HB227INTRODUCED
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28Y6II-1
By Representative Cole
RFD: Health
First Read: 04-Apr-23
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5 28Y6II-1 03/01/2023 ANS (L)cr 2023-325
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SYNOPSIS:
Under existing law, a person must have a
qualifying medical condition to use medical cannabis.
This bill would further provide for the
conditions that are considered a qualifying medical
condition.
Under existing law, no employee or member of the
Alabama Medical Cannabis Commission or family member of
a member of the commission may have an economic
interest in a licensee.
This bill would expand this prohibition to
include other individuals and establish a time period
for the prohibition.
Under existing law, a registered certifying
physician may certify patients for the use of medical
cannabis.
This bill would further provide for the
definition of a registered certifying physician and
provide that a registered certifying physician may only
certify a patient for medical cannabis use if he or she
is board certified in the field of specialty required
to diagnose a qualifying medical condition as provided
by law.
This bill would prohibit a non-registered
certifying physician from having a financial
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arrangement with a registered certifying physician for
patient referrals.
Under existing law, a designated caregiver may
use medical cannabis if he or she is also a registered
qualified patient.
This bill would provide that an individual
cannot qualify as a registered caregiver if he or she
is also a qualified registered patient.
Under existing law, a dispensary is required to
comply with certain location restrictions and
dispensing protocols.
This bill would further provide for location
restrictions and dispensing protocols for a dispensary.
This bill would make it a crime for an
individual to sell a medical cannabis card.
Section 111.05 of the Constitution of Alabama of
2022, prohibits a general law whose purpose or effect
would be to require a new or increased expenditure of
local funds from becoming effective with regard to a
local governmental entity without enactment by a 2/3
vote unless: it comes within one of a number of
specified exceptions; it is approved by the affected
entity; or the Legislature appropriates funds, or
provides a local source of revenue, to the entity for
the purpose.
The purpose or effect of this bill would be to
require a new or increased expenditure of local funds
within the meaning of the amendment. However, the bill
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does not require approval of a local governmental
entity or enactment by a 2/3 vote to become effective
because it comes within one of the specified exceptions
contained in the amendment.
A BILL
TO BE ENTITLED
AN ACT
Relating to medical cannabis; to amend Sections
20-2A-3, 20-2A-8, 20-2A-21, 20-2A-32, 20-2A-36, and 20-2A-64,
Code of Alabama 1975, to further provide for the conditions
that are considered a qualifying medical condition; to further
restrict individuals from having an economic interest in a
licensee and to establish a time period for the prohibition;
to further provide for the definition of a registered
certifying physician and provide that a registered certifying
physician may only certify a patient for medical cannabis use
if he or she is board certified in the field of specialty
required to diagnose a qualifying medical condition as
provided by law; to prohibit a non-registered certifying
physician from having a financial arrangement with a
registered certifying physician for patient referrals; to
provide that an individual cannot qualify as a registered
caregiver if he or she is also a qualified registered patient;
to further provide for location restrictions and dispensing
protocols for a dispensary; to make it a crime for an
individual to sell a medical cannabis card; and in connection
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therewith would have as its purpose or effect the requirement
of a new or increased expenditure of local funds within the
meaning of Section 111.05 of the Constitution of Alabama of
2022.
BE IT ENACTED BY THE LEGISLATURE OF ALABAMA:
Section 1. Sections 20-2A-3, 20-2A-8, 20-2A-21,
20-2A-32, 20-2A-36, and 20-2A-64, Code of Alabama 1975, are
amended to read as follows:
"§20-2A-3
As used in this chapter, the following terms have the
following meanings:
(1) APPLICANT. The entity or individual seeking a
license under Article 4.
(2) BOARD. The State Board of Medical Examiners.
(3) CANNABIS. a. Except as provided in paragraph b.,
all parts of any plant of the genus cannabis, whether growing
or not, including the seeds, extractions of any kind from any
part of the plant, and every compound, derivative, mixture,
product, or preparation of the plant.
b. The term does not include industrial hemp or hemp
regulated under Article 11 of Chapter 8 of Title 2.
(4) COMMISSION. The Alabama Medical Cannabis Commission
created pursuant to Section 20-2A-20.
