Hawaii’s lawmakers have passed a medical marijuana bill that, among other things, allows healthcare providers to prescribe cannabis for any condition, they feel it will benefit.
But the latest version of the bill, HB 302—approved Friday by a conference committee consisting of members of both legislative chambers—offers a narrower path to medical marijuana for patients with conditions not already listed in the program. The recommendation for these patients would have to be from the “primary treating provider”, not a specialist in cannabis.
Rep. Gregg Takayama said (D) at the committee’s hearing: “It expands access to the medical marijuana law, by allowing doctors and nurses to treat patients beyond their specified conditions when they deem it appropriate.”
Takayama said, “I have been waiting for this entire session to be able to state that it has been an incredible joint effort.”
Advocates, however, say the change mandating that only “primary treating medical providers” could recommend marijuana—combined with others made in the conference committee that would establish a new felony charge for unlicensed dispensary operation and give the state Department of Health sweeping authority to review patients’ medical records—has led them to reconsider their stance on the bill.
Marijuana Policy Project – MPP, for example – now opposes HB302 despite having previously submitted testimony in favor of previous versions. Karen O’Keefe is the MPP’s director of state-policy. She noted that MPP’s research suggests only a tiny subset (of Hawaii’s physicians) are willing to recommend marijuana.
In Hawaii, she said to MEDCAN24: “Less than 250 doctors have made recommendations accross the state.” The vast majority of medical cannabis patients are required to consult with a specialist in order to receive a recommendation.
This provision may also make it more difficult for veterans who have primary doctors working for the Department of Veterans Affairs to obtain a recommendation.
O’Keefe noted that MPPs would probably have supported this bill even if the changes had been made. But the group also believes the changes were too radical.
First, it authorizes the Department of Health, “to examine the medical records of a qualified patient held by the doctor, advanced-practice registered nurse or hospice provider that issued the written certification of the qualifying patient.”
The ability of providers to provide medical cannabis could be revoked if they do not comply with the department’s request for patient records.
The state has already enacted laws to combat illegal marijuana distribution. But a second change adds an additional charge for operating a dispensary without a license.
In addition, the revised conference committee bill will appropriate up to $750,000 (or whatever amount is necessary) to hire and recruit five investigators and one analyst to “enforce and minimize nuisances in relation to illegal hemp and cannabis products.”
A second provision of the bill allows patients to receive medical marijuana recommendations through telehealth sessions, rather than having an in-person connection with a healthcare provider.
Now, the bill of the conference committee will be sent back to both chambers in order for them to vote on it. This is scheduled for Wednesday. After the bill is approved by lawmakers, the governor will sign it. There is a possibility that the bill could be revised further, but in order to adopt them both chambers will need to agree on identical changes.
O’Keefe said that she was disappointed that rather than move toward broader legalization of marijuana—which remains illegal for adults in Hawaii—lawmakers are moving instead toward a more tightly regulated medical program.
Prior to the conference committee’s changes, the state Senate passed the measure on a 24–1 vote earlier this month. The House had unanimously passed the measure in early March. During the time between these two votes, Senate committees made changes to the bill that were later rejected by House legislators. To resolve this disagreement, a conference committee formed.
Among the Senate’s changes, one provision amended the bill to effectively allow medical marijuana to be recommended for any condition that a doctor or advanced practice registered nurse (APRN) believes it would benefit. Presently, providers are only allowed to recommend medical marijuana as a treatment for those conditions listed on state lists.
It would have defined “debilitating conditions” as any condition determined by a physician or advanced-practice registered nurse that was appropriate for cannabis to be used medically.
This would have allowed patients with conditions which could benefit from the use of medical marijuana to have access to it, even if their ailments weren’t specifically acknowledged by officials.
The revised bill retains the list of debilitating medical conditions, but allows the “primary treating physician” of a qualifying patient to prescribe marijuana to treat other medical conditions. This is if that provider has “determined the benefits of medical cannabis use are likely to exceed the risks associated with it.”
The state Department of Health had a problem with the bill to expand medical marijuana earlier in the session.
In a previous written statement, the Department stated that “while it supports the ability of medical professionals to diagnose and treat patients using their professional judgement,” there is little scientific evidence in support of the use cannabis in conditions other than those listed by statute. The Department of Health is concerned with potential patient safety risks, such as adverse drug interactions that may occur between cannabis and the patient’s current treatment.
The department suggested an amendment to address these concerns. It stated that only the patient’s consent could be used. Treatment provider be authorized to certify patients for nonspecified conditions—a suggestion lawmakers had declined to take up until the conference committee.
The move to allow healthcare providers to recommend medical cannabis to patients for any condition they see fit is in line with a plan announced last year by Gov. Josh Green (D) to expand access to marijuana in light of the legislature’s failure to pass recreational legalization measures.
“This would make it very available—that’s marijuana—for those who choose it in their lives,” the governor said in an interview, “and it would still keep kids safe, which has been everyone’s priority.”
Green also reiterated that he supports the full legalization of recreational marijuana.
He added: “I’m in favor of legalizing marijuana for those adults that can use it responsibly.”
A conference committee is currently considering a bill that would create a pilot two-year program for clinical research on psychedelics-assisted therapy, which includes substances like psilocybin or MDMA.
Lawmakers also recently sent a bill to the governor that would help speed the expungement process for people hoping to clear their records of past marijuana-related offenses—a proposal Green signed into law earlier this month.
The measure, HB 132 by Rep. David Tarnas(D), is designed to accelerate expungements through a program pilot signed last year into law. Josh Green, a Democrat. The program will eliminate the distinction made between marijuana and Schedule V drugs in the context of expungement.
Bill’s supporters said that the existing wording in the law requires state officials to manually comb through thousands criminal records to determine which ones are eligible to be expunged under the pilot project.
Hawaii’s Senate narrowly rejected a proposal in February that would have allowed a person to possess five times as much cannabis without being charged with a crime. The body voted 12–11 against the decriminalization measure, SB 319, from Sen. Joy San Buenaventura (D).
The amount of cannabis that is decriminalized on Hawaii would be increased to 15 g if the law had been passed. The possession of up to 15 grams of marijuana would be considered a civil offense punishable with a $130 fine.
During the same time, an adult-friendly marijuana bill in the Senate was stalled. SB 1613 was unable to get out of committee in time for a legislative deadline.
Although advocates believed there was enough support in the Senate for the legalization bill, many believe that House legislators would ultimately have scuttled it, just as they did with HB 1246, a companion legalization measure last month.
Last session, a Senate-passed legalization bill also fizzled out in the House.
Just days before, two joint committees had approved the bill at an open hearing. The panels had received almost 300 pages of testimonies from various state agencies, advocacy groups and the general public.
This past fall, regulators solicited proposals to assess the state’s current medical marijuana program—and also sought to estimate demand for recreational sales if the state eventually moves forward with adult-use legalization. Others interpreted the move to be a signal that regulators needed to get ready for the reform.
Hawaii passed a law legalizing medical marijuana in its state legislature. This was done by the Hawaii State Legislature.
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