Patients who register with their state’s medical cannabis program typically become, literally, card carrying members. What many do not realize is that some states recognize the registrations of those from outside areas, something that is called reciprocity. While most states do not recognize out-of-state medical cannabis exemptions or qualifications, a few do. Of these, there are important differences of which millions of traveling patients should be aware.
The medical cannabis laws of most states do not allow reciprocity for one simple reason: It invites scrutiny by federal authorities, specifically those in the Drug Enforcement Administration, or DEA. The Justice Department is home to the DEA and exercises oversight for interstate commerce. It therefore has a vested concern to ensure that diversion (legal cannabis being delivered to illegal recipients) and other fraudulent activity is not involved. The issue becomes only more complex based on the fact that medical, and even recreational, cannabis is legal in some states, but all forms of cannabis are illegal at the federal level.
The federal government categorizes cannabis as Schedule I, meaning it is officially as “dangerous and addictive” as heroin and bath salts. In fact, both cocaine and methamphetamines, two truly addictive drugs that nearly any medical professional will testify are more dangerous than cannabis, both reside in less-restrictive Schedule II; they can even be prescribed by a physician.
Possession vs. Purchase
Four states with medical cannabis laws on the books allow visitors to legally possess and consume cannabis (within limits), but do not provide safe access via dispensaries to the medicine or related products (like concentrates, edibles, tinctures, and topicals).
States allowing registered patients from out-of-state to possess cannabis include:
- New Hampshire: Visiting patients are permitted to possess and consume cannabis, but cannot purchase or grow the herb.
- Arizona: Card-carrying patients from other states are permitted to possess and use cannabis, but not purchase it.
- Michigan: Visiting patients may possess and use. If driving with cannabis, the herb must be stored in a case in a locked trunk of the vehicle.
- Rhode Island: Like similar states, visiting qualifying patients may use and possess up to 2.5 ounces of cannabis, but cannot purchase from dispensaries in the state.
There are three states that practice full reciprocity and will legally allow, under certain circumstances, out-of-state patients to make purchases at licensed dispensaries. This is a way for those suffering a debilitating disease or condition, especially those who must medicate daily, to obtain medicine when they are traveling. It is not recommended that patients attempt to carry cannabis through an airport or on a flight. While many are successful, the legal ramifications in some states — or from federal authorities — simply are not worth the risk for the average patient.
It is legal for any patient possessing a valid medical cannabis card, from any state, to purchase, possess, and consume cannabis products at Nevada dispensaries. In fact, because reciprocity is practiced by so few states in the U.S., Nevada may become a destination for patients in other states who wish to vacation or meet business clients, but don’t desire to — or simply can’t — go without their medicine for the duration of their travel.
In Nevada, reciprocity is fairly straightforward. At their first dispensary visit, patients from out-of-state are asked to sign an affidavit testifying that they are currently a valid patient in another state. In addition, traveling patients are restricted to that initial dispensary for one month. Because most travelers, especially those vacationing in Las Vegas, will be staying a considerably shorter period of time than a month (a two to seven day span is more common), they are limited to a single dispensary for that particular trip. Las Vegas is significant, especially considering that 40 million people travel there each year (that’s the entire population of California, the most populous state in the nation).
Thus, patients visiting Las Vegas or Reno should be careful when selecting their initial dispensary. If their next trip to the Silver State is more than 30 days in the future, they will then be able to shop at the dispensary of their choice. Some have pondered if Nevada will pass recreational legalization via a ballot initiative in November 2016. If it does, Las Vegas could become the Amsterdam of the United States, being America’s legal adult playground for more than merely gambling and big-dollar magic acts.
The fact that Nevada is risking federal scrutiny to do what is best for patients is both relatively novel among states that have enacted medical cannabis laws, but also within the theme of Nevada’s tourism. If there are three states that understand the economic and cultural benefits of a robust tourism industry, it is Nevada, Colorado, and California. This spirit is finally being expressed within state laws affecting medical cannabis patients.
