Wednesday, June 28, 2017

Cannabis Use And “Impairment”


During the regular legislative session for 2017 in New Mexico, we saw the attempt by retired police officer, William “Bill” Rehm file HB-22, “DUI For Certain Drugs & Interlocks”. HB-22, DUI For Certain Drugs & Interlock, was an arbitrary proposal with the use of metabolite concentration to determine DUI for cannabis (THC, dissolves in fat, whereas alcohol dissolves in water). The proposed law stated a person would get a DUI, “for the active compound in marijuana, delta-9-tetrahydrocannabinol, five nanograms per milliliter of blood” ( 5ng/ml THC).  

For patients in the state’s medical cannabis program, they would potentially be in jeopardy of DUI even without medicating prior to driving due to residual levels of cannabis in a person’s system. When you drink, alcohol spreads through your saliva and breath. It evenly saturates your lungs and blood. Measuring the volume of alcohol in one part of your body can predictably tell you how much is in any other part of your body. Because THC is fat soluble, it moves readily from water environments, like blood, to fatty environments. Fatty tissues, like the brain, act like sponges for the THC.

Marilyn Huestis, who headed the chemistry and drug metabolism section at the National Institute on Drug Abuse, conducted a study finding that when a smoker’s blood THC level peaks at 15-18 nanograms per milliliter, that could be just as a dangerous as driving drunk.


Medical Cannabis and Impaired Driving

On, June 27, 2017 – Canadians for Fair Access to Medical Marijuana (CFAMM), a national non-profit organization, released a first-of-its-kind preliminary research review on medical cannabis impaired driving – one of the major public safety concerns stemming from the legalization of non-medical cannabis.

Although the federal illegality of both medical and recreational cannabis in the United States makes it a difficult comparison to Canada, it is still worthwhile to explore examples of how individual states have approached impaired driving. Overall, approximately one-third of US states have laws related to THC- impaired driving with policy ranging state-to-state. Sixteen states have zero-tolerance approaches, meaning any detectable level of THC presence results in a charge, and six others have per se laws according to the National Conference of State Legislatures, 2017.

States with per se limits, such as Washington and Colorado, have been using blood tests to determine THC levels as a measure of impairment. Both states use a legal threshold of five ng/ml THC of a driver’s blood. However, in Colorado, five ng/ml only triggers a "presumption" of impairment and drivers can challenge this presumption at trial. In other states without per se limits, such as Oregon, Alaska and Washington, D.C., trained observations by police are used to determine impairment.  
However, medical uses of cannabis have not been reviewed in these contexts.


Defining “Impairment”

While CNJ is fully against impaired driving and supports responsible driving legislation, the term “impairment” is widely used but is not always clearly defined. When speaking of impairment, crucial to this dialogue is speaking to actual impairment of cognitive, psychomotor, and other functions necessary to safely drive – not simply a measure of previous use such as the presence of THC in blood. Unlike blood alcohol concentration, which is scientifically linked to levels of impairment, matching levels of impairment to levels of THC in one’s system is still widely debated and has not been studied related to medical cannabis use.

Although many studies have explored the risk of recreational or occasional use of cannabis related to driving impairment, few have studied the risk related to responsible medical use of cannabis. For most patients, the goal of medical cannabis use is not to experience its psychoactive effects, but rather to treat or manage symptoms of an illness using the smallest effective dose. Although it's a limited example, a past study on the medical use of cannabis (Sativex) for multiple sclerosis identified better driving safety measures after the introduction of cannabis in patients' treatment regimens, suggesting a need for further research on medical users.


It is also important to note that U.S. states have recorded an 8-11% drop in overall traffic fatalities one year following the introduction of medical cannabis legislation.

Many medically authorized people in both the US and Canada use cannabis daily or near daily to manage symptoms associated with their illness and are expected to follow advice from health care providers. This includes safe-use guidelines, such as waiting 4+ hours after consumption before driving, to help eliminate risk of potential impairment. The metabolism and effects of THC are highly variable from person-to-person and THC can remain detectable within a regular user's blood for days after last consumption.

