Sunday, July 28, 2019

So Tired of Still Fighting for Medical Cannabis Rights

So Tired of Still Fighting for Medical Cannabis Rights

It is now the year, 2019, and since the approval and implementation of the medical cannabis programs across the country, states have had to confront those seeking to profit from the commercial value of cannabis. This is happening instead of providing vulnerable medical patients, often with limited financial means, affordable medication to treat their conditions. Every year, patients are required to attempt to hold on to their initial rights along with hoping there are improvements of the programs based upon patient needs, rather than enhancing private profits or creating tax revenues for the states.

Like all states, many nights of long hours waiting to testify were behind the final approval of our program in Rhode Island thirteen years ago. At that time, the legislature showed compassion towards us and supported the program in the name of hoping to offer an alternative safe option to consider to help improve the quality of lives of many patients often suffering from lifelong afflictions. The question is why do we every year have to return to our statehouses to speak out in an effort to hold on to what we’ve already earned? Depending on the state, some patients have had to engage in a draining fight for any number of issues. To possess, grow, to be a caregiver, meet the qualifying condition list, the rising cost to run a compassion center which means higher cost to the consumer, the amount of medicine we are allowed to possess, fees for tags to grow, increased costs to register are some examples.

Ellen Lenox Smith

The answer is that the altruism of representatives, which was the driving force behind the establishment of the medical cannabis program, has been replaced by the drive for profit and expansion of tax revenue. As most states are attempting to improve their programs, unfortunately, it appears that the movement to expand the various programs has come to be dominated but individuals driven by commercialism, not compassion. The initial support and feeling of compassion are being replaced by those that see our medical issues as a way to make more money.


Those of us destined to confront serious and often chronic medical conditions on a daily basis already deal with having no access to medical coverage for cannabis and we also must confront the reality that the direction of these programs does not appear to be designed with the interests of patients in mind, as envisioned.

So, what to do?

How about this!

My Dream List:
  • Let doctors make the recommendation for possible use with their patient – stop all the inequitable qualifying conditions across the country
  • Get Cannabis out of Schedule I – allow research, use in hospitals, and giving comfort, confidence, legal support to the medical field and possible patients still leery due to the governments listing.
  • Allow all to make the choice to home grow or have a caregiver grow for them to stop others from making a profit off our medical issues along with the ability to have the strain compatible to our bodies in supply.
  • Make this medical use a required insurance coverage!
  • Stop trying to make a buck off of us and keep the cost down so people can afford to use it.
  • Stop the scare tactics, show compassion and allow those using for medical use treated with respect, not like drug addicts or illegal people using it.

All of us need to remember that state medical cannabis programs are there due to medical issues that are disrupting the normal flow of our lives. We have enough on our plate to then also have to worry if can afford our medication, find the strains compatible, continue to grow, travel to where we need to purchase, along with many other issues. To add having to continue advocating to hold on to our lifeline is just too much to keep taking on. So, let’s return to compassion, equality, and kindness of others to leave our programs alone, and not see this as a way to make a profit off our health and wellbeing.
“Issues such as access, police harassment, and the price and quality of medicine will still be relevant to the patient community despite the adoption of a policy of legalization for recreational use. The federal refusal to recognize the medical efficacy of cannabis causes more harm and difficulty for patients than any failure by local or state governments to adopt policies of legalization of cannabis for recreational use. Any system of regulation should not be built on the backs of current medical cannabis laws.
The legalization of cannabis for recreational use is a separate issue from safe and legal access to cannabis for therapeutic use. We caution policy makers against letting the debate surrounding legalization of cannabis for recreational use obscure the science and policy regarding the medical use of cannabis.” - Americans For Safe Access

May life be kind to you,

Ellen Lenox Smith

Author of: It Hurts Like Hell!: I Live With Pain– And Have a Good Life, Anyway, and My Life as a Service Dog!

Posted by National Pain Report on July 28, 2019 by Ellen Lenox Smith

Friday, July 26, 2019

Safe Access New Mexico Public Comment Provided to New Mexico Public Education Department for Safe Access to Medical Cannabis in Schools

Medical Cannabis in Schools Policy Currently Enacted in the United States

Safe Access New Mexico
Jason Barker

Thursday, July 25th 2019

Policy Division
New Mexico Public Education Department
300 Don Gaspar Avenue, Room 101
Santa Fe, New Mexico 87501
FX (505) 827-6520.

Background:The Public Education Department link for the new rules
The PED will hold a public hearing about it Friday, July 26, 2019 from 9 a.m. to 11 a.m. at Mabry Hall in Santa Fe.
The PED's notice of rulemaking is posted here. You can read public comments already submitted this summer here.

New Mexico Medical Cannabis Program Website:

Table of ContentsPg. 1 Cover Page
Pg. 2 - 3 Table of Contents and Policy Narrative
Pg. 4 Oklahoma City School District Medical Cannabis in Schools Policy
Pg. 4 - 5 Oklahoma Department of Health Medical Cannabis Program-Rules
Pg. 5 - 12 Oklahoma State Department of Education FAQ
Pg. 13 - 14 Maine - Kittery School District
Pg. 15 - 16 Illinois - Illinois State Board of Education
Pg. 16 - 20 New Jersey -NJ Dept. of Children and Families Policy Manual
Pg. 21 Pennsylvania - Pennsylvania Department of Health
Pg. 22 Florida - Broward County Public Schools Policy
Pg. 22 Policy Resources

Safe Access New Mexico appreciates the opportunity to provide comment on the pending rulemaking for the implementation of Senate Bills 204 Medical Cannabis in School and 406 Medical Cannabis Changes that passed during the 2019 Regular Legislative Session and was signed into law by Governor Michelle Lujan Grisham.

Safe Access New Mexico strongly supports Senate Bill 204 and the implementation of rules allowing for safe access to medical cannabis at schools. No school or school district in the US has ever lost any federal funding for allowing safe access to medical cannabis at school, nor has there been any problems.

New Mexico State PolicyFinal Version of Paloma’s Law (SB-204: Medical Cannabis in Schools):

Currently there are now Nine other states and one capital city with comprehensive medical cannabis programs allowing safe access to medical cannabis at school: Oklahoma City School District and these states; New Mexico, New Jersey, Maine, Washington, Colorado, Pennsylvania, Florida, Illinois and Virginia. 

No school or school district in the US has ever lost any federal funding for allowing safe access to medical cannabis at school, nor has there been any problems.
California and New York have active 2019 Legislation for Allowing Safe Access to Medical Cannabis in School.

Federal Policy: Protection for state medical cannabis laws, as provided in the Rohrabacher–Farr amendment, Sec. 538 of the “omnibus” appropriations bill. Every year, the federal budget in the US Congress (“omnibus” appropriations bill) includes a rider that continues to bar the DOJ from enforcing the federal marijuana ban in some circumstances pertaining to states who enact their own medical cannabis laws. This rider is also known as the Rohrabacher–Farr amendment.

