IOWA LEGISLATURE

Iowa House approves medical cannabidiol changes, setting up clash with Senate

The Iowa House chamber at the State Capitol in Des Moines. (Rebecca F. Miller/The Gazette)
The Iowa House chamber at the State Capitol in Des Moines. (Rebecca F. Miller/The Gazette)

DES MOINES — Iowans with some autistic conditions or post-traumatic stress disorder could be certified to participate in the state’s medical cannabidiol program under changes approved Tuesday by the Iowa House.

The House voted 52-48 to add “severe, intractable autism with self-injurious or aggressive behaviors” and PTSD to the list of debilitating conditions for which an Iowan can be certified to receive medical cannabidiol.

The bill, House File 2589, now goes to the Senate, where even more expansive changes have been proposed.

HF 2589 would establish a cap of 4.5 grams of THC — tetrahydrocannabinol, which is the psychoactive component of marijuana — over 90 days, Rep. Jarad Klein, R-Keota, told colleagues in the debate that started after 8 p.m.

The current law allows health care practitioners to certify patients for medical cannabidiol products of no more than 3 percent THC, However, there is no purchasing limit, so some patients with severe cancers can receive as much as 260 milligrams per day.

HF 2589 would allow a dosage of 50 milligrams a day.

Several amendments were offered to raise the cap to 25 grams per 90-day period. That’s what has been approved by the Senate Judiciary Committee. Judiciary Chairman Brad Zaun, R-Urbandale, said he’s “going for the gusto” so he can negotiate with Klein and Gov. Kim Reynolds. She’s been adamant about capping medical cannabidiol use at no more than 4.5 grams over 90 days.

Among the reasons for the 4.5 gram cap, Klein said, is that he doesn’t want to risk Reynolds vetoing the bill as she did last year when legislators sent her a bill with a 25 gram cap.

He described the 4.5 gram cap as “compassionate, but not causing harm.”

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But Rep. John Forbes, D-Urbandale, a pharmacist, said there are no clinical studies to show that 4.5 grams over 90 days is a safe level. The state medical cannabidiol board “pulled it out of the air.”

The cap would mean about 2,300 people in the Iowa medical cannabidiol program would have to reduce their daily dosage, Forbes said.

Klein reminded colleagues that HF 2589 would allow a patient to receive more than 4.5 grams if their health care provider certifies either they have a debilitating condition with a life expectancy of a less than a year and determined that 4.5 grams is insufficient to treat the condition.

Among the other changes in the bill are:

— Replacing “untreatable pain” with “chronic pain” on the list of debilitating conditions for which a person can be certified to receive medical cannabidiol.

— Adding physician assistants, advanced registered nurse practitioners, advanced practice registered nurses and podiatrists to health care practitioners who can certify a patient to receive a medical cannabidiol registration card.

— Removing a prohibition on patients and primary caregivers with certain felony offenses from receiving a medical cannabidiol registration card.

All amendments to raise the cap to 25 grams were defeated, mostly along party lines.

In the end, Klein said, Iowa’s program is based on the advice of “smart medical professionals.”

“We have a medical program, not a recreational program masquerading as a medical program and that’s the way we’re going to keep it,” Klein said.

Disability benefits

“We have your back,” Rep. Bobby Kaufmann, R-Wilton, said after the Iowa House voted 98-1 to expand coverage for police and firefighters to cover injuries that occur over time as well as PTSD.

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HF 2592 would expand the 411 retirement system for police and firefighters to cover cumulative injuries and PTSD. Kaufmann doubted it was the intent of the Legislature when it set up the system in 1992 to treat police and firefighters unfairly.

A public employee who suffers a knee injury to repeatedly doing a task is covered by the 411 system.

“Think of that firefighter carrying that same hose for 15 years eroding his or her shoulder. They’re on their own,” Kaufmann said. “That is unacceptable.”

Rep. Tim Kacena, D-Sioux City, called himself the “a poster boy” for the bill because three years after retiring from 33 years of police and fire service he was diagnosed with job-related lung cancer.

“This bill is personal to me,” he said.

Changing tables

The House unanimously passed HF 2097 to require the Iowa Department of Transportation to install adult changing tables in rest stops.

Rep. Ann Meyer, R-Fort Dodge, said the tables would benefit families with members who are developmentally disabled and have difficulty finding an appropriate place to attend to their needs when traveling.

Asbestos claims

Representatives voted 54-46 to approve changes to a 2017 law outlining requirements for making asbestos and silica claims despite objections that they changes would make the process too onerous on claimants.

Among the new requirements are detailing any current and past worksites, listing each asbestos-containing product or silica product to which the claimant was exposed, the frequency of the exposure to the product or its use and the seller of the specific asbestos or silica product.

All Republicans voted for the bill and all but one Democrat voted “no.”

Pharmacy benefits managers

House members voted 100-0 regulate pharmacy benefits managers, which are supposed to reduce prescription drug costs and improve convenience and safety of prescription medications.

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PBMs are hired by insurance carriers to negotiate better prices with drug manufacturers. They administer plans for 266 million Americans on several different health care plans, including Medicare and managed Medicaid. HF 2553 would protect pharmacies from several PBM practices that the bill’s supporters say shortchange pharmacies and overcharge programs, such as Medicaid.

Comments: (319) 398-8375; james.lynch@thegazette.com

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