Posts Tagged ‘medical marijuana’

Dispensary Agent Collaborative

February 27th, 2014

Last Wednesday we held a Medical Marijuana Dispensary Collaborative.  It was modeled after last year’s successful ADVICE Collaborative, which brought dialysis facilities together to share best practices and engage in a dialog to reduce infection control violations and improve patient care.  The goal of the meeting was to avoid future deficiencies by ensuring that dispensaries understand our expectations and to help us better understand their challenges. 

The Dispensary Collaborative had a great turnout, with almost 150 dispensary agents, board members, and medical directors. The all-day meeting covered dispensary inspection results, patient and dispensary agent educational resources offered by the Arizona Poison Control, the administrative rules process, financial audit requirements (including the difference between profit and non-profit entities), and our computerized Point of Sale system that’s used by dispensaries to verify the status of cards and record marijuana transactions. 

Overall, the input and suggestions that we received from the dispensaries was constructive and will be helpful as we continue to move forward with building a solid relationship with our dispensary stakeholders.

New Medical Marijuana Rules Up for Public Comment

February 5th, 2014

Last summer a Superior Court judge decided that a portion of our medical marijuana regulations are unreasonable because our regulations didn’t have a process for dispensary registration certificate holders to renew their dispensary registration certificate if they didn’t earn their approval to operate within 1 year.  

This week we posted new draft rules (and an Online Survey to get public comment) to comply with the Judge’s Order.  We’re also using this opportunity to refine the regulations- basically to close some loopholes we’ve found in physician certifications and delivery by dispensaries among other things.  Here’s a summary of some of the modifications to our current rules that we’re proposing: 

  • Adding a process by which dispensary registration certificate holders, who don’t earn their approval to operate within 1 year due to individual circumstances, may renew their dispensary registration certificate;
  • Removing the prohibition of an individual who was a principal officer or board member of a dispensary that failed to get an approval to operate within 1 year from being a principal officer or board member of a new dispensary;
  • Revising the method of selecting future dispensaries to match the method we used in 2012… removing the allocation on the basis of locations with the highest number of qualifying patient residents;
  • Clarifying what is required of a dispensary to be considered open, operating, and available to dispense;
  • Clarifying the policies and procedures for inventory control and the transportation of marijuana to a dispensary’s cultivation site or to other dispensaries, and delivering to qualifying patients and designated caregivers;
  • Clarifying that a dispensary agent delivering marijuana for a dispensary is required to have a registry identification card issued under the registration certificate;
  • Clarifying where a dispensary may dispense medical marijuana to a qualifying patient or designated caregiver;
  • Clarifying where a dispensary agent may transport medical marijuana, plants, or paraphernalia;
  • Clarifying what a trip plan needs to include;
  • Limiting dispensary donations by patients and caregivers to 2.5 ounces of useable marijuana every 2 weeks;
  • Adding seniors, veterans, and folks that receive Supplemental Security Income or Social Security Disability Insurance benefits to the list of folks that qualify for discounts on patient registration cards; and
  • Amending the meaning of “25 miles” to by road rather than as the crow flies. 

This is “regular” rulemaking, so we’ll be holding oral proceedings during the formal rulemaking period.  We think we’ll be able to work through the process and establish the modified rules by early 2015.

Medical Marijuana News

January 17th, 2014

We published our mid-year update of the medical marijuana annual report this week.  It contains different data than our  standard annual report in that we’re reporting aggregate dispensary transaction data.  In the report you’ll see that there were about 422,000 transactions made at dispensaries in ‘13 among the 40,000 patients (about 10 transactions/patient/year).   Dispensaries sold 2,700 Kg of marijuana in ’13 for an estimated gross revenue stream of about $33M.  Transaction data is broken down by age group as well.   Fridays are the busiest day of the week at dispensaries.  

In other news, we completed our review of the latest petitions to add debilitating medical conditions to the official list this week.  As you recall, the AZ Medical Marijuana Act charges us to periodically accept petitions to add new medical conditions to the list that qualifies folks for a card.  Last summer we accepted petitions from the public to add new medical conditions for PTSD, depression and migraines. We also received a lot of informal comments regarding adding PTSD; depression & migraines and heard in person testimony from dozens of folks at our public hearing in October. 