The current laws and proposed laws in many states, which would set a per se cut-off of 5 ng/ml THC at the lower end, means even when patients are not impaired, they would have to stop using their medicine for 3 to 7  days before driving.

"Although driving is not a right but a privilege, patients who use cannabis responsibly and are not impaired should still be able to drive without risk or fear of being charged. It is necessary for the government to incentivize further research and include considerations for patients using cannabis. While a strict precautionary approach may be appropriate in light of limited evidence, policymakers have a responsibility to both safeguard road safety and balance the rights of medical cannabis patients to ensure they are not unfairly criminalized by drugged driving laws that do not target impairment."-       Jonathan Zaid, Lead Author and Executive Director, CFAMM

 

Monday, June 26, 2017

Attorney General Jeff Sessions And The Cannabis Law Institute


On Monday, June 12th 2017, a letter from Attorney General Jeff Sessions that highlights his opposition to medical cannabis became public.  While the Administration had previously given somewhat vague statements about their intentions relating to medical cannabis, this letter provides clear cut opposition to appropriations riders that prevent the Department of Justice from expending funds against medical cannabis activities. The letter requested that leaders of congress not restrict the Department of Justice’s funding in the prosecution of state medical cannabis laws.

Further, Sessions claims that it would be “unwise for Congress to restrict the discretion of the [Justice] Department to fund particular prosecutions, particularly in the midst of a historic drug epidemic and potentially long-term uptick in violent crime.”
Mr. Sessions is right about one thing. There is a drug epidemic. Except that epidemic has not resulted from cannabis, but rather from opioids. In the FY18 Budget Hearing for the Department of Justice, Deputy Attorney General Rod Rosenstein indicated that the death total from drug overdose for 2016 could be as high as 60,000 people with 60% of those deaths coming from prescription opioids.  No one has ever died from a medical cannabis overdose, largely in part due to how safe this from of medicine is.


According to the National Conference of State Legislatures, a total of 29 states, the District of Columbia, Guam and Puerto Rico now allow for comprehensive public medical cannabis programs.  Recently approved efforts in 17 states allow use of "low THC, high cannabidiol (CBD)" products for medical reasons in limited situations or as a legal defense. In March 2016, the estimated number of medical cannabis patients in the United States was 2,604,079; and now we are easily pushing that number close to having 3,230,867 citizens using medical cannabis under state approved laws.

The National Cannabis Bar Association

All of those medical cannabis patients, all of those producing the medicine for the medical industry and for all those in states with legalized adult-use and medical programs; these are all area’s that are going to need the crucial role of Cannabis Attorney’s to uphold, defend and protect these state rights.



Cannabis law is a fantastic but mine-filled practice area. For attorney’s who are looking for something different, where one can help forge the laws, culture, and trajectory of an entire industry, there is nothing like it. Nothing is boilerplate and everything requires creative thinking in protecting this safe plant and the people who depend upon it’s medicine. Cannabis law, like entertainment law, is an amalgamation of other practice areas, including medical law,  business law, administrative law, intellectual property, criminal law, employment law and tax law.

The National Cannabis Bar Association was formed in 2015 by a group of lawyers who saw a need to educate and connect with other cannabis industry lawyers for the purpose of providing excellent, ethical, and advanced legal assistance to this growing industry.

