Friday, March 10, 2017

Petition: Medical Treatment; Adequate Supply: Quantity of Useable Cannabis That May Be Possessed By A Qualified Patient Or Primary Caregiver


Jason Barker - Medical Cannabis Patient & Organizer with LECUA Patient’s Coalition Of New Mexico LECUA_thc_cbd.png

LECUAPatientsCoalitionNM@gmail.com
dukecitywellness.blogspot.com

Tuesday, February 28th 2017

New Mexico State Department of Health
Medical Cannabis Advisory Board
Medical Cannabis Program
PO Box 26110
Santa Fe, NM, 87502-6110
Petition: Medical Treatment; Adequate Supply:
Quantity of Useable Cannabis That May Be Possessed By A Qualified Patient Or Primary Caregiver
Table of Contents
Pg.  1 Cover Page
Pg.  2 - 4 Petition Introduction
Pg.  4 - 8 Petition Purpose and Background
Pg.  8 Relief Requested In Petition
Pg.  9 References
Pg.  9-10 Appendix A

 

Printing Provided By:
Petition Introduction: Medical Treatment; Adequate Supply:
Quantity of Useable Cannabis That May Be Possessed By A Qualified Patient Or Primary Caregiver

New Mexico’s medical cannabis history started in 1978, after public hearings the legislature enacted H.B. 329, the nation’s first law recognizing the medical value of cannabis. The New Mexico’s medical cannabis program (MCP)  is the only program in the U.S. that places sole responsibility for regulation on the state’s Department of Health. Doctors must comply with state requirements for patients to be considered for applying to the medical cannabis program.

The Santa Fe New Mexican reported on February 13th (2017) that the New Mexico Medical Cannabis program has grown dramatically from 9,000 patients in 2013 to more than 33,000 today. The Department of Health estimates approximately 500 to 800 new patients join the program weekly. The tremendous growth of the Medical Cannabis Program with new program participants, an increase of 75% during 2016, so that currently means we have almost 45,000 patients benefiting from medical cannabis. The medical cannabis program office is currently processing applications in a 12-14 day range and recommends submitting renewal and new patient applications a minimum of 60 days prior to expiration to allow ample time for processing. Due to the incredible growth in the medical cannabis program participants, there needs to be a clear increase to the plant count allowed for by the licensed producers from the Department of Health. In order for the Department of Health Medical Cannabis Program to allow for the beneficial treatment with medical cannabis, the Department must properly have “adequate supply”.

There are 35 licensed producers growing medical cannabis, operating 41 dispensaries around the state, and 23 of these dispensaries are located in the Albuquerque area.  Current state law does not limit the number of plants that can be grown by the state’s licensed producers. Each one of the licensed producers is can choose to grow up to 450 medical cannabis plants, the maximum allowed under the Department of Health program rules and regulations. The department may issue two classes of producer licenses; to a qualified patient who holds a valid personal production license and to a non-profit producer who operates a facility.

The 2016/17 licensure list for the medical cannabis program shows a total of 13,800 medical cannabis plants licensed by the 35 producers for the All patients in the program.

In the Lynn and Erin Compassionate Use Act, (2007) the law states; The Secretary of Health shall establish an advisory board consisting of eight practitioners representing the fields of neurology, pain management, medical oncology, psychiatry, infectious disease, family medicine and gynecology. The practitioners shall be nationally board-certified in their area of specialty and knowledgeable about the medical use of cannabis. The members shall be chosen for appointment by the Secretary from a list proposed by the New Mexico Medical Society. A quorum of the advisory board shall consist of three members.
The advisory board shall:
A. review and recommend to the department for approval additional debilitating medical conditions that would benefit from the medical use of cannabis;
B. accept and review petitions to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the medical use of cannabis;
C. convene at least twice per year to conduct public hearings and to evaluate petitions, which shall be maintained as confidential personal health information, to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the medical use of cannabis;
D. issue recommendations concerning rules to be promulgated for the issuance of the registry identification cards; and
E. recommend quantities of cannabis that are necessary to constitute an adequate supply for qualified patients and primary caregivers.

