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Edited on Fri Oct-30-09 08:26 AM by Fly by night
Good morning, all y'all. As some of you know, I have spent the past seven years dancing with federal weasals who want to confiscate my 170 acre farm for seven pounds of medical cannabis that I was growing for myself and four terminally ill neighbors (all of whom died withn months of the raid.) It has been a tough time, and I would not recommend it for anyone. But it is coming to a conclusion soon (I hope). When the ordeal is over, I will post a thread here to celebrate. In the meantime, I wanted to share with my DU community a proposal that we have developed here to re-establish Tennessee's medical cannabis program using a production/distribution model that several other states have proposed, but none have implemented.
I remain proud that a position paper I wrote for then-New Mexico Governor Gary Johnson back in 2002 influenced that state to be the first to authorize state-licensed and -monitored medical cannabis production and distribution. (The position paper was sitting by my computer the day my farm was raided, and I gave the raiders a copy to take with them when they left.) I am also pleased that at least a half-dozen states are moving in the same direction now (with Rhode Island's program being the best of the bunch right now.)
However, I don't think any state has moved far enough to develop medical cannabis programs that will provide low-cost, high-quality medical cannabis to eligible patients as soon as they are diagnosed with a relevant condition; and that will do so with appropriate controls and supervision. That is why I wrote the following proposal, which is now being reformatted as legislation that will be filed in our legislature in January.
This week's announcement from the US Justice Department that the feds will leave patients and providers alone as long as they comply with state regulations was a water-shed event. Now it's time to take it the next step. So please read our draft Tennessee proposal and give us your feedback. I believe it is immoral to tell newly diagnosed cancer patients that they can grow their own medicine when we know that it will take 5-8 months for them to harvest their first crop. It is also immoral to charge sick and dying people $80 for one-eighth ounce of medicine, something that is now going on in California and elsewhere.
We can do better -- yes we can(nabis).
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Establishing a Model Medical Cannabis Program in Tennessee:
Taking the Lead in Reintroducing Cannabis to the Medical Pharmacopeia
Preface
President Barack Obama, March 22, 2008
"When it comes to medical marijuana, I have more of a practical view than anything else. My attitude is that if it's an issue of doctors prescribing medical marijuana as a treatment for glaucoma or as a cancer treatment, I think that should be appropriate because there really is no difference between that and a doctor prescribing morphine or anything else. I think there are legitimate concerns in not wanting to ... start setting up mom and pop shops because at that point it becomes fairly difficult to regulate. I think the basic concept that using medical marijuana in the same way, with the same controls, as other drugs prescribed by doctors, I think that's entirely appropriate. I would not punish doctors if it's prescribed in a way that is appropriate.”
—
Attorney General Eric Holder, February 28, 2009
"What the president said during the campaign, you'll be surprised to know, will be consistent with what we'll be doing in law enforcement. He was my boss during the campaign. He is formally and technically and by law my boss now. What he said during the campaign is now American policy."
Attorney General Holder announced that the Justice Department will no longer raid medical marijuana operations established legally under state law. His declaration honors President Obama’s campaign pledge and marks a major shift from the previous administration.
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Senator Barbara Boxer (D-California), March 1, 2009
"It's good news for people in California who are so ill that they have gotten a doctor's prescription in compliance with the (state’s medical marijuana) law. If you have a doctor's prescription, you should be able to get whatever medicine you need."
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Dr. Donald Abrams, San Francisco General Hospital, March 15, 2009
"I think marijuana is a very good medicine. I'm a cancer doctor. I take care every day of patients who have loss of appetite, nausea, pain, difficulty sleeping and depression. I have one medicine that can treat all of those symptoms, instead of five different medicines to which they may become addicted. That one (medicine) is marijuana, and my patients are not going to become addicted to it."
(Dr. Abrams is chairman and principal investigator of the Community Consortium, an association of Bay Area HIV health care providers, one of the pioneer community-based clinical trials groups, established in 1985. He is the Assistant Director of the AIDS Program at San Francisco General Hospital and a professor of Clinical Medicine at the University of California, San Francisco. Dr. Abrams has been conducting National Institute on Drug Abuse-approved research on marijuana for the past twelve years. He considers marijuana to be both a safe and an effective medicine.)
