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General Assembly Raised Bill No. 5147
February Session, 2022
LCO No. 1205
Referred to Committee on GENERAL LAW
Introduced by:
(GL)
AN ACT CONCERNING PHYSICIAN ASSISTANTS AND THE
PALLIATIVE USE OF MARIJUANA.
Be it enacted by the Senate and House of Representatives in General
Assembly convened:
Section 1. Section 21a-408 of the 2022 supplement to the general 1
statutes is repealed and the following is substituted in lieu thereof 2
(Effective January 1, 2023): 3
As used in this section, sections 21a-408a to 21a-408o, inclusive, as 4
amended by this act, and sections 21a-408r to 21a-408v, inclusive, unless 5
the context otherwise requires: 6
(1) "Advanced practice registered nurse" means an advanced practice 7
registered nurse licensed pursuant to chapter 378; 8
(2) "Cannabis establishment" has the same meaning as provided in 9
section 21a-420; 10
(3) "Cultivation" includes planting, propagating, cultivating, growing 11
and harvesting; 12
(4) "Debilitating medical condition" means (A) cancer, glaucoma, 13 Raised Bill No. 5147
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positive status for human immunodeficiency virus or acquired immune 14
deficiency syndrome, Parkinson's disease, multiple sclerosis, damage to 15
the nervous tissue of the spinal cord with objective neurological 16
indication of intractable spasticity, epilepsy or uncontrolled intractable 17
seizure disorder, cachexia, wasting syndrome, Crohn's disease, 18
posttraumatic stress disorder, irreversible spinal cord injury with 19
objective neurological indication of intractable spasticity, cerebral palsy, 20
cystic fibrosis or terminal illness requiring end-of-life care, except, if the 21
qualifying patient is under eighteen years of age, "debilitating medical 22
condition" means terminal illness requiring end-of-life care, irreversible 23
spinal cord injury with objective neurological indication of intractable 24
spasticity, cerebral palsy, cystic fibrosis, severe epilepsy or uncontrolled 25
intractable seizure disorder, or (B) any medical condition, medical 26
treatment or disease approved for qualifying patients by the 27
Department of Consumer Protection and posted online pursuant to 28
section 21a-408l; 29
(5) "Dispensary facility" means a place of business where marijuana 30
may be dispensed, sold or distributed in accordance with this chapter 31
and any regulations adopted thereunder to qualifying patients and 32
caregivers and for which the department has issued a dispensary facility 33
license pursuant to this chapter; 34
(6) "Employee" has the same meaning as provided in section 21a-420; 35
(7) "Institutional animal care and use committee" means a committee 36
that oversees an organization's animal program, facilities and 37
procedures to ensure compliance with federal policies, guidelines and 38
principles related to the care and use of animals in research; 39
(8) "Institutional review board" means a specifically constituted 40
review body established or designated by an organization to protect the 41
rights and welfare of persons recruited to participate in biomedical, 42
behavioral or social science research; 43
(9) "Laboratory" means a laboratory located in the state that is 44
licensed by the department to provide analysis of marijuana and that 45 Raised Bill No. 5147
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meets the licensure requirements set forth in section 21a-246; 46
(10) "Laboratory employee" means a person who is registered as a 47
laboratory employee pursuant to section 21a-408r; 48
(11) "Licensed dispensary" or "dispensary" means an individual who 49
is a licensed pharmacist employed by a dispensary facility or hybrid 50
retailer; 51
(12) "Producer" means a person who is licensed as a producer 52
pursuant to section 21a-408i; 53
(13) "Marijuana" means marijuana, as defined in section 21a-240; 54
(14) "Nurse" means a person who is licensed as a nurse under chapter 55
378; 56
(15) "Palliative use" means the acquisition, distribution, transfer, 57
possession, use or transportation of marijuana or paraphernalia relating 58
to marijuana, including the transfer of marijuana and paraphernalia 59
relating to marijuana from the patient's caregiver to the qualifying 60
patient, to alleviate a qualifying patient's symptoms of a debilitating 61
medical condition or the effects of such symptoms, but does not include 62
any such use of marijuana by any person other than the qualifying 63
patient; 64
(16) "Paraphernalia" means drug paraphernalia, as defined in section 65
21a-240; 66
(17) "Physician" means a person who is licensed as a physician under 67
chapter 370; [, but does not include a physician assistant, as defined in 68
section 20-12a;] 69