The Cannabis Law Institute, the seminal two-day cannabis industry legal education event produced by the National Cannabis Bar Association and co-sponsored by the University of Denver Sturm College of Law will be held on July 28-29, 2017 in Denver, Colorado. This event will convene the best minds and visionaries working in the legal cannabis industry for two days of legal education and two intimate evening networking events. The conference will feature many of the nation’s leading attorneys, academics, and politicians. The conference offers multiple tracks for practitioners, academics, and policy advocates. Courses range from introductory to advanced and include relevant information from Canadian attorneys.
Henry Wykowski, the lead attorney on the Harborside Health Center civil forfeiture case and one of the foremost business and tax attorneys in the country serving the cannabis industry, will be in conversation with Lara DeCaro discussing emerging issues in cannabis law.
Matt Houtsma of the IRS will keynote the lunch hour at the Cannabis Law Institute.
Two different sessions covering the Western US and the Eastern US:
Attorneys from around the country will discuss the status cannabis laws, both adult use and medical, in Washington, Oregon, Colorado, Alaska, California--the West. Mitzi Vaughn, Kimberly Simms, and Leland Berger will cover the West.
The East is represented by Jeffrey McCourt, Dina Rollman, and Jason Klein.  Attorneys should attend these sessions to get a robust overview of the status of the laws in each state and a comparative view of the states.

NCBA Logo

The National Cannabis Bar Association is a non-partisan, non-profit organization formed in 2015 by a group of U.S. lawyers who saw a need to educate and connect with other cannabis industry attorneys for the purpose of providing excellent, ethical, and in advanced legal assistance to this growing industry. Our primary objectives are to educate and build community among lawyers serving the cannabis industry and to assist them in identifying the ethical guidelines that dictate their practices and business dealings within the industry. You can read more about the organization at www.canbar.org.
On the second day of the Institute, John Vardaman, Executive Vice President and General Counsel of Hypur, Inc., will discuss money laundering and banking issues in the cannabis industry. John was instrumental in devising federal policy for enforcing Bank Secrecy Act (BSA) and anti-money laundering (AML) laws while working at the Department of the Treasury and then at the Department of Justice. He also was involved in drafting the  DOJ guidance regarding financial crimes related to state legalization of cannabis, one of the few policies on the enforcement of federal law with respect to cannabis-related businesses. John was also instrumental in devising DOJ policy regarding the enforcement of laws governing the structuring of financial transactions.
View a full schedule of events and presentations here: http://www.canbar.org/cannabis-law-institute-1/

Single-day passes begin at only $399! Click here for more information and to purchase tickets and save now.

Check their website regularly or their Facebook page for updates on the schedule or contact us directly at info@canbar.org for more information about this program. Register early for substantial savings. Admission includes lunch and reception on Friday, and breakfast and lunch plus a reception on Saturday.

*CLE credits available in California, Colorado, and New York. *Contact us for information on other jurisdictions.*



“A majority of states now have comprehensive medical marijuana laws on the books, and a supermajority of Americans support letting patients access cannabis without fear of arrest. It’s well past time for Congress to modernize federal law so that people with cancer, multiple sclerosis and PTSD don’t have to worry about Jeff Sessions sending in the DEA to arrest them or their suppliers," Marijuana Majority founder Tom Angell said in a statement.

Thursday, June 22, 2017

Trump Commission Ignores the Role of Medical Cannabis in Fighting the Opioid Crisis


