North Dakota Department of Health Division of Medical Marijuana Presentation for ND League of Cities March 7, 2018

Legal Disclaimer This presentation is intended to convey general information only and does not provide legal advice. The contents should not be construed as legal advice. Contact your attorney for advice on your specific circumstances and legal issues.

Product available for patients and caregivers Patient and caregiver applications accepted Patient and caregiver applications accepted Represents where the Division is in the implementation process Dispensaries selected Dispensary application period opens Steps to implementing the ND Medical Marijuana Program Lab selected to conduct testing Lab selected to conduct testing Manufacturing facilities selected Legislative review of Administrative rules; Manufacturing Facility application period opens Legislative review of administrative rules; Manufacturing facility application period opens Lab RFP released Information Management System selected (BioTrackTHC) Administrative rules (NDAC Chapter 33-44-01) drafted; Public hearings held Law effective (NDCC Chapter 19-24.1) — April 18, 2017

United States 30 states and D.C. with medical marijuana laws 8 states and D.C. with recreational marijuana programs (Vermont recently passed a legalization law)

ND Voters Approve Measure 5 (63.7%) North Dakota Nov. 8, 2016: ND Voters Approve Measure 5 (63.7%) Apr. 17, 2017: Governor signs SB 2344 and the Medical Marijuana Program requirements are effective the next day https://www.nytimes.com/elections/results/north-dakota-ballot-measure-5-medical-marijuana

Marijuana is still illegal under the federal Controlled Substances Act Importance of a well regulated program

How will ND Regulate Medical Marijuana? North Dakota Century Code, Chapter 19-24.1: North Dakota Administrative Code 33-44-01: (proposed) North Dakota Department of Health; Division of Medical Marijuana Division Director Program Administrator Administrative Assistant FUTURE: Compassion Center Reviewer, additional Administrative Assistant

Definitions Health Care Provider A physician or an advanced practice registered nurse. Qualifying Patient An individual who has been diagnosed by a health care provider as having a debilitating medical condition. Designated Caregiver An individual who agrees to manage the well-being of a registered qualifying patient with respect to the qualifying patient’s medical use of marijuana. Registry Identification Card A document issued by the Department of Health which identifies an individual as a registered qualifying patient, registered designated caregiver, or registered compassion center agent. (proposed rules adds laboratory agents)

Registry Identification Cards Registered Qualifying Patient Qualifying Medical Condition Written Certification from Health Care Provider Application Fee-$50/year Registered Designated Caregiver 21 years of age Passed a Criminal History Record Check Patient(s) they are caring for registered with state (fee may be waved for minors) Application Fee-$50/year Compassion Center or Lab Agent 21 years of age Passed a Criminal History Record Check Application Fee-$200/year (lab agent, fee waved)

THC CBD Marijuana components Psychoactive Non-psychoactive Different concentrations of both THC and CBD are used for different symptoms of qualifying medical conditions

Types of Usable Marijuana Not for Minors! *Products with >6% THC *Smokable form Types of Usable Marijuana Usable Marijuana Not for minors Maximum purchase amounts per 30 days: *2.5 ounces total—dried leaves and flowers; and *2000 mg THC total—other products Dried Leaves & Flowers Medical Marijuana Products Cannabinoid Concentrate or Extract Medical Cannabinoid Products Max 6% THC per serving Tinctures Topicals Max 50 mg THC per serving Max 50 mg THC per serving Capsules Transdermal patches

Qualifying Medical Conditions Cancer HIV/AIDS Cirrhosis caused by hepatitis C Amyotrophic lateral sclerosis (ALS) Posttraumatic stress disorder (PTSD) Agitation of Alzheimer’s disease or related dementia A terminal illness Crohn’s disease Fibromyalgia Spinal stenosis or chronic back pain with objective neurological indication of intractable spasticity Glaucoma Epilepsy A chronic or debilitating disease or medical condition or treatment for such disease that produces Cachexia or wasting syndrome Severe debilitating pain that has not responded to previously prescribed medication or surgical measures for more than three months or for which other treatment options produced serious side effects Intractable nausea Seizures, or Severe and persistent muscle spasms, including those characteristic of multiple sclerosis