(18) "Physician assistant" means a person who is licensed as a 70
physician assistant under chapter 370; 71
[(18)] (19) "Caregiver" means a person, other than the qualifying 72
patient and the qualifying patient's physician, physician assistant or 73 Raised Bill No. 5147
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advanced practice registered nurse, who is eighteen years of age or older 74
and has agreed to undertake responsibility for managing the well-being 75
of the qualifying patient with respect to the palliative use of marijuana, 76
provided (A) in the case of a qualifying patient (i) under eighteen years 77
of age and not an emancipated minor, or (ii) otherwise lacking legal 78
capacity, such person shall be a parent, guardian or person having legal 79
custody of such qualifying patient, and (B) in the case of a qualifying 80
patient eighteen years of age or older or an emancipated minor, the need 81
for such person shall be evaluated by the qualifying patient's physician, 82
physician assistant or advanced practice registered nurse and such need 83
shall be documented in the written certification; 84
[(19)] (20) "Qualifying patient" means a person who: (A) Is a resident 85
of Connecticut, (B) has been diagnosed by a physician, physician 86
assistant or [an] advanced practice registered nurse as having a 87
debilitating medical condition, and (C) (i) is eighteen years of age or 88
older, (ii) is an emancipated minor, or (iii) has written consent from a 89
custodial parent, guardian or other person having legal custody of such 90
person that indicates that such person has permission from such parent, 91
guardian or other person for the palliative use of marijuana for a 92
debilitating medical condition and that such parent, guardian or other 93
person will (I) serve as a caregiver for the qualifying patient, and (II) 94
control the acquisition and possession of marijuana and any related 95
paraphernalia for palliative use on behalf of such person. "Qualifying 96
patient" does not include an inmate confined in a correctional institution 97
or facility under the supervision of the Department of Correction; 98
[(20)] (21) "Research program" means a study approved by the 99
Department of Consumer Protection in accordance with this chapter 100
and undertaken to increase information or knowledge regarding the 101
growth or processing of marijuana, or the medical attributes, dosage 102
forms, administration or use of marijuana to treat or alleviate symptoms 103
of any medical conditions or the effects of such symptoms; 104
[(21)] (22) "Research program employee" means a person who (A) is 105
registered as a research program employee under section 21a-408t, or 106 Raised Bill No. 5147
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(B) holds a temporary certificate of registration issued pursuant to 107
section 21a-408t; 108
[(22)] (23) "Research program subject" means a person registered as a 109
research program subject pursuant to section 21a-408v; 110
[(23)] (24) "Usable marijuana" means the dried leaves and flowers of 111
the marijuana plant, and any mixtures or preparations of such leaves 112
and flowers, that are appropriate for the palliative use of marijuana, but 113
does not include the seeds, stalks and roots of the marijuana plant; and 114
[(24)] (25) "Written certification" means a written certification issued 115
by a physician, physician assistant or [an] advanced practice registered 116
nurse pursuant to section 21a-408c, as amended by this act. 117
Sec. 2. Section 21a-408a of the 2022 supplement to the general statutes 118
is repealed and the following is substituted in lieu thereof (Effective 119
January 1, 2023): 120
(a) A qualifying patient shall register with the Department of 121
Consumer Protection pursuant to section 21a-408d, as amended by this 122
act, prior to engaging in the palliative use of marijuana. A qualifying 123
patient who has a valid registration certificate from the Department of 124
Consumer Protection pursuant to subsection (a) of section 21a-408d, as 125
amended by this act, and complies with the requirements of sections 126
21a-408 to 21a-408m, as amended by this act, inclusive, shall not be 127
subject to arrest or prosecution, penalized in any manner, including, but 128
not limited to, being subject to any civil penalty, or denied any right or 129
privilege, including, but not limited to, being subject to any disciplinary 130
action by a professional licensing board, for the palliative use of 131
marijuana if: 132
(1) The qualifying patient's physician, physician assistant or 133
advanced practice registered nurse has issued a written certification to 134
the qualifying patient for the palliative use of marijuana after the 135
