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.
As a wave of medical cannabis laws sweeps the nation, with even conservative states jumping on the bandwagon, the mainstream press sometimes makes it appear as though laws are proposed, passed, and then simply help millions of patients improve their conditions with the kind herb.
However, many states have passed or in the process of passing very narrow, limited medical cannabis laws that exclude millions of sick children and adults. Chronically and severely ill patients who find little or no relief — and plenty of negative side effects — from conventional therapies and pharmaceutical drugs are desperate for help. After having exhausted traditional treatments, doctors and friends often recommend medical marijuana as a last resort.
Unfortunately, many of these patients, with conditions such as epilepsy, severe pain, and PTSD, are breaking the law if they try something as benign as a CBD oil (which contains no THC and can’t get them high). From conservative Louisiana to progressive Colorado, laws supposedly crafted to help the sick and dying often exclude major diseases and, in the process, leave millions in pain and suffering who could otherwise be helped.
Louisiana Deprives Epileptic Children
One example is Ella Grace Hall, a four-year-old girl in Louisiana who suffers from severe epilepsy. Hall consumes six separate drugs each day in an attempt to control her seizures and give her a semblance of a normal life. The only problem: The drugs aren’t working. Amazingly, Louisiana’s law doesn’t cover epilepsy, HIV/AIDS, PTSD, or even Crohn’s disease.
The lack of legal protection for treating a major condition like epilepsy has caused Hall’s mother to split up her family, moving her daughter to Colorado where CBD oil is legal and readily available. Like hundreds of other families, Hall is a “cannabis refugee” who must leave her home and loved ones to reside in a more enlightened, reasonable state that permits her to treat her condition with CBD oil and other derivatives of the plant.
Even Colorado is Guilty
Which, of course, makes Colorado appear to be the smartest kid on the block in terms of progressive compassion and science-based public policy. Unfortunately, even the Centennial State is guilty of excluding major conditions from its list of those qualifying for legal consumption of marijuana to gain relief. As recently as July 15, the Colorado Board of Health, in a vote of 6-2, elected to continue excluding PTSD from its list of qualifying conditions.
A number of other states, including New York, North Carolina, and Alabama, have passed very narrow medical cannabis laws that do not include a long list of major conditions. These states relegate thousands of very sick patients to obtaining their herbal medicine from the black market, with no legal protections or assurances of purity or quality.
Even in progressive Colorado, a state that has become the beacon of hope for millions of sick people and marijuana legalization advocates throughout the nation, patients are sometimes denied safe, legal access to an herb for which overwhelming empirical and anecdotal evidence is available (especially for conditions like epilepsy, PTSD, and Crohn’s disease).
Until state governors and legislative leaders cease using medical marijuana as a political football and bill signing photo opp, thousands of patients will continue to needlessly suffer. Those who defend prohibition and exclusion of major conditions from very narrow state laws due to a lack of research — but then defend the Schedule I status of cannabis that prevents research from occurring — are playing a hypocritical and illogical game that insults patients and perpetuates a crude and decades-long culture war.
And until that stops, very sick patients like Ella Grace Hall will continue to suffer or be separated from their families — or worse, die.
The state of New York recently passed its first medical marijuana law, and is currently defining the specific rules that will govern participants in this legal system. Feedback, so far, has been largely comprised of those who claim the law and rules are too restrictive.
The regulations are being scrutinized because the list of qualifying conditions is only 10 deep, and smoking the plant is not a legal method of consumption. Also, only 20 dispensaries will be licensed to serve the entire state, all of which will be controlled by just five organizations.
Progress is Progress
On the upside, any relief for those with serious disease or illness in the state is welcome. But can providing legal cannabis treatment for only 10 conditions and through only 20 dispensaries be truly effective?
After all, New York isn’t the first state to legalize regulated medical marijuana. California’s law, the first in the nation, was passed nearly 19 years ago. Critics cite that New York’s regulations impliy that it is one of the first states to do so and the clock has been turned back 15 or 20 years.
Gabriel Sayegh, managing director for policy and campaigns at the Drug Policy Alliance pointed out,
“The administration continues to operate as though medical marijuana programs have never been operated before. If we were having this discussion in 1998, one would understand the extreme caution. But it’s not the late 1990s, it’s 2015.”
Can New York’s highly pragmatic and unusually restrictive rules, in a nation where nearly two dozen states have passed considerably more lenient and open medical cannabis laws in the past two decades, deliver more help for patients than frustration?
Patients and dispensary operators may reasonably be confused by or protest some stipulations, like the fact that an electrician or carpenter servicing a dispensary would require prior written approval from the Health Department and a full-time escort when inside a dispensary — a requirement that will inevitably increase prices for patients. Also, the regulations contain strange limitations, such as the fact that consumption of any sort of food or beverage on the premises of a dispensary could be viewed as being in violation of the law.
121 Pages of Restrictions
The state has defended these tight restrictions, the draft regulations for which span 121 pages, by claiming that it wants to protect itself — and, by extension, patients — against “legal challenges and enforcement action,” referring to the federal ban on marijuana. Monica Mahaffey, the director of public affairs at New York’s Health Department, said the law ensures “appropriate access through comprehensive regulations and safeguards.” But again, this applies only to patients with one of 10 qualifying ailments (a considerably more restrictive list than those implemented by many other states).
Are the new regulations overly narrow and too comprehensive? Will “safeguards” ensure that millions of sick patients are denied access to medical cannabis, rather than granting them safe, legal access? Will the program be so restrictive as to fail, allowing politicians and prohibitionists to claim that there’s little demand or that such a system simply doesn’t work?
Closed-market Prices Too High?
Another major concern for potential patients is price which, unlike in an open market like Colorado, will be determined by a single individual, Dr. Howard Zucker, the state’s health commissioner. Because medical cannabis will not be covered by insurance, Zucker’s pricing may be prohibitive for extremely sick patients who are unable to work and may live on government assistance.
Ironically, this is the group that needs medical cannabis the most. If they can get better prices or more ready access on the black market, patients may find themselves in the exact same situation they’ve always faced: Breaking the law and having to purchase from street dealers.
Democratic Senator Diane Savino has admitted that the new regulations will be burdensome for many. “Is it inconvenient? Yes,” she said. Savino later elaborated,
“But what’s a bigger inconvenience is if we don’t have these tight controls and the federal government comes in and shuts down the whole program and disrupts the flow of product to patients.”
This is a logical stance, especially given the recent federal law enforcement activity of the Department of Justice and the DEA in progressive states like California and Washington. However, one must ask oneself if such strict regulations defy the spirit of the law, which is simply to provide safe access to affordable, legal medical cannabis for millions of sick New Yorkers.
The following are the only conditions which qualify a patient for a medical marijuana recommendation in The Empire State:
- Lou Gehrig’s disease
- Parkinson’s disease
- Multiple sclerosis
- Spinal cord damage
- Inflammatory bowel disorder
- Huntington’s disease