Introduction
There are now fourteen US states that have implemented medical cannabis programs for residents suffering a range of medical conditions for which cannabis has been demonstrated to be beneficial. In addition, there are at least a half dozen other states that are actively considering in their legislatures the establishment or re-establishment of similar programs. The momentum for these programs has grown steadily as the awareness of the medical benefits of cannabis has expanded among both the general public and the medical profession. At present, over 75% of American adults approve of expanding access to medical cannabis and dozens of medical, public health and related professional organizations have endorsed this idea.
State-level medical cannabis programs have served to insulate approved patients, providers and medical professionals from prosecution by state authorities for marijuana possession, production and distribution. However, these persons have remained at risk of federal prosecution and, in a number of cases, those prosecutions have been pursued aggressively in previous administrations. With the implementation of a new, more patient-centered federal policy toward medical cannabis, one that respects a state’s right to develop and dictate the conditions of its own program, the opportunity to re-establish a medical cannabis program for Tennessee residents has entered a new era, one that may allow our state to develop and implement a medical cannabis program that not only serves our own residents more promptly and with more controls than now exist in other states, but which can also serve as a potential model for other states that do not now have medical cannabis programs.
The key to moving forward here in Tennessee is to take seriously President Obama’s statement that “... using medical marijuana in the same way, with the same controls, as other drugs prescribed by doctors, ... (is) entirely appropriate.” At present, no state’s medical cannabis program fulfills this requirement. For the most part, existing state medical cannabis programs require that patients go through an approval process before being allowed to obtain and use cannabis. In most states, approved patients are allowed to grow a limited amount of cannabis for their own use, or to find someone (usually designated as a “caregiver”) to grow or otherwise provide cannabis for them. However, patients and caregivers may not begin growing cannabis until they are approved for program participation, which usually means a 5-8 month delay between approval and the harvesting of any medically beneficial cannabis.
Some states – notably California – have addressed the access issue by allowing the development of medical cannabis “dispensaries” to sell cannabis to eligible patients. However, these dispensaries still must rely primarily on cannabis grown for the illicit market to provide much of the cannabis that they sell. As a result, these dispensaries continue to charge inflated illicit market prices (sometimes exceeding $600 per ounce) for the cannabis they sell. At least four other states – New Mexico, Colorado, Rhode Island and Maine – have formulated mechanisms for allowing dispensaries (sometimes called “compassion centers”) to grow and distribute cannabis, but these states continue to place varying restrictions on the amount of cannabis that can be produced and distributed by these providers. In all cases, the illicit marketplace continues to set the price for medical cannabis and many patients, including patients in these four states, do not have immediate access to this medicine at reasonable prices when they are diagnosed with an eligible medical condition.
In all states with approved medical cannabis programs, there remain lingering concerns about how law enforcement officials can and should respond when they find cannabis being grown in their jurisdictions. In some areas, the establishment of medical cannabis programs has increased the number of cannabis grow operations and has increased the perceived burden on local law enforcement. In addition, every state with an approved medical cannabis programs has fostered alternate distribution systems to provide access to medical cannabis in ways that are distinctly different from how patients access any other medically beneficial pharmaceutical.
All of these circumstances remain vestiges of our historically more punitive attitude toward medical cannabis at the federal level, and they continue to make medical cannabis difficult and expensive for eligible patients to obtain, problematic for law enforcement and challenging to medical professionals who might consider recommending medical cannabis but who have no way to insure access to safe and effective medicine for their patients. These medical cannabis programs have in some cases imposed a net cost to state and local governments for implementing and monitoring these programs, rather than providing a mechanism to collect revenue from the implementation of these programs that could both wholly fund the programs and contribute to the general tax revenue in those states.
With all of this in mind, it is time to break the mold established over the past thirteen years in the implementation of medical cannabis programs. It is time to develop a program here in Tennessee that rises to the challenge (and the opportunity) provided by the shift in federal policy brought on by the election of President Obama. It is time to develop and implement a program that eliminates the delay between the onset of qualifying medical conditions and access to medical cannabis, that reduces the costs to patients and the impact of the illicit market on that pricing structure, that improves the safety and efficacy of available medical cannabis and that reduces (rather than increases) the impact on law enforcement agencies. That should be our goal here in Tennessee, and achieving that goal is the focus of the remainder of this program prospectus.