physician, physician assistant or advanced practice registered nurse has 136
prescribed, or determined it is not in the best interest of the patient to 137 Raised Bill No. 5147
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prescribe, prescription drugs to address the symptoms or effects for 138
which the certification is being issued; 139
(2) The combined amount of marijuana possessed by the qualifying 140
patient and the caregiver for palliative use does not exceed five ounces; 141
(3) The qualifying patient has not more than one caregiver at any 142
time; and 143
(4) Any cannabis plants grown by the qualifying patient in his or 144
home is in compliance with subsection (b) of section 21a-408d, as 145
amended by this act, and any applicable regulations. 146
(b) The provisions of subsection (a) of this section do not apply to: 147
(1) Any palliative use of marijuana that endangers the health or well-148
being of a person other than the qualifying patient or the caregiver; or 149
(2) The ingestion of marijuana (A) in a motor bus or a school bus or 150
in any other moving vehicle, (B) in the workplace, (C) on any school 151
grounds or any public or private school, dormitory, college or university 152
property, unless such college or university is participating in a research 153
program and such use is pursuant to the terms of the research program, 154
(D) in any public place, or (E) in the presence of a person under the age 155
of eighteen, unless such person is a qualifying patient or research 156
program subject. For the purposes of this subdivision, (i) "presence" 157
means within the direct line of sight of the palliative use of marijuana or 158
exposure to second-hand marijuana smoke, or both; (ii) "public place" 159
means any area that is used or held out for use by the public whether 160
owned or operated by public or private interests; (iii) "vehicle" means a 161
vehicle, as defined in section 14-1; (iv) "motor bus" means a motor bus, 162
as defined in section 14-1; and (v) "school bus" means a school bus, as 163
defined in section 14-1. 164
Sec. 3. Section 21a-408c of the 2022 supplement to the general statutes 165
is repealed and the following is substituted in lieu thereof (Effective 166
January 1, 2023): 167 Raised Bill No. 5147
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(a) A physician, physician assistant or [an] advanced practice 168
registered nurse may issue a written certification to a qualifying patient 169
that authorizes the palliative use of marijuana by the qualifying patient. 170
Such written certification shall be in the form prescribed by the 171
Department of Consumer Protection and shall include a statement 172
signed and dated by the qualifying patient's physician, physician 173
assistant or advanced practice registered nurse stating that, in such 174
physician's, physician assistant's or advanced practice registered nurse's 175
professional opinion, the qualifying patient has a debilitating medical 176
condition and the potential benefits of the palliative use of marijuana 177
would likely outweigh the health risks of such use to the qualifying 178
patient. 179
(b) Any written certification for the palliative use of marijuana issued 180
by a physician, physician assistant or [an] advanced practice registered 181
nurse under subsection (a) of this section shall be valid for a period not 182
to exceed one year from the date such written certification is signed and 183
dated by the physician, physician assistant or advanced practice 184
registered nurse. Not later than ten calendar days after the expiration of 185
such period, or at any time before the expiration of such period should 186
the qualifying patient no longer wish to possess marijuana for palliative 187
use, the qualifying patient or the caregiver shall destroy all usable 188
marijuana possessed by the qualifying patient and the caregiver for 189
palliative use. 190
(c) A physician, physician assistant or [an] advanced practice 191
registered nurse shall not be subject to arrest or prosecution, penalized 192
in any manner, including, but not limited to, being subject to any civil 193
penalty, or denied any right or privilege, including, but not limited to, 194
being subject to any disciplinary action by the Connecticut Medical 195
Examining Board, the Connecticut State Board of Examiners for Nursing 196
or other professional licensing board, for providing a written 197
certification for the palliative use of marijuana under subdivision (1) of 198
subsection (a) of section 21a-408a, as amended by this act, if: 199
(1) The physician, physician assistant or advanced practice registered 200 Raised Bill No. 5147
