at the same time acknowledging that Alaskans have also told them that they want marijuana as an illegal substances through the recriminalization vote, with a substantial majority. There are two sets of directions, somewhat conflicted. It is obvious without HB 213, it will make it difficult for law enforcement to enforce the laws for illegal use of marijuana. Without a mandatory registry, it will be very difficult, and there will be law enforcement officers who will be unwilling to deal with the issue of illegal use at all. He encouraged the committee to pass the bill. SHERRIE MYERS, Beowulf Drug Education, came forward to testify. She is a former federal law enforcement officer with eleven years experience, including extensive work with marijuana and investigating "marijuana grows." Her experience was in California, and she verified that the marijuana does grow very large. She is concerned with the amounts that would be permissible and has a way to solve that issue. If they look at how much useable marijuana an ounce provides, an average marijuana cigarette contains approximately half of a gram of marijuana, and there are 28 grams in one ounce. One ounce of marijuana would yield about 56 marijuana cigarettes. A conservative estimate would be four cigarettes per day, so one ounce would last 14 days. She suggested they figure out what a typical plant would yield and set the limit at that number, which would keep a steady supply of marijuana every fourteen days. She doesn't know where the figure of six plants came from, but it seems like a lot considering the potential yields. MS. MYERS agreed with removing the ambiguity of being able to possess a greater amount. She referred to people's concern about the invasion of privacy with the registration, and she agrees that the registration is critical to the success of this law. She doesn't see the registration program any more invasive than getting a driver's license or hunting license. People need to register in order to have the privilege and protection of the medicinal marijuana law. CO-CHAIRMAN DYSON asked Ms. Myers if she has any current clients who have an interest in the proceedings. MS. MYERS answered not at the moment. CO-CHAIRMAN DYSON asked Ms. Myers why she is taking an interest. Number 1236 MS. MYERS answered that she has been in law enforcement for many years and has seen what marijuana and drugs have done to people she has worked with, and she sees no redeeming qualities in it. MS MYERS said the law needs to be clarified so the officers on the street know what a violation looks like. Number 1131 ELMER LINDSTROM, Special Assistant, Office of the Commissioner, Department of Health and Social Services (DHSS), came forward to testify. The DHSS has worked with law enforcement and recognized for some time that there were legitimate law enforcement issues involved with the passage of the marijuana initiative. The DHSS is supportive of the legislation, with the caveat that there were several amendments offered in the Senate HES committee which he would like to bring before them. MR. LINDSTROM suggested an additional amendment to the ones in the Senate version which would change page 4, line 5 from "explored" to "considered." He also pointed out that there is a fiscal note attached to HB 213 for $87,700, but with the adoption of the committee substitute and the amendment, they will provide a new fiscal note for $57,000. The department has requested an increment in the fiscal year 2000 budget to operate the register, but that was denied by both the House and Senate Finance Committees, so the fiscal note would replace that increment. In order for the DHSS to provide the information to law enforcement, they do need that support. CO-CHAIRMAN DYSON asked if there is a provision in the initiative or the bill that charges the people a fee that would cover the cost of administering the registration. MR. LINDSTROM answered that there is a fee for the initial registration of $25 and a fee of $20 for the annual renewal. CO-CHAIRMAN DYSON asked if those fees would cover the anticipated costs of the program. MR. LINDSTROM answered that it does not and referred him to Mr. Zangri to answer. Number 0919 AL ZANGRI, Chief, Vital Statistics, Division of Public Health, came forward to answer questions saying that the department estimates that those fees will recover approximately $5,000. REPRESENTATIVE BRICE asked Mr. Zangri how they arrived at the fees because they seem low. MR. ZANGRI answered that they are comparable to other fees that the department charges for their services, and the initiative stated that the fees needed to be reasonable. Number 0836 DAVID FINKELSTEIN, Alaskans for Medical Rights, came forward to testify. He noted that this is very complicated legislation, and that the changes in SB 94 addressed concerns from patients, but now the bill is a major rewrite of a citizen-passed initiative. Mr. Finkelstein acknowledged that the legislature has the power to amend initiatives, but he wondered should the legislature amend initiatives. The supporters of the initiative feel that the case should be more compelling than average legislation. There