(5) CULTIVATOR. An entity licensed by the Department of
Agriculture and Industries under Section 20-2A-62 authorized
to grow cannabis pursuant to Article 4.
(6) DAILY DOSAGE. The total amount of one or more
cannabis derivatives, including, but not limited to,
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cannabidiol and tetrahydrocannabinol, which may be present in
a medical cannabis product that may be ingested by a
registered qualified patient during a 24-hour period, as
determined by a registered certifying physician.
(7) DEPARTMENT. The Department of Agriculture and
Industries.
(8) DISPENSARY. An entity licensed by the commission
under Section 20-2A-64 authorized to dispense and sell medical
cannabis at dispensing sites to registered qualified patients
and registered caregivers pursuant to Article 4.
(9) DISPENSING SITE. A site operated by a dispensary
licensee or an integrated facility licensee pursuant to
Article 4.
(10) ECONOMIC INTEREST. The rights to either the
capital or profit interests of an applicant or licensee or, if
the applicant or licensee is a corporation, the rights to some
portion of all classes of outstanding stock in the
corporation.
(11) FACILITY or MEDICAL CANNABIS FACILITY. Any
facility, or land associated with a facility, of a licensee.
(12) INTEGRATED FACILITY. An entity licensed under
Section 20-2A-67 authorized to perform the functions of a
cultivator, processor, secure transporter, and dispensary
pursuant to Article 4.
(13) LICENSEE. A cultivator, processor, secure
transporter, state testing laboratory, dispensary, or
integrated facility licensed by the commission under Article
4.
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(14) MEDICAL CANNABIS. a. A medical grade product in
the form of any of the following, as determined by rule by the
commission, that contains a derivative of cannabis for medical
use by a registered qualified patient pursuant to this
chapter:
1. Oral tablet, capsule, or tincture.
2. Non-sugarcoated gelatinous cube, gelatinous
rectangular cuboid, or lozenge in a cube or rectangular cuboid
shape.
3. Gel, oil, cream, or other topical preparation.
4. Suppository.
5. Transdermal patch.
6. Nebulizer.
7. Liquid or oil for administration using an inhaler.
b. The term does not include any of the following:
1. Raw plant material.
2. Any product administered by smoking, combustion, or
vaping.
3. A food product that has medical cannabis baked,
mixed, or otherwise infused into the product, such as cookies
or candies.
(15) MEDICAL CANNABIS CARD. A valid card issued
pursuant to Section 20-2A-36.
(16) MEDICAL USE or USE OF MEDICAL CANNABIS or USE
MEDICAL CANNABIS. The acquisition, possession, use, delivery,
transfer, or administration of medical cannabis authorized by
this chapter. The term does not include possession, use, or
administration of cannabis that was not purchased or acquired
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from a licensed dispensary.
(17) PACKAGE. Any container that a processor may use
for enclosing and containing medical cannabis. The term does
not include any carry-out bag or other similar container.
(18) PATIENT REGISTRY. The Alabama Medical Cannabis
Patient Registry System that is an electronic integrated
system that tracks physician certifications, patient
registrations, medical cannabis cards, the daily dosage and
type of medical cannabis recommended to qualified patients by
registered certifying physicians, and the dates of sale,
amounts, and types of medical cannabis that were purchased by
registered qualified patients at licensed dispensaries.
(19) PHYSICIAN CERTIFICATION. A registered certifying
physician's authorization for a registered qualified patient
to use medical cannabis.
(20) PROCESSOR. An entity licensed by the commission
under Section 20-2A-63 authorized to purchase cannabis from a
cultivator and extract derivatives from the cannabis to
produce a medical cannabis product or products for sale and
transfer in packaged and labeled form to a dispensing site
pursuant to Article 4.