We also contracted with the U of A College of Public Health to do an evidence review of published scientific studies.  You can see the UA’s analyses for depression; migraine headaches and PTSD on our petition website.  Our ADHS Medical Advisory Committee reviewed and analyzed the data, as in past submission periods, and provided me with recommendations earlier this week. 

Our literature review found limited scientific evidence to support permanently adding the petitioned conditions to the statutory list of qualifying debilitating conditions identified in the Act.  I didn’t approve the petitions because of the lack of published data regarding the risks and benefits of using Cannabis to treat or provide relief for the petitioned conditions.  We’ll be accepting petitions again January 27 – 31, 2014.

MM “Declaratory Judgment”

November 13th, 2013

A Complaint was filed against the ADHS and others last week.  It’s called a “Request for Declaratory Judgment and Permanent and Preliminary Injunction”.  It basically asks the Court to declare that: 1) extracts and resins from the marijuana plant are protected in the definition of “Useable Marijuana” under the Arizona Medical Marijuana Act; and 2) dispensaries, patients, caregivers, and agents are from criminal prosecution for violations of the Title 13 (criminal code) “Cannabis” statutes.  Of course, it’s more complicated than that, but that’s the thumbnail sketch of the Complaint.  This relates to one of my previous posts entitled Marijuana v. Cannabis  In a related matter, a Superior Court judge dismissed a complaint this week that argued that the 25 mile provision should be thrown out.

AZ Medical Marijuana @ 2

November 12th, 2013

Our Vital Health Statistics team along with our partners at the UA College of Public Health completed our Year 2 Annual Report for the Arizona Medical Marijuana Program last week. You’ll find a wide range of information in the report including data about the demographics and kinds and qualifying conditions of our cardholders, geographic distribution and rates as well as background information on the budget and fund, the various lawsuits, and de-identified information about physicians that are writing certifications.

Perhaps the most striking thing in the report is that 25 doctors have signed about 70% (about 25,000) of the 36,000 or so certifications in Year 2… and a handful of doctors wrote more than 2,000 certifications. That doesn’t necessarily mean that these doc’s aren’t acting in the best interests of their patients- but it does give us some insight into which ones we should be focusing on to ensure that they’re meeting our certification expectations. The report goes into more detail if you’re interested.

You can see some of the recommendations at the end of the report. Of course… the info in the Annual Report is just a sub-set of all of the data we have about the program… and you can see the full array of data and information including our summary monthly reports on our hub website.

Medical Marijuana Rulemaking Underway

October 11th, 2013

A few weeks ago a Superior Court judge decided that a portion of our medical marijuana regulations are unreasonable because they lack a formal appeal process for dispensary registration certificate holders who don’t earn their approval to operate within 1 year.  Because of the  ruling, we approved renewal requests for all the current dispensaries (open or not).  The ruling also means we need to modify our rules.  

Now that we’ve completed the overhaul of our medical, skilled nursing, assisted living and behavioral health rules (18 Articles in all)- we’ve turned our attention toward amending our medical marijuana rules.  We began that process this week by scoping out modifications to the rules for renewing dispensary certificates.  We’re also planning to make some modifications to the “25-mile rule” (measuring by road rather than “as the crow flies”), eliminating the former “year 2” selection criteria for dispensaries by focusing on vacant CHAAs rather than patient density, and removing the lifetime disqualification for those applicants that receive a dispensary registration certificate but don’t execute. 

Once we have an initial “straw-man” draft, we’ll solicit public comment and have oral proceedings just like we did for the original rules in 2011.  We think we’ll be able to work through the process and establish the modified rules by the Fall of 2014.

Medical Marijuana Edibles

September 4th, 2013

Last week I posted a blog that points out that the words “Marijuana” in the Arizona Medical Marijuana Act and “Cannabis” in the Arizona Criminal Code have different definitions…  and that the distinction may be an important one for Qualifying Patients. 

The major difference is that the definition of “Useable Marijuana” in AMMA includes “… dried flowers of the marijuana plant, and any mixture or preparation thereof…” without specifically addressing the “resins” and “extracts” identified in the Criminal Code.

Marijuana v. Cannabis

August 30th, 2013

Are Marijuana and Cannabis the same thing when it comes to Arizona Law?  The short answer is no- and the distinction may be  an important one for Qualified Patients. 

