A good day…

Today the Illinois Senate passed House Amendment 3 to Senate Bill 10 – sending to Illinois Governor Rauner a significant package of reforms and changes to the Illinois medical cannabis program – and believe it or not, he is going to sign the Bill.

We owe thanks to Representatives Lou Lang, Jim Durkin, and Governor Rauner.

                                                               

Anyone interested in reading the specifics can go here, and press coverage here and here.  The short version:

  • Extends the program several years to mid-2020 (instead of expiring Dec. 31, 2017);
  • Adds PTSD and terminal illnesses (terminal illnesses will have an expedited Dept. of Public Health approval);
  • Changes patient registration to 3-years before renewal, and the horrid patient fingerprinting need only be done once;
  • Clarifies that a doctor only certify a patient has a qualifying medical condition (not necessarily condoning the therapeutic benefit);
  • Dissolves the existing Medical Cannabis Advisory Board of patients, doctors and other health professionals, to be reconstituted under Gov. Rauner; and
  • Fixes a conflict in the law that threatened the lawful gun ownership of medical cannabis patients, plus more.

This Bill does not have everything for advocates (it does not add chronic pain, it does not add home-grow, etc), but with all the positive things SB 10 does, perhaps the most critical is that it gives hope and positive momentum to the Illinois program.

There is one notable (albeit minor) downside.

Having been involved in the creation of the Medical Cannabis Advisory Board, the dissolution of this Board gave me a moment of pause – the leadership of Dr. Leslie Mendoza Temple, Dr. Eric Christoff, Dr. Allison Weathers, patients Jim Champion and Michael Fine, and all the others has been outstanding, and frankly exactly what I had hoped for when we initially designed this team of volunteers and medical experts to consider the ever-changing research behind medical cannabis.

I will need to look past the downside of losing these wonderful volunteers, and focus on the huge benefit to the medical cannabis program.

One of the heroes of the Pilot Program, Leader Lou Lang, said it best:

“I have followed the work of the [Advisory] Board and they have done a stellar job.  They have listened to a lot of testimony, they read a lot of documents.  Before I made my final agreement to move this bill in this way, I called each of them to tell them what was in this bill.  Each of them said to me, ‘we think this board does good work… but if what we have to do to lengthen and strengthen this program, and make it better for patients and licensees and doctors and everyone in the pipeline, is to agree to reconstitute this board, then count us in.'”

Amen.

Medical Cannabis Advisory Boards

On January 29, 2016, the Illinois Department of Public Health (“IDPH”) announced that Director Nirav Shah had once again rejected adding debilitating medical conditions to the Illinois Medical Cannabis Pilot Program Act (“MCPP”).

Though highly disappointing, this came as no surprise to those of us closely monitoring the words of Illinois Governor Rauner.  See hereHereHere.  And even his January 2015 comments here.

“I’m concerned about the process,” Rauner said today during a signing ceremony in Springfield.  “I don’t think it’s been run well.’

No offense taken.

The new Rauner Administration has been a mixed bag with regards to the medical cannabis program (on the bright side, cannabis businesses received their licenses, were allowed to initiate cultivation, and the program was allowed to start patient sales in November 2015 without any government obfuscation or inexplicable delays).

Yet the Illinois Department of Public Health, guided by the principles of Governor Rauner, has twice rejected the recommendations of the Medical Cannabis Advisory Board (“Advisory Board”) to expand the program.  The truly outstanding and overly qualified Advisory Board, comprised of doctors and patients, nearly unanimously urged IDPH to add new medical cannabis conditions such as PTSD and chronic pain.

advisory-board

The recommendations were rejected.  No explanation was given.  There is no reason to expect a different result in the future – you know that old saying about doing the same thing over and over again but expecting a different result…

While many of us are upset and disappointed about the news, I want to focus on the legal side of the ledger.

The Advisory Board is one of the better aspects of the MCPP – designed for the law to evolve over time.  [Full disclosure: I am also a former general counsel for IDPH, and was involved in the creation and appointment of the Advisory Board.]  As more medical cannabis research provides stronger justification for how it benefits PTSD, for example, IDPH has the authority to add the conditions through administrative rules (specifically through the Administrative Procedure Act and the Joint Committee on Administrative Rules).

Seems a bit boring, but wait… What if the Advisory Board recommends adding a condition to the MCPP and the IDPH says “no” to the recommendation?  Of course, that is exactly the situation we find ourselves in.

Not surprisingly, those who applied to add their medical condition are heartbroken, and some have even sued IDPH:

“An Illinois veteran is asking a judge to reverse a state decision against adding post-traumatic stress disorder to the list of diseases eligible for medical marijuana treatment.

“In the case of PTSD, the advisory board voted unanimously to recommend that it be added to the list after hearing testimony about the existing medical evidence.

“Potential patients ‘are disappointed in the governor for going against the recommendations of his own medical cannabis advisory board,’ [Attorney Michael] Goldberg said.  ‘The governor’s office has reversed the board’s recommendations without giving any reason, and they are seeking relief from the judicial branch.”

Can IDPH continue to refuse adding any conditions in the face of repeated Advisory Board decisions to the contrary?  Does IDPH need to give a reason for the denial?  If so, would any reason be legally sufficient?  What role, if any, does the Office of the Governor have?

Much of this will be addressed in court, so I’ll let those questions linger.  But we have some other states to take cues from.

Arizona’s medical marijuana law is one of the models for our program in Illinois, and also includes a Medical Advisory Committee to consider adding new conditions.  Arizona’s Advisory Committee recommended against adding conditions like PTSD in 2012 and again in 2014.  Based on these recommendations, their Director of the Department of Health Services denied the addition of PTSD citing “a lack of scientific evidence.”  When challenged in administrative review, the Department was ordered to reconsider and the Director ultimately acquiesced to adding PTSD as an eligible condition under their program.

“At the hearing, there was substantial evidence showing that PTSD sufferers receive a palliative benefit from marijuana use.

“The preponderance of the evidence shows that marijuana use provides a palliative benefit to those suffering from PTSD.”

Minnesota’s medical cannabis program closely mirrors Illinois program in many ways, including an advisory panel to consider new conditions.  Despite the panel recommending against intractable pain, the Minnesota Commissioner of Health decided to add the condition.

As disheartening as the gutting of the Advisory Board in Illinois may be, the Board still offers a unique and high-profile opportunity to present the litany of latest research supporting the medicinal benefits of cannabis.  The Advisory Board may not succeed at adding medical conditions any time soon, but it continues to be valuable and we all benefit from the Board’s thoughtful and passionate members.

If there is any takeaway from this, we should acknowledge that reasonable government officials and medical professionals can disagree on substantive decisions like adding eligible conditions to a medical cannabis program.  But when we are considering treatments for our country’s heroes returning from battle and suffering from PTSD, or solutions for millions of Americans battling chronic pain with addictive opioids freely prescribed by their doctors, we should not stand in the way of medicine that can improve their lives.