(21) QUALIFYING MEDICAL CONDITION. Any of the following
conditions or symptoms of conditions , but only after
documentation indicates that conventional medical treatment or
therapy has failed unless current medical treatment indicates
that use of medical cannabis is the standard of care :
a. Autism Spectrum Disorder (ASD) diagnosed by a
psychiatrist, after documentation indicates that conventional
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medical treatment has failed for three years and the
individual is unable to work .
b. Cancer-related cachexia, nausea or vomiting, weight
loss, or chronic pain diagnosed by an oncologist, after
documentation indicates that conventional medical treatment
has failed.
c. Crohn's Disease diagnosed by a gastroenterologist,
after documentation indicates that conventional medical
treatment has failed for three years .
d. Depression diagnosed by a psychiatrist, after
documentation indicates that conventional medical treatment
has failed for three years and the individual is unable to
work.
e. Epilepsy or a condition causing seizures diagnosed
by a neurologist, after documentation indicates that
conventional medical treatment has failed for three years and
the individual is unable to work .
f. HIV/AIDS-related nausea or weight loss lasting for a
period over two years .
g. Panic disorder diagnosed by a psychiatrist, after
documentation indicates that conventional medical treatment
has failed for three years and the individual is unable to
work.
h. Parkinson's disease , after documentation indicates
that conventional medical treatment has failed for three years
and the individual is unable to work .
i. Persistent nausea that is not significantly
responsive to traditional treatment , except for nausea related
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to pregnancy, cannabis-induced cyclical vomiting syndrome, or
cannabinoid hyperemesis syndrome , after documentation
indicates that conventional medical treatment has failed for
three years and the individual is unable to work .
j. Post Traumatic Stress Disorder (PTSD). Sickle Cell
Anemia, after documentation indicates that conventional
medical treatment has failed for three years.
k. Sickle Cell Anemia. Spasticity associated with a
motor neuron disease, including Amyotrophic Lateral Sclerosis
diagnosed by a neurologist, after documentation indicates that
conventional medical treatment has failed for three years and
the individual is unable to work.
l. Spasticity associated with a motor neuron disease,
including Amyotrophic Lateral Sclerosis. Spasticity associated
with Multiple Sclerosis or a spinal cord injury diagnosed by a
neurologist, after documentation indicates that conventional
medical treatment has failed for three years and the
individual is unable to work.
m. Spasticity associated with Multiple Sclerosis or a
spinal cord injury. A terminal illness.
n. A terminal illness. Tourette's Syndrome diagnosed by
a psychiatrist, after documentation indicates that
conventional medical treatment has failed for three years and
the individual is unable to work.
o. Tourette's Syndrome. A condition causing chronic or
intractable pain in which conventional therapeutic
intervention and opiate therapy is contraindicated or has
proved ineffective.
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p. A condition causing chronic or intractable pain in
which conventional therapeutic intervention and opiate therapy
is contraindicated or has proved ineffective.
(22) REGISTERED CAREGIVER. An individual who meets the
requirements described in subsection (c) of Section 20-2A-30
and is authorized to acquire and possess medical cannabis and
to assist one or more registered qualified patients with the
use of medical cannabis pursuant to this chapter.
(23) REGISTERED CERTIFYING PHYSICIAN. A physicianboard
certified medical doctor or doctor of osteopathic medicine
authorized by the State Board of Medical Examiners to certify
patients for the use of medical cannabis under this chapter.
(24) REGISTERED QUALIFIED PATIENT. Either of the
following:
a. An adult who meets the requirements described in
subsection (a) of Section 20-2A-30 and is authorized to
acquire, possess, and use medical cannabis pursuant to this
chapter.
b. A minor who meets the requirements described in
subsection (b) of Section 20-2A-30 and is authorized to use
medical cannabis pursuant to this chapter with the assistance
of a registered caregiver.
(25) SECURE TRANSPORTER. An entity licensed by the
commission under Section 20-2A-65 authorized to transport
cannabis or medical cannabis from one licensed facility or
site to another licensed facility or site.
(26) STATE TESTING LABORATORY. An entity licensed under
Section 20-2A-66 authorized to test cannabis and medical
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cannabis to ensure the product meets safety qualifications
required under this chapter.
(27) STATEWIDE SEED-TO-SALE TRACKING SYSTEM. The
tracking system established pursuant to Section 20-2A-54 that
tracks all cannabis and medical cannabis in the state.
(28) UNIVERSAL STATE SYMBOL. The image established by
the commission pursuant to Section 20-2A-53 made available to
processors which indicates the package contains medical
cannabis."