The Outlines of a Model Medical Cannabis Program in Tennessee
There are three criteria that should be met for a state’s medical cannabis program to be successful:
a) Patients should have access to medical cannabis at time of diagnosis of an eligible condition.
b) Medical cannabis that is made available to patients should be of a consistent high quality.
c) Production and distribution of medical cannabis should occur under controlled conditions.
Today, no state medical marijuana program meets these three criteria. However, Tennessee’s previous medical cannabis program approached fulfillment of these criteria and should be studied as a model as our state’s program is re-established. For a decade (1984-92), Tennessee was one of a number of states that operated medical cannabis programs by obtaining cannabis grown at the federally-funded production facility at the University of Mississippi. That program was authorized by the Tennessee General Assembly and signed into law by then-Governor Lamar Alexander. During its operation, the program was administered by the Tennessee State Board of Pharmacy, which reviewed patient applications and provided cannabis that was grown, processed and provided by the University of Mississippi facility. This previous experience with administering a medical cannabis program here in Tennessee can serve as useful background information for our new program.
For a newly re-established Tennessee medical cannabis program to be successful, it should operate in a manner that provides sufficient controls over the production and distribution of this medicine to discourage interactions with the illicit market. Likewise, medical cannabis should be grown under the most stringent organic production standards and the cultivars to be grown should be of proven medical benefit to insure the safety and efficacy of this medicine. Finally, access to medical cannabis should be a decision between a health care provider and patient, and no intervening hurdle should be placed between the time of diagnosis and access to medical cannabis for eligible patients. No such hurdles now exist between patients and access to demonstrably more powerful (and hazardous) medicines, and those hurdles should not exist for medical cannabis.
How might such a program be established here in Tennessee? The following suggested program elements cover many of the components of a proposed program that should be considered and approved by our General Assembly. This prospectus is intended to provide a starting point for discussion, and for clarification and modification of these elements of a successful program.
Eligibility – Tennessee residents who are diagnosed with serious medical conditions that have been demonstrated to benefit from the use of medical cannabis should be eligible for this medicine. In all states, there are at least six medical conditions that have been universally identified as meeting this requirement: cancer, HIV/AIDS, multiple sclerosis, glaucoma, intractable spasticity due to spinal cord injury and hepatitis C. In Tennessee, there are approximately 150,000 patients who suffer from these medical conditions at present. Since that number includes only newly diagnosed cancer patients, it is a considerable underestimation of the patients who might benefit from access to medical cannabis.
In addition, there are other serious medical conditions for which medical cannabis has demonstrated benefits. These conditions should be considered for inclusion under Tennessee’s program through a process of systematic review of the available research evidence by an advisory group qualified to conduct this review. That group should operate under the auspices of the Tennessee Department of Health, and should meet regularly to review evidence for an orderly expansion of the list of eligible conditions. However, Tennessee’ authorizing legislation should be written to allow medical conditions to be added, and medical cannabis to be prescribed, without the necessity for having to return to the legislature to amend this legislation every time new conditions are added. For the sake of the remainder of this prospectus, we will use the 150,000 figure as an estimate of the number of patients who potentially would be eligible for medical cannabis at the initiation of this program.
Access – As mentioned earlier, under Tennessee’s earlier medical cannabis program (1984-92), cannabis was made available through pharmacies under the oversight of the State Board of Pharmacy. A new medical cannabis program in Tennessee should also distribute cannabis through pharmacies, eliminating the need for alternate distribution systems like “dispensaries” or “compassion centers” and applying the same controls over access to this medicine that apply to every other controlled substance. The State Board of Pharmacy should again play a role in the establishment of mechanisms to distribute medical cannabis through regularly established and licensed pharmacies in this state.
Tennessee’s program should not require that patients undergo an application and approval process in order to be prescribed medical cannabis. That application process imposes an unnecessary burden on patients and delays their access to medical cannabis needlessly. For example, newly diagnosed cancer patients need access to medical cannabis prior to undergoing chemotherapy that, in most cases, begins shortly after diagnosis. Thus, patients should be able to access medical cannabis prior to the onset of chemotherapy. As with all other medicines, the decision to use medical cannabis should be one that is made after consultation between the patient and that patient’s health provider. Once the decision is made, the patient should be provided a prescription for medical cannabis that can be filled at one or more pharmacies in their area. No third party need intervene in that decision process, just as no third party intervenes now in the decision to prescribe other pharmaceuticals.