First, do no harm.  As an important step in becoming a doctor, medical students must take the Hippocratic Oath. And one of the promises within that oath is “first, do no harm”.  

Dr. William Johnson, former chair of the New Mexico Medical Cannabis Advisory Board in 2014 told KUNM public radio that many of the changes proposed by the Department of Health would hurt patient access to medical cannabis.  After the Rules and Regulations changes from the medical cannabis meetings in 2014 went into effect in February of 2015, the results for patients and caregivers in the program has been clearly harmful to patient well being and overall program health. And it is the patient’s,  producers, and medical cannabis community members that are now paying the price in regards to health and financial costs.

We have a sound law in the Lynn and Erin Compassionate Use Act, yet we are unable to provide “adequate supply” and it can not be properly defined by the Department by using unknown variables it has not collected then this leads to further examination of how these definitions pertaining to adequate supply were determined in the past years.

In order for the Department of Health Medical Cannabis Program to allow for the medical treatment of cannabis, the Department must properly have “adequate supply”.  For the Department to have “adequate supply” they would need to know the different amounts of plant material that goes into all the different types of medicine being produced in the MCP. Dried cannabis flower (bud), pre-rolls, edibles, tinctures, topicals/salves, and concentrated forms of cannabis- all require different amounts of cannabis plant material to produce. This is empirical data that has not been collected, studied or researched within the state’s medical cannabis program by the Department of Health.

The current law for the Medical Cannabis Program, passed in 2007, states the following, (Page 1/Section 2) “PURPOSE OF ACT.--The purpose of the Lynn and Erin Compassionate Use Act is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments.”

Mosby’s Medical Dictionary states that “medical treatment” means; the management and care of a patient to combat disease or disorder. Medical treatment includes: Using prescription medications, or use of a non-prescription drug at prescription strength; and or treatment of disease by hygienic and pharmacologic remedies, as distinguished from invasive surgical procedures. Treatment may be pharmacologic, using drugs; surgical, involving operative procedures; or supportive, building the patient's strength. It may be specific for the disorder, or symptomatic to relieve symptoms without effecting a cure.(Mosby's Medical Dictionary, 9th edition.)

What is a chronic medical condition?
A chronic disease is one lasting 3 months or more, by the definition of the U.S. National Center for Health Statistics. Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor do they just disappear. Harvard Medical Dictionary defines chronic as: Any condition that lasts a long time or recurs over time; chronic pain as: Pain that persists after an injury has healed or a disease is over; and chronic pain syndrome as : Long-term, severe pain that doesn't spring from an injury or illness, that interferes with daily life, and is often accompanied by other problems, such as depression, irritability, and anxiety.
What is the meaning of debilitating?
Something that's debilitating seriously affects someone or something's strength or ability to carry on with regular activities, like a debilitating illness. Debilitating comes from the Latin word debilis, meaning "weak." That's why you'll often see the adjective used to describe illness, despite the negative reference.
Petition Purpose and Background

The purpose of this Medical Treatment petition; Adequate Supply:
Quantity of Useable Cannabis That May Be Possessed By A Qualified Patient Or Primary Caregiver.

This petition for the Medical Treatment that pertains to Adequate Supply and the Quantity of Useable Cannabis That May Be Possessed By A Qualified Patient Or Primary Caregiver, is being provided to bring the state Department of Health Medical Cannabis Program in compliance with the Lynn and Erin Compassionate Use Act.

Currently for patients and primary caregivers in the medical cannabis program, rules and regulations established limit patients and primary caregivers to having 230 Units (grams) of any amount of medical cannabis for a three month period.  