Here is the full text of the rider: (
“SEC. 538. None of the funds made available under 4 this Act to the Department of Justice may be used, with respect to any of the States of Alabama, Alaska, Arizona, Arkansas, California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming, or with respect to the District of Columbia, Guam, or Puerto Rico, to prevent any of them from implementing their own laws that authorize the use, distribution, possession, or cultivation of medical marijuana.”

United States v. McIntosh: The federal Ninth Circuit Court of Appeals interpreted the quoted language to bar the DOJ from prosecuting individuals who manufacture, distribute, or possess marijuana in strict compliance with state medical cannabis laws.

Conant v. Walters (2002): The Ninth Circuit Court of Appeals held that the federal government could not punish, or threaten to punish, a doctor merely for telling a patient that his or her use of cannabis for medical use is proper. However, because it remains illegal for a doctor to "aid and abet" a patient to obtain cannabis or conspire with him or her to do so, the court drew the line between protected First Amendment speech and prohibited conduct as follows -- A physician may discuss the pros and cons of medical cannabis with his or her patient, and issue a written or oral recommendation to use cannabis within a bona fide doctor-patient relationship without fear of legal reprisal. There have been no such criminal or administrative proceedings against doctors to date. (

Recent Articles:
Article: New Mexico is now the 8th Medical Cannabis State to allow Safe Access to Medical Cannabis at Schools | April 11, 2019 | Americans For Safe Access |

Article: Understanding New Mexico’s Medical Cannabis in Schools Law | Wednesday, April 10, 2019 | Cannabis News Journal |

Article: A Parents and Caregivers Guide to New Mexico’s Medical Cannabis in Schools Legislation (Senate Bill 204) | Saturday, January 12, 2019 | Cannabis News Journal |

Medical Cannabis in Schools Policy Currently Enacted 
Oklahoma City Schools District
Oklahoma City School Board Policy (01-14-19):

The district will not regulate or take any adverse action against an employee for holding a medical marijuana license. The school district may take action against an employee who possesses a medical marijuana license if the employee uses or possesses marijuana while at school or during the hours of employment as per 63 O.S. § 425.

Students whose medical condition requires the use of medical marijuana are allowed to access and utilize marijuana in accordance with state law. School personnel are not legally permitted to administer medical marijuana to students. The district will provide a private location for a caregiver to administer medical marijuana to students at school. Oklahoma law limits who may act as a caregiver and any caregiver will have a medical marijuana license designating them to act on behalf of a student. The caregiver is responsible for bringing the medical marijuana to the qualifying student and promptly removing the medical marijuana from the premises after consumption or use.

Upon arriving at school, the caregiver will follow district protocol with regard to check in and departure.

There will be no smoking on school premises of any substance 24/7 in accordance with the state’s no smoking act. At no time will marijuana be grown or stored on school premises.

School employees will not under any circumstances:

a. Assist students in obtaining or using medical marijuana;

b. Store medical marijuana for students;

c. Take and/or use a student’s medical marijuana;

d. Serve as a student’s designated caregiver, unless the student is the child or in the legal custody of the employee.

The district reserves the right to discipline employees or students who fail to adhere to Oklahoma law and/or the requirements of this policy. Such disciplinary action will be addressed in accordance with the student discipline code and/or the standards of conduct for employees. Employees may be subject to termination or nonreemployment.

If a student has specific procedures regarding medical marijuana that are written into the student’s Individualized Education Program (IEP) and such procedures are consistent with state and federal law, those provisions will take precedent over this policy.

If the federal government declares that the District’s federal funds are jeopardized by this policy or asks the District to cease and desist the implementation of this policy, this policy shall be suspended immediately and the District will comply with any federal guidance and/or directives related to this policy.

Adoption Date: January 14, 2019”

Oklahoma Department of Health Medical Cannabis Program-Rules (Definitions):
"Public School" means an elementary, middle, or high school established under state law, regulated by the local state authorities in the various political subdivisions, funded and maintained by public taxation, and open and free to all children of the particular district where the school is located.

"Private School" means an elementary, middle, or high school maintained by private individuals, religious organizations, or corporations, funded, at least in part, by fees or tuition, and open only to pupils selected and admitted based on religious affiliations or other particular qualifications.

Oklahoma State Department of Education FAQ on Medical Cannabis in Schools:

“The Oklahoma State Department of Education (OSDE) has received a number of questions about how State Question 788 (now codified at 63 O.S. § 420A, et seq.) relates to public schools. This document is non-binding, does not create or impose a legal requirement and is not intended to serve as legal advice or to replace or supplement the advice of a school district’s retained legal counsel. Rather, it is general in nature in response to questions that the OSDE has received as of September 10, 2018. School districts, and their personnel, are urged to seek the legal advice of their respective licensed school attorney with regard to any legal issue(s) encountered, including the matters set forth below.

Best regards,

Joy Hofmeister”

“Student License Holder Services (Oklahoma)

9. Can a student self-administer medical marijuana on school property?

No. There is not a current Oklahoma law authorizing a student to use, possess and/or self-administer medical marijuana on school property. Oklahoma laws authorizing students to self-administer medication are limited to sunscreen, inhaled asthma medication and anaphylaxis medication. See 70 O.S. §§ 1-116.2 - 1-116.3.

10. Can school personnel, including but not limited to a school nurse, possess (on behalf of) and/or administer medical marijuana to a student?

No. Some states, such as Colorado and Illinois, have enacted statutes specifically authorizing school personnel, including school nurses, to store, possess and administer medical marijuana to a license holder. However, in Oklahoma, there is not a current law authorizing school personnel to administer medical marijuana. Oklahoma laws authorizing a school nurse, or other designated school employee in absence of a school nurse, to administer are limited to a filled prescription medicine (defined by 59 O.S. § 353.1), assisting in the application of sunscreen and administering a nonprescription medicine. See 70 O.S. § 1-116.2.

11. Can a parent/guardian administer medical marijuana treatments to a student license holder while on school property?

Marijuana (in any form) remains a controlled illegal substance under federal law, and federal program assurances that are signed in exchange for the receipt of federal funds remain unchanged and continue to require that districts assure that they are compliant with the Safe and Drug Free Schools Act and the Drug Free Workplace Act. As such, a district authorizing the possession, use or administration of medical marijuana is at risk of losing (and having to repay) federal funds. It should be noted, however, that we are not aware of a state with a marijuana authorization law (medical or otherwise), or a school district in such a state, that has lost or been required to repay federal funds as a result of its authorizing the possession, use or administration of marijuana on school property consistent with that state’s law.

As clear as the prohibition in federal law is, equally clear is that as a part of State Question 788, Oklahomans affirmatively put in state law that if an individual meets the requirements to have a license, that individual, including qualifying minors, shall have access to medical marijuana. Further, neither in State Question 788 nor in the Department of Health’s administrative rules are there limitations on a patient license holder having access to and/or receiving treatments on school property. Notably, State Question 788 and the Department of Health’s rules contain limitations on medical marijuana dispensaries being located within a certain distance (1,000 feet) of school property. This absence of a restriction in one part of the provisions, and affirmative placement of a restriction on dispensaries in another part (see Question 4 above), indicates Oklahomans’ intent that there are not to be restrictions on a patient license holder’s access to medical marijuana on school property.