In Hawaii, patients from the mainland must simply register with the state. None of the details of this program are available, however, due to the fact that it will not go into effect until January 1, 2018. Patients traveling to this classic vacation destination of perfect temperatures and gorgeous beaches must remain patient for their opportunity to spend a few days in paradise while also remaining medicated to reduce or eliminate pain and nausea or deliver relief from inflammation-based diseases such as fibromyalgia, arthritis, and even cancer.
Maine requires that the recommending physician of visiting patients submit a form that testifies to the patient’s condition and eligibility in their home state. Visiting patients may designate a caregiver or dispensary in Maine, but not both. Surprisingly — in what seems to be an effort to accommodate those who relocate to Maine, not just visitors or vacationers — patients can have their doctor petition for their right to cultivate up to six mature plants.
Thus, patients who qualify for their home state’s medical cannabis program may visit or move to Maine and immediately request, via their recommending doctor, legal permission to consume and even cultivate cannabis.
Federal legality would eliminate the need for states to practice reciprocity in their recognition of registered medical cannabis patients from fellow states. However, this isn’t something that is on the political horizon in Washington, D.C. and a popular topic in Congress. Until true progress is made on Capitol Hill, patients will have to rely upon the handful of states that officially recognize the programs of those outside their own borders.
In late December 2015, lost amongst the hustle and bustle of holiday shopping, office parties, and spiked egg nog, a group of eight U.S. senators, all Democrats, sent a letter to three high-level bureaucrats in Washington, D.C., one each at the Department of Health and Human Services (HHS), the Office of National Drug Control Policy (ONDCP), and the Drug Enforcement Administration (DEA).
Senators Barbara Boxer (California), Elizabeth Warren and Edward Markey (Massachusetts), Cory Booker (New Jersey), Kirsten Gillibrand (New York), Jeff Merkley and Ron Wyden (Oregon), and Barbara Mikulski (Maryland) sent a nearly four-page letter to the acting officers of these government agencies. Conspicuously absent from the author list was Republican senator and libertarian torch bearer Rand Paul (Kentucky), possibly due to his presidential campaign.
Paul, along with junior senators Booker and Gillibrand, in early 2015 sponsored the CARERS Act, bi-partisan legislation that would further force the federal government to recognize a state’s right to legalize cannabis for any reason, reclassify the herb as Schedule II (it is currently Schedule I), eliminate several barriers to research, and — most important — make it easier for military veterans to obtain recommendations for medical cannabis from Veterans Affairs doctors (most notably for PTSD, depression, and anxiety).
More specifically, the target of the letter was Chuck Rosenberg, the Acting Administrator of the DEA, Michael Botticelli, Director of the ONDCP, and Sylvia Mathews Burwell, the Secretary of HHS. Rosenberg made headlines in late 2015 when he discounted the medicinal properties of cannabis and the efficacy gained by millions of patients nationwide, calling med pot a “joke” and saying that cannabis “never has been shown to be safe or effective as a medicine.”
Call for Collaboration
The letter pointed out the need for a wide range of government agencies and research organizations to somehow combine their efforts to reach the goal of more comprehensive medical cannabis research. Wrote the senators in the opening of their letter:
“…there is a need and unique opportunity for federal agencies to collaborate with each other…”
The letter stressed the “unique opportunity” for states to conduct population-based, clinical, “and other basic research on the risks and benefits of medical marijuana.” The letter went on to note the hurdles and barriers to federally-authorized cannabis research that are supported or maintained by a variety of government agencies. It identified the current regulatory scheme for medical cannabis research as “outdated and in desperate need of serious and immediate review.”
Areas of Focus
The letter focused on five key points, as summarized below:
- Supply Limits. The senators questioned the ability of a single farm at the University of Mississippi to produce an adequate supply of high-quality, “medical grade” cannabis for multiple research studies nationwide. The pot farm at the University of Mississippi holds the only bulk manufacture permit issued by the DEA and has cultivated and produced cannabis that many patients, physicians, and experts have labeled low-quality and as offering relatively little medicinal benefit. Thus, any study conducted in the United States using this low-quality herb would result in lower efficacy rates among participants — in essence, rigging the game for those who oppose medical pot.