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nurse has diagnosed the qualifying patient as having a debilitating 201
medical condition; 202
(2) The physician, physician assistant or advanced practice registered 203
nurse has explained the potential risks and benefits of the palliative use 204
of marijuana to the qualifying patient and, if the qualifying patient lacks 205
legal capacity, to a parent, guardian or person having legal custody of 206
the qualifying patient; 207
(3) The written certification issued by the physician, physician 208
assistant or advanced practice registered nurse is based upon the 209
physician's, physician assistant's or advanced practice registered nurse's 210
professional opinion after having completed a medically reasonable 211
assessment of the qualifying patient's medical history and current 212
medical condition made in the course of a bona fide health care 213
professional-patient relationship; and 214
(4) The physician, physician assistant or advanced practice registered 215
nurse has no financial interest in a cannabis establishment, except for 216
retailers and delivery services, as such terms are defined in section 21a-217
420. 218
(d) A physician assistant or nurse shall not be subject to arrest or 219
prosecution, penalized in any manner, including, but not limited to, 220
being subject to any civil penalty, or denied any right or privilege, 221
including, but not limited to, being subject to any disciplinary action by 222
the Connecticut Medical Examining Board, Board of Examiners for 223
Nursing [,] or other professional licensing board, for administering 224
marijuana to a qualifying patient or research program subject in a 225
hospital or health care facility licensed by the Department of Public 226
Health. 227
(e) Notwithstanding the provisions of this section, sections 21a-408 to 228
21a-408b, inclusive, as amended by this act, and sections 21a-408d to 229
21a-408o, inclusive, as amended by this act, a physician assistant or an 230
advanced practice registered nurse shall not issue a written certification 231
to a qualifying patient when the qualifying patient's debilitating medical 232 Raised Bill No. 5147
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condition is glaucoma. 233
Sec. 4. Section 21a-408d of the 2022 supplement to the general statutes 234
is repealed and the following is substituted in lieu thereof (Effective 235
January 1, 2023): 236
(a) Each qualifying patient who is issued a written certification for the 237
palliative use of marijuana under subdivision (1) of subsection (a) of 238
section 21a-408a, as amended by this act, and the caregiver of such 239
qualifying patient, shall register with the Department of Consumer 240
Protection. Such registration shall be effective from the date the 241
Department of Consumer Protection issues a certificate of registration 242
until the expiration of the written certification issued by the physician, 243
physician assistant or advanced practice registered nurse. The 244
qualifying patient and the caregiver shall provide sufficient identifying 245
information, as determined by the department, to establish the personal 246
identity of the qualifying patient and the caregiver. If the qualifying 247
patient is under eighteen years of age and not an emancipated minor, 248
the custodial parent, guardian or other person having legal custody of 249
the qualifying patient shall also provide a letter from both the qualifying 250
patient's care provider and a physician who is board certified in an area 251
of medicine involved in the treatment of the debilitating condition for 252
which the qualifying patient was certified that confirms that the 253
palliative use of marijuana is in the best interest of the qualifying 254
patient. A physician may issue a written certification for the palliative 255
use of marijuana by a qualifying patient who is under eighteen years of 256
age, provided such written certification shall not be for marijuana in a 257
dosage form that requires that the marijuana be smoked, inhaled or 258
vaporized. The qualifying patient or the caregiver shall report any 259
change in the identifying information to the department not later than 260
five business days after such change. The department shall issue a 261
registration certificate to the qualifying patient and to the caregiver and 262
may charge a reasonable fee, not to exceed twenty-five dollars, for each 263
registration certificate issued under this subsection. Any registration 264
fees collected by the department under this subsection shall be paid to 265
the State Treasurer and credited to the General Fund. 266 Raised Bill No. 5147
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(b) Any qualifying patient who is eighteen years of age or older may 267
