Some say it’s a gateway to other substance abuses. Others say it serves as treatment for a variety of medical concerns.
One thing is certain. The opinions on medical marijuana [cannabis] are almost as varied as the lists of cited pros and cons from both sides of the debate, which has spanned multiple state and federal governments across the world.
Multiple countries have passed legislation to permit the medical use of whole-plant cannabis. Counted among them are Australia, Canada, Germany, Greece, Israel, Italy, Portugal and the United Kingdom. In the U.S., the use of medical marijuana is legal in 31 states, plus the territories of Guam, Puerto Rico and the District of Columbia.
In November, medical marijuana will appear on the Missouri ballot three different times in the form of Amendment 2, Amendment 3 and Proposition C.
All three measures are in favor of legalizing medical marijuana by prescription for specific medical conditions as deemed appropriate by licensed physicians. All three measures also establish procedures regulating its production and distribution. However, each measure varies in tax rates, estimated revenue generation and costs.
A general list of conditions for which medical cannabis can be prescribed includes: cancer, epilepsy, glaucoma, intractable migraines that are unresponsive to other treatment, and chronic medical conditions that cause severe persistent pain or muscle spasm such as those associated with multiple sclerosis, seizures, Parkinson’s Disease and Tourette’s Syndrome among others. Medical cannabis also could be prescribed for debilitating psychiatric disorders, including post-traumatic stress disorder, if diagnosed by a state-licensed psychiatrist, and for HIV/AIDS or any terminal illness. Some variances do occur within each individual list.
“All of us have friends, family and colleagues that are suffering from these debilitating diseases, and in Missouri right now, they have to make the decision whether to move to other states or, in some cases, to break the law, and that’s not a viable option,” Jack Cardetti, New Approach Missouri’s campaign consultant, said. New Approach Missouri is the organizing group behind Amendment 2.
“We think that doctors and patients ought to have to be able to work together to determine those best healthcare options,” Cardetti said.
According to Cardetti, the list of qualifying conditions for Amendment 2 was compiled after looking at lists used by states that have already legalized medical cannabis. “There are a number of different illnesses covered, including cancer, epilepsy, HIV, PTSD and others, but ultimately, it’s up to the state-licensed physician, an MD or a DO, to work with the patient to determine what the best medical treatment option is,” Cardetti said.
Amendment 2 also contains a provision allowing physicians to recommend medical cannabis to qualifying patients for chronic medical conditions normally treated with prescription medications that could lead to physical or psychological dependence. According to Cardetti, the primary example addictive medication would be the use of opioids.
“There was actually an article published not too long ago in the Journal of American Medicine [JAMA] that really looks at states that pass medical marijuana laws, and you actually see the prescription of opioids decrease in [those] states,” Cardetti said. “We all know the effect the opioid crisis is having in Missouri right now, so not only does Amendment 2 help the patients, but it also can help combat that crisis, which we think is important.”
Also known as the “Find the Cures” initiative, Amendment 3 would create a new facility known as Biomedical Research and Drug Development Institute led by a nine-person Research Board. The research institute’s stated goal is to develop cures and treatments for cancer and other incurable diseases or medical conditions.
The Research Board also would have the power to suggest other conditions in the presence of medical and scientifically supplied data. Springfield-based physician-surgeon and lawyer Brad Bradshaw, who also is Amendment 3’s major funder, would serve as the automatic coordinator of the board in an unpaid position until the final governing board is selected.
“This allows for individual, targeted research groups to be set up within this institution,” Bradshaw said. “This could really become, over time, the greatest medical research center in the world. We could make Missouri a world leader in medical research.”
Another unique attribute of Amendment 3, according to Bradshaw, is that a physician could prescribe medical marijuana to a patient with a condition not listed, but only on the grounds that licensed physicians can write no more than 25 percent of their prescriptions for medical marijuana.
