2019 House Standing Committee Minutes

2019 HOUSE HUMAN SERVICES

HB 1283

2019 HOUSE STANDING COMMITTEE MINUTES

Human Services Committee Fort Union Room, State Capitol

HB1283 1/14/2019 30726

☐ Subcommittee ☐ Conference Committee

Committee Clerk: Elaine Stromme

Explanation or reason for introduction of bill/resolution: Relating to medical marijuana written certifications and to access to medical marijuana.

Minutes: Attachment 1-9

Vice Chairman Rohr opened the HB 1283

Representative Skroch: (refer to testimony: #1 ,2, 3) (obstacles)

Representative Schneider: In an earlier testimony it was stated that Sanford is in a neutral position, were you able to follow up on this?

Representative Skroch: I did do some following up and I did receive mixed messages in visiting with a high level executive of Sanford I was told that they were not putting any obstacles between Doctor & patient. They were objecting to signing the certificate application that was on their own volition, the reason was they were concerned about losing their license’s. That is why I included this in my testimony was to show the direct response from a patient who was having difficulty finding a doctor, she is still looking for a doctor that will sign an application.

Mr. Peterson Written (Testimony #4) (had testimony for all 3 bills) We are in support of this bill.

Chris Noldon; I have a presentation on video. I am a 40 yr. old fully disabled man. This judgement was made by a federal judge. I have many conditions I have the pleasure of having to deal with all of them at the same time. I am not a doctor or an expert medical witness, I am a ND citizen, who has lost everything and just about losing my life. I am in the opioid crisis no one will listen to me. I wasn’t always a permantly disabled man. I grew up around Anamose, ND worked for several different people in the farming industry also the college in ND, I worked for the railroad, I also have a college degree from a ND collage. I worked as a surveyor. I also worked on a Project for the governor, ND should have a collage level ND Ag. Program. My body was deteriorating the pain was terrible so I transferred back to the IT dept. at Lake Region College. I filed for disability in late 2014. My Headaches, were indescribable, I was declared to be legally Disabled by a federal judge, it took 3 years from House Human Services Committee HB 1283 1/14/19 Page 2 the time I applied. My medical condition is very complicated; I have a Level 5 - fracture in leg. They wanted to cut off leg. I said No. I left hospital that day, the Doctor Called and wanted To fix my leg, so they did. Basically, I am here to help heal the ND people & ND doctors. My injuries cannot be Certified. The program has to be fixed or it will fail. I don’t blame anyone.

Representative Westlind: I would like to make a comment, that President Trump did sign a farm bill so that ND Farmers can raise Hemp.

Dustin Peyer: Chairman of Real ND news. (Testimony’s # 5- 6- 7)

Justin Wilhelm-Lorenz: I was in a car accident and shattered every bone in the upper part of my body. My girlfriend died in the accident, I was in a coma for a month and a half my parents were told I wasn’t going to make it, If I did, I would be in a nursing home the rest of my life I broke 19 ribs in the accident, fractured a lot of bones. I have seen 56 doctors in the last 4 ½ years trying to get fixed. I have no feeling in my arm, I am still in therapy, I woke up in a nursing home. There is no way to fix my back. I have a daughter and twin sons. I was self- employed and can’t do that anymore. I am on a lot of pain medication. I need to be there for my kids. I want a safer option. I went to Colorado tried recreational marijuana it really helped. My only option right now is to live with pain. I have custody of children (3). After taking Medical Marijuana in CO, I felt a lot better. 48;29

John Bailey: I was Captain of the Merchant Marines’ Held 3 federal License’s, married, one daughter 8 years old, I am 47 yr. old, I was permantly disabled from an accident I suffered on the job 25 years earlier I slipped in a ditch of snow and ruptured the bottom 3 disks in my back. I refused the surgery. Two years out of work, a year flat on my back Then I went to maritime academy. I moved to ND in 2011, bought our house in 12, in 15 the pain changed, spinal cord was pinched, had surgery, killed 7 inches of nerves in my hand, (talked about Justin’s children). I will not take any drugs over 10 mg in strength. Mayo did a federal study of Medical Marijuana. They said it was Ok. But the Doctors will not prescribe it.

Opposed?

Jason Wahl, Director of the division of Medical Marijuana within the department of Health. (Testimony 8) Wants to change wording in bill.

Representative Schneider: You have listened to several testimonies from people in pain, That are not able to get certification needed have you accessed the barriers, looked at Other states or made recommendations for changes or can you do that, so this program does not have a bottle neck at the very beginning of the process to get help of pain relief.

Jason Wahl: We sympathize with the people that have been waiting for the program to become operational and to have the products available to dispense to them. We are trying to get this to happen as quickly as we could be keeping in mind that the program is very well regulated, and that the products are going to be safe, especially considering some of the medical issues that these people have. We have received information that the Health Care Provider will not sign the form. The statement was made that the medical professionals have House Human Services Committee HB 1283 1/14/19 Page 3 to believe that they may benefit from the use of Medical Marijuana and they would like to see that removed. I don’t believe that is in the current bill that we are discussing. That would have certain health care providers more willing to sign the form. The medical providers fear that they face a possible raid since this is an illegal drug, from the DEA or FBI. We are not aware of any raids on providers if they sign a Medical Marijuana paper. We would like our review done at a state level rather than a federal level. This is a slow acceptance from the medical field.

Representative Schneider: I would hate to see if we have a bottle neck at the beginning of this program. Can’t you work that out? Looking at what other states are doing or did?

Jason Wahl: We were continuing to do education to the medical field and administrative people to provide information about the program. Other states have a similar language or some states have a broad area in their language with in their law. Certainly

Attachment # 9 Division of Medical Marijuana hand out no oral testimony.

Vice Chairman Rohr : The Hearing is closed on HB 1283

2019 HOUSE STANDING COMMITTEE MINUTES

Human Service Committee Fort Union Room, State Capitol

HB 1283 A 2/6/2019 32298

☐ Subcommittee ☐ Conference Committee

Committee Clerk Signature Nicole Klaman

Explanation or reason for introduction of bill/resolution: Relating to medical marijuana written certifications and to access to medical marijuana.

Minutes:

Chairman Weisz: opened meeting

Chairman Weisz: I want to talk about everything in 1283. I know there are suggested amendments. But let’s discuss reciprocity.