cultivate up to three mature cannabis plants and three immature 268
cannabis plants in the patient's primary residence at any given time, 269
provided such plants are secure from access by any individual other 270
than the patient or patient's caregiver and no more than twelve cannabis 271
plants may be grown per household. 272
(c) A dispensary shall not dispense any marijuana products in a 273
smokable, inhalable or vaporizable form to a qualifying patient who is 274
under eighteen years of age or such qualifying patient's caregiver. 275
(d) Information obtained under this section shall be confidential and 276
shall not be subject to disclosure under the Freedom of Information Act, 277
as defined in section 1-200, except that reasonable access to registry 278
information obtained under this section shall be provided to: (1) State 279
agencies, federal agencies and local law enforcement agencies for the 280
purpose of investigating or prosecuting a violation of law; (2) 281
physicians, physician assistants, advanced practice registered nurses 282
and pharmacists for the purpose of providing patient care and drug 283
therapy management and monitoring controlled substances obtained by 284
the qualifying patient; (3) public or private entities for research or 285
educational purposes, provided no individually identifiable health 286
information may be disclosed; (4) a licensed dispensary for the purpose 287
of complying with sections 21a-408 to 21a-408m, inclusive; as amended 288
by this act; (5) a qualifying patient, but only with respect to information 289
related to such qualifying patient or such qualifying patient's caregiver; 290
or (6) a caregiver, but only with respect to information related to such 291
caregiver's qualifying patient. 292
Sec. 5. Section 21a-408m of the 2022 supplement to the general 293
statutes is repealed and the following is substituted in lieu thereof 294
(Effective January 1, 2023): 295
(a) The Commissioner of Consumer Protection may adopt 296
regulations, in accordance with chapter 54, to establish (1) a standard 297
form for written certifications for the palliative use of marijuana issued 298 Raised Bill No. 5147
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by physicians, physician assistants and advanced practice registered 299
nurses under subdivision (1) of subsection (a) of section 21a-408a, as 300
amended by this act, and (2) procedures for registrations under section 301
21a-408d, as amended by this act. Such regulations, if any, shall be 302
adopted after consultation with the Board of Physicians established in 303
section 21a-408l. 304
(b) The Commissioner of Consumer Protection shall adopt 305
regulations, in accordance with chapter 54, to establish a reasonable fee 306
to be collected from each qualifying patient to whom a written 307
certification for the palliative use of marijuana is issued under 308
subdivision (1) of subsection (a) of section 21a-408a, as amended by this 309
act, for the purpose of offsetting the direct and indirect costs of 310
administering the provisions of sections 21a-408 to 21a-408m, inclusive, 311
as amended by this act. The commissioner shall collect such fee at the 312
time the qualifying patient registers with the Department of Consumer 313
Protection under subsection (a) of section 21a-408d, as amended by this 314
act. Such fee shall be in addition to any registration fee that may be 315
charged under said subsection. The fees required to be collected by the 316
commissioner from qualifying patients under this subsection shall be 317
paid to the State Treasurer and credited to the General Fund. 318
(c) The Commissioner of Consumer Protection shall adopt or amend 319
regulations, as applicable, in accordance with chapter 54, to implement 320
the provisions of sections 21a-408 to 21a-408g, inclusive, as amended by 321
this act, and section 21a-408l. Notwithstanding the requirements of 322
sections 4-168 to 4-172, inclusive, in order to effectuate the purposes of 323
sections 21a-408 to 21a-408g, inclusive, as amended by this act, and 324
section 21a-408l, and protect public health and safety, prior to adopting 325
or amending such regulations the commissioner shall adopt policies and 326
procedures to implement the provisions of sections 21a-408 to 21a-408g, 327
inclusive, as amended by this act, and section 21a-408, as amended by 328
this act, that shall have the force and effect of law. The commissioner 329
shall post all policies and procedures on the department's Internet web 330
site, and submit such policies and procedures to the Secretary of the 331
State for posting on the eRegulations System, at least fifteen days prior 332 Raised Bill No. 5147