Proposition C, also known as the Missourians for Patient Care Act, would remove state prohibitions on personal use and possession of medical cannabis by individuals with a written certification from a physician who is treating the patient diagnosed with the qualifying medical condition. It also would remove state prohibitions on the growth, possession, production and sale of medical marijuana by licensed and regulated facilities, and said facility’s licensed owners and employees.
Amendment 2 is the only ballot initiative that would permit patients to grow their own cannabis plants – up to six plants – for personal use.
“Most of the medical marijuana initiatives that have been passed allow for some level of patient cultivation,” Cardetti said. “It’s not used often, but it is a failsafe for the patients that are, frankly, too sick or too poor to access dispensaries, [so they] are still able to have that as a treatment option. But it is a highly regulated system. It would have to be under lock and key and be available for inspection by the state … That’s how it’s worked well in other states.”
All plants would have to be grown in a state-registered facility and all edible products containing marijuana products would have to be labeled as such and sold in child-resistant packaging.
Under Amendment 2, regulatory authority for the state’s medical marijuana program would fall to the Missouri Department of Health and Senior Services.
According to the National Council on Alcoholism and Drug Abuse [NCADA], the Department of Health and Senior Services would have oversight of the medical marijuana program, including oversight of production, sales, purchase and distribution.
Under Amendment 3, regulatory authority goes to the proposed Biomedical Research and Drug Development Institute.
Under Proposition C, regulatory authority goes to the Division of Alcohol and Tobacco.
The Division of Alcohol and Tobacco may limit licenses to 1 per 100,000 Missouri residents, but that provision is not required under Proposition C. Licensed dispensaries must be at least 60-percent owned by individuals who have been Missouri residents for at least three years. The statute also would require the Division of Alcohol and Tobacco to create a “seed to sale” tracking system and require licensees to be subject to regulation from cultivation to final sale. The funds from the license fees will go to the Division of Liquor Control to administer the program to license, certify and regulate marijuana and marijuana facilities.
“In our case, we prefer the Division of Liquor Control to run the state revenue collection, regulatory enforcement and work with local communities,” said Travis Brown, a lobbyist with the PR firm Pelopidas, which led the initiative petition efforts to get Proposition C on the ballot. “We think that’s the most similar to the 86-year history they’ve had running post-Prohibition alcohol regulation at a local level, not just regarding enforcement, but also all the different things you have to do to make sure things are done right.”
Proposition C also would require local municipalities to pass regulating ordinances and requirements for licensure; municipalities also may vote to prohibit cultivation and sale of marijuana with a 2/3 vote in a general election.
According to Brown, passage of Proposition C would help the state to “avoid millions of dollars being re-spent for changes to tweak the constitution.” He noted that “the likelihood that things would be perfect in a new industry” which is “at least as complicated as tobacco, if not more complicated than alcohol” is slim.
According to Brown, Proposition C was created using previous experiences and observed methods from existing systems, such as post-Prohibition with alcohol and successful medical marijuana integrations utilized by states like Colorado.
“We felt that it was important to have a statute that could remain flexible with a light, regulatory touch and a low tax rate so that we’re not jeopardizing the early days of anybody doing this licensure,” Brown said.
TAXES, COSTS & REVENUE
Amendment 2 would impose a 4-percent tax on the retail sale of marijuana. Funds from those taxes would go toward health and care services for military veterans as administered by the Missouri Veterans Commission.
“It’s an underfunded area in Missouri, and we do a really good job preparing our men and women to go overseas to fight battles, but we don’t do nearly as good of a job caring for them when they come back home,” Cardetti said. “We think this fills that need, and veterans are really a focus of Amendment 2. It’s kind of a win for veterans. Not only do they get some of the revenue from the small tax that we’ve placed on the sale of marijuana, but PTSD and many other things Missouri veterans suffer from are covered under our qualifying conditions.”
According to the Secretary of State’s office, it is estimated that Amendment 2 would generate annual taxes and fees of $18 million for state operating costs and veterans programs, and $6 million for local governments. Annual state operating costs are estimated at $7 million.