Representative Karen Rohr: Define it please

Chairman Weisz: Reciprocity would allow someone from ND to use their card in MN, or where ever medicinal is legal and vice versa.

Representative Todd Porter: I would not be able to support the reciprocity component. It complicates things between state lines and complicates things for MN and ND which have drastically different laws.

Representative Rohr: As a provider, I did all that.

Representative M. Ruby: In our conversations with the attorney general’s office. This is not included in any amendments.

Chairman Weisz: Not a lot of support for reciprocity, I will take it off the table. If we were going to deal with it I was going to put it into 1283.

Chairman Weisz: Doctor/Patient relationship. I realize the medical community has issues with checking the box with “I’m certifying”

Representative Skroch: To restore subsection B, page 1 line 15 and 16. Medical provider still wanted C left out. Going to D, restore all language up to “care to the patient”. I don’t know if that’s incorporated into the amendments.

Chairman Weisz: So they will not have to monitor the medical use? House Human Service Committee HB 1283 2/6/19 Page 2

Where does the committee think the doctors’ involvement should be?

Representative Porter: I’m somewhat hesitant on the side of doc in a box shopping around component. That the relationship isn’t for the actual care for the patient. Pg. 1 the removal of some of that language. I think the relationship between them has to be for the sole purpose of getting the medical marijuana. If it’s medical, then it must remain medical and not remove all of the language.

Rep. Rohr: I would like to see letter E returned as well.

Representative Skroch: Line 10 restores “all the following are present” B would be restored and that is that “the health care provider has created and maintained records, etc” Restored is the portion in D, and restored if so desired would be E. I would accept that. I think it’s important for patients to be able to change doctors if there current doctors are not willing to support based on patients condition.

Chairman Weisz: If a medical doc is unwilling to do it, there may be a medical reason why.

Representative Porter: I fully agree with you. If your doctor says no you may fire your doctor and go elsewhere.

Chairman Weisz: Any opposition to adding PA? Seeing none. Page 2 of the bill, written certification. “I certified that they are likely to receive therapeutic”

Representative Porter: Inside of that component I don’t have a problem leaving that amendment in section 2 the way it is. They have the debilitating condition.

Chairman Weisz: Put section 1 back in. Chairman Weisz: closed meeting 2019 HOUSE STANDING COMMITTEE MINUTES

Human Services Committee Fort Union Room, State Capitol

HB 1283 2/6/2019 32327

☐ Subcommittee ☐ Conference Committee

Committee Clerk: Nicole Klaman

Explanation or reason for introduction of bill/resolution:

Relating to medical marijuana written certifications and to access to medical marijuana.

Minutes:

Chairman Weisz: Back to patient doctor relationship

Chairman Weisz: I don’t see where it says there was a benefit.

Representative Skroch: The way it can be interpreted is that the doctor will be required to monitor that patients use of marijuana in the treatment of their patient.

Chairman Weisz: A reasonable expectation that the provider would continue expect them to come back 2.) Follow up care to monitor the use for their treatment.

Representative Porter: Move to amend, remove section 1 and then page 4 line 3 overstrike physicians insert “health care providers” pg.4 line 3 and insert health care providers.

Rep. Rohr: Second

Chairman Weisz: Health care providers because we are adding physician assistant. Removing certify. Leave in current language to maintain a patient provider relationship. The docs are off the hook by giving an opinion that patient will benefit.

Representative Skroch: Completely stripping Section 1

Chairman Weisz: It would just go back to current law. Removes the physician from saying, Yes, you are likely to benefit.

Representative Porter: You keep saying physician, but it should be healthcare provider.

Chairman Weisz: I stand corrected.

House Human Services Committee HB 1283 2/6/19 Page 2

Representative Schneider: Are we not declaring an emergency?

Chairman Weisz: Lets deal with what is on the table.

Representative Skroch: Rep. Porter you also suggested a change in section 5

Chairman Weisz: Page 4 line 3 says physician and it should say “health care provider”. Representative Skroch: I have an amendment to make the certification public.

Voice Vote: Motion Carries to add Amendment

Rep. M. Ruby: Move that we add Physician Assistant and add an emergency clause.

Rep. Rohr: Second

Chairman Weisz: Adding Physician Assistant only, not naturopath. And to add an emergency clause.

Voice Vote: Motion Carries to add amendment

Chairman Weisz: Further Amended bill, Added PA’s and Emergency clause. Any desire to add naturopath? I think that will hurt your two-thirds.

Rep. Westlind: I believe they decided to take that off because they cannot diagnose several of the debilitating issues anyway.

Rep. M. Ruby: We do define physician.

Chairman Weisz: Then the language would be under 33 in 1272. Anything else dealing with doctor/patient relationship.

Rep. M. Ruby: Move a Do Pass on HB 1283 as amended.

Rep. Dobervich: Second.

Roll Call Vote: Yes 12 No 1 Absent 1 Do Pass As Amended carries Carrier: Rep. M. Ruby

2019 HOUSE STANDING COMMITTEE MINUTES

Human Services Committee Fort Union Room, State Capitol

HB 1283 C 2/6/2019 32330

☐ Subcommittee ☐ Conference Committee

Committee Clerk: Nicole Klaman

Explanation or reason for introduction of bill/resolution:

Relating to medical marijuana written certifications and to access to medical marijuana.

Minutes:

Chairman Weisz: Opened meeting on HB1283.

Chairman Weisz: Page 2 lines 10 and 11, written certification. Need a motion to reconsider.

Rep. Porter: I move for reconsideration

Rep. M. Ruby: Seconded.

Voice Vote: Motion for reconsideration carries

Rep. M. Ruby: Motion to further amend remove the overstrike page 2 lines 10 and 11.

Rep. Westlind: Seconded.

Voice Vote: Motion Carries to remove overstrike page 2 lines 10 and 11

Rep. M. Ruby: Do Pass As Amended

Rep. Skroch: Seconded.

Roll Call Vote: Yes 12 No 1 Absent 1.

Do Pass As Amended on HB 1283 Carries

Rep. M. Ruby: Carrier.

Hearing closed.

2019 HOUSE STANDING COMMITTEE MINUTES

Human Services Committee Fort Union Room, State Capitol

HB 1283 D 2/12/2019 32597

☐ Subcommittee ☐ Conference Committee

Committee Clerk: Nicole Klaman

Explanation or reason for introduction of bill/resolution:

Relating to medical marijuana written certifications and to access to medical marijuana Minutes:

Chairman Weisz: opened meeting

Chairman Weisz: The Health Department has found a small error in HB 1283, which has not left our control so we will address this first.