In light of the foregoing, school districts may adopt a policy authorizing a student license holder to have access to his or her medical treatment on school property. If a district adopts such a policy, a student’s parent(s), legal guardian and/or caregiver should be permitted to bring an appropriate dosage of a student’s recommended medical marijuana product(s) to the school for the parent/legal guardian/caregiver (as applicable) to administer to the student.

Additionally, if a district adopts such a policy, the school should establish a place for a parent/legal guardian/caregiver to meet the student and administer the student’s dosage of medical marijuana product(s). In the same manner, schools must provide an appropriate space for the administration of insulin injections or space for a student to nurse or express milk for an infant. (This could be one designated space for all such student medical needs, or separate spaces, depending on the school’s available space and any relevant scheduling or privacy considerations.) Further, a school district policy should require that a record be kept of the name of the student to whom the medicine was administered, the date the medicine was administered, the dosage administered and the name of the person who administered the medicine.

12. If a district adopts a policy authorizing the administration of medical marijuana on school property, what should be included in the policy?

As a part of any policy, schools should require a parent/legal guardian/caregiver (as applicable) to provide the current and valid license for the student, any caregiver license(s) associated with the student, and a written authorization form, to include the following as applicable:

Copy of the student’s current and valid medical marijuana license and any associated caregiver’s license;
Purpose of the medication;
Time to be administered;
Dosage to be administered;
Termination date for the administration of the medicine;
Side effects to be observed, if any, the management of such effects and student allergies to food and/or medicine;
Emergency instructions, as appropriate;

Written acknowledgement assuming all responsibility for the provision, administration, maintenance and use of medical marijuana under state law, and release of liability for any injury, personal or otherwise, to a student which results from the acts or omissions of the parent/guardian/other licensed caretaker in administering or possessing the medical marijuana; and,

Other appropriate information.

13. Are there barriers to enrollment or access to instructional services based on the qualification for a medical marijuana license or use of medical marijuana by a student patient license holder?

No. Students may not be denied enrollment or services by a public school district or charter school based on their holding of a license. In fact, State Question 788 expressly provides that a school shall not refuse to enroll and may not otherwise penalize a person solely for his or her status as a medical marijuana license holder, unless failing to do so would imminently cause the school to lose a monetary benefit under federal law or regulations.

14. Are there restrictions on smokable medical marijuana and medical marijuana products?

Yes. All smokable, vaporized, vapable and e-cigarette medical marijuana and medical marijuana products ingested, smoked or consumed by a patient license holder are subject to the same restrictions for tobacco under 63 O.S. § 1-1521 et. seq., (i.e., the Smoking in Public Places and Indoor Workplaces Act.)

15. What do these restrictions mean as they relate to school and/or school property?

The same prohibitions that exist relating to the use of tobacco in schools and/or on school property now also extend to all smokable, vaporized, vapable and e-cigarette medical marijuana on such property. As such, and because the Smoking in Public Places and Indoor Workplaces Act and the 24/7 Tobacco-free Schools Act (70 O.S. § 1210.213) prohibit the use of tobacco (now inclusive of all smokable, vaporized, vapable and e-cigarette medical marijuana), these forms of medical marijuana may not in any instance be used or consumed by a patient license holder (adult or minor) on school property.* School property includes, but is not limited to, buildings, physical grounds, motor vehicles and any school-sponsored or school-sanctioned event or activity. See 70 O.S. § 1210.212.

*Note: Notably, this prohibition does not extend to other forms of medical marijuana, such as edible.

16. Are there restrictions on a minor’s use of medical marijuana?

Yes. In addition to the aforementioned prohibitions on the smoking or vaping of medical marijuana in a public place (including a public school), under no circumstance shall a minor patient license holder be authorized to consume, smoke or inhale any smokable or vapable medical marijuana or smokable or vapable medical marijuana products, unless both recommending physicians agree it is medically necessary. See OAC 310:681-2-2(c).

17. Can a school district conduct a random drug testing program of students participating in interscholastic competitions and extra-curricular activities?

Yes. Consistent with the U.S. Supreme Court ruling in Board of Education of Independent School District No. 92 of Pottawatomie County et al v. Earls et al, 536 U.S. 822 (2002) and other court decisions, a school district may implement and conduct a random drug testing program of students participating in interscholastic competitions and extra-curricular activities requiring registration with the Oklahoma Secondary Schools Athletic Association (OSSAA).

A school district conducting a random drug testing program for such students should adopt a policy relating to the scope of such drug testing program, the activities within the scope of the random selection method, what substance(s) are included as being in violation of the policy and any consequences of violation(s). Importantly, any adopted policy should be provided to students and parents/guardians/caregivers.*

*Note: A school district conducting a random drug testing program may adopt a policy providing that a student with a medical marijuana license will not be subject to penalties or loss of privileges associated with testing positive for medical marijuana or its components, other than eligibility restrictions imposed by an outside organization that are beyond the control of the school district. See also Question 18.

18. What policies can school districts put in place relating to a student patient license holder participating in interscholastic athletics and/or extra-curricular activities?

The OSDE does not regulate or oversee secondary interscholastic school activities in the state; rather, this is done through the OSSAA and other associations charged with overseeing such activities (i.e., FFA, FCCLA, etc.). As such, any questions relating to medical marijuana and its relation and/or effects on interscholastic school activity participation should be directed to the OSSAA or the respective organization charged with overseeing such activity.*

A school district may establish its own policies regarding district- or school-specific activities that do not involve competition between schools and do not fall under the authority of OSSAA or other organization (as applicable).

*Note: Marijuana is on the banned substances list for the NCAA, and there is not yet an exemption for medical use – some student-athletes at the college level have lost eligibility through recommended use under medical oversight. It may be advisable for any school district policies that permit student-athletes to compete while testing positive for cannabinoids due to recommended medical use to include language in their policy putting students on notice of NCAA's total prohibition.

Employment & Human Resources

19. Can employers discriminate against a person in hiring, termination, or other employment matters?

No. State Question 788 provides:

Unless a failure to do so would cause an employer to imminently lose a monetary or licensing related benefit under federal law or regulations, an employer may not discriminate against a person in hiring, terminating or imposing any term or condition of employment or otherwise penalize a person based upon the person’s status as a medical marijuana license holder. See State Question 788.

20. What if an employee exhibits reasonable suspicion of being under the influence of drugs in the workplace? Can an employer take action then?

Yes. State Question 788 further provides:

Employers may take action against a holder of a medical marijuana license if the holder uses or possesses marijuana while in the holder’s place of employment or during the hours of employment. Employers may not take action against the holder of a medical marijuana license solely based upon the status of an employee as a medical marijuana license holder or the results of a drug test showing positive for marijuana or its components.