The Arizona Medical Marijuana Act provides registry identification card holders and dispensaries a number of legal protections for their medical use of Marijuana pursuant to the Act.  Interestingly, the Arizona Medical Marijuana Act definition of “Marijuana” in A.R.S. § 36-2801(8) differs from the Arizona Criminal Code’s (“Criminal Code”) definition of “Marijuana” in A.R.S. § 13-3401(19). In addition, the Arizona Medical Marijuana Act makes a distinction between “Marijuana” and “Usable Marijuana.” A.R.S. § 36-2801(8) and (15)

The definition of “Marijuana” in the Arizona Medical Marijuana Act is “… all parts of any plant of the genus cannabis whether growing or not, and the seeds of such plant.”  The definition of “Usable Marijuana” is  “…  the dried flowers of the marijuana plant, and any mixture or preparation thereof, but does not include the seeds, stalks and roots of the plant and does not include the weight of any non-marijuana ingredients combined with marijuana and prepared for consumption as food or drink.”  The “allowable amount of marijuana” for a qualifying patient and a designated caregiver includes “two-and-one half ounces of usable marijuana.”  A.R.S. § 36-2801(1)

The definition of “Marijuana” in the Criminal Code is “… all parts of any plant of the genus cannabis, from which the resin has not been extracted, whether growing or not, and the seeds of such plant.”   “Cannabis” (a narcotic drug under the Criminal Code) is defined as: “… the following substances under whatever names they may be designated: (a) The resin extracted from any part of a plant of the genus cannabis, and every compound, manufacture, salt, derivative, mixture or preparation of such plant, its seeds or its resin.  Cannabis does not include oil or cake made from the seeds of such plant, any fiber, compound, manufacture, salt, derivative, mixture or preparation of the mature stalks of such plant except the resin extracted from the stalks or any fiber, oil or cake or the sterilized seed of such plant which is incapable of germination; and (b) Every compound, manufacture, salt, derivative, mixture or preparation of such resin or tetrahydrocannabinol.A.R.S. § 13-3401(4) and (20)(w)

An issue the Department has been wrestling with for some time is how the definition of “Marijuana” and “Usable Marijuana” in the Arizona Medical Marijuana Act and the definition of “Cannabis” and “Marijuana” in the Criminal Code fit together.  This confusion, which appears to be shared by dispensaries and registered identification card holders alike, is not easy to clear up and has resulted in the Department receiving numerous questions regarding the interplay between the protections in A.R.S. § 36-2811 and the Criminal Code.  While we can’t provide legal advice as to whether a certain conduct is punishable under the Criminal Code (only an individual’s or entity’s legal counsel can do this), “Cannabis” is defined as the “resin extracted from any part of a plant of the genus cannabis” and “Cannabis” is listed as a narcotic drug according to the Criminal Code in A.R.S. § 13-3401(4) and (20)(w).   

In other words, registered identification card holders and dispensaries may be exposed to criminal prosecution under the Criminal Code for possessing a narcotic drug if the card holder or dispensary possesses resin extracted from any part of a plant of the genus Cannabis or an edible containing resin extracted from any part of a plant of the genus Cannabis.  If you’re concerned that your conduct may expose you to criminal prosecution, you may wish to consult an attorney.  We’ll be providing some specific guidance for dispensaries licensed by the ADHS next week.

 

3 Medical Conditions Move to Hearing

August 28th, 2013

Three of the petitions to add debilitating conditions to the medical marijuana program that we received last month will be moving forward to a public hearing, which will be on Tuesday, October 29 from 9 am to noon in our State Lab conference room.  We’ll also broadcast the hearing via Livestream. 

The petitions are for PTSD, Migraines, Depression.  All these conditions have already been through the review process in previous petitions- but we’ve asked the UA College of Public Health to look for any new literature that has been published on these topics since the previous review.  This will be the first set of hearings since the first round back in 2012.

Dispensary Ruling

July 31st, 2013

The Superior Court judge ruled this morning that our requirement for Registration Certificate holders (dispensaries) to get an approval to operate within one year in order to renew their certificates is unreasonable.  Because of today’s ruling, we’re going to accept renewal requests for all the current dispensaries in the state, whether they’re open or not.  The initial year for dispensaries is over next week.

The ruling also means we’ll need to rewrite our rules – but that’s not a simple process.  We’ll begin the process of adjusting our regulations to be in accordance with today’s ruling, but it will likely take several months to have everything in line.  Today’s ruling will also delay our decision about how to proceed with “year 2” dispensary applications.