Rep. M. Ruby: Move to reconsider.

Rep. Rohr: Seconded.

Voice Vote: Motion Carries to reconsider.

Chairman Weisz: The issue is with Section 4, newly added, which is written certification. It states “the department shall establish a written certification to make this form available to health care providers and members of the public.” They don’t make it available to the public, it’s online for the health care provider only. They would like that taken out and the rest of the language is already in parts of the bill so it is not necessary. I would entertain a motion to delete all of Section 4.

Rep. Skroch: I move the amendment to HB 1283 to delete all of Section 4.

Rep. Westlind: Seconded.

Voice Vote: Motion carries to adopt amendment.

Rep. Dobervich: I move a Do Pass As Amended on HB 1283.

Rep. Anderson: Seconded.

Roll Call Vote: Yes 11 No 1 Absent 2.

House Human Services Committee HB 1283 2/12/2019 Page 2

Motion carries: For a Do Pass as amended on HB 1283

Carrier: Rep. M. Ruby.

Hearing closed.

19.0415.01003 Prepared by the Legislative Council staff for Title. Representative Weisz February 1, 2019

PROPOSED AMENDMENTS TO HOUSE BILL NO. 1283 Page 1, line 1, remove "create and enact a new section to chapter 19-24.1 of the North Dakota" Page 1, line 2, remove "Century Code, relating to medical marijuana written certifications; and to" Page 1, line 3, remove "subsections 3 and 40 of" Page 1, line 5, after "marijuana" insert "; and to declare an emergency" Page 1, remove lines 7 through 23 Page 2, replace lines 1 through 11 with: "SECTION 1. AMENDMENT. Section 19-24.1-01 of the North Dakota Century Code is amended and reenacted as follows:

19-24.1-01. Definitions.

As used in this chapter, unless the context indicates otherwise:

1. "Advanced practice registered nurse" means an advanced practice registered nurse defined under section 43-12.1-02.

2. "Allowable amount of usable marijuana" means the amount of usable marijuana a registered qualifying patient or registered designated caregiver may purchase in a thirty-day period under this chapter.

a. During a thirty-day period, a registered qualifying patient may not purchase or have purchased by a registered designated caregiver more than two and one-half ounces [70.87 grams] of dried leaves or flowers of the plant of genus cannabis in a combustible delivery form. At any time a registered qualifying patient, or a registered designated caregiver on behalf of a registered qualifying patient, may not possess more than three ounces [85.05 grams] of dried leaves or flowers of the plant of the genus cannabis in a combustible delivery form. b. A registered qualifying patient may not purchase or have purchased by a registered designated caregiver more than the maximum concentration or amount of tetrahydrocannabinol permitted in a thirty-day period. The maximum concentration or amount of tetrahydrocannabinol permitted in a thirty-day period for a cannabinoid concentrate or medical cannabinoid product, or the cumulative total of both, is two thousand milligrams. 3. "Bona fide provider-patient relationship" means a treatment or counseling relationship between a health care provider and patient in which all the following are present:

a. The health care provider has reviewed the patient's relevant medical records and completed a full assessment of the patient's medical

Page No. 1 19.0415.01003 history and current medical condition, including a relevant, in-person, medical evaluation of the patient. b. The health care provider has created and maintained records of the patient's condition in accordance with medically accepted standards. c. The patient is under the health care provider's continued care for the debilitating medical condition that qualifies the patient for the medical use of marijuana. d. The health care provider has a reasonable expectation that provider will continue to provide followup care to the patient to monitor the medical use of marijuana as a treatment of the patient's debilitating medical condition. e. The relationship is not for the sole purpose of providing written certification for the medical use of marijuana. 4. "Cannabinoid" means a chemical compound that is one of the active constituents of marijuana.

5. "Cannabinoid capsule" means a small, soluble container, usually made of gelatin, which encloses a dose of a cannabinoid product or a cannabinoid concentrate intended for consumption. The maximum concentration of amount of tetrahhydrocannabinol permitted in a serving of a cannabinoid capsule is fifty milligrams.

6. "Cannabinoid concentrate" means a concentrate or extract obtained by separating cannabinoids from marijuana by a mechanical, chemical, or other process.

7. "Cannabinoid edible product" means a food or potable liquid into which a cannabinoid concentrate or the dried leaves or flowers of the plant of the genus cannabis is incorporated.

8. "Cannabinoid tincture" means a solution of alcohol, cannabinoid concentrate, and other ingredients intended for consumption.

9. "Cannabinoid topical" means a cannabinoid product intended to be applied to the skin or hair. The maximum concentration or amount of tetrahydrocannabinol permitted in a cannabinoid topical is six percent.

10. "Cannabinoid transdermal patch" means an adhesive substance applied to the skin which contains a cannabinoid product or cannabinoid concentrate for absorption into the bloodstream. The maximum concentration or amount of tetrahydrocannabinol permitted in a serving of a cannabinoid transdermal patch is fifty milligrams.

11. "Cardholder" means a qualifying patient, designated caregiver, or compassion center agent who has been issued and possesses a valid registry identification card.

12. "Compassion center" means a manufacturing facility or dispensary.

Page No. 2 19.0415.01003 13. "Compassion center agent" means a principal officer, board member, member, manager, governor, employee, volunteer, or agent of a compassion center.

14. "Contaminated" means made impure or inferior by extraneous substances.

15. "Debilitating medical condition" means one of the following:

a. Cancer; b. Positive status for human immunodeficiency virus; c. Acquired immune deficiency syndrome; d. Decompensated cirrhosis caused by hepatitis C; e. Amyotrophic lateral sclerosis; f. Posttraumatic stress disorder; g. Agitation of Alzheimer's disease or related dementia; h. Crohn's disease; i. Fibromyalgia; j. Spinal stenosis or chronic back pain, including neuropathy or damage to the nervous tissue of the spinal cord with objective neurological indication of intractable spasticity; k. Glaucoma; l. Epilepsy; m. A terminal illness; and n. A chronic or debilitating disease or medical condition or treatment for such disease or medical condition that produces one or more of the following: (1) Cachexia or wasting syndrome; (2) Severe debilitating pain that has not responded to previously prescribed medication or surgical measures for more than three months or for which other treatment options produced serious side effects; (3) Intractable nausea; (4) Seizures; or (5) Severe and persistent muscle spasms, including those characteristic of multiple sclerosis. 16. "Department" means the state department of health.