For medical cannabis registry identification cards, in the definitions ( Title 7-Chapter 34-Part 3-Section A) Rules and Regulations for “unit” and “useable cannabis” needs changed and should be increased with a quantity of usable medical cannabis set to 425.243 grams per 3 months (or 2.5 ounces every two weeks). Along with the inclusion of a medical exception that would still allow for the patient or primary caregiver to petition the MCAB for a medical exception increase of units (or grams) with the amount of the medical exception increase to be determined by a patient's medical practitioner.


In the Rule and Regulations for the Medical Cannabis Program, Title 7-Chapter 34-Part 2 Advisory Board Responsibilities and Duties defines Adequate Supply as the following:
 “Adequate supply” means an amount of cannabis, derived solely from an intrastate source and in a form approved by the department, that is possessed by a qualified patient or collectively possessed by a qualified patient and the qualified patient’s primary caregiver, that is determined by the department to be no more than reasonably necessary to ensure the uninterrupted availability of cannabis for a period of three months or 90 consecutive calendar days.

In the same section of the Rules and Regulation (Title 7-Chapter 34-Part 2) are the following definitions:
                    “Unit” means a quantity of usable cannabis, concentrate, or cannabis-derived product that is used in identifying the maximum supply that a qualified patient may possess for purposes of department rules.
                   “Usable cannabis” means the dried leaves and flowers of the female cannabis plant and cannabis-derived products, including concentrates, but does not include the seeds, stalks, or roots of the plant.

And then that will bring us to Title 7-Chapter 34-Part 3: Registry Identification Card for the complete definitions in Rules and Regulations for “unit” and “useable cannabis” :
QUANTITY OF USABLE CANNABIS THAT MAY BE POSSESSED BY A QUALIFIED PATIENT OR PRIMARY CAREGIVER:
               A.            Maximum quantity:  A qualified patient and a qualified patient’s primary caregiver may collectively possess within any three-month period a quantity of usable cannabis no greater than 230 total units.  For purposes of department rules, this quantity is deemed an adequate supply.  (For ease of reference: 230 units is equivalent to 230 grams, or approximately eight ounces, of dried usable cannabis plant material.)  A qualified patient and primary caregiver may also possess cannabis seeds.
               B.            Calculation of units:  For purposes of department rules, one unit of usable cannabis shall consist of one gram of the dried leaves and flowers of the female cannabis plant, or 0.2 grams (200 milligrams) of THC for cannabis-derived products.
               C.            Maximum THC content of concentrates:  A qualified patient or primary caregiver shall not possess a concentrated cannabis-derived product that contains greater than seventy percent (70%) THC by weight.
               D.            Medical exception:  A greater quantity of usable cannabis, not to exceed 115 additional units, may be allowed, and a concentrated cannabis-derived product with THC content greater than seventy percent (70%) by weight may be allowed, at the department’s discretion, upon the submission of a statement by a medical practitioner explaining why a greater number of units of usable cannabis, or a higher concentration of THC in concentrated cannabis-derived product, is medically necessary.  Any such allowance shall be reviewed for approval by the program’s medical director. [7.34.3.9 NMAC - N, 2/27/2015]” http://164.64.110.239/nmac/parts/title07/07.034.0003.htm


