This docum ent does not reflect the intent or official position of the bill sponsor or House of Representatives. STORAGE NAME: h1269b.HRS DATE: 2/2/2024 HOUSE OF REPRESENTATIVES STAFF ANALYSIS BILL #: CS/HB 1269 Potency for Adult Personal Use of Marijuana SPONSOR(S): Healthcare Regulation Subcommittee, Massullo and others TIED BILLS: IDEN./SIM. BILLS: REFERENCE ACTION ANALYST STAFF DIRECTOR or BUDGET/POLICY CHIEF 1) Healthcare Regulation Subcommittee 13 Y, 4 N, As CS McElroy McElroy 2) Health & Human Services Committee SUMMARY ANALYSIS Delta-9-tetrahydrocannabinol (THC) is the psychoactive chemical in marijuana. The full extent of the health impact of consuming products with high concentration of THC is unknown; however, research indicates that such use significantly increases the risk of marijuana-associated psychosis. Studies have found daily use, especially of high-potency marijuana (over 10 percent THC), is strongly associated with earlier onset of psychosis and the development of schizophrenia in marijuana users. Some studies have also shown that marijuana with a THC concentration of 10 percent or less is effective for medical treatment, including the relief of neuropathic pain and pain caused by conditions such as HIV/AIDS, multiple sclerosis, and post-traumatic surgical pain. Currently, 24 states and the District of Columbia have legalized the adult use of marijuana. Two states, Connecticut and Vermont, currently have potency limits for adult use marijuana products. Both states prohibit cannabis flower with a total THC concentration greater than 30% and solid or liquid concentrate cannabis products with a total THC concentration of greater than 60% from being cultivated, produced or sold in the adult use market. Adult personal use of marijuana is not legal in Florida; however, there is a pending ballot initiative to legalize adult personal use. Although Florida does not have an adult personal use program it does have a well-established medical marijuana program, including 25 licensed Medical Marijuana Treatment Centers (MMTC). Currently licensed MMTCs would be eligible to acquire, cultivate, process, manufacture, sell, and distribute adult personal use marijuana products if the ballot initiative were to pass. The THC concentration of the products currently offered by MMTCs varies by the route of administration from .4 percent to 90 percent THC. CS/HB 1269 establishes THC potency limits for various adult personal use marijuana products. Marijuana in the form for smoking cannot have a THC potency of greater than 30 percent and all other marijuana products, excluding edibles, cannot have a THC potency of greater than 60 percent. Identical to the potency limits in the medical marijuana program, the bill prohibits multi-serving edibles from containing more than 200 mg of THC and a single serving edible from containing more than 10 mg of THC. The bill has no fiscal impact on state or local government. The bill provides an effective date of 30 days after passage of an amendment to the State Constitution authorizing adult personal use of marijuana. STORAGE NAME: h1269b.HRS PAGE: 2 DATE: 2/2/2024 FULL ANALYSIS I. SUBSTANTIVE ANALYSIS A. EFFECT OF PROPOSED CHANGES: Background Research on the Health Effects of THC Although there are more than 100 cannabinoids in a marijuana plant, the two main cannabinoids are Delta-9- tetrahydrocannabinol THC and cannabidiol (CBD). 1 THC is a mind-altering chemical that increases appetite and reduces nausea and may also decrease pain, anxiety, and muscle control problems. 2 Though CBD may also have an effect on the mind, it does not produce the high or sense of euphoria associated with THC. CBD has been shown to help with anxiety, depression, reducing pain and inflammation, controlling epileptic seizures, and possibly treating psychosis or mental disorders. 3 Marijuana has changed over time. The THC concentration in commonly cultivated marijuana plants increased three-fold between 1995 and 2014 (4% and 12% respectively). 