17. "Designated caregiver" means an individual who agrees to manage the well-being of a registered qualifying patient with respect to the qualifying patient's medical use of marijuana.

Page No. 3 19.0415.01003 18. "Dispensary" means an entity registered by the department as a compassion center authorized to dispense usable marijuana to a registered qualifying patient and a registered designated caregiver.

19. "Enclosed, locked facility" means a closet, room, greenhouse, building, or other enclosed area equipped with locks or other security devices that permit access limited to individuals authorized under this chapter or rules adopted under this chapter.

20. "Health care provider" means a physician, a physician assistant, or an advanced practice registered nurse.

21. "Manufacturing facility" means an entity registered by the department as a compassion center authorized to produce and process and to sell usable marijuana to a dispensary.

22. "Marijuana" means all parts of the plant of the genus cannabis; the seeds of the plant; the resin extracted from any part of the plant; and every compound, manufacture, salt, derivative, mixture, or preparation of the plant, the seeds of the plant, or the resin extracted from any part of the plant.

23. "Maximum concentration or amount of tetrahydrocannabinol" means the total amount of tetrahydrocannabinol and tetrahydrocannabinolic acid in a medical cannabinoid product or a cannabinoid concentrate.

24. "Medical cannabinoid product" means a product intended for human consumption or use which contains cannabinoids.

a. Medical cannabinoid products are limited to the following forms: (1) Cannabinoid tincture; (2) Cannabinoid capsule; (3) Cannabinoid transdermal patch; and (4) Cannabinoid topical. b. "Medical cannabinoid product" does not include: (1) A cannabinoid edible product; (2) A cannabinoid concentrate by itself; or (3) The dried leaves or flowers of the plant of the genus cannabis by itself. 25. "Medical marijuana product" means a cannabinoid concentrate or a medical cannabinoid product.

26. "Medical marijuana waste" means unused, surplus, returned, or out-of-date usable marijuana; recalled usable marijuana; unused marijuana; or plant debris of the plant of the genus cannabis, including dead plants and all unused plant parts and roots.

Page No. 4 19.0415.01003 27. "Medical use of marijuana" means the acquisition, use, and possession of usable marijuana to treat or alleviate a qualifying patient's debilitating medical condition.

28. "Minor" means an individual under the age of nineteen.

29. "North Dakota identification" means a North Dakota driver's license or comparable state of North Dakota or federal issued photo identification card verifying North Dakota residence.

30. "Pediatric medical marijuana" means a medical marijuana product containing cannabidiol which may not contain a maximum concentration or amount of tetrahydrocannabinol of more than six percent.

31. "Physician" means a physician licensed under chapter 43-17 to practice medicine in the state of North Dakota.

32. " Physician assistant " means an individual licensed under chapter 43 - 17 to practice as a physician assistant in the state.

33. "Posttraumatic stress disorder" means a patient meets the diagnostic criteria for posttraumatic stress disorder under the "Diagnostic and Statistical Manual of Mental Disorders", American psychiatric association, fifth edition, text revision (2013).

33.34. "Processing" or "process" means the compounding or conversion of marijuana into a medical marijuana product.

34.35. "Producing", "produce", or "production" mean the planting, cultivating, growing, trimming, or harvesting of the plant of the genus cannabis or the drying of the leaves or flowers of the plant of the genus cannabis.

35.36. "Qualifying patient" means an individual who has been diagnosed by a health care provider as having a debilitating medical condition.

36.37. "Registry identification card" means a document issued by the department which identifies an individual as a registered qualifying patient, registered designated caregiver, or registered compassion center agent.

37.38. "Terminal illness" means a disease, illness, or condition of a patient:

a. For which there is not a reasonable medical expectation of recovery; b. Which as a medical probability, will result in the death of the patient, regardless of the use or discontinuance of medical treatment implemented for the purpose of sustaining life or the life processes; and c. As a result of which, the patient's health care provider would not be surprised if death were to occur within six months. 38.39. "Usable marijuana" means a medical marijuana product or the dried leaves or flowers of the plant of the genus cannabis in a combustible delivery form. However, the term does not include the dried leaves or flowers unless authorized through a written certification and does not include a cannabinoid edible product. In the case of a registered qualifying patient

Page No. 5 19.0415.01003 who is a minor, "usable marijuana" is limited to pediatric medical marijuana.

39.40. "Verification system" means the system maintained by the department under section 19-24.1-31 for verification of registry identification cards.

40.41. "Written certification" means a form established by the department which is executed, dated, and signed by a health care provider within ninety calendar days of the date of application, stating that in the health care provider's professional opinion the patient is likely to receive therapeutic or palliative benefit from the medical use of marijuana to treat or alleviate the patient'sthe patient has a debilitating medical condition. A health care provider may authorize the use of dried leaves or flowers of the plant of the genus cannabis in a combustible delivery form to treat or alleviate the patient's debilitating medical condition. A written certification may not be made except in the course of a bona fide provider-patient relationship."

Page 3, remove lines 29 and 30 Page 4, replace lines 1 through 4 with: "SECTION 4. EMERGENCY. This Act is declared to be an emergency measure."

Renumber accordingly

Page No. 6 19.0415.01003 Df7 ;J-//;/!f 19.0415.01004 Adopted by the Human Services Committee / of 6 Title.02000 February 6, 2019

PROPOSED AMENDMENTS TO HOUSE BILL NO. 1283 Page 1, line 3, remove "subsections 3 and 40 of' Page 1, line 5, after "marijuana" insert "; and to declare an emergency" Page 1, remove lines 7 through 23 Page 2, replace lines 1 through 11 with: Section 19-24.1-01 of the North Dakota Century "SECTION 1. AMENDMENT. Code is amended and reenacted as follows:

19-24.1-01. Definitions. As used in this chapter, unless the context indicates otherwise:

1. "Advanced practice registered nurse" means an advanced practice registered nurse defined under section 43-12.1-02.

a. The health care provider has reviewed the patient's relevant medical records and completed a full assessment of the patient's medical history and current medical condition, including a relevant, in-person, medical evaluation of the patient. b. The health care provider has created and maintained records of the patient's condition in accordance with medically accepted standards.

