Medical Marijuana in the State Budget

The Rhode Island medical marijuana law has been on the books since 2006 but still remains controversial. As part of the fiscal year ending 2017 state budget proposed by Governor Gina Raimondo on Feb. 3, although structured as a budget bill, H. 7454 Article 14 (pages 194 through 229) makes numerous substantive changes to the state’s medical marijuana program.

Michael Raia, communications director for the state Executive Office of Health and Human Services, said the proposal is “an attempt to improve the integrity and quality” of the program. Patient cardholders would be able to buy from any compassion center without having to designate it as their caregiver (as currently required), which he said would improve accessibility. Instead of a caregiver who grows for them, patients could designate an “authorized purchaser” allowed to buy for them from a compassion center. (A patient who grows for himself or herself could designate neither an authorized purchaser nor a caregiver.) Raia also pointed to other provisions that would encourage expedited consideration of patients in hospice care.

However, the main change attracting attention from patients and caregivers is the proposed chapter (21-28.6-15, p. 220) that would require “every marijuana plant, either mature or seedling” to be “accompanied by a physical medical marijuana tag” purchased from the Department of Business Regulation. The per-plant tags would cost $150 each for patients who grow for themselves and $350 each for caregivers and others, although no reason is given for the price difference.

A tag would be valid for one year and could be transferred among different plants and seedlings throughout the year, although only one at a time.

Fees from licensing cardholders would be put into a restricted fund to cover the costs of the medical marijuana program, but the revenue from tag sales would go into the state general fund (21-28.6.19(c), p, 227). At the same time, the net revenue tax paid by buyers at compassion centers will be reduced from 4% to 3%.

The distinction between mature plants and seedlings (which current law distinguishes as “usable” and “unusable” marijuana) would be eliminated, so seedlings would weigh against the plant count limits. The proposal would also reduce by half, from 12 to 6, plants allowed to a patient who grows for himself or herself. Caregivers would still be allowed to have up to 24 plants and grow for up to five patients (including themselves if they are also a patient), but there would be a new limit of 24 plants in any single location “except for licensed compassion centers, licensed cooperative cultivators, and licensed cultivators.” Each grower would be limited to a single location that would be required to be registered with the Department of Business Regulation. If two or more growers have a cooperative cultivation facility, a new provision requires that it must be separately licensed.

Raia defended the tag plan as an effort to provide “a level of accountability” and “bring some oversight and order to a marketplace that hasn’t had that” due to “ill-defined rules.” In particular, he said that a major goal was to “cut down on the overflow into the illegal recreational market” from the legal medical market. Of the anticipated $8 to $8 1/2 million in revenue, he said, $1 to $1 1/2 million would be used to improve the administration of the medical marijuana project. Another major goal, he said, was to enable the Department of Health to develop regulations for testing of safety and quality, although he was unable to say at this time how the costs of the required testing would be funded. “We’re focused on the legislative process, and promulgation of the regulations would come after the legislation is in place,” he said.

The current statutory provision that allows a patient to appoint up to two primary caregivers (21-28.6-6(d), p, 202) would be removed, which would have the apparent effect of reducing the number to only one. Patients would no longer designate a compassion center as a caregiver and could purchase from any licensed compassion center, but all compassion centers would be required (21-26.8-12(g)(3), p. 216) to record every dispensing transaction into a statewide database that they would also check before dispensing – to prevent a patient from exceeding a 15-day limit. Patients would be identified in this new database by their card number but not by name. A new class of “licensed cultivators” would be created who grow for compassion centers rather than for particular patients.

There is a wide variety of other proposed changes. Possession of marijuana products made by extraction using flammable chemicals, such as butane hash oil (BHO), would be totally banned for both patients and caregivers. Medical professionals from states other than Rhode Island, even Massachusetts and Connecticut, would no longer be allowed to certify a patient’s need. Current law mandates the Department of Health decide an application or renewal within 15 days, and this would be changed to allow the department to set its own time limit by regulation.

The patient and caregiver community has reacted extremely negatively to the proposals, especially to paid tagging and reductions in plant count. The Rhode Island Patient Advocacy Coalition in a statement on their web site said the lower plant counts, in combination with reclassifying seedlings as plants, effectively constitute a 75% reduction in production for patients who grow for themselves and for caregivers who grow for a single patient. Whether patients, many on disability, are in a position to pay this up-front per-plant fee has also been questioned.

The proposed changes, taken together, appear to be an effort by the state to discourage growing by patients and caregivers and instead to provide economic incentives for patients to obtain medical marijuana from compassion centers. The proposed changes also appear to remove the extensive statutory regime (21-26.8-12(b), pp. 207-208) that mandates the licensing of exactly three compassion centers, no more and no less, and instead leave the total up to the discretion of the Department of Health by regulation: under the new proposal, the department would appear to be free to license dozens of compassion centers or none at all.