4 Conversely, the CBD content decreased from .28% in 2001 to .15% in 2014. In 1995, the level of THC was 14 times higher than its CBD level. In 2014, the THC level was 80 times the CBD level. 5 The marijuana available today is much stronger than previous versions. Some studies have shown that marijuana with a THC concentration of 10% or less is effective for medical treatment, including the relief of neuropathic pain and pain caused by conditions such as HIV/AIDS, multiple sclerosis, post-traumatic surgical pain. 6 Studies on the use of marijuana for pain relief found that marijuana cigarettes with a THC concentration between 2% and 10% THC provided sufficient pain relief, 7 with one study finding that medium-dose marijuana cigarettes with 3.5% THC were as effective as higher dosed marijuana cigarettes at 7% THC. 8 A 2014 New England Journal of Medicine study warned that long-term marijuana use can lead to addiction and that adolescents are more vulnerable to adverse long-term outcomes from marijuana use. 9 Specifically, the study found that, as compared with persons who begin to use marijuana in adulthood, those who begin in adolescence are approximately 2 to 4 times as likely to have symptoms of marijuana dependence within 2 years after first use. 10 The study also found that marijuana-based treatments with THC may have irreversible effects on brain development in adolescents as the brain’s endocannabinoid system undergoes development in childhood and adolescence. 11 1 U.S. Department of Health & Human Services, National Center for Complementary and Integrative Health, Cannabis (Marijuana) and Cannabinoids: What You Need To Know, available at https://www.nccih.nih.gov/health/cannabis-marijuana-and-cannabinoids-what- you-need-to-know (last visited January 30, 2024). 2 Healthline, CBD vs. THC: What’s the Difference?, https://www.healthline.com/health/cbd-vs-thc (last visited January 30, 2024). 3 Id. 4 U.S. Surgeon General’s Advisory: Marijuana Use and the Developing Brain, https://www.hhs.gov/surgeongeneral/reports-and- publications/addiction-and-substance-misuse/advisory-on-marijuana-use-and-developing-brain/index.html (last visited January 30, 2024). 5 ElSohly, M.A., Mehmedic, Z., Foster, S., Gon, C., Chandra, S. and Church, J.C. Changes in Cannabis Potency Over the Last 2 Decades (1995-2014): Analysis of Current Data in the United States, Biological Psychiatry. April 1, 2016; 79(7):613-619. 6 Igor Grant,1 J. Hampton Atkinson, Ben Gouaux, and Barth Wilsey. Medical Marijuana: Clearing Away the Smoke. Open Neurol J. 2012; 6: 18–25. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3358713/; Ellis RJ, Toperoff W, Vaida F, et al. Smoked Medicinal Cannabis for Neuropathic Pain in HIV: A Randomized, Crossover Clinical Trial, Neuropsychopharmacology, 2009; 34(3):672- 680, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3066045/ (last viewed on January 30, 2024); Abrams DI, Jay CA, Shade SB, et al. Cannabis in Painful HIV-associated Sensory Neuropathy: A Randomized Placebo-controlled Trial. Neurology. 2007; 68(7):515-521 available at https://pubmed.ncbi.nlm.nih.gov/17296917/ (last viewed on January 30, 2024); Wilsey B, Marcotte T, Tsodikov A, et al. A Randomized, Placebo-controlled, Crossover Trial of Cannabis Cigarettes in Neuropathic Pain, J Pain. 2008;9(6):506-521, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4968043/ (last viewed on January 30, 2024); Wallace M, Schulteis G, Atkinson JH, et al. Dose-dependent Effects of Smoked Cannabis on Capsaicin-induced Pain and Hyperalgesia in Healthy Volunteers. Anesthesiology. 2007; 107(5):785–96, available at https://pubs.asahq.org/anesthesiology/article/107/5/785/7080/Dose-dependent-Effects-of-Smoked-Cannabis-on (last viewed on January 30, 2024). 7 Id. 8 Wilsey B, Marcotte T, Tsodikov A, et al. A Randomized, Placebo-controlled, Crossover Trial of Cannabis Cigarettes in Neuropathic Pain. J Pain. 2008; 9(6):506–21, available at https://pubmed.ncbi.nlm.nih.gov/18403272/ (last viewed on January 30, 2024). 