Page No. 1 19.0415.01004 C. The patient is under the health care provider's continued care for the debilitating medical condition that qualifies the patient for the medical use of marijuana. d. The health care provider has a reasonable expectation that provider will continue to provide followup care to the patient to monitor the medical use of marijuana as a treatment of the patient's debilitating medical condition. e. The relationship is not for the sole purpose of providing written certification for the medical use of marijuana. 4. "Cannabinoid" means a chemical compound that is one of the active constituents of marijuana.

6. "Cannabinoid concentrate" means a concentrate or extract obtained by separating cannabinoids from marijuana by a mechanical, chemical, or other process.

7. "Cannabinoid edible product" means a food or potable liquid into which a cannabinoid concentrate or the dried leaves or flowers of the plant of the genus cannabis is incorporated.

8. "Cannabinoid tincture" means a solution of alcohol, cannabinoid concentrate, and other ingredients intended for consumption.

11. "Cardholder" means a qualifying patient, designated caregiver, or compassion center agent who has been issued and possesses a valid registry identification card.

12. "Compassion center" means a manufacturing facility or dispensary.

13. "Compassion center agent" means a principal officer, board member, member, manager, governor, employee, volunteer, or agent of a compassion center.

14. "Contaminated" means made impure or inferior by extraneous substances.

15. "Debilitating medical condition" means one of the following:

Page No. 2 19.0415.01004 a. Cancer; b. Positive status for human immunodeficiency virus; c. Acquired immune deficiency syndrome; d. Decompensated cirrhosis caused by hepatitis C; e. Amyotrophic lateral sclerosis; f. Posttraumatic stress disorder; g. Agitation of Alzheimer's disease or related dementia; h. Crohn's disease; i. Fibromyalgia; j. Spinal stenosis or chronic back pain, including neuropathy or damage to the nervous tissue of the spinal cord with objective neurological indication of intractable spasticity; k. Glaucoma; I. Epilepsy; m. A terminal illness; and n. A chronic or debilitating disease or medical condition or treatment for such disease or medical condition that produces one or more of the following: (1) Cachexia or wasting syndrome; (2) Severe debilitating pain that has not responded to previously prescribed medication or surgical measures for more than three months or for which other treatment options produced serious side effects; (3) Intractable nausea; (4) Seizures; or (5) Severe and persistent muscle spasms, including those characteristic of multiple sclerosis. 16. "Department" means the state department of health.

17. "Designated caregiver" means an individual who agrees to manage the well-being of a registered qualifying patient with respect to the qualifying patient's medical use of marijuana.

18. "Dispensary" means an entity registered by the department as a compassion center authorized to dispense usable marijuana to a registered qualifying patient and a registered designated caregiver.

Page No. 3 19.0415.01004 Df -;J/lt//1 20. "Health care provider" means a physician, a physician assistant, or an advanced practice registered nurse. c/of0

21. "Manufacturing facility" means an entity registered by the department as a compassion center authorized to produce and process and to sell usable marijuana to a dispensary.

22. "Marijuana" means all parts of the plant of the genus cannabis; the seeds of the plant; the resin extracted from any partof the plant; and every compound, manufacture, salt, derivative, mixture, or preparation of the plant, the seeds of the plant, or the resin extracted from any part of the plant.

24. "Medical cannabinoid product" means a product intended for human consumption or use which contains cannabinoids.

27. "Medical use of marijuana" means the acquisition, use, and possession of usable marijuana to treat or alleviate a qualifying patient's debilitating medical condition.

28. "Minor" means an individual under the age of nineteen.

29. "North Dakota identification" means a North Dakota driver's license or comparable state of North Dakota or federal issued photo identification card verifying North Dakota residence.

Page No. 4 19.0415.01004 30. "Pediatric medical marijuana" means a medical marijuana product containing cannabidiol which may not contain a maximum concentration or amount of tetrahydrocannabinol of more than six percent.

31. "Physician" means a physician licensed under chapter 43-17 to practice medicine in the state of NorthDakota.

32. "Physician assistant" means an individual licensed under chapter 43-17 to practice as a physician assistant in the state.

"Posttraumatic stress disorder" means a patient meets the diagnostic criteria for posttraumatic stress disorder under the "Diagnostic and Statistical Manual of Mental Disorders", American psychiatric association, fifth edition, text revision (2013).

"Processing" or "process" means the compounding or conversion of marijuana into a medical marijuana product.

"Producing", "produce", or "production" mean the planting, cultivating, growing, trimming, or harvesting of the plant of the genus cannabis or the drying of the leaves or flowers of the plant of the genus cannabis.

"Qualifying patient" means an individual who has been diagnosed by a health care provider as having a debilitating medical condition.

"Registry identification card" means a document issued by the department which identifies an individual as a registered qualifying patient, registered designated caregiver, or registered compassion center agent.

"Terminalillness" means a disease, illness, or condition of a patient:

a. For which there is not a reasonable medical expectation of recovery; b. Which as a medical probability, will result in the death of the patient, regardless of the use or discontinuance of medical treatment implemented for the purpose of sustaining life or the life processes; and c. As a result of which, the patient's health care provider would not be surprised if death were to occur within six months. 39. "Usable marijuana" means a medical marijuana product or the dried leaves or flowers of the plant of the genus cannabis in a combustible delivery form. However, the term does not include the dried leaves or flowers unless authorized through a written certification and does not include a cannabinoid edible product. In the case of a registered qualifying patient who is a minor, "usable marijuana" is limited to pediatric medical marijuana.

0. "Verification system" means the system maintained by the department under section 19-24.1-31 for verification of registry identification cards.

4M1 "Written certification" means a form established by the department which is executed, dated, and signed by a health care provider within ninety calendar days of the date of application, stating that in the health care provider's professionalopinion the patient is likely to recei•;e therapeutic or

Page No. 5 19.0415.01004 Dr Jtfe/M 1 palliativebenefit from the medical use of marijuanato treat or allc.iiatc the paticnt'sthc patient has a debilitating medical condition. A health care �(/) ft provider may authorize the use of dried leaves or flowers of the plant of the genus cannabis in a combustible delivery form to treat or alleviate the patient's debilitating medical condition. A written certification may not be made except in the course of a bona fide provider-patient relationship."