Bona Fide Provider-Patient Relationship A treatment or counseling relationship between a health care provider and patient in which all of the following are present: The health care provider has reviewed the patient’s relevant medical records and completed a full assessment of the patient’s medical history and current medical condition, including a relevant, in-person, medical evaluation of the patient. The health care provider has created and maintained records of the patient’s condition in accordance with medically accepted standards. The patient is under the health care provider’s continued care for the debilitating medical condition that qualifies the patient for the medical use of marijuana. The health care provider has a reasonable expectation that provider will continue to provide follow-up care to the patient to monitor the medical use of marijuana as a treatment of the patient’s debilitating medical condition. The relationship is not for the sole purpose of providing written certification for the medical use of marijuana.

Process Overview Patient has a debilitating medical condition Health Care Provider executes a written certification Patient applies for a registry identification card with DoH Approved patient receives a registry identification card Patient can purchase usable marijuana at registered dispensary

2 8 Compassion Centers Manufacturing Facilities Dispensaries 1,000 plant limit Growers, Producers, Processors $110,000/2 years for registration 8 Dispensaries 3,500 ounce limit Patient Educators $90,000/2 years for registration

Dispensary Regions Map

Patients and Caregivers must have a ND registry identification card Patients and Caregivers must have a ND registry identification card. (We do not recognize other state’s cards.) Patients and Caregivers must purchase their product from registered ND dispensaries. Authorizing healthcare providers must be licensed in ND & have a license in good standing.

Zoning Requirements When an applicant applies to become a registered manufacturing facility or a dispensary, the applicant is required to: Provide evidence of approval from local officials as to the applicant’s compliance with local zoning laws for the physical address to be used; and Provide evidence the physical address of the proposed location is not located within 1,000 feet of a property line of a pre-existing public or private school.

What is considered a school? NDCC Chapter 19-24.1 does not provide a specific definition of “school.” The common definition of school is (1) An institution of learning and education, especially for children; (2) The collective body of students under instruction in an institution of learning; (3) A group of people adhering to the same philosophy or system of beliefs. We interpret the definition of school to include the following: An entity included on the Department of Public Instruction’s “Approved Schools By City” or “Approved Schools By District” list. An entity included on the Department of Public Instruction’s “Head Start Sites” list. A public or private institution of higher education or career and technical education school.

Restrictions on Use State law does not allow for the possession or consumption of usable marijuana: On a school bus or school van that is used for school purposes; On the grounds of any public or private school; At any location while a public or private school sanctioned event is occurring at that location; On the ground of a correctional facility; or On the grounds of a child care facility or licensed home day care, unless authorized under rules adopted by the Department of Human Services.

Additional Restrictions May not operate, navigate, or be in actual physical control of a motor vehicle, aircraft, train, or motorboat while under the influence of marijuana May not use a combustible delivery form or vaporizing if the smoke or vapor would by inhaled by a minor (unless the minor is the registered qualifying patient) The same state law smoking provisions existing for smoking, vaping, etc. in public places and places of employment are applicable to the medical marijuana program

Keeping up on program information https://www.ndhealth.gov/MM/ Common Definition/FAQs State Laws & Federal Guidance Status Updates User Guides for Laboratory Testing Sample Manufacturing Facility Application Dispensary 8 Region Map Subscribe/Unsubscribe to Updates Button

Contact Information Jason Wahl Renae Sisk Division Director Program Administrator North Dakota Department of Health North Dakota Department of Health Division of Medical Marijuana Division of Medical Marijuana 600 East Blvd Ave, Dept 301 600 East Blvd Ave, Dept 301 Bismarck, ND 58505-0200 Bismarck, ND 58505-0200 Phone: 701.328.4925 Phone: 701.328.1334 Email: jwahl@nd.gov Email: rsisk@nd.gov