"§20-2A-8
(a)(1) An individual may not distribute, possess,
manufacture, or use medical cannabis or a medical cannabis
product that has been diverted from a registered qualified
patient, a registered caregiver, or a licensed cultivator,
processor, secure transporter, dispensary, or a state testing
laboratory.
(2) An individual who violates this section is guilty
of a Class B felony.
(3) The penalty under this section is in addition to
any penalties that a person may be subject to for manufacture,
possession, or distribution of marijuana under Title 13A.
(b) This chapter does not permit any individual to
engage in, and does not prevent the imposition of any civil,
criminal, or other penalty for engaging in any of the
following conduct:
(1) Undertaking any task under the influence of
cannabis, when doing so would constitute negligence,
professional malpractice, or professional misconduct, or
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violation of law.
(2) Possessing or using medical cannabis on any
property of a K-12 school or day care or child care facility,
in any correctional facility, or in a vehicle unless the
medical cannabis is in its original package and is sealed and
reasonably inaccessible while the vehicle is moving.
(c)(1) An individual may not sell a medical cannabis
card.
(2) An individual who violates this section is guilty
of a Class B felony. "
"§20-2A-21
(a) A member of the commission and any individual
employed by the commission may not be an owner, shareholder,
director, or board member of, or otherwise have any economic
interest in, a licensee. In addition, a member or employee of
the commission may not have any family member who is employed
by a licensee. A member or employee of the commission or his
or her family member may not have an interest of any kind in
any building, fixture, or premises occupied by any person
licensed under this chapter; and may not own any stock or have
any interest of any kind, direct or indirect, pecuniary or
otherwise, by a loan, mortgage, gift, or guarantee of payment
of a loan, in any licensee.
(b) A member or employee of the commission may not
accept any gift, favor, merchandise, donation, contribution,
or any article or thing of value, from any person licensed
under this chapter.
(c) Any individual violating this section shall be
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terminated from employment or position, and as a consequence,
the individual shall forfeit any pay or compensation which
might be due.
(d) For purposes of this section, family member
includes a spouse, child, parent, or sibling, by blood or
marriage.
(e) An individual who has served in any of the
following positions A former member of the commission, for a
period of two years after leaving service as a member of the
commission, may not be an employee of a licensee, owner,
shareholder, director, board member, or otherwise have an
economic interest in an applicant or license issued under
Article 4 for a period of five years after serving in the
position:
(1) A member of the commission.
(2) A federal or state legislator.
(3) A federal or state judicial employee.
(4) A state executive constitutional officer .
(f) In addition to any violation of Chapter 25 of Title
36, a violation of this section is a Class C misdemeanor."
"§20-2A-30
(a)(1) A resident of this state who is 19 years of age
or older is a registered qualified patient if he or she meets
all of the following conditions:
a. Has been certified by a registered certifying
physician as having a qualifying medical condition.
b. Is registered with the commission.
c. Has been issued a valid medical cannabis card by the
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commission.
(2) A registered qualified patient described in
subdivision (1) may purchase, possess, or use medical
cannabis, subject to subsection (d).
(b)(1) A resident of this state who is under the age of
19 is a registered qualified patient if he or she meets all of
the following conditions:
a. Has been certified by a registered certifying
physician as having a qualifying medical condition.
b. Is registered with the commission.
c. Has a qualified designated caregiver who is the
patient's parent or legal guardian.
(2) A registered qualified patient described in
subdivision (1) may use medical cannabis but may not purchase
or possess medical cannabis.
(c)(1) A resident of this state is a registered
caregiver if he or she meets all of the following conditions:
a. Is registered with the commission.
b. Has been issued a valid medical cannabis card as a
caregiver by the commission.
c. Is at least 21 years of age, unless he or she is the
parent or legal guardian of, and caregiver for, a registered
qualified patient.
d. Is the parent, legal guardian, grandparent, spouse,
or an individual with power of attorney for health care of a
registered qualified patient.
(2) A registered caregiver described in subdivision (1)
may purchase and possess medical cannabis, subject to
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subsection (d), but may not use medical cannabis unless he or
she is also a registered qualified patient .
(3) The commission, by rule, may limit the number of
registered qualified patients a registered caregiver may have
under his or her care.