School districts may adopt policies prohibiting any and all employees – medical marijuana license holder or otherwise –from using, possessing or being under the influence of marijuana while on school district property or while performing duties for the district. Further, districts may adopt policies for medical marijuana similar to those that may already be in existence prohibiting an individual from being under the influence of alcohol or a controlled dangerous substance as defined in 63 O.S. § 2-101.

To the extent an employer implements a drug-testing program of potential and/or current employees, school districts are encouraged to adopt a policy prohibiting the taking of any action against such applicant or employee based on their status as a medical marijuana license holder. Should an individual test positive for cannabinoids, districts should allow the individual an opportunity to provide evidence of a current and valid medical marijuana license.

21. How, if at all, might State Question 788 impact school district decisions relating to employment of bus drivers?

An individual must possess a Commercial Driver License (“CDL”) in order to legally drive and operate a school bus. CDL holders are regulated by state and federal law. While medical marijuana has been legalized in Oklahoma, federal law does not make an exception for possession or use of medicinal marijuana by an individual with a CDL. In fact, CDL holders are prohibited from failing a drug and alcohol test due to the fact they are in a “safety-sensitive” position. The U.S. Department of Transportation’s drug and alcohol testing regulations do not authorize medical marijuana use under a state law to be a valid medical explanation for a transportation employee’s positive drug test result.

Further, while Oklahoma employers may not make adverse hiring decisions based solely on an individual’s status as a medical marijuana license holder, an employer may make a hiring decision based on the fact that an applicant is not qualified for a certain position (i.e., school bus drivers must possess a valid CDL and provide a negative drug screening in order to be qualified). Finally, bus drivers and bus maintenance employees who are required to have a CDL could be subject to random drug testing.

22. How will SQ 788 affect drug testing employees, including bus drivers?

Random drug testing of a school employee, other than those in a “safety-sensitive” position, has been held to be unconstitutional by several courts. However, for those in a “safety-sensitive” position, such as a bus driver, bus maintenance employee or one required to have a CDL, that employee may be subject to random testing.

Cannabidiol (CBD)

23. Is cannabidiol (CBD) the same thing as medical marijuana?

No. Cannabidiol or “CBD” is a derivative of the cannabis plant that also has therapeutic uses, but is not included in Oklahoma’s state definition of “marijuana.” It is therefore not subject to the same restrictions as medical marijuana. By definition, CBD can contain only up to a trace amount of tetrahydrocannabinol (THC), the main psychoactive component of marijuana, so CBD products have no psychoactive effects. This is Oklahoma’s statutory definition for cannabidiol:

“ ‘Cannabidiol’ means a nonpsychoactive cannabinoid found in the plant Cannabis sativa L. or any other preparation thereof, that has a tetrahydrocannabinol concentration of not more than three-tenths of one percent (0.3%) and that is delivered to the patient in the form of a liquid” (63 O.S. § 2-801(3)).

Under state law, only specific uses are authorized for CBD with a detectable THC content (though it must always be below 0.03%). CBD that contains no detectable THC content, however, is commonly sold and used in Oklahoma with few restrictions. In general, the cannabidiol products sold in Oklahoma’s “CBD shops” do not contain detectable THC.

Under federal law, cannabidiol does not have a separate status from other marijuana derivatives, and so is still classified as a Schedule I controlled substance – even when it contains no THC. While legalization of CBD at the federal level has been discussed as a likely possibility, at this time it is still only explicitly legal at the state level under the conditions of state law.

24. Can school districts have different policies for CBD and medical marijuana?

Yes, but separate policies are not necessary. While students may not be restricted from enrolling in or attending public school due to their use of either category of cannabis-derived treatments, because they are classified differently under Oklahoma law, it is permissible for school districts to have different policies addressing CBD and medical marijuana. It is, however, not required for a school district to have a different policy governing CBD, and a district may adopt one policy that applies to both medical marijuana and CBD as long as the policy appropriately protects a student’s access to both school district services and recommended medical treatments.

25. Could CBD products be included in a school district’s general policy on the storage and administration of prescription and non-prescription drugs?

This determination must be made by a school district. There are no provisions of state law that would either require a school district to treat CBD as equivalent to other non-prescription medications, nor prohibit a district from doing so. For CBD, which is not classified as “marijuana” in Oklahoma, this appears to be a local decision. School districts should be aware that cannabidiol has not yet been clearly excluded from the Controlled Substances Act at the federal level, although drug enforcement action involving CBD is unlikely, and clarification of its status is expected to occur in the coming years.

If a school district chooses to consider CBD a non-prescription medication parents/legal guardians may authorize a school to store and administer, the requirements of 70 O.S. § 1-116.2 would apply in addition to any specific policies adopted by the district. Because of the uncertain federal status of cannabidiol, a school district should not compel a school nurse to administer CBD if the school nurse is not comfortable administering it. In such a case, a district that chooses to consider cannabidiol a non-prescription medication should ensure that a parent/guardian’s written authorization for the school to administer CBD gives explicit permission to an administrator or a non-nurse school designee to administer the student’s CBD dosage. All directions for use must be included in the parent/guardian’s written authorization.

If a school district does not choose to consider CBD a non-prescription medication subject to 70 O.S. § 1-116.2 and associated policies, and does not adopt a specific policy addressing how students may access their CBD treatments, then students who are treated using cannabidiol should be permitted to access their CBD treatments in the same manner as the district provides for access to medical marijuana treatments for qualifying students.

If you have additional questions, please contact OSDE's Office of Legal Services at (405) 521-4906.”

Kittery School District / Kittery School Committee for Kittery School (Kittery, MA )

Current Rules used by a School District in Maine:

The Kittery School Committee recognizes that there may be some students in the Kittery
School District who rely on the use of medical marijuana to manage a medical condition and who may be unable to effectively function at school without it.

The Maine Medical Use of Marijuana Act governs administration of medical marijuana in schools in Maine. The Department of Administration and Financial Services (“DAFS”) is the regulatory agency charged with implementing the Maine Medical Use of Marijuana Act. The Maine Medical Use of Marijuana Program, located within DAFS, is charged with the Administrative duties associated with implementation, such as issuance of registration cards. The following procedure must be followed for the administration of medical marijuana to students at school.

1. The student’s parent/legal guardian/legal custodian shall obtain a copy of the Kittery
School District’s Request to Administer Medical Marijuana in School Form and
School Committee Policy JLCD from the school nurse.

2. The parent/legal guardian/legal custodian and the student’s authorized medical
provider (physician, certified nurse practitioner or physician assistant) shall complete
and sign the Request Form, and attach a copy of the student’s current written
certification for the use of medical marijuana. The original certification must be
shown to the school employee processing the request. A copy will be retained by the

3. The parent/legal guardian/legal custodian must designate the caregiver who will
administer medical marijuana to the student in school (including for students over the
age of 18). The designated caregiver must be registered with the Maine Medical
Marijuana Program. The original registry identification card and caregiver
designation form must be shown to the school employee processing the request.
Copies will be retained by the school.