- Rescheduling. Cannabis, which currently is part of Schedule I under the Controlled Substances Act, has been argued as a logical candidate for a lower ranking, such as Schedule II or III. The Food and Drug Administration has completed an analysis of the rescheduling of cannabis, and, it appears, HHS has provided “scientific and medical evaluations, as well as a scheduling recommendation” to the DEA. The query from the senators: What was the recommendation, and what is the timetable for review of the recommendation? This section of the letter also calls for the rescheduling of CBD oil.
- Interagency Coordination. Echoing one of the primary themes of the letter, coordination and cooperation, its authors cite a research application approval process that is “long, cumbersome, and difficult to navigate.” The senators request that the recipients explain how they “plan to work together to encourage qualified research applications” and asks them to describe the application process for qualified cannabis researchers.
- Surveillance and Epidemiological Studies. Such studies would gather data regarding how cannabis is actually being used, both medically and recreationally. The letter specifically calls for an investigation of cannabis use in “diverse populations and with multiple modes of administration.” If this actually occurred, government authorities would gather some rare insight into the economic and social aspects of cannabis consumption among a wide variety of demographic groups.
- Coordination with States. The senators would like to see “regular and organized communication” between agencies like HHS and state organizations such as public health departments — especially those in legal medical or recreational states like Michigan, California, Colorado, and Oregon — from which invaluable data can be obtained for further analysis or consideration from a national perspective.
The senators requested responses to their inquiries by January 31, 2016.
Photo credit: MSNBC, CBS News
In an unprecedented move, federal researchers visited a medical cannabis farm in Vancouver, Washington to gauge the health impacts of working in the industry and performing tasks such as cultivation and processing. Does the repetitive motion of trimming marijuana flowers promote carpal tunnel? Are those processing dozens of pounds of freshly harvested cannabis, over the long term, in danger of inhaling plant particles that may be harmful to their health?
These are the questions that researchers from the National Institute for Occupational Safety and Health (NIOSH) are trying to answer by making observations and gathering data in a real world facility. They recently spent the majority of a week in carefully controlled observations on a working cannabis farm outside of Vancouver in an effort to gather metrics.
This is a highly ironic and even perplexing research study. Simply put: Because cannabis remains a Schedule I drug under the Controlled Substances Act, the federal government officially regards it as completely lacking medical benefit and being a highly addictive and dangerous drug, as much so as heroin. Even all forms of cocaine and methamphetamines are less-restricted Schedule II drugs that can be prescribed by a doctor.
This study is especially ironic given the refusal of government bodies, such as Congress, to allow even minimal research at the federal level. Last summer, Congress voted not to allow cannabis research, especially that focused on CBD efficacy for conditions like epilepsy and cancer, to be orchestrated by the Drug Enforcement Administration (DEA) and conducted by the National Institutes of Health outside of D.C.
This scientific investigation involved a team of four researchers descending on a pot farm owned by Tom Lauerman, also known as Farmer Tom to locals and customers, that lies just east of Vancouver. Their overall goal is to develop federal best practices and standards for workers in the cannabis industry. Again, a highly ironic and even confusing move for any group that’s officially part of the federal government. Until this farm visit, the team had never set foot on an actual, working commercial cannabis cultivation facility. The infamous University of Mississippi pot farm was the closest any of the researchers had officially come to a real world cultivation and processing operation.
Lauerman told reporters how he never imagined that his farm might someday be occupied by friendly employees of the federal government. He told local media:
“I never thought in my life that, by the time I’m 55 in the year 2015, we would have federal agents welcome onto my farm — like asking to come onto my farm — and get to educate them about cannabis. It simply just blows my mind.”
Researchers, who were not permitted to be identified by the media, outfitted cultivation and harvest workers with special sensors designed to do things like analyze air quality inside grow facilities. They even leveraged a high-tech glove (photos below) right out of science fiction that featured sensors that measured the activity of trimmers manicuring freshly harvested cannabis flowers.
What about the conflicting messages being sent by the feds to those in the cannabis industry and consumers of their products across the country? NIOSH claims that its research effort in no way conflicts with federal law simply because the researchers are analyzing working conditions, not the substance or product being produced. Because the activities of the cannabis farm are in full compliance with Washington State law, NIOSH — and apparently other government watchdogs — find no problem with the study or the researcher’s presence on the cannabis farm.