9 Volkow, N.D., Baler, R.D., Compton, W.M. and Weiss, S.R., Adverse Health Effects of Marijuana Use, NEW ENG. J. MED., June 5, 2014, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4827335/ (last viewed on January 30, 2024). 10 Id. 11 Id. STORAGE NAME: h1269b.HRS PAGE: 3 DATE: 2/2/2024 Heavy use of marijuana by adolescents is associated with impairments in attention, learning, memory, poor grades, high drop rates and I.Q. reduction. 12 Though the full extent of the health impact of consuming products with high concentration of THC is unknown, research indicates that use of such products significantly increases the risk of marijuana-associated psychosis, 13 regardless of age at first use or the type of marijuana used. 14 A 2019 European study showed that the use of high-potency marijuana (over 10% THC) only modestly increased the odds of a psychotic disorder compared to never using it; however, individuals who started using high-potency marijuana by age 15 showed a doubling of risk. 15 The European study also found that daily use of high-potency cannabis increased the risk of psychotic disorder nearly five times compared with never having used marijuana. 16 Another study found that frequent use of marijuana or use of marijuana with high THC potency increased the risk of schizophrenia six-fold. 17 According to a literature review of studies on the impact of marijuana use on mental health published in the Journal of the American Medical Association Psychiatry, there is strong physiological and epidemiological evidence supporting a link between marijuana use and schizophrenia. 18 High doses of THC can cause acute, transient, dose-dependent psychosis, which are schizophrenia-like symptoms. 19 Additionally, prospective, longitudinal, and epidemiological studies have consistently found an association between marijuana use and schizophrenia in which marijuana use precedes psychosis, independent of alcohol consumption, and even after removing or controlling for those individuals who had used other drugs. 20 Even though marijuana use may have been discontinued long before the onset of psychosis, studies have found that the age at which marijuana use begins appears to correlate with the age of onset of psychosis, which suggests that early marijuana use plays a role in initiating psychosis that is independent of actual use. 21 Overall, studies have found that the association between marijuana use and chronic psychosis (including a schizophrenia diagnosis) is stronger in those individuals who have had heavy or frequent marijuana use, use marijuana during adolescence, or use marijuana with high THC potency. 22 While studies have not shown that marijuana use alone is either necessary or sufficient for the development of schizophrenia, studies suggests that marijuana use may initiate the emergence of a lasting psychotic illness in some individuals, especially those with a genetic vulnerability to develop a psychotic illness. 23 State Legalization of Adult Use of Marijuana Currently, 24 states and the District of Columbia have legalized the adult use of marijuana: 24 12 See footnote 9; see also The Influence of Marijuana Use on Neurocognitive Functioning in Adolescents, Schweinsburg AD, Brown SA, Tapert SF, Curr Drug Abuse Rev. 2008;1(1):99-111, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2825218/ (last viewed on January 30, 2024). 13 Robin Murray, Harriet Quigley, Diego Quattrone, Amir Englund and Marta Di Forti, Traditional Marijuana, High-Potency Cannabis and Cannabinoids: Increasing Risk for Psychosis, World Psychiatry, 2016 Oct; 15(3): 195–204, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5032490/ (last viewed January 30, 2024). 14 Di Forti et al. The Contribution of Cannabis Use to Variation in the Incidence of Psychotic Disorder Across Europe (EU-GEI): A Multicenter Case-control Study. Lancet Psychiatry. 2019; 6:427-36, available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7646282/ (last viewed on January 30, 2024); High-Potency Cannabis and Incident Psychosis: Correcting the Causal Assumption, The Lancet, Volume 6, Issue 6, June 2019, available at https://doi.org/10.1016/S2215- 0366(19)30174-9 (last viewed January 30, 2024); High-Potency Cannabis and Incident Psychosis: Correcting the Causal Assumption – Author’s Reply, The Lancet, Volume 6, Issue 6, June 2019 available at https://doi.org/10.1016/S2215-0366(19)30176-2 (last viewed January 30, 2024). 