4. If the designated caregiver is not a parent/legal guardian/legal custodian of the
student, the designated caregiver must also submit verification that he/she is
authorized by the State to administer marijuana to the student on school grounds.

5. Arrangements will be made between the school administration and the designated
caregiver to schedule the administration of medical marijuana in a manner that will
minimize disruption to school operations and the student’s educational program, and
that will not impact other students or employees. The designated caregiver must
comply with all School Committee policies and school rules while on school
premises to administer medical marijuana to a student.

6. Medical marijuana must be brought to school by the caregiver, and may not be held,
possessed or administered by anyone other than the caregiver. The student may only
possess the medical marijuana during the actual administration process. Medical marijuana administered in school must be in nonsmokeable form (vaporizers are not

7. The designated caregiver must check-in at the school office upon arrival for the
administration of medical marijuana. Medical marijuana may only be administered
in a private, designated area and must be observed by a school designee.

8. The designated caregiver must check-out at the school office following
administration of the medical marijuana and transport any remaining medical
marijuana with him/her off school premises.

A student who holds written certification for the medical use of marijuana may not be
excluded (suspended or expelled) from school because he/she requires medical marijuana to
attend school.

Cross Reference: JLCD - Administration of Medication to Students
JLCDA-E - Administering Medical Marijuana in Schools Form
Legal Reference: Maine 2015 P.L. Ch. 369
Adopted: March 15, 2016
Revised: March 19, 2019

Law passed in Maine:

Illinois State Board of Education

“ Use of Medicinal Marijuana Public Act 98-0122, an amendment to the Compassionate Use of Medical Cannabis Pilot Program Act, allows a student to use medicinal cannabis under certain conditions. For more information, go to the Illinois Department​ of Public Health.​​​​​

Ashley’s Law – Ensuring Access to Medical Cannabis for Registered Patients Under Age 18
Effective August 1, 2018, Public Act 100-0660, also known as Ashley’s Law, amends the School Code to allow students registered with the Illinois Medical Cannabis Pilot Program access to medical cannabis-infused products at school or on the school bus. A parent or guardian with a designated caregiver registry identification card issued by IDPH may administer the product to the student. After the student is given the medical cannabis-infused product, it must be removed from the school premises or school bus. Registered qualifying patients under age 18 cannot smoke or vape medical cannabis. Medical cannabis-infused products include oils, ointments, foods, and other products that contain usable cannabis but are not smoked or vaped.

Only students who are registered qualifying patients under the Compassionate Use of Medical Cannabis Pilot Program are eligible to use these products, and both the student and the designated caregiver must have a registry identification card. Minors are eligible to register with the program if a physician has diagnosed them with a qualifying debilitating medical condition. A medical cannabis registered patient under age 18 is required to have a designated caregiver; usually a parent or guardian. The designated caregiver must be at least 21 years old and meet other requirements under the law:

A parent or guardian or other individual may not administer a medical cannabis infused product under this Section in a manner that, in the opinion of the school district or school, would create a disruption to the school's educational environment or would cause exposure of the product to other students.

A school district or school may not discipline a student who is administered a medical cannabis infused product by a parent or guardian or other individual under this Section and may not deny the student's eligibility to attend school solely because the student requires the administration of the product.

A school district, public school, charter school, or nonpublic school may not authorize the use of a medical cannabis infused product under this Section if the school district or school would lose federal funding as a result of having such a policy.

A school district, public school, charter school, or nonpublic school shall adopt a policy to implement these requirements.”

New Jersey
New Jersey Department of Children and Families Policy Manual

“A. OBJECTIVE To provide Department of Children and Families (DCF) Regional Schools with a policy and procedures for implementing P.L. 2015 c. 158, which supplements the New Jersey Compassionate Use Medical Marijuana Act.

B. STANDARDS The use of medical marijuana shall be permitted on school grounds, on a school bus, on a field trip and at a school-sponsored function to authorized students enrolled in Department of Children and Families (DCF) Regional Schools.

A parent, guardian or primary caregiver as defined in this policy, shall be the only individuals who may administer medical marijuana to his/her child.

A student who is 18 years of age or older may self-administer medical marijuana according to the conditions of this policy.

Medical marijuana shall be in a nonsmokable and non-inhalation form for students.

Authorized student: means a student who is a qualifying patient for medical marijuana in a nonsmokable, non-inhalation form, issued by his/her primary care physician.

Bona fide physician-patient relationship: means a relationship in which the physician has ongoing responsibility for the assessment, care and treatment of a patient’s debilitating medical condition.

Certification: means a statement signed by a physician with whom a qualifying patient has a bona fide physician-patient relationship, which attests to the physician’s authorization for the patient to apply for registration for the medical use of marijuana.

Medical use of marijuana: means the acquisition, possession, transport, or use of marijuana or paraphernalia by a registered qualifying patient as authorized by the New Jersey Compassionate Use Medical Marijuana Act, except that for school students, the marijuana shall be in a nonsmokable, non-inhalation form.

Physician: means a person licensed to practice medicine and surgery pursuant to Title 45 of the Revised Statutes with whom the patient has a bona fide physician-patient relationship and who is the primary care physician, hospice physician, or physician responsible for the ongoing treatment of a patient’s debilitating medical condition, provided, however, that such ongoing treatment shall not be limited to the provision of authorization for a patient to use medical marijuana or consultation solely for that purpose.

Primary caregiver: means a resident of the State who:
a. is at least 18 years old;
b. has agreed to assist with a registered qualifying patient's medical use of marijuana, is not currently serving as primary caregiver for another qualifying patient, and is not the qualifying patient's physician;
c. has never been convicted of possession or sale of a controlled dangerous substance, unless such conviction occurred after the effective date of this act and was for a violation of federal law related to possession or sale of marijuana that is authorized under this act;
d. has registered with the New Jersey Department of Health pursuant to section four of the New Jersey Compassionate Use Medical Marijuana Act, and has satisfied the criminal history record background check requirement of section four of that act; and
e. has been designated as primary caregiver on the qualifying patient's application or renewal for a registry identification card or in other written notification to the New Jersey Department of Health.

Qualifying patient: means a resident of the State who has been provided with a certification by a physician pursuant to a bona fide physician-patient relationship.

Registry Identification Card: means a document issued by the New Jersey Department of Health that identifies a person as a registered qualifying patient or primary caregiver.

