2020 IOWA LEGISLATIVE PREVIEW

Iowa lawmakers again look to expand medical marijuana program

Cannabis plants grow inside the mother room at MedPharm Iowa in Des Moines on Tuesday, Jul. 24, 2018. (Stephen Mally/The
Cannabis plants grow inside the mother room at MedPharm Iowa in Des Moines on Tuesday, Jul. 24, 2018. (Stephen Mally/The Gazette)
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Editor’s note: The third paragraph of this article has been updated to better describe the history of the bill.

Fifth in a series of articles about issues likely to come up for debate in the 2020 Iowa Legislature.

DES MOINES — Lawmakers this session are almost certain to propose ideas for expanding Iowa’s medical marijuana program, but with tension from last year’s vetoed measure still echoing, efforts may be more tempered this time.

Based on recommendations from the board appointed by the governor to advise on possible changes to the medical marijuana program, lawmakers heading back to Des Moines next week may consider legislation for stronger products.

Similar policies were under consideration during the 2019 legislative session, and almost made it into law. Last year, lawmakers passed a bill that allowed for medical marijuana products to be produced with a higher amount of THC — the psychoactive component of cannabis — that advocates said was needed to make the product strong enough to help some patients. .

The move, however, was at odds with recommendations from Iowa Medical Cannabidiol Advisory Board. As a result, a physician who served on the board resigned in protest and Gov. Kim Reynolds vetoed the bill.

The proposal passed by legislators in the 2019 session would have replaced a 3 percent THC cap with a 25 gram purchasing limit of THC over 90 days.

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But the board previously voted unanimously to maintain the state’s current cap on THC in products to 3 percent.

Des Moines neurologist Wendy Zadeh quit the board the day after the bill passed the Iowa House, writing in her resignation letter that legislators “misstated what the board has recommended in pushing their THC dose.”

Reynolds vetoed the bill, saying she preferred to follow the recommendation of the Iowa Medical Cannabidiol Advisory Board. But the Republican governor said she supported other portions of the bill.

“I agreed with every other component of that bill. They were all recommendations of the cannabidiol board. I thought they were great recommendations. And I said that I agreed with every one of those. It was just the level from the 3 percent cap to 25 grams over 90 days,” she said.

If enacted, the law would have required a pharmacist or pharmacy technician be employed at the five state-licensed dispensaries. It also would have allowed physician assistants and nurse practitioners to the list of qualified providers who can recommend patients for the program.

The cannabidiol board’s latest report to legislators includes the possibility of replacing the 3 percent THC cap with a limit of 4.5 grams of THC over 90 days.

“We do not believe there’s any justification for 25 grams,” Dr. Stephen Richards, a Spirit Lake pharmacist and physician, told The Gazette earlier this month.

Under the board’s recommendation, the purchase limit would not apply to the terminally ill. The limit also could be increased by the certifying health care provider without board approval.

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Richards’ main concern is the potential harm these products could cause. Richards said he’s found little research that illustrates the health benefits of a higher concentration of THC, but added that board members have come to understand the products “won’t cause harm with 4.5 grams of THC.”

“First, do no harm,” Richards said. “That’s the oath I took both in pharmacy school and in medical school.”

But some say such a move would be detrimental to some patients in Iowa’s cannabidiol program.

Twenty-five grams of THC over a 90-day period would cap the maximum per-day dose of THC to about 50 milligrams.

Some chronic pain patients need as many as 200 milligrams per day to manage their symptoms, Lucas Nelson, general manager of medical marijuana manufacturing company MedPharm, previously told The Gazette.

That’s why Rep. Todd Prichard, leader of the House Democrats from Charles City, suggested legislators send the same bill to Reynolds again — even knowing she would veto it a second time.

“I would like to see the bill that passed the House go back. I think it was a good bill. It got the (THC) levels, for what we were told and what we understood, where they need to be where they can do good for people who are suffering from certain ailments. In my mind, we sent a good bill down,” Prichard said. “I think (the governor’s veto) was a mistake.”

Republican leaders who control both chambers of the Iowa Legislature said they expect to work with the governor this year to pass a bill she is willing to support.

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“Obviously, I supported the bill that we passed last year. I voted in favor of it. I have been a strong supporter of medical cannabis since I came into the Legislature,” said Sen. Charles Schneider, the Republican Senate president from West Des Moines. “And I’d like to find a way to send something to the governor that she would be willing to sign and something over to the House that they would be willing to pass as well.

“So it’s a matter of us working together and finding a way to get something done for Iowans that makes dosing more practical for patients and for the producers, something that potentially expands conditions, if that’s something we can find agreement on, and something that just works better for Iowans.”

Minnesota and Illinois have grown their medical marijuana programs in recent years, but neither have caps on THC.

Under Illinois law, qualifying patients can purchase up to 2.5 ounces, or about 70.9 grams, of medical cannabis every two weeks.

A Minnesota patient’s dosage — which is determined through a consultation with a licensed pharmacist — is not affected by any product or time period limitations.

Comments: (319) 368-8536; michaela.ramm@thegazette.com

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