15 Id. at 430. 16 Id. at 431. The odds were lower for those who use low-potency marijuana daily. 17 Nora D. Volkow, MD; James M. Swanson, PhD; A. Eden Evins, MD; Lynn E. DeLisi, MD; Madeline H. Meier, PhD; Raul Gonzalez, PhD; Michael A. P. Bloomfield, MRCPsych; H. Valerie Curran, PhD; Ruben Baler, PhD., Effects of Cannabis Use on Human Behavior, Including Cognition, Motivation, and Psychosis: A Review. JAMA Psychiatry. 2016; 73(3):292-297, available at https://core.ac.uk/reader/79505094?utm_source=linkout (last viewed January 30, 2024). 18 Id. 19 Id. 20 Id. 21 Id. 22 Id. 23 Id. 24 California, Alaska, Nevada, Oregon, Washington, Maine, Colorado, Montana, Vermont, Rhode Island, New Mexico, Michigan, Arizona, New Jersey, Delaware, Connecticut, Massachusetts, Illinois, Maryland, Minnesota, New York, Ohio, Missouri, Virginia. STORAGE NAME: h1269b.HRS PAGE: 4 DATE: 2/2/2024 25 State Potency Limits for Adult Use Marijuana Two states, Connecticut and Vermont, currently have potency limits for adult use marijuana products. Both states prohibit cannabis flower with a total THC concentration greater than 30% and solid or liquid concentrate cannabis products with a total THC concentration of greater than 60% from being cultivated, produced or sold in the adult use market. 26 Both states provided an exception to these potency limits for pre-filled cartridges for vape pens. 27 Florida - Adult Personal Use of Marijuana Adult personal use of marijuana is not legal in Florida; however, there is a pending ballot initiative to legalize adult personal use. The proponents of the initiative were required to obtain 891,523 valid signatures to qualify the initiative for the ballot. The proponents have met this requirement as there are currently 1,033,770 valid signatures for the initiative. 28 The ballot summary of the initiative states: 29 Allows adults 21 years or older to possess, purchase, or use marijuana products and marijuana accessories for non-medical personal consumption by smoking, ingestion, or otherwise; allows Medical Marijuana Treatment Centers, and other state licensed entities, to acquire, cultivate, process, manufacture, sell, and distribute such products and accessories. Applies to Florida law; does not change, or immunize violations of, federal law. Establishes possession limits for personal use. Allows consistent legislation. Defines terms. Provides effective date. 25 More Than Half of Americans Live in Places Where Recreational Marijuana is Legal, Tim Meko and Adrian Blanco, The Washington Post, Nov. 8, 2023, available at https://www.washingtonpost.com/politics/2023/legal-weed-states-map/ (last viewed January 30, 2024). 26 See CT ST s. 21a-421j and VT ST T.7 s. 868. 27 Id. 28 Adult Personal Use of Marijuana 22-05, Florida Division of Elections, available at https://dos.elections.myflorida.com/initiatives/initdetail.asp?account=83475&seqnum=2 (last viewed January 31, 2024). 29 Constitutional Amendment Full Text, available at https://initiativepetitions.elections.myflorida.com/InitiativeForms/Fulltext/Fulltext_2205_EN.pdf (last viewed January 31, 2024). STORAGE NAME: h1269b.HRS PAGE: 5 DATE: 2/2/2024 The State of Florida requested an advisory opinion from the Florida Supreme Court as to the validity of the initiative specifically seeking guidance on whether the initiative and the ballot title and summary comply with applicable Florida law. 30 Oral arguments occurred in November 2023, and the issue remains pending before the court. 