1. Establishing the status of a student as an “authorized student”:
a. The student shall be a qualifying patient for medical marijuana in a nonsmokable, non-inhalation form, issued by his/her primary care physician, pursuant to a bona fide physician-patient relationship.
b. The student’s parent/guardian shall provide to the Regional School’s nurse and Education Supervisor (ES) a copy of the certification statement for both the student and herself/himself or other authorized primary caregiver as a person authorized to administer the medication. The certifications shall have been signed by the student’s physician. The nurse shall retain the copies of the certifications in the student’s medical record. A student who is 18 years of age or older may also provide the certification statement when he/she has been issued this.
c. The parent/guardian shall present the Registry Identification Cards for the student and the parent, guardian, other authorized primary caregiver to the school’s nurse. The nurse shall make a photocopy of the Cards and retain them in the student’s medical record. A student who is 18 years of age or older may also provide the Registry Identification Card when he/she has been issued this.
d. The parent/guardian shall provide a copy of the prescription for the medical marijuana to the school’s nurse since the dispensing agent is required to retain the original prescription. The nurse shall retain a copy of the current prescription in the student’s medical record. A student who is 18 years of age or older may also provide the prescription when he/she has been issued this.
e. The nurse shall verify the registration status of the student and the parent/guardian/primary caregiver by visually checking the dates listed on the student and the parent/guardian/primary caregiver’s Registry Identification Card.
f. The nurse shall verify the registration status and ongoing authorization of the student and parent, guardian and authorized primary caregiver to ensure the Registry Identification Cards, certifications and prescriptions are current and valid by conferring with the physician’s office and the New Jersey Department of Health, as necessary.

2. Administering medical marijuana to an authorized student in school, on a school bus, on a field trip or at a school-sponsored function:
a. The student’s parent, guardian, or authorized primary caregiver or a student who is 18 years of age or older shall administer the medical marijuana in the nurse’s office if the medication is given at a time when the student is in the school building. The parent, guardian or authorized primary caregiver shall sign a log book maintained by the nurse, for each visit to the school building.
b. Prior to the parent, guardian or authorized caregiver or a student who is 18 years of age or older administering any dose of medical marijuana, the school’s nurse shall review all Administration of Medication/Treatment Record information and any “Record of Medical Marijuana Administered in Locations Outside of the Regional School Building” (Attachment 1) to ensure the dosage(s) being given is within the guidelines of the physician’s orders.
c. The school’s nurse shall witness the administration of the medical marijuana and note that the parent or student who is 18 years of age or older administered the medication and write this remark within the Administration of Medication/Treatment Record.
d. If the medical marijuana is given by the parent, guardian, or authorized primary caregiver or a student who is 18 years of age or older in a location other than the Regional School building, the following procedures shall be implemented.
i. On a school bus, the parent, guardian, or authorized primary caregiver or a student who is 18 years of age or older shall discreetly give the prescribed dose while the bus is stopped/parked. A regional school staff member shall witness the medication being given. The date, time and other designated information shall be recorded on the “Record of Medical Marijuana Administered in Locations Outside of the Regional School Building” (Attachment 1) by the staff member.
ii. On a field trip, the parent, guardian, or authorized primary caregiver or a student who is 18 years of age or older shall discreetly give the prescribed dose in an area that is outside of the view of other students but within the view of a regional school staff member who shall witness the medication being given. The date, time and other designated information shall be recorded by the staff member on Attachment 1.
iii. At a school-sponsored function, the parent, guardian, or authorized primary caregiver or a student who is 18 years of age or older shall discreetly give the prescribed dose in an area outside of the view of other students but within the view of a regional school staff member who shall witness the medication being given. The date, time and other designated information shall be recorded by the staff member on Attachment 1.
iv. The Regional School staff member who witnesses the administration of the medication in locations outside of the school building shall provide the school’s nurse with the written record Attachment 1 as soon as practically possible. The nurse shall retain this copy in the section of the Administration of Medication/Treatment Record in the student’s health record.

3. The designation of a DCF Regional School nurse or any other employee, contracted person, volunteer or intern as a primary caregiver for administering medical marijuana is expressly prohibited.

4. The school’s nurse shall routinely inform the ES of the ongoing status of any student who is authorized for the use of medical marijuana.

5. The parent/guardian of a student who is an authorized student with a valid prescription for medical marijuana shall be provided with a copy of this policy.

6. A student who is 18 years of age or older who is an authorized student with a valid prescription for medical marijuana shall be provided with a copy of this policy.


Kelley Michalowski

Attachment For Field Trips and School Functions of Campus: A-1 Record of Medical Marijuana Administered in Locations Outside of the Regional School Building”

Printable PDF of the New Jersey Issuance:

Pennsylvania Department of Health Guidance for Schools and School Districts

The Pennsylvania Departments of Health and Education support the administration of medical marijuana under a Safe Harbor Letter to students with serious medical conditions and the maintenance of a safe environment for other students while on school property. The below guidance provides information to school administrators to assist them in developing policies for the administration of medical marijuana on school property.

Recommended Guidance: A parent, legal guardian or caregiver may administer medical marijuana to their child/student on school premises provided that the parent, legal guardian or caregiver: (1) provides the school principal with a copy of the Safe Harbor Letter; and (2) notifies the school principal, in advance, of each instance in which the parent or caregiver will administer the medical marijuana to the child/student. The school principal shall provide notification to the school nurse in each instance a parent or caregiver will be administering medical marijuana to the child/student as well. The parent/caregiver shall follow all school protocols applicable to visitors to the school during the school day. A parent, legal guardian or caregiver shall bring to the school and administer the medical marijuana to their child/student without creating a distraction, and shall promptly remove any excess medical marijuana and related materials from the school premises after the administration of medical marijuana is complete. The school shall provide a secure and private location for the parent/legal guardian/caregiver to administer the medical marijuana to the student. Students themselves shall not be permitted to possess any form of medical marijuana at any time on school property or during any school activities on school property.

Expiration: The recommended guidance will remain in effect until the Pennsylvania Department of Education promulgates regulations regarding the possession and use of medical marijuana in the commonwealth's schools.

Broward County Public Schools Policy (6th Largest Public School System in the US)
Medical Marijuana/Low THC Cannabis Use To Qualified Students In Schools Policy 6305.1 (23 Page Slide Presentation)

Policy Resources (

Americans For Safe Access:

Tuesday, July 23, 2019

Accredited CME Credits for Medical Cannabis Medical Professionals Now Available through Cannabis Care Certification Program

Americans for Safe Access Partners with to Provide Continuing Medical Education (CME) Credits for Medical Professionals

Washington, DC -- Americans for Safe Access (ASA) announced today a partnership to provide continuing medical education (CME) credits for medical professionals through their Cannabis Care Certification (CCC) website. The CCC Comprehensive Medical Cannabis Curriculum, created by The Answer Page, Inc. (TAP), introduces the endocannabinoid system and its interaction with the components of the cannabis plant, and addresses administration, therapeutic use, drug metabolism, physiologic and cognitive effects, potential risks, and drug interactions of cannabinoid-based medicines.
The CCC program has offered education for patients and caregivers since 2016. This new course offering created for medical professionals was approved under the latest rules for dealing with controversial subjects in CME programs and provides physicians, pharmacists, nurse practitioners, nurses, and psychologists with the highest quality peer-reviewed and accredited educational content focused on medical marijuana and the endocannabinoid system. The content provides Accreditation Council for Continuing Medical Education (ACCME), Accreditation Council for Pharmacy Education (ACPE), American Academy of Nurse Practitioners (AANP), American Nurses Credentialing Center (ANCC), and American Psychological Association (APA) credits. 
The content and its presentation are designed to be of educational value and interest for those new to medical cannabis, as well as for those with years of experience in this area of clinical practice.Those who enroll in the course through the CCC website using code CCC2019 receive:
  • Membership to the Cannabis Care Certification (CCC) Program for medical professionals
  • Full access to TheAnswerPage’s CCC Comprehensive Medical Marijuana Curriculum for 12 months
  • The ability to earn CME/CE credit for physicians, pharmacists, nurse practitioners, nurses, psychologists, as well as other healthcare professionals
  • Full access to the “Cannabis Care Certification Patient and Caregiver” suite of educational videos
  • “Cannabis Care Certification” Certificate of Completion
  • Eligibility for being placed on the referral list for patients seeking doctors with Cannabis Care Certification training
  • Resources for medical professionals including:
    • Current information on state-by-state requirements for recommending medical cannabis.
    • Overview of federal laws and memos concerning medical professionals and cannabis.
    • Educational material for patients