Facts About The Medical Conditions That Qualify For The Medical Cannabis Program.
Patients in New Mexico diagnosed with one or more of the following medical conditions qualify into the program and are allowed legal protection under the Lynn and Erin Compassionate Use Act:
Amyotrophic Lateral Sclerosis (ALS) : Can't be cured, but treatment does help. Chronic: lifelong.
Cancer : Chronic disease, can be treated, & average treatment plan length 5 years or more.
Crohn’s Disease : Can't be cured, but treatment does help. Chronic: Lasting several years or lifelong.
Epilepsy : Is a chronic neurological disorder. Can't be cured, but treatment does help.
Glaucoma : Chronic, can't be cured, but treatment does help.  ( Can braille cards be printed ? )
Hepatitis C : Chronic, but treatment does help.
HIV/AIDS : Can't be cured, but treatment does help. Chronic: lifelong.
Huntington’s Disease : Can't be cured, but treatment does help. Chronic: lifelong.
Hospice Care :Palliation of a chronically ill, terminally ill or seriously ill patient's pain and symptoms.
Inclusion Body Myositis : Can't be cured, but treatment does help. Chronic: lifelong.
Inflammatory Autoimmune-mediated Arthritis Can't be cured, treatment does help. Chronic: lifelong.
Multiple Sclerosis Can't be cured, but treatment does help. Chronic: lifelong.
Damage to the nervous tissue of the spinal cord :No cure, treatment does help. Chronic: lifelong.
Painful peripheral neuropathy :Can't be cured, but treatment does help. Chronic: lifelong.
Parkinson’s disease :Can't be cured, but treatment does help. Chronic: lifelong.
Post-Traumatic Stress Disorder (PTSD) :Can't be cured, but treatment does help. Chronic: lifelong.
Severe Chronic Pain :Can't be cured, but treatment does help. Chronic: lifelong.
Severe Anorexia/Cachexia :Often a sign of disease, such as cancer, AIDS, heart failure, or advanced chronic obstructive pulmonary disease (COPD). Chronic but treatment does help.
Spasmodic Torticollis (Cervical Dystonia) :Can't be cured, but treatment does help. Chronic: lifelong.
Ulcerative Colitis: Can't be cured, but treatment does help. Chronic: lifelong.
All of these types of debilitating medical conditions have some common medical facts; treatment plan for 5 years if not lifelong, most all have no cure, all of them are chronic health conditions, and sadly some take a person’s life. They all also require a medical treatment plan with several visits to more than one medical practitioner throughout the course of a year.
For those rules and regulations that have been established limiting patients and primary caregivers to having 230 Units (grams) of any amount of medical cannabis for a three month period.  This current format being used by the Department of Health Medical Cannabis Program in devising adequate supply does not allow for the beneficial use of medical cannabis. This in fact prevents  patients from fully being able to alleviate symptoms caused by debilitating medical conditions and their medical treatments and that creates a liable situation for the state being out of compliance with the LECUA, 2007.  

How Is The Medical Cannabis Program Out Of Compliance With The LECUA, 2007?  

For  example, a cancer patient in the medical cannabis program, to be able to receive beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments under the current law; cancer patients would need to be allowed to posses a minimum quantity of usable medical cannabis of 425.243 grams per 3 months (or 2.5 ounces every two weeks). Types of medicine made from the medical cannabis plants for treating cancer is a concentrated medical cannabis oil. A three month supply of this concentrated medical cannabis oil requires 450-500 grams (or Units) of dried cannabis flower plant material.  (The oil is also known as, hemp oil, Phoenix Tears, and Rick Simpson Oil (RSO), whole-plant cannabis oil can be orally administered or applied directly to the skin. Sublingual delivery is the preferred method of treatment for many cancer patients.)
To understand how cannabis oil, or Rick Simpson Oil (RSO) and CBD oil are different, one must first understand that there are many different types of CBD oil currently available on the market.
The first type of CBD oil is whole-plant oil derived from the highly resinous buds of the cannabis plant and is only legal in MMJ-friendly states because it contains other minor cannabinoids (although CBD is the most abundant cannabinoid in these types of products).
The second type of CBD oil is usually marketed as legal across all 50 states and typically sources industrial hemp (non-psychoactive cannabis hemp stalk with < .03% THC). CBD oil derived from hemp stalk/seeds is not the preferred oil choice for many medical marijuana patients looking to treat a specific ailment or health condition because it lacks other cannabinoids like THC that have significant medical benefits.
Along with the massive medicinal benefits of CBD oil, RSO also contains THC and other key cannabinoids resulting in patients having a much more euphoric medicating session than if they took CBD oil on its own. Research has found tetrahydrocannabinol (THC) to offer very promising therapeutic benefits for many conditions. This is one reasons some patients prefer whole plant cannabis oil over individual cannabinoids. ( Source )

