Arizona Medical Marijuana Don Herrington Assistant Director, Public Health Preparedness Arizona Department of Health Services January 31, 2011

Important Dates Proposition 203 passed in the November 2nd general election which was completed on November 12th. Governor Brewer signed the certified results and Medical Marijuana will be in effect on April 13, January 31, 2011 will begin our formal rule comment period. Public meetings will be held on February 14, 15, 16 and 17, 2011 to gather citizen, business and government comments.

Voting results by County CountyYESNOTotal Apache ,542 Cochise ,445 Coconino ,386 Gila ,354 Graham ,832 Greenlee ,349 La Paz ,342 Maricopa ,155 Mohave ,305 Navajo ,246 Pima ,608 Pinal ,870 Santa Cruz ,400 Yavapai ,905 Yuma ,617 Total:841,348837,0081,678,356

Premise The proposition that passed was the Arizona Medical Marijuana Act, not the Arizona Recreational Marijuana Act. Important note: the following information is based upon the Draft Rules published on January 31, 2011, and the State Law signed in December 2010

Licensed entities Qualifying patients Designated Caregivers Dispensaries Dispensary agents

Qualifying patient (QP) requirements to be eligible for Medical Marijuana Must have a qualifying condition *Must have a Doctor provide initialed statements– –that patient has a debilitating condition –Physician assumes responsibility for providing management and routine care of the debilitating condition, after conducting a full assessment of the QP’s medical history.

QP requirements to be eligible for Medical Marijuana –That the Physician has conducted an in- person physical examination of the QP. –That the Physician reviewed the QP’s medical records including those from other treating physicians for the previous 12 months QP’s response to conventional medications and medical therapies.

QP requirements to be eligible for Medical Marijuana –That the Physician has explained the potential risks and benefits of the medical use of marijuana to the QP. –That the Physician plans to continue to assess the QP and the QP’s use of medical marijuana during the course of the physician- patient relationship.

QP requirements to be eligible for Medical Marijuana –That, in the Physician's professional opinion, the QP is likely to receive therapeutic or palliative benefit from the QP’s medical use of marijuana to treat or alleviate the QP’s debilitating condition. *An attestation that the information provided in the written certification is true and correct, and

QP requirements to be eligible for Medical Marijuana *Physician's signature and date the physician signed. *Must be re-evaluated by Doctor each year and renew their license. Must pay required fees.

Qualifying patient regulations May obtain 2 ½ ounces of marijuana every two weeks. May grow their own marijuana in their home if they live more than 25 miles from a licensed dispensary. Up to 12 plants may be grown. May “give” (receive no compensation) usable marijuana and marijuana plants to dispensaries.

Designated Caregivers Can have up 5 qualifying patients that they care for. Can grow up to 12 plants for each qualifying patient if the qualifying patients live more than 25 miles from a registered dispensary. Must have a separate registry identification card for each qualifying patient A signed statement from the designated caregiver, if any, agreeing to be the patient's designated caregiver and pledging not to divert marijuana to anyone who is not allowed to possess marijuana.

Nonprofit Medical Marijuana Dispensaries Means a not-for-profit entity that acquires, possesses, cultivates, manufactures, delivers, transfers, transports, supplies, sells or dispenses marijuana or related supplies and educational materials to cardholders. A nonprofit medical marijuana dispensary may receive payment for all expenses incurred in its operation.

*Determination of Dispensary approval Dispensaries will be allocated based on one dispensary per Community Health Analysis Areas (CHAA) If only one application is received, and the application meets all requirements, then that application will be approved as a dispensary. If more than one, then the Department will randomly select one.

*After the first year (beginning in April 2012)… ADHS will review current valid dispensary certificates to determine if additional dispensaries can be approved. –Post availability on the ADHS website, including deadlines. –If more than one application is received that meets all requirements, the ADHS will determine who is approved based on a priority system.

*Priorities for additional Dispensary approvals If only one applicant that meets all of the requirements, then that applicant will be approved. If more than one application is received that meets all requirements, the ADHS will determine who is approved based on a priority system.

*If there are still certificates available… Priority to: –The number of registry identification cards issued to QP’s who reside within 10 miles of the proposed dispensary location. –The number of dispensaries operating within 10 miles of the applicant’s proposed dispensary location. –If there is a tie or a margin of <1% on the scores, it will be randomly selected.