Page 4, line 3, replace "physicians" with "health care providers" Page 4, after line 4, insert: "SECTION 5. EMERGENCY. This Act is declared to be an emergency measure."

Renumber accordingly

Page No. 6 19.0415.01004 uP �-i/l1 19.0415.01005 Adopted by the Human Services Committee / of h Title.03000 February 12, 2019

PROPOSED AMENDMENTS TO HOUSE BILL NO. 1283 Page 1, line 1, remove "create and enact a new section to chapter 19-24.1 of the NorthDakota" Page 1, line 2, remove "Century Code, relating to medical marijuana written certifications; and to" Page 1, line 3, remove "subsections 3 and 40 of' Page 1, line 5, after "marijuana" insert "; and to declare an emergency" Page 1, remove lines 7 through 23 Page 2, replace lines 1 through 11 with: "SECTION 1. AMENDMENT. Section 19-24.1-01 of the North Dakota Century Code is amended and reenacted as follows:

19-24.1-01. Definitions.

As used in this chapter, unless the context indicates otherwise:

1. "Advanced practice registered nurse" means an advanced practice registered nurse defined under section 43-12.1-02.

a. During a thirty-day period, a registered qualifying patient may not purchase or have purchased by a registered designated caregiver more than two and one-half ounces [70.87 grams] of dried leaves or flowers of the plant of genus cannabis in a combustible delivery form. At any time a registered qualifying patient, or a registered designated caregiver on behalf of a registered qualifying patient, may not possess more than three ounces [85.05 grams] of dried leaves or flowers of the plant of the genus cannabis in a combustible delivery form. b. A registered qualifying patient may not purchase or have purchased by a registered designated caregiver more than the maximum concentration or amount of tetrahydrocannabinol permitted in a thirty-day period. The maximum concentration or amount of tetrahydrocannabinol permitted in a thirty-dayperiod for a cannabinoid concentrate or medical cannabinoid product, or the cumulative total of both, is two thousand milligrams. 3. "Bona fide provider-patient relationship" means a treatment or counseling relationship between a health care provider and patient in which all the following are present:

a. The health care provider has reviewed the patient's relevant medical records and completed a full assessment of the patient's medical

Page No. 1 19.0415.01005 history and current medical condition, including a relevant, in-person, medical evaluation of the patient. b. The health care provider has created and maintained records of the patient's condition in accordance with medically accepted standards. c. The patient is under the health care provider's continued care for the debilitating medical condition that qualifies the patient for the medical use of marijuana. d. The health care provider has a reasonable expectation that provider will continue to provide followup care to the patient to monitor the medical use of marijuana as a treatment of the patient's debilitating medical condition. e. The relationship is not for the sole purpose of providing written certification for the medical use of marijuana. 4. "Cannabinoid" means a chemical compound that is one of the active constituents of marijuana.

6. "Cannabinoid concentrate" means a concentrate or extract obtained by separating cannabinoids from marijuana by a mechanical, chemical, or other process.

7. "Cannabinoid edible product" means a food or potable liquid into which a cannabinoid concentrate or the dried leaves or flowers of the plant of the genus cannabis is incorporated.

8. "Cannabinoid tincture" means a solution of alcohol, cannabinoid concentrate, and other ingredients intended for consumption.

11. "Cardholder" means a qualifying patient, designated caregiver, or compassion center agent who has been issued and possesses a valid registry identification card.

12. "Compassion center" means a manufacturing facility or dispensary.

Page No. 2 19.0415.01005 Pp cJ/11/11 13. "Compassion center agent" means a principal officer, board member, r l member, manager, governor, employee, volunteer, or agent of a J or ({J compassion center.

14. "Contaminated" means made impure or inferior by extraneous substances.

15. "Debilitating medical condition" means one of the following:

a. Cancer; b. Positive status for human immunodeficiency virus; c. Acquired immune deficiency syndrome; d. Decompensated cirrhosis caused by hepatitis C; e. Amyotrophic lateral sclerosis; f. Posttraumatic stress disorder; g. Agitation of Alzheimer's disease or related dementia; h. Crohn's disease; i. Fibromyalgia; j. Spinal stenosis or chronic back pain, including neuropathy or damage to the nervous tissue of the spinal cord with objective neurological indication of intractable spasticity; k. Glaucoma; I. Epilepsy; m. A terminal illness; and n. A chronic or debilitating disease or medical condition or treatment for such disease or medical condition that produces one or more of the following: (1) Cachexia or wasting syndrome; (2) Severe debilitating pain that has not responded to previously prescribed medication or surgical measures for more than three months or for which other treatment options produced serious side effects; (3) Intractable nausea; (4) Seizures; or (5) Severe and persistent muscle spasms, including those characteristic of multiple sclerosis. 16. "Department" means the state department of health.

17. "Designated caregiver" means an individual who agrees to manage the well-being of a registered qualifying patient with respect to the qualifying patient's medical use of marijuana.

Page No. 3 19.0415.01005 18. "Dispensary" means an entity registered by the department as a compassion center authorized to dispense usable marijuana to a registered qualifying patient and a registered designated caregiver.

20. "Health care provider" means a physician, a physician assistant. or an advanced practice registered nurse.

21. "Manufacturing facility" means an entity registered by the department as a compassion center authorized to produce and process and to sell usable marijuana to a dispensary.

22. "Marijuana" means all parts of the plant of the genus cannabis; the seeds of the plant; the resin extracted from any partof the plant; and every compound, manufacture, salt, derivative, mixture, or preparation of the plant, the seeds of the plant, or the resin extracted from any part of the plant.

24. "Medical cannabinoid product" means a product intended for human consumption or use which contains cannabinoids.

Page No. 4 19.0415.01005 Df>d /)-z Iii 27. "Medical use of marijuana" means the acquisition, use, and possession of ) of(p usable marijuana to treat or alleviate a qualifying patient's debilitating medical condition.

28. "Minor" means an individual under the age of nineteen.

29. "NorthDakota identification" means a NorthDakota driver's license or comparable state of North Dakota or federal issued photo identification card verifying North Dakota residence.

30. "Pediatric medical marijuana" means a medical marijuana product containing cannabidiol which may not contain a maximum concentration or amount of tetrahydrocannabinol of more than six percent.