A 30 day supply of cannabis oil is 60 grams or ml of oil with a dose of 2 grams or ml per day. It requires 450-500 grams of dried cannabis flower plant material to make high quality cannabis oil. So a 90 day supply or three months is 180 grams or ml of oil or 1425 grams of dried cannabis flower plant material ( Source: Rick Simpson ). Those rules and regulations that have been established limiting patients and primary caregivers to having 230 Units (grams) of any amount of medical cannabis for a three month period does not allow for the beneficial use of medical cannabis and further prevents the purpose of the law to be fulfilled as stated in section two. This also does not allow for the beneficial use of medical cannabis for other medical cannabis medicine products like tinctures and medibles, which further prevents the purpose of the law to be fulfilled.

Medical cannabis patients registered in the New Mexico MCP use the different kinds of cannabis oil with all types of conditions including, but not limited to, Amyotrophic Lateral Sclerosis (ALS), Cancer, Crohn’s Disease, Epilepsy, Glaucoma, Hepatitis C, HIV/AIDS, Huntington’s Disease, Hospice Care, Inclusion Body Myositis, Inflammatory, Autoimmune-mediated Arthritis, Multiple Sclerosis, Damage to the nervous tissue of the spinal cord, Painful peripheral neuropathy, Parkinson’s disease, Post-Traumatic Stress Disorder (PTSD), Severe Chronic Pain, Severe Anorexia/Cachexia, Spasmodic Torticollis (Cervical Dystonia), Ulcerative Colitis, arthritis, diabetes, depression, osteoporosis, psoriasis, insomnia, asthma, burns, migraines, regulation of body weight, chronic pain, and mutated cells (polyps, warts, tumors).

These rules and regulations that have been established limiting patients and primary caregivers to having 230 Units (grams) of any amount of medical cannabis for a three month period;  and this current format being used by the Department of Health Medical Cannabis Program in devising adequate supply does not allow for the beneficial use of medical cannabis. This in fact prevents every patient in the MCP from fully being able to alleviate symptoms caused by all of the qualifying debilitating medical conditions and their medical treatments and creates a liable situation for the state being out of compliance with the LECUA, 2007. Even if the patient or primary caregiver is granted the “Medical Exception” and provided the additional 115 Units (or grams) for a total of 345 Units (or grams), the state and MCP would still not be in compliance with the LECUA law.

Rules, Regulations, & Policy Solution For Adequate Supply
And then that will bring us to Title 7-Chapter 34-Part 3-Section A: Medical cannabis registry identification cards, where the definitions in Rules and Regulations for “unit” and “useable cannabis” needs to be increased & adjusted with a quantity of usable cannabis increased to 425.243 grams per 3 months (2.5 ounces every two weeks). Along with the inclusion of a medical exception that would still allow for the patient or primary caregiver to petition the MCAB for a medical exception increase of units (or grams) with the amount of the medical exception increase to be determined by a patient's medical practitioner.

The approval of this petition and providing the proper increase to “useable cannabis”  would bring the Department of Health in compliance with the intent of the law and uphold the spirit of the Lynn and Erin Compassionate Use Act, 2007.

In order for the Department of Health Medical Cannabis Program to allow for the medical treatment of cannabis, the Department must properly have “adequate supply” and have it properly defined.  And for the Department to have “adequate supply” they would need to know the different amounts of plant material that goes into all the different types of medicine being produced. Dried cannabis flower (bud), pre-rolls, edibles, tinctures, topicals/salves, and concentrated forms of cannabis all require different amounts of cannabis plant material to produce. Adequate Supply can not have a set definition in the rules and regulations and needs to be reviewed to coincide with MCP growth and patient/caregiver needs. Adequate Supply should be reviewed quarterly (4 times per year) with a current census completed of qualified patients, caregivers and licensed non-profit producers.

(Ad·e·quate: (ˈadəkwət/) adjective; satisfactory or acceptable in quality or quantity.
Sup·ply (səˈplī/) verb; 1. make (something needed or wanted) available to someone; provide.
"the farm supplies apples to cider makers" or a noun; 1. a stock of a resource from which a person or place can be provided with the necessary amount of that resource.)