Production – Instead of relying on un-licensed and unsupervised producers (including producers from the illicit market) to provide medical cannabis or relying on thousands of “caregivers”, each of whom is only allowed to grow for a limited number of patients, Tennessee’s production system should be initiated and implemented to provide sufficient medical cannabis with a minimum number of producers. This aspect of the program should be accomplished with the involvement of the Tennessee Department of Agriculture and the University of Tennessee Institute of Agriculture. To be safe and effective, medical cannabis should be grown using the most stringent and well-researched organic production practices, and its production should be supervised by agriculture professionals who are equipped to insure that the resultant medicine is grown under the most appropriate conditions befitting the use of this substance as medicine. The University of Tennessee Institute of Agriculture possesses both the expertise and the facilities necessary to initiate this process, and the Tennessee Department of Agriculture possesses the regulatory authority necessary to oversee the expansion of this production process to trained, licensed and supervised farmers as the need grows.
To launch the Tennessee medical cannabis program, we propose growing medical cannabis on three of the University of Tennessee Agricultural Research and Education (UT/ARE) farms, preferably one in each grand division of the state. Each of these farms would produce medical cannabis for the initiation of the state’s program using a “best practices” protocol as articulated by the input of recognized experts in medical cannabis production in the US and overseas. The newly established UT Organic Research farm in Knoxville would take the lead in the development of these “best practices” protocols, and would be one of the three farms engaged in initial medical cannabis production. Given its size and proximity to Nashville, the Spring Hill UT/ARE farm should also be included among the first three farms. The third farm, ideally located in West Tennessee, can be selected from among the several UT/ARE farms in that region that express an interest in being involved in this program.
A worthy production model would have medical cannabis being grown in 50 X 100 foot greenhouses, both to facilitate control over access and to moderate conditions favorable to optimal cannabis production. Given the wide range of current production estimates (that is at least partially dependent on the cannabis cultivars that are selected for production), each greenhouse should be able to produce between 20-80 pounds of usable medicine (i.e., dried female cannabis flowers), with one acre capable of housing eight greenhouses. If the three participating UT/ARE farms were to devote four acres apiece to cannabis production, enough cannabis should be produced at these three farms to serve, at a minimum, the needs of the first 2,500 patients enrolled in Tennessee’s program. This minimum estimate is based on 2,500 patients suffering from chronic conditions (e.g., multiple sclerosis, HIV/AIDS) that would result in the use of approximately one ounce of medical cannabis per week. However, since many eligible patients would use medical cannabis in a time-limited fashion and only during the course of medical treatment for their conditions (e.g., cancer, hepatitis C), it is highly likely that more than 2,500 patients can be served at this initial level of production.
Although serving the needs of 2,500 patients would be a worthy start for Tennessee’s program, it would represent less than 2% of the patients suffering from the first six medical conditions eligible for program participation. Since Tennessee’s program would allow access to medical cannabis easier and at lower cost than in other states, it is imperative that the program be capable of growing rapidly to serve the needs of many more patients for whom medical cannabis would be beneficial.
Consequently, we propose that Tennessee farmers be allowed to be licensed and certified medical cannabis producers, trained by the University of Tennessee Institute of Agriculture and under the continuous monitoring and supervision of the Tennessee Department of Agriculture. These farmers will be licensed to produce medical cannabis that they can sell only to the state-managed medical cannabis program. For the sake of this preliminary discussion, licensed farmers would be allowed to grow as little as one 50 X 100 greenhouse and as much as four acres of medical cannabis. If their medical cannabis passes inspection by meeting all requirements of the program, farmers would be paid $500 per pound for the dried female cannabis flowers that they produce. Thus, the gross income to the farmers would range from $10,000 - $40,000 (and possibly more) per greenhouse. (One acre would hold up to eight greenhouses, with farmers allowed a maximum of four acres of production.)