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to the effective date of any policy or procedure. Any such policy or 333
procedure shall no longer be effective upon the earlier of either adoption 334
of such policies or procedures as a final regulation pursuant to section 335
4-172 or forty-eight months from October 1, 2021, if such policies or 336
procedures have not been submitted to the legislative regulation review 337
committee for consideration under section 4-170. Such policies and 338
procedures and regulations shall include, but not be limited to, how the 339
department shall: 340
(1) Accept applications for the issuance and renewal of registration 341
certificates for qualifying patients and caregivers; 342
(2) Establish criteria for adding medical conditions, medical 343
treatments or diseases to the list of debilitating medical conditions that 344
qualify for the palliative use of marijuana; 345
(3) Establish a petition process under which members of the public 346
may submit petitions, regarding the addition of medical conditions, 347
medical treatments or diseases to the list of debilitating medical 348
conditions; 349
(4) Establish requirements for the growing of cannabis plants by a 350
qualifying patient in his or her primary residence as authorized under 351
section 21a-408d, as amended by this act, including requirements for 352
securing such plants to prevent access by any individual other than the 353
patient or the patient's caregiver, the location of such plants and any 354
other requirements necessary to protect public health or safety; 355
(5) Develop a distribution system for marijuana for palliative use that 356
provides for: 357
(A) Marijuana production facilities within this state that are housed 358
on secured grounds and operated by producers; 359
(B) The transfer of marijuana between dispensary facilities; and 360
(C) Distribution of marijuana for palliative use to qualifying patients 361
or their caregivers by dispensary facilities, hybrid retailers and delivery 362 Raised Bill No. 5147
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services, as such terms are defined in section 21a-420; and 363
(6) Ensure an adequate supply and variety of marijuana to dispensary 364
facilities and hybrid retailers to ensure uninterrupted availability for 365
qualifying patients, based on historical marijuana purchase patterns by 366
qualifying patients. 367
Sec. 6. Section 7 of public act 21-9 is repealed and the following is 368
substituted in lieu thereof (Effective from passage): 369
(a) As used in this section: 370
(1) "Advanced practice registered nurse" means an advanced practice 371
registered nurse licensed pursuant to chapter 378 of the general statutes; 372
(2) "Physician" has the same meaning as provided in section 21a-408 373
of the general statutes, as amended by this act; 374
(3) "Physician assistant" has the same meaning as provided in section 375
21a-408 of the general statutes, as amended by this act; 376
[(3)] (4) "Qualifying patient" has the same meaning as provided in 377
section 21a-408 of the general statutes, as amended by this act; and 378
[(4)] (5) "Written certification" has the same meaning as provided in 379
section 21a-408 of the general statutes, as amended by this act. 380
(b) Notwithstanding the provisions of sections 21a-408 to 21a-408n, 381
inclusive, of the general statutes, as amended by this act, or any other 382
section, regulation, rule, policy or procedure concerning the certification 383
of medical marijuana patients, a physician, physician assistant or 384
advanced practice registered nurse may issue a written certification to a 385
qualifying patient and provide any follow-up care using telehealth 386
services during the period beginning on the effective date of this section 387
and ending on June 30, 2023, provided all other requirements for issuing 388
the written certification to the qualifying patient and all recordkeeping 389
requirements are satisfied. 390 Raised Bill No. 5147
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This act shall take effect as follows and shall amend the following
sections:
Section 1 January 1, 2023 21a-408
Sec. 2 January 1, 2023 21a-408a
Sec. 3 January 1, 2023 21a-408c
Sec. 4 January 1, 2023 21a-408d
Sec. 5 January 1, 2023 21a-408m
Sec. 6 from passage PA 21-9, Sec. 7
Statement of Purpose:
To authorize physician assistants to perform duties that are similar to
the duties that physicians and advanced practice registered nurses are
authorized to perform with respect to the palliative use of marijuana.
[Proposed deletions are enclosed in brackets. Proposed additions are indicated by underline, except
that when the entire text of a bill or resolution or a section of a bill or resolution is new, it is not
underlined.]