This is empirical data that has not been collected within the state’s medical cannabis program by the Department of Health. Therefore “adequate supply” can not be properly defined by the department by using unknown variables it has not collected. This further prevents the Department of Health from being able to set a proper plant count for each kind of licensed producer in the program for the means of achieving adequate supply within the medical cannabis program as required by law.

This is empirical data has been studied and researched by the state of Colorado by the Colorado Department of Revenue: “An assessment of physical and pharmacokinetic relationships in marijuana production and consumption in Colorado”.

How is the purpose of the law able to be fulfilled without knowing Adequate Supply and by preventing patients from properly treating themselves due to adequate supply limits?
Section 2. PURPOSE OF ACT.--The purpose of the Lynn and Erin Compassionate Use Act is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments.
“ARTICLE 2B. LYNN AND ERIN COMPASSIONATE USE ACT
N.M. Stat. Ann. § 26-2B-2 (2009)
    § 26-2B-2. Purpose of act
The purpose of the Lynn and Erin Compassionate Use Act [26-2B-1 NMSA 1978] is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments.
HISTORY: Laws 2007, ch. 210, § 2.
EFFECTIVE DATES. --Laws 2007, ch. 210, § 12 makes the act effective July 1, 2007.”

The approval of this would bring the Department of Health in compliance with the intent of the law and uphold the spirit of the Lynn and Erin Compassionate Use Act, 2007.  New Mexico’s medical cannabis history started in 1978.  After public hearings the legislature enacted H.B. 329, the nation’s first law recognizing the medical value of cannabis...the first law.

References
The solution provided above was derived from the following sources:
Americans For Safe Access [http://www.safeaccessnow.org/policy_shop], Colorado Medical Marijuana Program [https://www.colorado.gov/pacific/cdphe/medicalmarijuana], Colorado Department of Revenue- An assessment of physical and pharmacokinetic relationships in marijuana production and consumption in Colorado [https://www.colorado.gov/pacific/sites/default/files/MED%20Equivalency_Final%2008102015.pdf],  Cannabis Yields and Dosing by Chris Conrad (court qualified cannabis expert) [http://chrisconrad.com/], and the Hawaii Medical Cannabis Program-Medical Marijuana Dispensary Task Force Study 2015 [http://files.hawaii.gov/auditor/Reports/2014/14-12.pdf].

Appendix A: An Americans for Safe Access (ASA) national report was released on December 8th, 2016 and calls for an end to contradictions between federal and state guidelines with regard to medical cannabis policies. The Americans for Safe Access briefing book, “Medical Cannabis in America”, showing that not only do opiate related deaths drop an average of 24.8% in states with medical cannabis laws, the report also notes that the Department of Justice has spent an estimated $592 million to date in arrests, investigations, enforcement raids, pretrial services, incarceration, and probation.

Plant Count For Producers Based On Patient Population Growth For Adequate Supply Proposed: Legislators could easily solve this by looking to Americans For Safe Access for this policy.

About Americans for Safe Access.
The mission of Americans for Safe Access (ASA) is to ensure safe and legal access to cannabis for therapeutic use and research.  ASA was founded in 2002, by medical cannabis patient Steph Sherer, as a vehicle for patients to advocate for the acceptance of cannabis as medicine. With over 100,000 active members in all 50 states, ASA is the largest national member-based organization of patients, medical professionals, scientists and concerned citizens promoting safe and legal access to cannabis for therapeutic use and research. ASA works to overcome political, social and legal barriers by creating policies that improve access to medical cannabis for patients and researchers through legislation, education, litigation, research, grassroots empowerment, advocacy and services for patients, government's, medical professionals, and medical cannabis providers.


Lynn & Erin Compassionate Use Act Patient’s Coalition of New Mexico ~ A GrassRoots Movement!
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(All Rights Reserved 04/20/2016)

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