1. Medical Marijuana: Monitoring and Related Activities Francis B. Palumbo, PhD, Esq. Professor and Executive Director, University of Maryland School of Pharmacy Center on Drugs and Public Policy

2. Broad Topic The presentation is designed to promote discussion an debate. The presenter has no position to put forth.

3. What is Monitoring? For purposes of this discussion, monitoring is considered broadly as synonymous with oversight and actions relating to it: – “Oversight of dispensaries” – Patient registries – Physician registries

4. Federal Law Marijuana is a Schedule I Controlled Dangerous Substance It’s possession and use is illegal in the United States.

5. Gonzales v. Raich 545 U.S. 1, 2005 The CSA’s categorical prohibition of the manufacture and possession of marijuana did not, as applied to the intrastate manufacture and possession of marijuana for medical purposes pursuant to the CA statute, exceed Congress’ authority under the Commerce Clause.

6. Federal Law and the States The Department of Justice issued a memorandum in October 2009 to U.S. Attorneys that federal resources should not be used to prosecute people whose actions are in compliance with state laws providing for use of medical marijuana.

7. Closing Dispensaries (10-8-11) California's four U.S. Attorneys, including Sacramento's US Attorney Benjamin Wagner, held a press conference Friday to announce the federal government's intention to crack down on medical marijuana dispensaries. The federal government has sent out letters to dispensaries and their landlords in San Francisco, San Diego, and Marin County. The letters state that the dispensaries are in violation of federal law, which supersedes state law, and that landlords should evict their dispensary tenants and dispensaries should close up shop within 45 days otherwise both the dispensary owners and the landlords will be arrested and prosecuted. http://www.examiner.com/liberal-in-sacramento/the-federal-government-is-cracking-down-on- medical-marijuana

8. Closing Dispensaries They noted that they were focusing only on those that were "clearly profiteering" from the medical marijuana industry. http://www.examiner.com/liberal-in-sacramento/the-federal-government-is- cracking-down-on-medical-marijuana

9. Closing Dispensaries BUT, by December 5, 2011, in Sacramento, 99 dispensaries were reduced to only eight. http://www.examiner.com/liberal-in-sacramento/medical-marijuana- dispensaries-are-closing-up-shop

10. Enter the IRS A San Francisco Bay area medical marijuana dispensary that promotes itself as the world's largest has been hit with a $2.4 million tax bill following an audit by the Internal Revenue Service, the dispensary founder said Tuesday. The back taxes, penalties and interest levied against Harborside Health Center came after the IRS examined its returns for 2007 and 2008 and determined a 1982 tax code prohibiting cost deductions for businesses that traffic in illegal drugs applies to the dispensary. http://www.huffingtonpost.com/2011/10/04/harborside-health-center-tax- bill_n_995139.html

11. Dispensary Raids In March and November 2011, federal agents raided medical marijuana dispensaries around the state of Montana.

12. Slowdown of Establishment 10-25-11 Establishment of new dispensaries in New Jersey and other eastern states) is slowing down in the wake of the federal raids and closures. Municipal authorities in Maple Shade, NJ decided not to allow Compassionate Sciences (one of the 6 companies allowed to grow medical marijuana in the state) to operate in their community. http://blog.420petition.com/us-marijuana-news/dc-marijuana-news/medical- marijuana-news-more-delays-in-dc-and-new-jersey/

13. Prescription Drug Monitoring Programs (a controversial model?) PDMPs have been accused of creating a chilling effect on both prescribers and patients: – Prescribers would be presumably reluctant to prescribe the drugs or amounts for fear of being penalized – Patients would be reluctant to fill their prescriptions for fear of being stigmatized

14. PDMPs and Tension There exists a tension across the country between use of the information for law enforcement vs. improved patient care Programs have perceived positive as well as negative effects

15. Registries and Tension Would registries be associated with this same tension?

16. Patient Registry Issue Would having to register in a state create a chilling effect in that patients who needed medical marijuana would be reluctant to obtain it through the state sanctioned mechanism?

17. Registries Almost all of the states with medical marijuana decriminalization laws provide for registries. http://www.ncsl.org/issues-research/health/state-medical-marijuana- laws.aspx

19. Physician Registries Physician registries and chilling effect? NJ launched a physician registry program on October 2010. There are 28,000 physicians in the state but only 109 have registered as of January 2012 (and only 19 since June 2011 ).

20. Contact Information Francis B. Palumbo, PhD, Esq. University of Maryland School of Pharmacy Center on Drugs & Public Policy 220 Arch Street 12 th Floor Baltimore, MD 21201 410-706-2303 fpalumbo@rx.umaryland.edu