By Geoff Marshall, Americans For Safe Access News & Blog

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On June 16, President Trump’s Commission on Combating Drug Addiction and the Opioid Crisis held its first meeting to begin formulating recommendations on how to combat the opioid epidemic. The meeting provided compelling stories and thoughtful suggestions on how to resolve the opioid crisis. However, the suggestions that came out of this meeting were narrow; an increase in the availability and use of Naxolone or Narcan, which is a pharmaceutical that blocks the effects of opioids, further doctor education on the prescribing of opioids, and broad adoption of CDC guidelines and basing policy on evidence based research.
Unsurprisingly, medical cannabis was not mentioned once by any member of the Commission or any witness. Although Americans for Safe Access was not included on the list of invited nonprofits, we did submit comments to the commission urging them to consider using cannabis as a tool in the fight against opioids. In developing their recommendations to the President, the Commission will consider all comments that were submitted, both at the hearing itself and submitted in writing.
A major theme of the Commission was encouraging more research and developing evidence based policies. Unfortunately, the Commission appears to be selective in which evidence it is willing to believe. The evidence is clear. Medical cannabis can help the opioid crisis. A 2014 study indicated that in states with medical cannabis programs there was a 24.8% reduction in opioid deaths. A 2015 study found that in states with medical cannabis dispensaries there was a decrease in opioid deaths and opioid addictions. A studies from this year have indicated that there was a 13% decrease in hospitalizations related to opioid overdose in medical cannabis states and that patients spend significantly less on prescription medications in medical cannabis states compared to jurisdictions where cannabis remains illegal. These studies are only a few of many that clearly show cannabis can help reduce the number of preventable opioid deaths.
Jessica Nickel, of the Addiction Policy Forum, began her testimony to the Commission with the question “ What if we treated individuals through our healthcare system instead of our criminal justice system?” We need to pass legislation like the CARERS act so patients who use medical cannabis are no longer treated through the justice system. Patients who use medical cannabis for chronic pain in legal state run programs are not criminals and it is time they be treated as such.
The comments  of Americans for Safe Access are available in full here.
Ask your Congressional Members to co-sponsor the CARERS Act here.
The Commission's next meeting will be held on Monday, June 26, 2017 at 4:00PM. Members of the public may call in and listen via teleconference at (866) 233-3841, Access code 425352. Please call into the line five minutes before the call starts.


This article first appeared on safeaccessnow.org on June 16th 2017

Wednesday, June 21, 2017

Why Do States Make Patients Renew Medical Cannabis Cards Yearly?



The New Mexico Medical Cannabis Program is available to any New Mexico resident with certain medical conditions. A Primary Caregiver may be designated by the Qualified Patient to take responsibility for managing the well-being of the qualified patient in the use of medical cannabis. A qualified patient may also obtain a Personal Production License (PPL) to grow medical cannabis for personal use.
If you believe you have a debilitating medical condition that qualifies for the medical cannabis program, discuss your symptoms with your licensed physician.  A doctor has to recommend you to receive medical cannabis as treatment, so the doctor is not prescribing medical cannabis. And this does allow for any licensed physician or nurse practitioner, in New Mexico, to sign for your enrollment.  You must submit an application to New Mexico Department of Health’s Medical Cannabis Program administrator’s office along with all required forms.