“TheAnswerPage is the resource that I recommend for accredited education on the endocannabinoid system, medical cannabis, opioid prescribing, and pain medicine,” Professor Raphael Mechoulam, Faculty of Medicine of The Hebrew University of Jerusalem and member of the Israel Academy of Science.
“More than half of the country--33 states and counting--now has access to medical cannabis. It is essential for medical professionals to obtain education on the endocannabinoid system and medical cannabis in order provide needed guidance to their patients,” said Debbie Churgai, Interim Director of Americans for Safe Access. “Patients look to their health professionals for medical recommendations. Cannabis should be treated like any other medicine that patients can discuss openly with their health practitioners,” she said. 
For more info visit,

Americans for Safe Access
Americans for Safe Access (ASA), a national nonprofit (501(c)(3)), is the largest national member-based organization of patients, medical professionals, scientists and concerned citizens promoting safe and legal access to cannabis for therapeutic use and research with over 100,000 active members in all 50 states.
TheAnswerPage is a medical education resource that has been providing the highest quality accredited education to the healthcare community for over two decades. Awarded in the US and internationally, TheAnswerPage is now a recognized leader for providing comprehensive education on the endocannabinoid system and medical cannabis, pain medicine and opioid prescribing practices. 

Thursday, July 18, 2019

Congressional Members Introduce the Medical Marijuana Research Act of 2019

Washington, DC – U.S. Representatives Andy Harris, M.D. (R-MD), Earl Blumenauer (D-OR), Zoe Lofgren (D-CA), H. Morgan Griffith (R-VA), Debbie Dingell (D-MI), and Rob Bishop (R-UT) on July 17th introduced the Medical Marijuana Research Act of 2019. This bill addresses burdensome processes that currently impede legitimate medical research on marijuana. This bipartisan piece of legislation would amend the Controlled Substances Act to establish a new, separate registration process to facilitate research with marijuana for medical purposes.

“As a physician who has conducted NIH-sponsored research, I cannot stress enough how critical this legislation is to the scientific community. Our drug policy was never intended to act as an impediment to conducting legitimate medical research. If we are going to label marijuana as medicine, we need to conduct the same rigorous scientific research on efficacy and safety that every other FDA-approved treatment undergoes. This legislation will facilitate that research by removing the unnecessary administrative barriers that deter qualified researchers from thoroughly studying medical marijuana,” said Dr. Harris.

“47 states have legalized some form of cannabis, yet the federal government is still getting in the way of further progress on the potential for research,” said Rep. Blumenauer. “We owe it to patients and their families to allow for the research physicians need to understand marijuana’s benefits and risks and determine proper use and dosage.”

“While the definitive medical benefits of marijuana remain largely uncertain, it is important we remove the bureaucratic barriers which stand in the way of legitimate research,” said Rep. Bishop. “Many important questions remain unanswered. This legislation allows scientists and researchers to get at those answers in a responsible manner that isn’t hindered by unnecessary roadblocks.”

“There is evidence of marijuana’s potential medicinal benefits in treating conditions including cancer, epilepsy, and glaucoma,” said Rep. Griffith. “In order to move forward in evaluating the medicinal value of medical marijuana and determining its accompanying side effects, it is critical that we remove barriers to research. To that end, I am pleased to join in reintroducing this bipartisan legislation. The Medical Marijuana Research Act constitutes common sense legislation that could open the door to treatment that can substantially improve the quality of patient care.”

“This common-sense legislation would take the necessary step of advancing the Federal government’s scientific and medical research into the potential benefits and harms of medical cannabis for patients who need it,” said Rep. Zoe Lofgren.

“We all know marijuana has medical benefits, but the Federal government has continued to get in the way of further medical research that would help us better understand the effects,” said Dingell. “Removing barriers that prevent research will help improve our understanding of medical marijuana and provide additional treatment options for millions of patients.”

Letters and quotes of support from a wide coalition of organizations can be found here.

The Medical Marijuana Research Act of 2019 addresses two major barriers currently faced by researchers who wish to conduct legitimate medical research with cannabis, a Schedule I drug. First, it creates a new, less cumbersome registration process specifically for marijuana, reducing approval wait times, costly security measures, and additional, unnecessary layers of protocol review. Second, once researchers have been approved to conduct this research, this bill makes it easier for those researchers to obtain the cannabis they need for their studies through reforms in both production and distribution regulations. To this end, the bill also allows for the private manufacturing and distribution of cannabis solely for research purposes. Currently, the only marijuana available to be used in research legally comes from a single contract the National Institute on Drug Abuse holds with the University of Mississippi.

Monday, July 15, 2019

Medical Cannabis Costs Rise, Patient Pools Shrink With Full Legalization in California and Other States

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When states legalize cannabis for all adults, long-standing medical cannabis programs take a big hit, in some cases losing more than half their registered patients in just a few years, according to a data analysis by The Associated Press.

Much of the decline comes from consumers who, ill or not, got medical cards in their states because it was the only way to buy cannabis legally and then discarded them when broader legalization arrived. But for people who truly rely on cannabis to control ailments such as nausea or cancer pain, the arrival of so-called recreational cannabis can mean fewer and more expensive options.

Robin Beverett, a 47-year-old disabled Army veteran, said she resumed taking a powerful prescription mood stabilizer to control her anxiety and PTSD when the cost of her medical cannabis nearly tripled after California began general sales. Before last year, an eighth of an ounce of dry cannabis flower cost her $35. Now it’s approaching $100, Beverett said.

“It’s ridiculous. The prices are astronomical,” said Beverett, who moved to Sacramento from Texas because medical cannabis is illegal there. “Going to the dispensary is just out of the question if you’re on any kind of fixed income.”

It’s a paradox playing out nationwide as more states take the leap from care-centered medical programs to recreational models aligned with a multibillion-dollar global industry.

States see a “massive exodus” of medical patients when they legalize cannabis for all adults — and then, in many cases, the remaining ones struggle, said David Mangone, director of government affairs for Americans for Safe Access.
“Some of the products that these patients have relied on for consistency — and have used over and over for years — are disappearing off the shelves to market products that have a wider appeal,” he said.