Amendment 3 would impose a 15-percent tax on the retail sale of marijuana as well as a tax on the wholesale sale of marijuana flowers and leaves [per dry-weight ounce] to licensed facilities. Bradshaw said the tax would be a flat tax that would have no additional rates added onto it at later dates.
Excise taxes would include about $9.25 per ounce on flowers and buds and $2.75 per ounce on leaves. Both prices are linked to the Consumer Price Index
Tax revenue generated from the sale of medical cannabis would be deposited into the Biomedical Research and Drug Development Institute Trust Fund. However, services provided there [treatments, testing, etc.] will generate proceeds that Bradshaw said would go toward items like schools and education, infrastructure and bridge repairs. He estimates about $2 million also would go to law enforcement and 50 percent of the institute’s profits would go toward a citizen tax refund initiative.
“That means everyone in the state of Missouri that pays income taxes will get a refund check every year for Amendment 3,” Bradshaw said.
According to the Secretary of State’s office, it is estimated that Amendment 3 would generate annual taxes and fees of $66 million. State governmental entities estimate initial implementation costs of $186,000 and annual operating costs of $500,000.
Proposition C would impose a 2-percent tax on the retail sale of medical marijuana. Funds from the tax revenue would go toward veterans services, drug treatment, early childhood education and for public safety in cities with a medical marijuana facility.
The Secretary of State’s office estimates that the annual cost of the proposal at $10 million, with annual revenue projected to hit at least $10 million. The proposal is estimated to not cost local governments any money but would generate them $152,000 in annual revenue.
While there are multiple initiatives vying for the legalization of medical marijuana on the November ballot, not everyone is fired up.
Rockwood’s Drug-Free Coalition, operating under a federal Drug-Free Communities Grant and in collaboration with the nearby Parkway and Lindbergh school districts, has released a marijuana position statement with facts and statistics relevant to substance abuse and adolescents.
In the Rockwood Community, about 34 percent of youth believe it is “easy” to obtain marijuana, according to the 2018 Missouri Student Survey. According to the district’s 2017 Monitoring the Future Study, 25 percent of high school seniors reported they would “be more likely to try marijuana if it were legalized.”
“When we talk about legalization, our biggest concern is accessibility,” Anna Greenwood, Coalition project coordinator, said. “We know that as substances become legalized, they are more accessible to our young people. That’s a big concern. As far as students using marijuana, it negatively impacts brain development. Our brains aren’t fully developed until we’re 25 years old [as documented in 2015 by the American Psychological Association] and so introducing any substances that mess with how your brain works is concerning.”
NCADA also released an official statement regarding the medical marijuana initiatives on the ballot.
“Herbs and botanicals are still in use, but now largely as folk remedies – alternatives to modern, Western medicine,” NCADA stated in an official release. “Unlike FDA-approved drugs, they are neither standardized nor tested for effectiveness. As a result, their quality, concentrations and efficacy vary widely. Their therapeutic claims are not substantiated by scientific rigor and, unlike modern medicines, they are not subject to the same kind of regulation or approval.”
However, NCADA also stated in its official release that some active ingredients in marijuana, including THC and the non-psychoactive, CBD, should be turned into medicines with the approval of the FDA, and advocates for the relocation of marijuana to FDA Schedule II and be further researched.
“We believe that medical marijuana is not a human rights issue; it is, instead, a public health issue better decided by public health experts,” NCADA stated in an official release.
Greenwood agrees with NCADA’s stance.
“We definitely want to keep it out of the hands of young people and we know when it’s legalized, and when there’s more of it out there it easier to get their hands on it, but we also don’t usually vote on medication,” Greenwood said. “Seeing something come from the FDA, I think, would be better than every state having a vote on whether or not they think it should be legalized as a medication.”
The idea of wanting federal regulation is a concern for some pro-cannabis parties which claim that, despite multiple state approvals of medical cannabis, regulation on a federal level has never been finalized.
Brown called the three initiatives “a sign of the times.”
“There’s a big shift in patients and advocates that want to see change, not just at the state level, but at the federal level,” he said.