(4) A registered caregiver may receive compensation for
services provided to a registered qualified patient pursuant
to this chapter.
(d) Notwithstanding subdivision (2) of subsections (a)
and (c), a registered qualified patient or registered
caregiver may not purchase more than 60 daily dosages of
medical cannabis and may not renew the supply more than 10
days before the 60-day period expires. At no time may a
registered qualified patient or registered caregiver possess
more than 70 daily dosages of medical cannabis."
"§20-2A-32
(a) A registered certifying physician may not do any of
the following:
(1) Except for the limited purpose of performing a
medical cannabis-related study, accept, solicit, or offer any
form of remuneration from or to a qualified patient,
designated caregiver, or any licensee, including a principal
officer, board member, agent, or employee of the licensee, to
certify a patient, other than accepting payment from a patient
for the fee associated with the examination, medical
consultation, or other treatment, including, but not limited
to, any third party reimbursement for the same.
(2) Accept, solicit, or offer any form of remuneration
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from or to a dispensary for the purpose of referring a patient
to a specific dispensary.
(3) Offer a discount of any other item of value to a
qualified patient who uses or agrees to designate a specific
caregiver or use a specific dispensary to obtain medical
cannabis.
(4) Hold a direct or indirect economic interest in a
licensee.
(5) Serve on the board of directors or as an employee
of a licensee.
(6) Refer qualified patients to a specific caregiver or
a specific dispensary.
(7) Advertise in a dispensary.
(8) Advertise on the physician's website, brochures, or
any other media that generally describe the scope of practice
of the physician, any statement that refers to the physician
as a "medical cannabis" or "medical marijuana" physician or
doctor, or otherwise advertises his or her status as a
registered certifying physician, other than the following:
"Dr. _______ is qualified by the State of Alabama to certify
patients for medical cannabis use under the Alabama Compassion
Act."
(9) Certify a registered qualifying patient for medical
cannabis use unless the physician is board certified in the
field of specialty required to diagnose a qualifying medical
condition.
(b) A non-registered certifying physician shall have no
financial arrangement with a registered certifying physician
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for the purpose of referring a patient to the registered
certified physician.
(c) A family member, as defined in subsection
20-2A-21(d), of a registered certifying physician may not be
an employee of a licensee, owner, shareholder, director, board
member, or otherwise have an economic interest in an applicant
or license issued under Article 4. "
"§20-2A-36
(a) Once certified, a patient and, if applicable, the
patient's designated caregiver, shall register in the patient
registry. The commission shall develop the application and
renewal process for patient and designated caregiver
registration, that shall include, but not be limited to, an
application form, relevant information that must be included
on the form, any additional requirements for eligibility the
commission deems necessary, and an application fee not to
exceed of sixty-five dollars ($65).
(b) If the certified patient or designated caregiver
meets the criteria for registration, the commission shall
place the patient or caregiver on the patient registry and
issue the patient or designated caregiver a medical cannabis
card. The commission shall determine the criteria for revoking
or suspending a medical cannabis card. Medical cannabis cards
shall be resistant to counterfeiting and tampering and, at a
minimum, shall include all of the following:
(1) The name, address, and date of birth of the
qualified patient or caregiver, as applicable.
(2) A photograph of the qualified patient or caregiver,
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as applicable.
(3) Identification of the cardholder as a qualified
patient or a caregiver.
(4) The expiration date, as determined by commission
rulewhich shall be no more than 12 months from the issuance
date.
(5) The following statement: "This card is only valid
in the State of Alabama".
(c) Once a patient or designated caregiver is
registered and issued a medical cannabis card, he or she is
qualified to acquire, possess, or use medical cannabis, as
applicable. A designated caregiver who is registered and
issued a medical cannabis card is qualified to acquire or
possess medical cannabis.
(d) If a registered qualified patient or registered
caregiver loses his or her medical cannabis card, he or she
shall notify the commission within 10 days of becoming aware
the card is lost or stolen. The commission, by rule, shall
determine the process and fee for replacing a lost or stolen
card, including a process for invalidating the lost or stolen
card.
(e) No individual may receive a medical cannabis card
pursuant to this section unless the individual has a driver
license or nondriver identification card issued by the State
of Alabama.