31 Florida Potency of Medical Marijuana Products Although Florida does not have an adult personal use program it does have a well-established medical marijuana program. Section 381.986, F.S., authorizes patients with any of the following debilitating medical conditions to obtain medical marijuana from Medical Marijuana Treatment Centers (MMTC): Cancer Epilepsy Glaucoma Positive status for human immunodeficiency virus Acquired immune deficiency syndrome Post-traumatic stress disorder Amyotrophic lateral sclerosis Crohn’s disease Parkinson’s disease Multiple sclerosis Medical conditions of the same kind or class as or comparable to those enumerated above To obtain marijuana for medical use from a Medical Marijuana Treatment Center (MMTC), and maintain the immunity from criminal prosecution, the patient must obtain a physician certification from a qualified physician 32 and an identification card from the Department of Health. As of January 26, 2024, there are 871,459 qualified patients, 2,781 qualified patients and 25 MMTCs with 618 dispensing locations. 33 Currently licensed MMTCs would be eligible to acquire, cultivate, process, manufacture, sell, and distribute adult personal use marijuana products if the ballot initiative were to pass. The THC concentration of the products offered by MMTCs varies based on the route of administration as evidenced by the table below. 34 30 Advisory Opinion to the Attorney General Re: Adult Personal Use of Marijuana, SC2023-0682, 2023, available at https://acis.flcourts.gov/portal/court/68f021c4-6a44-4735-9a76-5360b2e8af13/case/85dca015-d108-4595-8cdb-d4488890aa88 (last viewed January 31, 2024). 31 Id. 32 To certify patients for medical use of marijuana, a physician must hold an active, unrestricted license as an allopathic physician under chapter 458 or as an osteopathic physician under chapter 459 and comply with certain physician education requirements. See ss. 381.986(1)(m), F.S. and 381.986(3)(a), F.S. 33 Office of Medical Marijuana Use Weekly Updates, January 26, 2024, DOH, Office of Medical Marijuana Use, available at https://knowthefactsmmj.com/wp-content/uploads/ommu_updates/2024/012624-OMMU-Update.pdf (last visited on January 29, 2024). 34 Florida’s Medical Marijuana Program Update, Office of Medical Marijuana Use, presented to the Health Care Regulation Subcommittee on December 13, 2023. STORAGE NAME: h1269b.HRS PAGE: 6 DATE: 2/2/2024 Edibles are the only medical marijuana products currently subject to THC potency limits. Effect of the Bill CS/HB 1269 establishes THC potency limits for various adult personal use marijuana products. Marijuana in the form for smoking cannot have a THC potency of greater than 30 percent and all other marijuana products, excluding edibles, cannot have a THC potency of greater than 60 percent. Identical to the potency limits in the medical marijuana program, the bill prohibits multi-serving edibles from containing more than 200 mg of THC and a single serving edible from containing more than 10 mg of THC. The bill provides an effective date of 30 days after passage of an amendment to the State Constitution authorizing adult personal use of marijuana. B. SECTION DIRECTORY: Section 1: Creates s. 381.9861, F.S., relating to the potency limits for adult personal use of marijuana. Section 2: Provides an effective date. II. FISCAL ANALYSIS & ECONOMIC IMPACT STATEMENT A. FISCAL IMPACT ON STATE GOVERNMENT: 1. Revenues: None. 2. Expenditures: None. A. FISCAL IMPACT ON LOCAL GOVERNMENTS: 1. Revenues: None. 2. Expenditures: None. STORAGE NAME: h1269b.HRS PAGE: 7 DATE: 2/2/2024 B. DIRECT ECONOMIC IMPACT ON PRIVATE SECTOR: None. C. FISCAL COMMENTS: None. III. COMMENTS A. CONSTITUTIONAL ISSUES: 1. Applicability of Municipality/County Mandates Provision: Not applicable. The bill does not appear to affect county or municipal governments. 2. Other: None. B. RULE-MAKING AUTHORITY: None. C. DRAFTING ISSUES OR OTHER COMMENTS: None. IV. AMENDMENTS/COMMITTEE SUBSTITUTE CHANGES On February 1, 2024, the Healthcare Regulation Subcommittee adopted an amendment and reported the bill favorable. The amendment established a THC potency limit for marijuana in the form for smoking in the adult personal use marijuana program. Such marijuana may not have a THC potency of greater than 30 percent. This analysis is drafted to the committee substitute as passed by the Healthcare Regulation Subcommittee.