*Dispensary required submissions A.Nonprofit medical marijuana dispensaries shall register with the department. B.Not later than ninety days after receiving an application, the department shall register the nonprofit medical marijuana dispensary and issue a registration certificate and a random 20-digit alphanumeric identification number if:

Dispensary required submissions, cont’d 1. The prospective nonprofit medical marijuana dispensary has submitted the following: (a) the application fee. (b) an application, including: (i) the legal name of the nonprofit medical marijuana dispensary.

Dispensary required submissions, cont’d (ii) the physical address of the nonprofit medical marijuana dispensary and the physical address of one additional location, if any, where marijuana will be cultivated, neither of which may be within five hundred feet of a public or private school existing before the date of the nonprofit medical marijuana dispensary application. (iii) the name, address and date of birth of each principal officer and board member of the nonprofit medical marijuana dispensary.

Dispensary required submissions, cont’d (iv) the name, address and date of birth of each nonprofit medical marijuana dispensary agent. (c) operating procedures consistent with department rules for oversight of the nonprofit medical marijuana dispensary, including procedures to ensure accurate record-keeping and adequate security measures.

Dispensary required submissions, cont’d (d) if the city, town or county in which the nonprofit medical marijuana dispensary would be located has enacted zoning restrictions, a sworn statement certifying that the registered nonprofit medical marijuana dispensary is in compliance with the restrictions.

Dispensary Board Members Requirements 2. None of the principal officers or board members has been convicted of an excluded felony offense. 3. None of the principal officers or board members has served as a principal officer or board member for a registered nonprofit medical marijuana dispensary that has had its registration certificate revoked. 4. None of the principal officers or board members is under twenty-one years of age.

Dispensary Board Members Requirements C. The department may not issue more than one nonprofit medical marijuana dispensary registration certificate for every ten pharmacies except if necessary to ensure that the department issues at least one nonprofit medical marijuana dispensary registration certificate in each county. D. The department may conduct a criminal records check in order to carry out this section.

*Medical Director, required The dispensary shall appoint a physician to function as medical director. During operational hours, the medical director or another physician designated by the medical director must be on-site or able to be contacted.

*Medical Director functions Develop and provide training to the dispensary agents at least once every 12 months, from the point of obtaining a certificate: –Guidelines for providing information to QP’s related to risks, benefits and side effects associated with MM. –Recognizing signs and symptoms for substance abuse.

*Medical Director functions –Guidelines for providing support to QP’s related to the QP’s self-assessment of the QP’s symptoms including a rating scale for pain, cachexia or wasting syndrome, nausea, seizures, muscle spasms, and agitation. –Guidelines for refusing to provide medical marijuana to a person who appears to be impaired or abusing MM, and

*Medical Director functions Assist in the development and implementation of review and improvement processes for patient education and support provided by dispensary.

*Medical Director shall Provide oversight for development and dissemination of Educational materials for QP’s and designated caregivers that include: –Alternative options for QP’s debilitating medical condition; –Guidelines for notifying a recommending physician if side effects or contraindications occur;

*Medical Director shall provide oversight, cont’d –Information about side effects and contraindications for MM including possible impairment with the use and operation of a motor vehicle or heavy machinery, when caring for children or of job performance; –A description of the potential for differing strengths of MM strains and products; –Techniques for the use of MM and marijuana paraphernalia;

*Medical Director shall provide oversight, cont’d –Information about potential drug-drug interactions, including interactions with alcohol, prescription drugs, no-prescription drugs, and supplements; –Different methods and forms of MM use; –Signs and symptoms of substance abuse including tolerance, dependency and withdrawal; –A list of substance abuse programs.

*Medical Director shall provide oversight, cont’d A system to document the QP’s pain, cachexia or wasting syndrome, nausea, seizures, muscle spasms or agitation that includes: –A log book maintained to track the use and effects of specific MM strains and products; –A rating scale for pain, cachexia or wasting syndrome, nausea, seizures, muscle spasms or agitation;

*Medical Director shall provide oversight, cont’d –Guidelines for the QP’s self-assessment or, if applicable, assessment of the QP by the QP’s designated caregiver; –Guidelines for reporting usage and symptoms to the recommending physician, and Policies and procedures for refusing to provide MM to an individual who appears to be impaired or abusing MM.