(e) (f) The commission shall adopt rules to implement
this section and may impose civil penalties for violations of
this section."
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"§20-2A-64
(a)(1) A dispensary license authorizes all of the
following:
a. The purchase or transfer of medical cannabis from a
processor.
b. If a cultivator contracted with a processor to
process its cannabis into medical cannabis on the cultivator's
behalf, the purchase or transfer of medical cannabis from the
cultivator.
c. The purchase or transfer of medical cannabis from an
integrated facility.
d. The dispensing and sale of medical cannabis only to
a registered qualified patient or registered caregiver.
(2) A dispensary license authorizes the dispensary to
transfer medical cannabis only by means of a secure
transporter, including transport between its dispensing sites.
(b) The commission shall issue no more than four
dispensary licenses.
(c) A dispensary license authorizes the dispensary to
transfer medical cannabis to or from a state testing
laboratory for testing by means of a secure transporter.
(d) A licensed dispensary shall comply with all of the
following:
(1) Each dispensing site must be located at least one
thousand feet from any school, day care, or child care
facility, prison or detention facility, federal or state
facility, or sports venue . For purposes of this subdivision, a
sports venue is any arena, stadium, or other facility that is
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used primarily as a venue for sporting and athletic events.
(2) Each dispensing site must be equipped with
surveillance cameras that are focused on each point of entry
and that operate on a continuous basis. The dispensary must
maintain surveillance records for a minimum of 60 days
following the date of recording.
(3) Sell and dispense medical cannabis at a dispensing
site to a registered qualified patient or registered caregiver
only after it has been tested and bears the label required for
retail sale.
(4) Enter all transactions, current inventory, and
other information into the statewide seed-to-sale tracking
system as required in Section 20-2A-54.
(5) Only allow dispensing of medical cannabis by
certified dispensers, as provided in subsection (e).
(6) Not allow the use of medical cannabis products on
the premises.
(7) Only allow registered qualified patients and
registered caregivers on the premises.
(e) (1) As used in this subsection, certified dispenser
means an employee of a dispensary who dispenses medical
cannabis to a registered qualified patient or registered
caregiver and who has been trained and certified by the
commission.
(2) The commission shall establish and administer a
training program for dispensers that addresses proper
dispensing procedures, including the requirements of this
subsection, and other topics relating to public health and
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safety and preventing abuse and diversion of medical cannabis.
The commission shall certify trained dispensers and may
require, as a qualification to remain certified, periodic
training.
(3) A certified dispensary shall comply with all of the
following:
a. Before dispensing medical cannabis, inquire of the
patient registry to confirm that the patient or caregiver
holds a valid, current, unexpired, and unrevoked medical
cannabis card and that the dispensing of medical cannabis
conforms to the type and amount recommended in the physician
certification and will not exceed the 60-day daily dosage
purchasing limit.
b. Before dispensing medical cannabis, verify that the
individual has an Alabama driver license or state
identification card.
b. c. Enter into the patient registry the date, time,
amount, and type of medical cannabis dispensed.
c. d. Comply with any additional requirements
established by the commission by rule.
(4) The commission shall adopt rules to implement this
subsection.
(f) A licensee may operate up to three dispensing
sites, each of which must be located in a different county
from any other dispensing site; provided, however, the
commission may authorize a licensee to operate a greater
number of dispensing sites if, at least one year after the
date when the maximum number of total dispensing sites
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authorized under this section and Section 20-2A-67 are
operating, the commission determines that the patient pool has
reached a sufficient level to justify an additional dispensing
site in an underserved or unserved area of the state.
Notwithstanding the foregoing, a licensee may not operate any
dispensing site in the unincorporated area of a county or in a
municipality that has not adopted a resolution or ordinance
authorizing the operation of dispensing sites under subsection
(c) of Section 20-2A-51."
Section 2. Although this bill would have as its purpose
or effect the requirement of a new or increased expenditure of
local funds, the bill is excluded from further requirements
and application under Section 111.05 of the Constitution of
Alabama of 2022, because the bill defines a new crime or
amends the definition of an existing crime.
Section 3. This act shall become effective on the first
day of the third month following its passage and approval by
the Governor, or its otherwise becoming law.
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