Registry Identification Cards And 3 Year Renewals

Due to the qualifying conditions requirement into the medical cannabis program, the types of debilitating medical conditions that are part of the MCP, the nature of these debilitating medical conditions that qualify (and many others); it only makes sense from a medical standpoint to certify patients for a 3 year period in the medical cannabis program. The qualifying health conditions for the program are all ones that modern pharmaceutical pills failed to cure, provide relief and in many case made the conditions worse. That is why we are in the medical cannabis program as this form of medicine provides us the best option for for treatment in improving our health.
What is a chronic medical condition?
A chronic disease is one lasting 3 months or more, by the definition of the U.S. National Center for Health Statistics. Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor do they just disappear.
What is the meaning of debilitating?
Something that's debilitating seriously affects someone or something's strength or ability to carry on with regular activities, like a debilitating illness. Debilitating comes from the Latin word debilis, meaning "weak." That's why you'll often see the adjective used to describe illness, despite the negative reference.
Facts About The Medical Conditions That Qualify For The Medical Cannabis Program.
Patients in New Mexico diagnosed with one or more of the following medical conditions qualify into the program and are allowed legal protection under the Lynn and Erin Compassionate Use Act:
Amyotrophic Lateral Sclerosis (ALS) : Can't be cured, but treatment does help. Chronic: lifelong.
Cancer : Chronic disease, can be treated, & average treatment plan length 5 years or more.
Crohn’s Disease : Can't be cured, but treatment does help. Chronic: Lasting several years or lifelong.
Epilepsy : Is a chronic neurological disorder. Can't be cured, but treatment does help.
Glaucoma : Chronic, can't be cured, but treatment does help.  ( Can braille cards be printed ? )
Hepatitis C : Chronic, but treatment does help.
HIV/AIDS : Can't be cured, but treatment does help. Chronic: lifelong.
Huntington’s Disease : Can't be cured, but treatment does help. Chronic: lifelong.
Hospice Care :Palliation of a chronically ill, terminally ill or seriously ill patient's pain and symptoms.
Inclusion Body Myositis : Can't be cured, but treatment does help. Chronic: lifelong.
Inflammatory Autoimmune-mediated Arthritis Can't be cured, treatment does help. Chronic: lifelong.
Multiple Sclerosis Can't be cured, but treatment does help. Chronic: lifelong.
Damage to the nervous tissue of the spinal cord :No cure, treatment does help. Chronic: lifelong.
Painful peripheral neuropathy :Can't be cured, but treatment does help. Chronic: lifelong.
Parkinson’s disease :Can't be cured, but treatment does help. Chronic: lifelong.
Post-Traumatic Stress Disorder (PTSD) :Can't be cured, but treatment does help. Chronic: lifelong.
Severe Chronic Pain :Can't be cured, but treatment does help. Chronic: lifelong.
Severe Anorexia/Cachexia :Often a sign of disease, such as cancer, AIDS, heart failure, or advanced chronic obstructive pulmonary disease (COPD). Chronic but treatment does help.
Spasmodic Torticollis (Cervical Dystonia) :Can't be cured, but treatment does help. Chronic: lifelong.
Ulcerative Colitis: Can't be cured, but treatment does help. Chronic: lifelong.
All of these types of debilitating medical conditions have some common medical facts; treatment plan for 5 years if not lifelong, most all have no cure, all of them are chronic health conditions, and sadly some take a person’s life. They all also require a medical treatment plan with several visits to more than one medical practitioner throughout the course of a year.  
Patients, like myself, and all patients are currently required to renew their cards every year despite all of patients in the program having serious debilitating medical conditions that are chronic and will never go away. Nor do we need a yearly reminder of our health problems...once a patient is accepted into the program the registry and identification cards should be set at a 3 yr renewal basis and expire 3 years from entry into the program.
The Department can then do yearly address verification with a simple form, by mail, all while maintaining safe access to medical cannabis for patients in the program. The current “change of address” form used by the Department of Health could also be used here. Setting the registry for the program at 3 years will save the Department of Health money by reducing employee hours spent on this process yearly, reduced cost in printing, and office supplies cost. This will also strengthen the medical cannabis program by knowing patient registration numbers and additional statistics for 3 year periods.
For the patients with a personal production license, they could submit annually to the department a statement or form for address verification and to provide that nothing has changed from the initial PPL application that was approved.
The physician or practitioner that you receive your recommendation from should be a practiced, and licensed with medical and research experience (preferably cannabis related). While these doctors cannot “prescribe” cannabis, they can “certify” or “recommend” patients use medical cannabis that meets the criteria to be a qualifying patient.
Although it is easy to walk into a green, 4:20 themed “clinic” and pay a cheap price for a evaluation, there are some factors you should consider before doing so. If you are a patient looking to get the maximum benefit from cannabis as a medicine, the relationship between yourself and your medical cannabis doctor should be respected as much as in any other medical circumstance. For this reason, Americans For Safe Access advise staying away from these types of places many call, “bargain clinics.”  Make sure there are no extra fees associated with obtaining ID cards, or extra copies of the letter of recommendation. Patients should protect themselves from clinics that treat them “strictly as a business.”