31. "Physician" means a physician licensed under chapter 43-17 to practice medicine in the state of North Dakota.

32. "Physician assistant" means an individual licensed under chapter 43-17 to practice as a physician assistant in the state.

33-:-34. "Processing" or "process" means the compounding or conversion of marijuana into a medical marijuana product.

�35. "Producing", "produce", or "production" mean the planting, cultivating, growing, trimming, or harvesting of the plant of the genus cannabis or the drying of the leaves or flowers of the plant of the genus cannabis.

�36. "Qualifying patient" means an individual who has been diagnosed by a health care provider as having a debilitating medical condition.

36-:-37. "Registry identification card" means a document issued by the department which identifies an individual as a registered qualifying patient, registered designated caregiver, or registered compassion center agent.

�38. "Terminal illness" means a disease, illness, or condition of a patient:

a. For which there is not a reasonable medical expectation of recovery; b. Which as a medical probability, will result in the death of the patient, regardless of the use or discontinuance of medical treatment implemented for the purpose of sustaining life or the life processes; and c. As a result of which, the patient's health care provider would not be surprised if death were to occur within six months. a&-39. "Usable marijuana" means a medical marijuana product or the dried leaves or flowers of the plant of the genus cannabis in a combustible delivery form. However, the term does not include the dried leaves or flowers unless authorized through a written certification and does not include a cannabinoid edible product. In the case of a registered qualifying patient

Page No. 5 19.0415.01005 who is a minor, "usable marijuana" is limited to pediatric medical marijuana.

a9:40. "Verification system" means the system maintained by the department under section 19-24.1-31 for verification of registry identification cards.

4GA1. "Written certification" means a form established by the department which is executed, dated, and signed by a health care provider within ninety calendar days of the date of application, stating that in the health care provider's professional opinion the patient is lil

Page 3, remove lines 29 and 30 Page 4, replace lines 1 through 4 with: "SECTION 4. EMERGENCY. This Act is declared to be an emergency measure."

Renumber accordingly

Page No. 6 19.0415.01005 2019 HOUSE STANDING COMMITTEE -1 ROLL CALL VOTES BILL/RESOLUTION NO. __..,._.._...._ r.....1

House Human Services Committee

□ Subcommittee ,,,/..• A,.·��- ,�� I Po/Lf � 3 � T"7__,_ Amendment LC# or Description:.�- ":kaa/, �-.- rr ------�� f'Vl,,r

Recommendation: !KlAdopt Amendment □ Do Pass □ Do Not Pass □ Without Committee Recommendation □ As Amended □ Rerefer to Appropriations □ Place on Consent Calendar Other Actions: □ Reconsider □

By Re,p. kv By · Motion Made Por Seconded f(eP RD l r

Representatives Yes No Representatives Yes No Robin Weisz - Chairman Gretchen Dobervich Karen M. Rohr - Vice Chairman Marv Schneider Dick Anderson Chuck Damschen Bill Devlin ,. / Clayton Feqley r - I Dwiqht Kiefert '- '\. I "'-. I" Todd Porter ' Matthew Ruby Bill Tveit / Greq Westlind Kathy Skroch

Total (Yes) ------No

Absent

Floor Assignment

If the vote is on an amendment, briefly indicate intent: '\Jo,Ce_Vo+{_ - (Yhhw1 Wr,es Date: Roll Call

2019 HOUSE STANDING COMMITTEE ROLL CALL BILL/RESOLUTION NO.vo 7¢KCJ1Es

House Human Services Committee

□ Subcommittee

0 Amend LC# Descri ;._ ....:...... :.'J-=------=;._0------== ment or ption: ---=--j q----'-, _4 \ -• ()...... \ 1) �'------

Recommendation: � Adopt Amendment □ Do Pass □ Do Not Pass □ Without Committee Recommendation □ As Amended □ Rerefer to Appropriations □ Place on Consent Calendar Other Actions: □ Reconsider □

Motion Made By �ep Q� Seconded By fkp. eo"-c

Representatives Yes No Representatives Yes No Robin Weisz - Chairman Gretchen Dobervich Karen M. Rohr - Vice Chairman Marv Schneider Dick Anderson Chuck Damschen Bill Devlin ' I ,,, Clayton Fegley I ,I"' Dwight Kiefert " I Todd Porter N Matthew Ruby Bill Tveit - .-' Greg Westlind Kathy Skroch

Total (Yes) ------No ------

Absent

Floor Assignment Date: Roll Call

2019 HOUSE STANDING COMMITTEE ROLL CALL VOT S BILL/RESOLUTION No. rJ.,'b3

House Human Services Committee

□ Subcommittee

Amendment LC# or Description: ------

Recommendation: □ Adopt Amendment Do Pass □ Do Not Pass □ Without Committee Recommendation As Amended □ Rerefer to Appropriations Place on Consent Calendar Other Actions: □ Reconsider □

By By Motion Made Be,p. � Seconded f?ep. Dolx,-vi ch

Representatives Yes No Representatives Yes No Robin Weisz - Chairman X Gretchen Dobervich X y Karen M. Rohr - Vice Chairman � Mary Schneider , Dick Anderson 'x. Chuck Damschen ){ Bill Devlin X Clayton Feqley ·-x Dwiqht Kiefert - Todd Porter � Matthew Ruby Y. Bill Tveit " Greq Westlind " Kathy Skroch

'J.-. Total (Yes) ...... \ ...... ______No �1------

Absent

...... ,... ffi i \\ Floor Assignment --'i e��- ---1-__._-__,_.....::\.,,,_Jb-=-+-, ------ If the vote is on an amendment, briefly indicate intent: DuVctSJ A'JAV'A lv\/Jed Wri--e� Date: ::2-lt., (er Roll Call Vote #: +-

2019 HOUSE STANDING COMMITTEE ROLL CALL VOTES BILL/RESOLUTION NO. 1 .¢.« 3

House Human Services Committee

□ Subcommittee

Amendment LC# or Description: ------

Recommendation: □ □ Adopt Amendment□ □ □ Do Pass Do Not Pass □ Without Committee Recommendation □ As Amended Rerefer to Appropriations Place on Consent Calendar □ Other Actions: � Reconsider