Processing/packaging – In order to maintain uniform standards, to minimize diversion to the illicit market and to allow for uniformity in processing and packaging of Tennessee’s medical cannabis, all cannabis that is harvested would be processed and packaged initially at the three participating UT/ARE farms. This work can be accomplished by UT/ARE seasonal employees hired and trained in this activity, or it can be accomplished by contract staff hired specifically for this purpose. Farmers participating in the program would allow UT/ARE employees or contractors to harvest the cannabis on their farms and transport the plant material to a central processing location on the nearest participating UT/ARE farm. There, the cannabis would be labeled by the farm of origin before being stored in a controlled climate to dry and cure. (This process normally takes several weeks.)
Once the cannabis is ready to be packaged, each farmer’s crop would be processed separately and weighed in its final state (i.e., dried female flowers) in order to determine the value of the farmer’s cannabis. It may be possible to process excess leaf trimmings for use in tinctures, salves and other medically beneficial products. If this occurs, farmers will also be compensated for the value of the excess leaf trimmings, though at a level below the dried female flowers (perhaps $100 per pound).
The resultant medical cannabis will be packaged in sealed containers that will represent the final form in which patients will receive the medicine. The smallest container will contain a quarter-ounce of medicine. The largest container will contain one ounce of medicine. Patients will be allowed to be prescribed a month’s worth of medical cannabis at a time. For some patients, that may involve as much as four ounces per month that will be provided with a single prescription.
Distribution – Once the medical cannabis has been packaged in its final form, it will be stored in secure facilities, ideally with one storage facility located on or in proximity to each UT/ARE farm. These facilities will be staffed with licensed personnel who will be responsible for filling orders from pharmacies and for distributing medical cannabis to these pharmacies under secure and controlled conditions. Pharmacies will be invoiced for the medical cannabis at the time of delivery. Staff at the storage facility will be responsible for record keeping and billing, in accordance with policies established for this purpose. A complete inventory of the quantity of medical cannabis stored at each facility will be maintained at all times, and the medical cannabis will be stored under conditions which maximize its longevity and efficacy. Each facility will be responsible for assisting in the determination of how much medical cannabis will need to be produced for each succeeding year.
Pricing – At present, Tennessee patients who seek out marijuana on the streets are forced to pay from $200-$600 per ounce for this medicine, even though its quality and purity – and the conditions under which it was grown and processed – are usually unknown. Unfortunately, this pricing range has been duplicated in most states with existing medical cannabis programs, in great part because medical cannabis in those states is often obtained from the same illicit market. This pricing level for medical cannabis is indefensible and unwarranted and it should not be repeated in Tennessee.
For the sake of this prospectus, we are proposing that Tennessee’s medical cannabis be provided to patients at a standard unit cost of $60 per ounce, regardless of the particular cultivar that patients are prescribed. (Based on the current level of knowledge about the differing medical benefits of different cannabis cultivars, we anticipate that at least four strains of cannabis will be grown in Tennessee.) For this price, farmers (or the UT/ARE farms) will receive approximately $30 per ounce, the State of Tennessee will receive approximately $20 per ounce (to fund all costs of the administration of this program, with all excess income going into the state’s general fund or allocated to specific programs, such as substance abuse treatment or indigent health care) and the participating pharmacist will receive approximately $10 per ounce. This allocation of income is subject to adjustment, depending on which aspects of the medical cannabis program are performed by each sector.
The smaller packages of medical cannabis (the one-quarter ounce size) may be billed at $30 per package in order to address the inelastic costs of packaging and distribution of these packages. Any excess income obtained by the sales of medical cannabis in these smaller packages, compared with ounce packages, will be retained by the State of Tennessee.
Under this pricing structure, farmers will receive approximately $500 per pound for the dried female flowers they produce (and a separate, but lower, amount for excess leaf trimmings if they are processed into alternate forms of the medicine). The State of Tennessee will receive approximately $300 per pound to fund the program, with any excess income going into the general fund. Pharmacists will receive approximately $150 per pound for their participation.