*Medical Director shall not Establish a physician-patient relationship with or write MM recommendations for QP’s.

Dispensary Agents A.A nonprofit medical marijuana dispensary agent shall be registered with the department before volunteering or working at a medical marijuana dispensary. B.A nonprofit medical marijuana dispensary may apply to the department for a registry identification card for a nonprofit medical marijuana dispensary agent by submitting: 1.The name, address and date of birth of the nonprofit medical marijuana dispensary agent.

Dispensary Agents, cont’d. 2.A nonprofit medical marijuana dispensary agent application. 3.A statement signed by the prospective nonprofit medical marijuana dispensary agent pledging not to divert marijuana to anyone who is not allowed to possess marijuana pursuant to this chapter.

Dispensary Agents, cont’d. 4. The application fee. C. A registered nonprofit medical marijuana dispensary shall notify the department within ten days after a nonprofit medical marijuana dispensary agent ceases to be employed by or volunteer at the registered nonprofit medical marijuana dispensary. D. No person who has been convicted of an excluded felony offense may be a nonprofit medical marijuana dispensary agent. E. The department may conduct a criminal records check in order to carry out this section.

Dispensary operations Verify patient before dispensing. Maintain a QP medical record. Maintain an inventory control system. Ensure that MM has required labeling and analysis. Provide required security.

Food If dispensary sells or provides food: –Must be prepared at a licensed food establishment, whether at the dispensary or through a contractual arrangement A dispensary is responsible for the content and quality of any edible food product sold or provided by the dispensary.

Arizona Department of Health Services functions License Verification system Regulate Annual Report

Licensing Qualifying patients, designated caregivers, dispensaries, and dispensary agents Annual renewal of each class Replacement of lost registration cards Amendments (adding a caregiver, changing address, etc.)

Verification system A. Within one hundred twenty days of the effective date of this chapter, the department shall establish a secure, password-protected, web-based verification system for use on a twenty- four hour basis by law enforcement personnel and nonprofit medical marijuana dispensary agents to verify registry identification cards.

Verification system, cont’d. B. The verification system must allow law enforcement personnel and nonprofit medical marijuana dispensary agents to enter a registry identification number and verify whether the number corresponds with a current, valid identification card. C. The system shall disclose: 1. The name of the cardholder, but must not disclose the cardholder's address.

Verification system, cont’d. D. The verification system must include the following data security features: Any time an authorized user enters five invalid registry identification numbers within five minutes, that user cannot log in to the system again for ten minutes.

Verification system, cont’d. E. The amount of marijuana that each registered qualifying patient received from nonprofit medical marijuana dispensaries during the past sixty days. F.A users log-in information shall be deactivated after 5 incorrect login attempts until the authorized user contacts the department and verifies his identity. G.The server must reject any log-in request that is not over an encrypted connection.

Regulate Who can receive a card – regulate through application process Regulate dispensaries – through inspections –Security, including structural requirements –Recordkeeping, including Inventory control –Validate not for profit status –Cultivation sites –Where marijuana is obtained

Annual Report The department shall submit to the legislature an annual report that contains at least all of the following information: 1.The number of registry identification card applications and renewals. 2.The number of qualifying patients and designated caregivers approved in each county.

Annual Report, cont’d. 3. The nature of the debilitating medical conditions of the qualifying patients. 4. The number of registry identification cards revoked. 5. The number of physicians providing written certifications for qualifying patients. 6. The number of registered nonprofit medical marijuana dispensaries.

Annual Report, cont’d. 7. The number of nonprofit medical marijuana dispensary agents in each county.

Annual report prohibitions The annual report cannot disclose any identifying information about cardholders, nonprofit medical marijuana dispensaries or physicians.

Presumption of medical use of marijuana; protections A.There is a presumption that a QP or designated caregiver is engaged in the medical use of marijuana pursuant to this chapter. 1.The presumption exists if the QP or designated caregiver: (a) Is in possession of a registry identification card.

Presumption of medical use of marijuana; protections (b) Is in possession of an amount of marijuana that does not exceed the allowable amount of marijuana. 2.The presumption may be rebutted by evidence that conduct related to marijuana was not for the purpose of treating or alleviating the QP's debilitating medical condition or symptoms associated with the QP’s debilitating medical condition pursuant to this chapter.

