[Update: The Senate Judiciary Committee passed the N.C. Compassionate Care Act Feb. 21.]
After a medical marijuana bill stalled in the House last summer, its legislative sponsors have brought it back to the table.
Sens. Michael Lee (R-New Hanover), Bill Rabon (R-Brunswick) and Paul Lowe (D-Forsyth) reintroduced the Compassionate Care Act, aimed to legalize cannabis use for medicinal purposes. They presented it to the Senate Judiciary Committee on Wednesday as substantially the same version as last year.
Senate Bill 3 was filed Jan. 27 and the sponsors said a version of its legislation has been coming before the General Assembly for at least two years, been crafted over the last six years, and has faced feedback from nearly 200 committees.
A handful of audience members from the public spoke about the bill this week, evenly split with those for and against its passage.
“Bill 3 is to make only changes to existing state law that are necessary to protect patients and their doctors from criminal and civil penalties,” Sen. Rabon told the committee Wednesday. “And it would not intend to change current civil and criminal laws governing the use of marijuana for non-medical purposes.”
According to the legislation, 39 states plus Washington D.C. have removed state-level criminal penalties for the medical use, cultivation and distribution of cannabis.
If signed into law, the bill would allow for qualifying physicians to write prescriptions to patients for a 30-day supply of marijuana. Specific illnesses considered for a prescription include cancer, epilepsy, HIV, AIDS, ALS, Crohn’s disease, sickle cell anemia, Parkinson’s, PTSD, Multiple sclerosis, wasting syndrome, and severe or persistent nausea. Also covered are terminal illnesses where life expectancy is less than six months and conditions resulting in hospice care.
“I have heard residents of North Carolina who suffer from chronic pain and don’t like to have to rely on prescription drugs have asked for access to medical marijuana as an alternative,” Sen. Natasha Marcus (D-Mecklenburg) said. “This version doesn’t include that.”
Rabon said the sponsors have considered adding chronic pain to the list, and there will likely be additional amendments as the legislation works its way through more committees before it reaches its first vote.
The Compassionate Use Advisory Board — comprising 11 members appointed by the governor to include doctors, pharmacists, research scientists, a registered cardholder and a parent of a minor qualified patient — has the discretion to add or remove conditions over time, Rabon added.
“It’s going to be a dynamic process,” he said.
The legislation would not tax marijuana for patients prescribed the drug and would not be covered by insurance. However, qualified patients would be required to carry registration cards, which must be renewed annually. Up to two designated caregivers per patient could qualify for registration cards.
Language has been added in the bill to require the name, address, date of birth, and delivery method of cannabis on the cards. Its previous iteration only required the date of issuance and expiration, a randomly assigned identification number and photo of the carrier.
Information on registered patients will be stored in a confidential database, accessible by law enforcement and the N.C. Department of Health and Human Services. The latter distributes registration cards and would govern the program.
“But it remains confidential, just as medical records are,” Rabon said.
Physicians with a “bona-fide” patient relationship can provide a written prescription to medical cannabis, to be taken to a dispensary for filling.
Physicians must follow additional provisions: screening for mental health and substance use disorders and providing patient education and follow up care frequently to test the efficacy of cannabis. Doctors are also obligated to check a patient’s prescription history in the controlled substances reporting system and may not advertise their ability to issue written certifications.
Before being eligible to prescribe medical marijuana, doctors must complete 10 hours of a medical education course on prescribing cannabis — to include benefits and risks of marijuana use, screening for high-risk psychosis, assessment of substance use and mental health issues to name a few. They must also annually complete three hours of continuing education.
To regulate the growing, selling and distribution of cannabis and cannabis-infused products, the legislation would create the Medical Cannabis Production Commission. Eleven members will be appointed by the governor — up from nine in last year’s version.
No member of the commission can have any direct or indirect financial interest in a licensed medical marijuana business.
“The cannabis supply will be the most tightly regulated system so far in any state,” Rabon said Wednesday.
There will be a seed-to-sale tracking system with real-time data.
“It’s for quality control, so we know [with] every single product, we can trace it from where it started to where it was processed and to who has it,” Rabon said. “That’s necessary in today’s world, and safety of this product is of paramount importance to the people who are going to be receiving it.”
The commission will adopt rules and regulations including security measures, employee training, record keeping, inventory controls, storage and transportation of cannabis products.