Cost also rises, a problem that’s compounded because many of those who stay in medical programs are low-income and rely on Social Security disability, he said.


In Oregon, where the medical program shrank the most following recreational legalization, nearly two-thirds of patients gave up their medical cards, the AP found. As patients exited, the market followed: The number of medical-only retail shops fell from 400 to two, and hundreds of growers who contracted with individual patients to grow specific strains walked away.

Now, some of the roughly 28,000 medical patients left are struggling to find affordable medical cannabis products they’ve relied on for years. While the state is awash in dry cannabis flower that’s dirt cheap, the specialized oils, tinctures and potent edibles used to alleviate severe illnesses can be harder to find and more expensive to buy.

“Lots of people have started trying to figure out how to make these concentrates and edibles themselves in their kitchen,” said Travis MacKenzie, who runs TJ’s Gardens, which provides free medical cannabis to children with epilepsy. “There are things that we don’t really want people to do at home, but the market conditions are such that people are trying to do more at home.”

The numbers compiled by the AP through public records requests and publicly available documents provide a snapshot of the evolution of cannabis as more states — Michigan was last in the door, and Illinois is about to follow — legalize pot for all adults.

Ten states have both medical and recreational markets. Four of them — Oregon, Nevada, Colorado, Alaska — have the combination of an established recreational marketplace and data on medical patients. The AP analysis found all four saw a drop in medical patients after broader legalization.

In Alaska, the state with the second-biggest decline, medical cardholders dropped by 63% after recreational sales began in 2016, followed by Nevada with nearly 40% since 2017 and Colorado with 19% since 2014.

The largest of all the legal markets, California, doesn’t keep data on medical patients, but those who use it say their community has been in turmoil since recreational pot debuted last year. That’s partly because the state ended unlicensed cannabis cooperatives where patients shared their homegrown pot for free.

There is limited scientific data backing many of the health claims made by medical cannabis advocates, and the U.S. government still classifies cannabis in any form as a controlled substance like LSD and cocaine.

Still, the popularity of medical pot is rising as more states legalize it. There are 33 such states, including the politically conservative recent additions of Oklahoma and Utah. Oklahoma has among the more liberal guidelines for use and has approved more than 100,000 patient licenses since voters backed legalization last June.

Getting a precise nationwide count of medical patients is impossible because California, Washington and Maine don’t keep data. However, absent those states, the AP found at the end of last year nearly 1.4 million people were active patients in a medical cannabis program. The AP estimates if those states were added the number would increase by about 1 million.

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As more states legalize cannabis for all adults, some who have been using it medically are feeling disenfranchised.

In Michigan, where medical cannabis has been legal for over a decade, the creation of a new licensing system for medical dispensaries has sparked court challenges as the state prepares for the advent of general cannabis sales later this year. A cancer patient there filed a federal lawsuit this month, alleging the slow licensing pace has created a shortage of the products she needs to maintain her weight and control pain.

In Washington, medical patients feel they were pushed aside when that state merged its medical and general-use markets, which also is what’s happening in California.

Los Angeles dispensary owner Jerred Kiloh sells medical and recreational cannabis and said those markets are quickly becoming one, since few companies are going to produce products for a vanishing group of customers. He said his medical business has dipped to 7% of overall sales and is dropping month to month.

“It’s going to be gone,” said Kiloh, president of the LA trade group United Cannabis Business Association.

In Oregon, regulators are struggling to find a path that preserves the state’s trailblazing low-cost medical pot program while tamping down on a still-thriving black market. A special state commission formed to oversee the market transition put out a report earlier this year that found affordability and lack of access are major hurdles for Oregon’s patients.

“Patients have needs. Consumers have wants,” said Anthony Taylor, a medical cannabis advocate who sits on the Oregon Cannabis Commission. “Patients are in crisis right now.”

General legalization has “indelibly changed the medical market,” and regulators want to identify the patients most affected by the transition, said Steve Marks, executive director of the Oregon Liquor Control Commission, which oversees Oregon’s recreational cannabis program.

Lawmakers just passed a bill that includes language that will allow the commission to explore a pilot program for home delivery of medical cannabis to patients in underserved areas, he said.

Meanwhile, Oregon U.S. Attorney Billy Williams has demanded lawmakers get control of excess weed being trafficked out of state and cited the medical industry as a potential source of illicit cannabis.

As a result, lawmakers are “paring the medical program back to what it probably should have been from the outset,” said Ben Pirie, a cannabis law attorney in Portland.

“There are patients with legitimate needs, but there are many more growing way more cannabis than needed to address those needs — and what do you do with that?” Pirie said, adding “there is this sweet spot in the middle that’s difficult to hit.”

Oregon law allows medical patients to shop tax-free at general-use stores, and recreational stores can sell medical pot, although those products comprise just 8.5% of their sales.

Meanwhile, the rules that came with general legalization put lower caps on the potency of edibles. That means medical customers often pay more for the same dose they got before broad legalization.

Medical cardholders, for example, used to buy gummies or chocolate bars infused with 400 mg of THC, cannabis’s high-inducing element. Now, edibles are capped at 100 mg for medical patients but cost the same or more.

“Who, with any medical condition, needs to be eating 20 pieces of candy a day?” asked Erich Berkovitz, Oregon’s last remaining state-licensed medical cannabis processor.

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Patients can also grow a small number of plants, but that doesn’t address the needs of the many medical patients who don’t smoke and instead rely on cannabis-infused edibles or tinctures.

Bill Blazina, a Navy veteran, used the state’s medical program in 2013 when he was diagnosed with esophageal cancer. But the 73-year-old grandfather found the landscape had changed dramatically when he was diagnosed last year with a new cancer in his lung.

The highly concentrated cannabis oil he took before — and wanted to take again — was selling for $60 a gram, his daily dose. A two-month supply would cost thousands at a retail pot shop, so Blazina connected with what he calls a “compassionate grower” who sold him the same amount at cost for $750, a transaction that fell in a legal gray area.

“I didn’t even know his name,” said Blazina, sitting in a rocking chair in his home in the tiny coastal town of Waldport. “I met him … and he’d bring it to me and smile, and I’d give him money and say, ‘Thank you,’ and I’d be on my way.”

After surgery and chemo, his cancer is in remission, but he still swallows a tiny drop of the oil on a piece of tortilla twice a day. He’s learned how to make it himself: He and his neighbor combine their eight legal plants, pulverize a pound (0.45 kilograms) of cannabis flower, steep it in grain alcohol, strain it and then simmer the resulting mix of alcohol and plant juice in a rice cooker until only dark black oil is left.

A pound of that flower at a retail store would be about $2,000, Blazina said.

“I think the regulations should go toward more access and how do we get more access, realistically, for the people who need it medically,” he said, before taking his afternoon dose. “It prohibits people who don’t have the ability to grow from getting the medicine they need because it drives the price up — and I don’t see that as being helpful at all.”

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