The Santa Fe New Mexican reported that the New Mexico Medical Cannabis program has grown dramatically from 9,000 patients in 2013 to more than 43,000 today. The Department of Health estimates approximately 500 to 800 new patients join the program weekly. The tremendous growth of the Medical Cannabis Program with new program participants, an increase of 75% during 2016, so that currently means we have almost 45,000 patients benefiting from medical cannabis. The medical cannabis program office is currently processing applications in a 12-14 day range and recommends submitting renewal and new patient applications a minimum of 60 days prior to expiration to allow ample time for processing.

The Department of Health should certify patients under presumptive eligibility and set the registry for the program at 3 years for every patient. This will benefit both the patients, whom the program was created for, and benefit the Department of Health in a state that is looking for ways to save money.  
This year in the Roundhouse, Senate Bill 177, “Medical Marijuana Changes, proposed making it so if the patient’s debilitating condition is considered chronic, then reapplication would be required no sooner than three years from the date of issuance. However, if the condition is not chronic, reapplication would be no sooner than three years but the patient would be required to submit a statement from a practitioner annually. The 3 year card renewal was also amended out late as a floor amendment. During Committee Hearings, former Department of Health Medical Cannabis Advisory Board member, Dr. Rosenberg spoke out against making cards renewed at a 3 year cycle. Interestingly enough, after speaking out against allowing cards to be set to 3 yrs, Dr. Rosenberg left the Department of Health and resumed operating his medical office that issues medical cannabis cards charging some of the highest prices in New Mexico to get one. That was never disclosed to lawmakers in Committee Hearings either.

It was changed to be a written attestation, thus "written attestation" means a written statement from a qualified patient that: (1) states that the qualified patient has been diagnosed by a practitioner as having a debilitating medical condition; (2) states that the qualified patient continues to receive care from a practitioner for the debilitating medical condition in accordance with a schedule determined by that Practitioner; (3) states that the qualified patient's practitioner has indicated that the practitioner believes that the potential health benefits of the medical use of cannabis would likely outweigh the health risks for the patient; and (4) provides the name, telephone number and address for the qualified patient's practitioner; and
"SECTION 5. A new section of the Lynn and Erin Compassionate
Use Act is enacted to read:
[NEW MATERIAL] REGISTRY IDENTIFICATION CARD--RENEWAL.--A qualified patient shall renew the qualified patient's and that qualified patient's primary caregiver's registry identification cards on an annual basis by submitting to the department a written attestation."

New material legislators could add that truly allows the beneficial use of medical cannabis;
(22) “ any other chronic or persistent medical symptom that either substantially limits a person’s ability to conduct one or more of major life activities as defined in the Americans with Disabilities Act of 1990, or if not alleviated, may cause serious harm to the person’s safety, physical, or mental health.”  
The addition of that language in Part B (22) of the law, would open up the medical cannabis program allowing for more participants and expand safe access to medical cannabis. Major life activities as defined in the Americans with Disabilities Act of 1990, major life activities include, but are not limited to, caring for oneself, performing manual tasks, seeing, hearing, eating, sleeping, walking, standing, lifting, bending, speaking, breathing, learning, reading, concentrating, thinking, communicating, and working.

If your debilitating medical condition is not on the list of qualifying conditions, you are strongly encouraged to petition the Medical Advisory Board with a request to add a new condition not currently on the list of qualifying conditions. The Medical Cannabis Advisory Board convenes at least twice each calendar year to conduct public meetings and is made up of eight board certified practitioners.  The board is responsible for reviewing and recommending to the department additional conditions that would benefit from the medical use of cannabis, accepting and reviewing petitions to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the use of medical cannabis; recommending quantities of cannabis necessary to constitute an adequate supply, and issuing recommendations concerning rules to be promulgated for the issuance of registry identification cards.

As New Mexico works to define a model for adult use cannabis legalization, it must be one that protects and improves the state’s medical cannabis program and puts patients first as well, lawmakers have a lot of history to contend with. New Mexico’s medical cannabis history started in 1978 - After public hearings the legislature enacted H.B. 329, the nation’s first law recognizing the medical value of cannabis.