Ten applications for medical cannabis supplier licenses — who would grow and sell the product — will be approved by the Medical Cannabis Production Commission, based on a list of 20 reviewed first by NCDHHS.
However, each of the 10 suppliers can own and operate up to eight retail centers (this increased from four in last year’s bill the previous iteration) and cannot operate between 7 p.m. and 7 a.m. Consumption on site is prohibited and products are not allowed to be visible to the public from the outside.
Suppliers must submit quarterly reports to the Medical Cannabis Production Commission and monthly updates to NCDHHS.
The commission’s job is to ensure medical centers are equally distributed throughout the state for patient accessibility. At least one dispensary from each license owner must be in a tier 1, or economically distressed, county in an attempt to suffice equitable distribution.
“If we don’t do that, the majority of the centers will end up where the most people are because, like most businesses, this is a for-profit business,” Rabon said.
Sen. Lisa Grafstein (D-Wake) asked whether more licenses could be offered in the state in the future for added assurance patients can easily access care; Rabon said yes.
“But you have to start somewhere and have to have a bill that first we can pass,” he said. “I believe we can control and learn as we go.”
Suppliers must prove state residency for at least two years, pay $50,000 to obtain a license, and an additional $5,000 for each facility they plan to operate. Annual renewal fees are $10,000, plus $5,000 for new centers and $1,000 for existing ones.
Marijuana use would not be permitted in public places, any place of employment, in a vehicle, or within 1,000 feet of a church, childcare facility, public school, community college or UNC campus (except in cases of research). Violations would result in a $25 fine.
A more stringent violations policy was added to the 2023 bill to dissuade illegal activity. This includes class G and H felonies for creating counterfeit cannabis, providing false information to obtain a registration card and possessing more than 1.5 ounces of cannabis.
Anyone caught trafficking marijuana purchased at a medical cannabis center will receive an additional 12 months in prison to the mandatory minimum sentence.
Any revenue collected from fees and violations associated with licenses and registration cards would support the continuation of the medical marijuana program. The money would be collected in a N.C. Medical Cannabis Program Fund and any excess profit not needed for operations or enforcement would annually be distributed to the state’s general fund.
Judiciary committee chair Sen. Danny Britt (R-Hoke, Robeson, Scotland) then opened the floor to audience members.
CIC Consultants CEO and lobbyist Chris Suttle gave an emotional speech urging senators to pass the bill.
“I’m begging you to be the heroes we need in this moment and push this bill forward so those good citizens of North Carolina dying in the dark can finally be allowed to grow in the light,” he said.
Suttle said he was diagnosed with a brain tumor six years ago and would still not qualify for medicinal marijuana the way the bill is written. However, he said cannabis should be used as an alternative to opioid treatment and referred to as opioid reduction therapy.
“I have now a clean bill of health and a passion no one will ever put out to make sure the voice of the people is always the loudest in the room,” he said. “And the voice of the people is calling for medical cannabis. Do not keep us in the dark any longer.”
Sen. Michael Lazzara (R-Onslow) also spoke in favor of using marijuana as an alternative to opioids.
NC Family Policy Council counsel Jere Royall was the first to speak in opposition to the bill. He said medical professionals encourage more research on medical marijuana but do not support its use due to possible side effects such as addiction, lung disease, impaired cognition, psychological illness, cardiovascular abnormalities and cancer.
“At this point in time, research shows the harm and cost to individuals, families and the state outweigh any potential benefits,” he said.
Rev. Mark Creech, executive director of the Christian Action League, agreed.
“Let’s not forget what has caused the opioid epidemic,” Lazzara said. “Evidence-based pharmaceutical grade medicine. So, I don’t buy into that theory.”
He pointed to cannabis use as a source of relief, both immediate and long term, for veterans — a demographic which has become a point of support for many legislators.
In 2021, veterans shared with the general assembly emotional stories of their battles returning from deployment in an effort to persuade legislators to legalize the use of marijuana as medicine. Lee told PCD last June a lot of legislators were moved by the testimony and likely changed the minds of some who were on the fence.
The Compassionate Care Act was originally filed in the Senate, by the same primary sponsors, in April 2021. It made its way through various committees but never made it to the House floor. It appeared again in the Senate June 2022 where it passed a second and third reading before being sent to the House the same month.
Last year, two bills were up for review: one for medical purposes only and one for recreation use in regulated quantities. Neither passed muster in the general assembly.
The Senate Judiciary Committee will discuss the N.C. Compassionate Care Act again Tuesday.
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