There were limitations, however. NIOSH researchers, for example, were prohibited under federal laws from touching or handling cannabis or cannabis products in any way. Results of the study won’t be released for at least a year (probably government speak for two to three). The cannabis industry and legalization movement should eagerly await and support the results of such studies to properly regulate and manage a burgeoning industry that promises to produce tens of billions in economic growth for a nation that has suffered a jobless recovery, severe underemployment, and a withering middle class for nearly a decade.
The White Hat Feds
Unlike the DEA and many Justice Department officials when dealing with individuals or companies in legal states like Washington, the NIOSH researchers were welcomed with open arms and conducted themselves professionally and with the best interests of cannabis industry workers in mind.
It should also be pointed out that the government researchers didn’t simply demand access to Lauerman’s farm or otherwise bully their way onto his property; they were invited. And who invited then? Lauerman. He said he wanted to ensure the eventual adoption by the industry of workplace protections for cannabis workers. Said Lauerman:
“Nobody has any idea what makes a safe workplace, it’s a new industry. I’m honored to have [the NIOSH] here.”
Will the DEA Step In?
Will the DEA try to squelch future research efforts by other government organizations, regardless of the legality? Normalization and acceptance of the plant, for any reason, including hardcore medical applications, are seriously frowned upon by the DEA, an organization that is beginning to see its budget reduced while progressive members of Congress call for its continued defunding and even dismantlement.
Cannabis activists and advocates can only hope that further cooperation between any faction of the federal government and the cannabis industry will occur in an effort to research and regulate what is becoming a multi-billion industry touching tens of millions of consumers and tax payers. Huge markets are being created in single states. The green rush is partially based on what might be accomplished by a majority of states declaring full legalization—let alone the anticipated eventual federal legalization that will inevitably occur after Luddites of Congress have retired and been replaced by more progressive colleagues.
To learn the results of this study, curious cannabis consumers must remain patient. For those who have suffered under the legal paranoia of prohibition and the uncertainty and frustration of black markets — especially those who are sick — patience has always been the modus operandi anyway.
Congress took very little time to kill an amendment that would have permitted limited federal research into the medical efficacy of cannabis. The effort was apparently killed by the House Judiciary Committee, which is led by Virginia Republican Robert Goodlatte.
It can easily be argued that nothing significant was lost in the demise of this amendment, however. Research permitted by the legislation would have been limited to that conducted by the National Institutes of Health (NIH) under guidance from the Drug Enforcement Administration (DEA) — somewhat akin to allowing the fox to run the hen house.
In addition, the regulations for the proposed new Schedule IR (the “R” indicating research), under which marijuana would have been re-classified if the amendment had passed, would have been written by the DEA. Even more disturbing is the fact that one of the amendment’s sponsors, Maryland Republican Andy Harris, a physician, sponsored the legislation based on his belief that the research would prove marijuana is dangerous and lacks medical benefits.
Harris is the same politician who crafted legislation intended to block the District of Columbia’s recreational legalization. Because D.C.’s law was passed as a ballot initiative (winning 65 percent of the vote), Harris is directly defying the will of the District’s voters — and they aren’t even his constituents.
The bi-partisan legislation was sponsored by two Democrats and two Republicans. Morgan Griffith, the other Republican behind the amendment, was hopeful that the bill would pass and that the medical merits of marijuana would be proven through hard clinical research. Said Griffith after the legislation was killed:
“Andy Harris doesn’t think the research will show anything positive, but I do, and both of us feel willing to take the risk, do the research, and let us use evidence to make decisions. This amendment would have answered the question one way or the other. I think it would have shown it is a valuable medical substance, but now we don’t have the evidence.”
While cannabis research of any type is welcome to a vibrant medical marijuana community and a burgeoning recreational industry, clinical studies conducted by the NIH and DEA would likely have been very limited, may have taken years to get started, may not have involved human subjects, and likely would have used relatively low-quality cannabis from the University of Mississippi farm (meaning the resulting efficacy for test subjects may have also been unrealistically low).
Conservatives and prohibitionists are doing their best to kill off efforts to simply research cannabis to determine if it is objectively beneficial as a medicine. Bills like the bi-partisan CARERS Act, which would reclassify marijuana as Schedule II under the Controlled Substances Act, would allow for robust research. Given the short life of the Schedule IR amendment, efforts like CARERS may be in for a bumpy ride.