For the sake of this prospectus, these pricing levels would aggregate as follows. If we presume that, to initiate this program, the three UT/ARE farms would each produce approximately 2,500 pounds of usable medicine (not counting the excess leaf trimmings) per harvest, that would result in approximately 7,500 pounds of medicine statewide that would serve a minimum of 2,500 patients (at a use level of one ounce per week). The value of this initial crop would thus calculate out as follows:
Income from production (farmers’ portion) $500 X 7,500 pounds = $3,750,000
Income from state sponsorship (state’s portion) $300 X 7,500 pounds = $2,250,000
Income from distribution (pharmacists’ portion) $150 X 7,500 pounds = $1,125,000
Total gross income: $7,125,000
At this pricing level, all costs would be covered for all program components of Tennessee’s medical cannabis program, and the program would be able to generate funds for the state’s general fund from the inception of the program. This is particularly the case at the initiation of the program, as the “farmers’ portion” would also be assigned to a state agency, the UT/ARE farms, with any excess income above the production and program development costs also being assigned to the general fund.
If we project this program to grow to serve patients with other conditions for which medical cannabis is currently being prescribed elsewhere, these resultant estimates become quite impressive. For example, we can presume that, within five years, 150,000 patients may be enrolled in Tennessee’s medical cannabis program. This number is not unrealistic, since adding other medical conditions such as arthritis, anorexia, chronic pain, fibromyalgia, Crohn’s disease, Parkinson’s disease, epilepsy and other conditions for which medical cannabis has been shown to be beneficial would dwarf the initial 150,000 estimate of eligible patients with the first six qualifying conditions alone (cancer, HIV/AIDS, multiple sclerosis, glaucoma, intractable spasticity due to spinal cord injury and hepatitis C.)
For the sake of discussion, let us estimate that these patients consume, on average, one ounce of medical cannabis per week. (Again, some patients will consume much less and others will consume more.) That consumption level would require approximately 500,000 pounds of medical cannabis to be made available each year. At that level, the following gross income levels result:
Income from production (farmers’ portion) $500 X 500,000 pounds = $250,000,000
Income from state sponsorship (state’s portion) $300 X 500,000 pounds = $150,000,000
Income from distribution (pharmacists’ portion) $150 X 500,000 pounds = $75,000,000
Total gross income: $475,000,000
Of course, the costs for program administration would grow with the expansion of Tennessee’s medical cannabis program to this level. It would be necessary to hire additional staff at both the UT/ARE farms and within the TN Department of Agriculture to handle the training, certification and monitoring of participating farmers who are involved with the program. Likewise, processing, storage and distribution costs would increase. However, at this level, there would be economies of scale that will increase the efficiency of the program. In any event, the total costs for state administration of this program, even at this level, are not expected to exceed $20 million (and that may be a high estimate). Thus, this program would involve a significant return to the state’s general fund. It would also involve a significant infusion of capital into our farm communities and into our agricultural sector in general.
All of this would occur while Tennessee would be providing the highest quality medical cannabis that our current knowledge base could accomplish to eligible patients as soon as their physician prescribes this medicine under very controlled production and distribution systems. Thus, all three principal criteria for a successful medical cannabis program would be accomplished at a cost to the patient that is perhaps one-third to one-tenth what they now must pay for illicit cannabis of unknown quality.
Training/Certification/Production Monitoring – To prepare for the orderly expansion of the Tennessee medical cannabis program, it will be necessary to train and certify a small number of farmers to produce medical cannabis under controlled conditions. These farmers will be considered contract producers for the State of Tennessee and, once selected, they will be monitored on a routine basis by program staff affiliated with the Tennessee Department of Agriculture and other agencies to insure that these farmers produce medical cannabis that meets the high standards for safety and efficacy established by the program.
Once farmers are selected for the program, they will undergo a training program conducted by the UT/ARE staff that are involved in producing medical cannabis. After the initial training program, these farmers will be involved in a continuous education and monitoring effort to insure full compliance with program requirements. On-site consultant services will be made available to farmers on request, and regular site visits to the participating farms will be a part of program monitoring. Farmers will be provided small vegetative cannabis plants from specific medically beneficial cultivars (as rooted clones) by the UT/ARE farms. They will be required to report regularly on the progress of their grow operations and will be encouraged to share information with other participating farmers.