is a higher standard that has to be reached before the legislature makes changes. Number 0688 MR. FINKELSTEIN agreed that the concerns expressed by law enforcement today are reasonable. The supporters don't disagree that there has to be a differentiation made between legal and illegal use of marijuana. The proponents of this law and the patients are the ones that will be the biggest loser if that were to occur. They are concerned with the interest of medical marijuana patients, not others who may try to get in under this banner who are not legitimate patients. MR. FINKELSTEIN stated that the supporters don't think legislation is necessary. Most of the concerns can be dealt with through regulations. The ability of the DHSS to issue regulations in the interest of public health under the statutes is very broad. Other changes that couldn't be made through regulations could be made through the revisor's bill. The Alaskans for Medical Marijuana would be glad to support a legislative solution next year on issues that can't be resolved in those ways. They haven't seen any evidence that something bad is going to happen. The critical thing to consider is patients are going to have small amounts of marijuana, not in public, and they are a small subgroup of a much bigger group in the state of marijuana users in general. The prosecution of these folks by the law enforcement officials, in their home for small amounts, is virtually nonexistent. The Alaskans for Medical Marijuana don't believe there will be any disaster over the interim, if this law is allowed to go into effect. The law hasn't had a chance to work. If they are proved wrong, they are committed to go back and work on legislation and try to find a solution. MR. FINKELSTEIN stated that there is no issue about accommodation in the workplace. The comments made that somehow people would be using medical marijuana in the workplace just are not correct. The law says clearly: no accommodation requirement in the workplace. The comment was made that it should be said no use in the workplace. That would be going too far because employers would have a right to allow employees to use medical marijuana if appropriate. MR. FINKELSTEIN noted that the initiative states if patients register with the state, they will be protected from arrest. If they don't register, but are legitimate medical marijuana users, they are left with an affirmative defense in court. If the patient is a legitimate user, he won't be convicted. MR. FINKELSTEIN agreed California is a model for registration, but there are not mandatory registration systems; there are voluntary systems. Patients are encouraged to register so law enforcement officials know them and will not give them a hard time. TAPE 99-51, SIDE A Number 0015 MR. FINKELSTEIN indicated that AIDS patients often times don't want to sign up because they don't want to disclose their situation. There are many circumstances which keep people from registering with the state. The Alaskans for Medical Rights feel that it would be a travesty to have an initiative pass that legalizes marijuana and then end up in a situation where someone with a doctor's recommendation still gets convicted, because they are not registered with the state. If patients have a doctor's recommendation, they should not be thrown in jail. Patients would be very disinclined to sign up because the original approach of the initiative is to use the registration system to allow the DHSS to have a way to verify who is a legitimate patient. The bill says that the list of users goes further, in that it can be accessed during a criminal investigation. MR. FINKELSTEIN said that the whole idea behind the registration system is to encourage patients to sign up because it will only be used to check to see whether their card is legitimate or not. With the loophole, that the list could be accessed at any time, and that will discourage patients from ever using the system. Whether the registration system is mandatory or voluntary the public interest requires that they encourage patients to sign up. Even if it is mandatory, there are plenty of patients who won't register. They would rather fend with the laws as they are than register with the state. They ought not to make it harder for patients to sign up. MR. FINKELSTEIN noted another provision that will discourage participation is where the doctor has to specify the condition. Doctors putting confidential medical history into a state record is completely unacceptable. The department does not want medical records of patients included in their records. All the initiative requires is certification that the patient has a debilitating medical condition and might benefit from medical use of marijuana. Listing the condition undermines the whole system and discourages participation. MR. FINKELSTEIN referred to the issue of the limits on caregivers and agreed it is a reasonable concern, and they supported the approach that the department chose to do in the draft regulations. That approach is if someone has to be a caregiver for more than one patient, he can apply to the department for a specific exception. This bill does not