The unwillingness of Congress to reschedule cannabis to allow any type of research could be interpreted as a conservative effort to prevent favorable research findings from proving the efficacy of the herb. Despite relatively rapid progress resulting in 23 states with legal medical programs in place and Alaska, Colorado, Oregon, Washington, and the District of Columbia having legalized recreational use, the full legalization of cannabis in the United States will be far from easy.
Unfortunately, given the power and money of conservative forces that oppose legalization and the culture of marijuana, national legalization that allows all citizens to possess and consume marijuana is in no way guaranteed.
Photo credit: parameter.sk
Is the end in sight for the gross lack of clinical research regarding medical marijuana in the United States, including human trials, that’s been enabled by the federal government’s Schedule I status of the herb? The short answer: Maybe.
An amendment proposal has been made in Congress for a bill intended to accelerate development of new medicines. If passed, this bill would include creation of a new section of the Controlled Substances Act called Schedule IR. Any drug falling under Schedule IR would necessarily be cannabis, because the category is intended to “facilitate credible research on the medical efficacy of marihuana.”
According to the language of the amendment (note the spelling of “marijuana” as marihuana):
“The National Institutes of Health should initiate credible research on the medical efficacy of marihuana, including cannabidiol, as a treatment for patients.”
The amendment calls for the National Institutes of Health and the Drug Enforcement Administration (DEA) to work together to study the pros and cons of the use of cannabis as medicine. This bi-partisan legislation is sponsored by California Democrat Sam Farr, Maryland Republican Andy Harris, Virginia Republican Morgan Griffith, and Oregon Democrat Earl Blumenauer.
Republican Harris is a unusual sponsor for the bill; he led an unsuccessful efforts to block Washington, D.C. from implementing marijuana legalization. His opposition to the District’s legalization was especially controversial and attracted harsh criticism based on the fact that D.C.’s law was passed by a ballot initiative and, thus, directly reflected the will of the voters. It is possible that Harris is hoping research resulting from the amendment might uncover health risks or other fuel for the war on drugs.
This legislation cites the need for research at the federal level due to the legalization of medical marijuana in nearly half of U.S. states.
“As some States have begun to allow patients suffering from diseases such as cancer, epilepsy, glaucoma, and post-traumatic stress disorder (PTSD) to be treated with marihuana, it is imperative that the NIH, in consultation with the Drug Enforcement Administration, study the benefits and risks of marihuana and its derivatives and whether they are safe and effective forms of treatment for patients.”
If passed, the actual effect of this legislation is unknown. It cannot be assumed that the rescheduling of cannabis, strictly for research purposes and as directed by the federal government, will result in more open research and possibly human trials in the U.S. In fact, the regulations surrounding the new Schedule IR drug category would be written after passage of the law.
And guess who would be writing them? The DEA.
It should be noted that Schedule IR would apply strictly to marijuana research, not sales or any activity regarding recreational applications of the herb. For all uses of marijuana outside of research, the United States government and the attorney general would continue to apply the draconian regulations of Schedule I to their enforcement strategies and activities.
According to the language of the proposed amendment, Schedule IR would be a subset of Schedule I, with the “R” denoting the research focus of this new designation. According to the language of the bill:
“Except to the extent to which marihuana is intended to be used exclusively for research…shall treat marihuana in such Schedule IR as a Schedule I controlled substance.”
Between maintaining the Schedule I status of cannabis for all uses unrelated to research and the fact that the regulations for Schedule IR would be crafted by the DEA, this legislation leaves cannabis patients and advocates with little to celebrate. This bill’s passage would probably result in limited research, most or all of which was conducted by the NIH — and closely regulated and monitored by the DEA. There are also no guarantees of human trials.
Until the passage of bi-partisan bills like the CARERS act — which would re-categorize marijuana as Schedule II — objective, robust research in the United States will largely be a fantasy. Countries such as Italy, Israel, Germany, Spain, Canada, and the United Kingdom will continue to conduct the bulk of clinical studies and human trials involving cannabis.