Presumption of medical use of marijuana; protections B.A registered QP or registered designated caregiver is not subject to arrest, prosecution or penalty in any manner, or denial of any right or privilege, including any civil penalty or disciplinary action by a court or occupational or professional licensing board or bureau: 1.For the registered QP’s medical use of marijuana pursuant to this chapter, if the registered QP does not possess more than the allowable amount of marijuana.

Presumption of medical use of marijuana; protections 2. For the registered designated caregiver assisting a registered QP to whom he is connected through the department's registration process with the registered QP's medical use of marijuana pursuant to this chapter if the registered designated caregiver does not possess more than the allowable amount of marijuana. 3.For offering or providing marijuana to a registered QP or a registered designated caregiver for the registered QP's medical use or to a registered nonprofit medical marijuana dispensary if nothing of value is transferred in return and the person giving the marijuana does not knowingly cause the recipient to possess more than the allowable amount of marijuana.

Presumption of medical use of marijuana; protections C. A physician shall not be subject to arrest, prosecution or penalty in any manner or denied any right or privilege, including but not limited to civil penalty or disciplinary action by the Arizona board of medical examiners or by any other business, occupational or professional licensing board or bureau, based solely on providing written certifications or for otherwise stating that, in the physician's professional opinion, a patient is likely to receive therapeutic or palliative benefit from the medical use of marijuana to treat or alleviate the patient's debilitating medical condition or symptoms associated with the debilitating medical condition, but nothing in this chapter prevents a professional licensing board from sanctioning a physician for failing to properly evaluate a patient's medical condition or otherwise violating the standard of care for evaluating medical conditions.

Presumption of medical use of marijuana; protections D.No person may be subject to arrest, prosecution or penalty in any manner, or denied any right or privilege, including any civil penalty or disciplinary action by a court or occupational or professional licensing board or bureau, for: 1.Providing a registered QP, a registered designated caregiver or a registered nonprofit MM dispensary with marijuana paraphernalia for purposes of a QP's medical use of marijuana. 2.Being in the presence or vicinity of the medical use of marijuana authorized under this chapter. 3.Assisting a registered QP with administering marijuana as authorized by this chapter.

Presumption of medical use of marijuana; protections E. A registered nonprofit MM dispensary is not subject to prosecution; search or inspection, except by the department pursuant to section , subsection H; seizure or penalty in any manner and may not be denied any right or privilege, including civil penalty or disciplinary action by a court or business licensing board or entity, for acting pursuant to this chapter and department regulations to acquire, possess, cultivate, manufacture, deliver, transfer, transport, supply, sell or dispense marijuana or related supplies and educational materials to registered QP’s, to registered designated caregivers on behalf of registered QP’s or to other registered nonprofit MM dispensaries.

Presumption of medical use of marijuana; protections F. A registered nonprofit MM dispensary agent is not subject to arrest, prosecution, search, seizure or penalty in any manner and may not be denied any right or privilege, including civil penalty or disciplinary action by a court or occupational or professional licensing board or entity, for working or volunteering for a registered nonprofit MM dispensary pursuant to this chapter and department regulations to acquire, possess, cultivate, manufacture, deliver, transfer, transport, supply, sell or dispense marijuana or related supplies and educational materials to registered QP’s, to registered designated caregivers on behalf of registered QP’s or to other registered nonprofit MM dispensaries.

Presumption of medical use of marijuana; protections G. Property, including all interests in the property, otherwise subject to forfeiture under title 13, chapter 39, that is possessed, owned or used in connection with the medical use of marijuana authorized under this chapter or acts incidental to the medical use of marijuana authorized under this chapter, is not subject to seizure or forfeiture. This subsection does not prevent civil forfeiture if the basis for the forfeiture is unrelated to the medical use of marijuana.

Presumption of medical use of marijuana; protections H. Mere possession of, or application for, a registry identification card may not constitute probable cause or reasonable suspicion, nor may it be used to support the search of the person or property of the person possessing or applying for the registry identification card. The possession of, or application for, a registry identification card does not preclude the existence of probable cause if probable cause exists on other grounds. I. No school, landlord or employer may be penalized or denied any benefit under state law for enrolling, leasing to or employing a registered QP or a registered designated caregiver.