include that exception, and it seems to be a reasonable compromise on the issue. MR. FINKELSTEIN commented that of all the states that have the medical marijuana law, Alaska has the lowest limit. He also noted that some marijuana plants are male plants, which do not produce a significant amount of useable marijuana. No one can predict which plant will be male or female. All the comments heard regarding the amount of marijuana have to be at least factored in half because of that particular consideration. The bill without the amendments has a great solution; if someone wants more than six plants, he just applies to the department. If the patient proves their medical need, then the department decides whether or not he needs it. The amendment removes that provision. MR. FINKELSTEIN explained that patients can't get marijuana now. They have to go out on the black market if they don't grow it. The idea of setting up a distribution system ought to be in the public interest, so the patients don't have to go out on the black market. Precluding sale would be fine, but precluding distribution is not realistic considering what the patients face. MR. FINKELSTEIN referred to the forfeiture language. He said HB 213 allows protection against forfeiture that the initiative intended. The amendments before them would remove that protection. He said that any patient who is innocent, who doesn't get convicted, deserves to have their assets returned. CO-CHAIRMAN DYSON asked Mr. Finkelstein that if they pass the committee substitute, the seized assets won't be returned if the person is innocent. MR. FINKELSTEIN answered yes. It gets into a very complicated area of law, but under the forfeiture laws involving drug cases, people don't get a lot of things back. He can't say conclusively because he is not a lawyer. All their standard says if someone is not found guilty, he will eventually get back his assets. MR. FINKELSTEIN said he doesn't understand why they raised the age of the primary caregiver to 21. He urged the committee to look at this with a higher standard than normal legislation. Mr. Finkelstein reiterated that he believes the initiative ought to be given a chance to work and doesn't see a compelling reason to change it. The Alaskans for Medical Rights would be the first in line next year if problems emerged, to try to find a solution. They don't want anyone scamming on this or taking advantage of it. The day that happens is the day they get discredited. REPRESENTATIVE KEMPLEN mentioned that Mr. Finkelstein said at the beginning of his comments that HB 213 was a major rewrite of the initiative and wondered if this were challenged in court, would it be found to be unconstitutional. MR. FINKELSTEIN answered he didn't know; it is a legal question and they might well be making the case to the Lieutenant Governor who makes the decision. The elimination of the protection for so many patients is more than a minor amendment, but he can't possibly guess the outcome of that. MR. FINKELSTEIN suggested a conforming amendment. If they delete the words "debilitating medical condition" and replace it with "symptom," changes need to be made on page 2 also. Number 957 REPRESENTATIVE WHITAKER made a motion to adopt the proposed committee substitute (CS) for HB 213, version 1-LSO892\D, Luckhaupt, 5/3/99, as a work draft. There being no objection, Version D was before the committee. Number 0996 GERALD LUCKHAUPT, Attorney, Legislative Legal and Research Services, Legislative Affairs Agency, came forward to comment on the amendments. He also had noted the conforming amendment that Mr. Finkelstein had pointed out. He recommended that on page 2, line 2 they replace the words "debilitating medical condition" with the word "symptoms." CO-CHAIRMAN COGHILL asked if this would change the intent of the referendum. MR. LUCKHAUPT answered that with this change, the physician is still required to state that the patient has been diagnosed with a debilitating medical condition; he just doesn't have to disclose what the condition is, just the symptoms. It still meets the referendum. CO-CHAIRMAN DYSON asked Mr. Luckhaupt if he sees any other inconsistencies. MR. LUCKHAUPT indicated that this is the same bill he prepared for the Senate, and these amendments mirror what has occurred there, except for the last conforming amendment, which the Senate missed. REPRESENTATIVE BRICE made a motion to adopt Amendment 1, which reads: Page 3, line 6 Delete the words "or prosecution" Page 4, line 4 Delete "condition;" Insert "symptoms;" Page 4, lines 9-13 Following "concluded that" on page 9, delete all material through "concluding that" on line 12 Page 4, line 5 Delete "explored" Insert "considered" Page 2, line 2 Delete "debilitating medical condition" Insert "symptoms" CO-CHAIRMAN DYSON asked whether there was any objection. There being none, Amendment 1 was adopted. CO-CHAIRMAN COGHILL made a motion to move CSHB 213, version 1-LSO892\D, Luckhaupt, 5/3/99, as amended, out of committee with individual recommendations and fiscal note. There being no objection, CSHB 213(HES) moved from the House Health, Education and Social Services Standing Committee.