Contract farmers may grow as little as one 50 X 100 foot greenhouse and as much as four acres of greenhouses (32 separate structures). They will be required to implement a security plan for their grow operations, and to cooperate with program staff at all times. As mentioned earlier, farmers will be paid $500 per pound for dried female flowers and may receive additional payment for excess leaf cuttings if they can be processed into medically useful products. In the initial stage of the program, each farmer’s medical cannabis will be labeled, stored and processed separately so that an accurate weight of useful medicine can be calculated for each farmer. Thereafter, farmers may be paid based on the wet (unprocessed) weight of their harvested plants, once an accurate estimate of the amount of useful dried medicine that will be obtained has been calculated by the program.
Once farmers are selected, trained and certified; they can begin participation in the program. Policies will be established for the orderly expansion of grow operations, dependent on the expanding needs of Tennessee’s medical cannabis program. Farmers who do not follow the strict guidelines for the production of medical cannabis will be terminated from the program and any cannabis they possess at the time will be confiscated and discarded. Farmers who are found to be diverting any of the cannabis to the illicit market will be terminated from the program and referred for prosecution.
Patient Monitoring – As stated earlier, the Tennessee medical cannabis program will not require that eligible patients submit applications to participate in the program. Although this process is common in other states, it is both burdensome to patients and health providers and imposes an unnecessary delay in allowing patients to access medical cannabis as soon as they need it. Instead of a prior registration process, medical cannabis patients will be identified through the Tennessee Department of Health’s (TDOH) controlled substances prescription tracking system.
At the time of the receipt of their first medical cannabis prescription, patients will be identified to the TDOH. They will be informed that their program participation will be monitored by the TDOH and that the TDOH may contact them periodically to obtain information on their use of medical cannabis and any beneficial or non-beneficial effects that occur as a consequence of their use. Patients will also be informed that their prescribing physicians may be contacted routinely by the TDOH to obtain similar information and to confirm, at regular intervals, the continued approval of the physician for the patient to remain in the program.
Patients will likewise be informed that any willful diversion of their medical cannabis into the illicit market will result in the patient’s immediate termination from the program and possible referral for prosecution. Patients who opt to obtain the certification necessary to grow their own medical cannabis supply will be informed that, with some exceptions, they cannot both grow their own cannabis and fill prescriptions for the medicine at the same time.
Patients who are certified to grow their own medical cannabis will be allowed to grow enough cannabis to produce a sufficient amount of medicine to last them between harvests. At this writing, it is estimated that patients should be allowed to grow up to 12 female plants and up to 24 vegetative plants, and that they should be allowed to possess enough medical cannabis to provide them one ounce of usable medicine per week. Any excess cannabis that patients produce will be surrendered to the program at the time of harvest. If patients have followed the same organic production protocols required of contract farmers in the production of their medical cannabis, they may be reimbursed for their excess medicine at the same rate as contract farmers, depending on program needs.
Research – This prospectus for the Tennessee medical cannabis program describes a program that we hope to establish to serve the needs of eligible patients in Tennessee whose physicians have prescribed this medicine. In addition to the primary mission of achieving the aforementioned three criteria for a successful medical cannabis program, there are secondary opportunities that the Tennessee medical cannabis program would provide to inform public policy as cannabis is returned in an orderly fashion to the medical pharmacopeia. These research opportunities include the following:
a) Biological – Much cannabis breeding activity of the past four decades has focused on developing cultivars with enhanced psychoactive properties. The Tennessee program will offer a chance to study cannabis cultivars for their ability to provide enhanced medically beneficial effects. This will include research to improve the palliative effects of cannabis use as well as to identify and enhance the plant’s chemotherapeutic properties for use in the treatment of cancer and other diseases.
b) Agricultural – The program will allow for the systematic study and dissemination of “best practices” procedures for medical cannabis production that should serve programs in other states.
c) Medical – Patient/medical provider monitoring will allow for the systematic collection and analysis of information to expand our knowledge base on the medical benefits and risks of cannabis use.
Conclusion – This prospectus is intended to provide a preliminary vision of how the Tennessee medical cannabis program might be developed and implemented. If we are successful, Tennesseans suffering from a host of serious diseases will be provided safe and effective medicine at low cost when they need it, and without increasing the burden on law enforcement agencies in our state.
It is time to return medical cannabis to our country’s pharmacopeia. The Tennessee model may provide the best way to accomplish this medically beneficial result with a minimum of negative costs to society.
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