Motion Made By Rep. {?(:('.kc Seconded By R-ep- /2.J:,'-4

Representatives Yes No Representatives Yes No Robin Weisz - Chairman Gretchen Dobervich Karen M. Rohr - Vice Chairman Mary Schneider Dick Anderson Chuck Damschen Bill Devlin / Clayton Fegley - I' \ I ----

Dwight Kiefert '\. I \/'V Todd Porter A I / Matthew Ruby \J Bill Tveit Greg Westlind Kathy Skroch

Total (Yes) No

Absent

Floor Assignment

If the vote is on an amendment, briefly indicate intent: �CoW:, 1d e, y- Y\J\.0-hb Vl W r, e S 2019 HOUSE STANDING COMMITTEE ROLL CALL VOTES 1 r) (/ 3 BILL/RESOLUTION NO. __._.. c?)...... __b__,.;,;

House Human Services Committee

□ Subcommittee b_e_l_o_w�)�_ Amendment LC# or Descriptior.· __,__· .....,(_s_ee..___

Recommendation: zJ'Adopt Amendment □ Do Pass □ Do Not Pass □ Without Committee Recommendation □ As Amended □ Rerefer to Appropriations □ Place on Consent Calendar Other Actions: □ Reconsider □

Motion Made By � . Q \A.-b'-4 Seconded By Re¥, - \,,Jes+I i r--d

Representatives Yes No Representatives Yes No Robin Weisz - Chairman Gretchen Dobervich Karen M. Rohr - Vice Chairman Mary Schneider Dick Anderson Chuck Damschen /' Bill Devlin ..... / / r,.., Clayton Fegley \ / VI Dwight Kiefert _\ I Todd Porter --- ,, Matthew Ruby Bill Tveit Greg Westlind Kathy Skroch

Total (Yes) ------No

Absent

Floor Assignment Date· ').,.;�-1 Cj Roll C�II Vote #: 3

2019 HOUSE STANDING COMMITTEE ROLL CALL VOTES f BILL/RESOLUTION NO. i � 2 House Human Services Committee

□ Subcommittee

Amendment LC# or Description: ------

Recommendation: □ Adopt Amendment � Do Pass □ Do Not Pass □ Without Committee Recommendation Jg'As Amended □ Rerefer to Appropriations □ Place on Consent Calendar Other Actions: □ Reconsider □

Motion Made By �p- l<'Ml� Seconded By 2iep. SiavcJ-i

Representatives Yes No Representatives Yes No Robin Weisz - Chairman " Gretchen Dobervich Karen M. Rohr - Vice Chairman y Marv Schneider , Dick Anderson ')(.- Chuck Damschen Y... Bill Devlin x Clayton Fegley X Dwight Kiefert Todd Porter "X. Matthew Ruby 'I. Bill Tveit ·..; Greg Westlind '){ Kathy Skroch 'i'

Total (Yes) ___._..\d::,c.._____ No _\;..______

Absent \

Floor Assignment

If the vote is on an amendment, briefly indicate intent: Date: � ..- f :J._..-lq Roll Call Vote #: -+-} _

2019 HOUSE STANDING COMMITTEE ROLL CALL VOTES BILL/RESOLUTION NO. 1 � �9

House Human Services Committee

□ Subcommittee

Amendment LC# or Description: ------

Recommendation: □ Adopt Amendment □ Do Pass □ Do Not Pass □ Without Committee Recommendation □ As Amended □ Rerefer to Appropriations □ Place on Consent Calendar Other Actions: 9'Reconsider □

Motion Made By � Seconded By ecp- �06.c f?- 2"'1�

Representatives Yes No Representatives Yes No Robin Weisz - Chairman Gretchen Dobervich Karen M. Rohr - Vice Chairman Marv Schneider Dick Anderson Chuck Damschen Bill Devlin J / Clayton Fegley '\....., I Dwiqht Kiefert Todd Porter "-.... / Matthew Ruby ✓ Bill Tveit Greg Westlind Kathy Skroch

Total (Yes) ------No

Absent

Floor Assignment Date: J,...) J--}q Roll Cal�

2019 HOUSE STANDING COMMITTEE ROLL CALL VOTES BILL/RESOLUTION NO. I ;t�3

House Human Services Committee

□ Subcommittee

Amendment LC# or Description: ------

Recommendation: i Adopt Amendment □ Do Pass □ Do Not Pass □ Without Committee Recommendation □ As Amended □ Rerefer to Appropriations □ Place on Consent Calendar Other Actions: □ Reconsider □

Motion Mad�� s��k_ro�k�h�-- Seconded By �-l � . vJ.e�+ LlY\ ol

Representatives Yes No Representatives Yes No Robin Weisz - Chairman Gretchen Dobervich Karen M. Rohr - Vice Chairman Mary Schneider Dick Anderson Chuck Damschen I Bill Devlin I / Clayton Fegley '' Dwiaht Kiefert ' Todd Porter " Matthew Ruby -/ Bill Tveit GreQ Westlind Kathy Skroch

Total (Yes) No

Absent

Floor Assignment

If the vote is on an amendment, briefly indicate intent: - \V\,bh il'Y' C llf(1 e_,S -h o.!1> pt 0--Jv,tv-J.{Vi.;U \::{--- - r<.){\\,O\Je, Q� MeY\JJers n} 1V\{ p�b[,' 1_, 2019 HOUSE STANDING COMMITTEE ROLL CALL VOTES l Ji(J 0 BILL/RESOLUTION NO. ___, ..,..�-3""

House Human Services Committee

□ Subcommittee

Amendment LC# or Description: ------

Recommendation: □ Adopt Amendment ,MDo Pass □ Do Not Pass □ Without Committee Recommendation b(As Amended □ Rerefer to Appropriations □ Place on Consent Calendar Other Actions: □ Reconsider □

I/i cJ, we.rs O Motion Made By &r,DP bu Seconded By 14P · le)

Representatives Yes No Representatives Yes No Robin Weisz - Chairman X: Gretchen Dobervich }( Karen M. Rohr - Vice Chairman 'I.. Mary Schneider Dick Anderson )(_ Chuck Damschen y Bill Devlin )( Clayton Fegley V. Dwight Kiefert - Todd Porter )( Matthew Ruby ")( Bill Tveit 'i GreQ Westlind � � Kathy Skroch .

Total (Yes) _.\...... \ ______No ______

Absent

Floor Assignment

If the vote is on an amendment, briefly indicate intent: Com Standing Committee Report Module ID: h_stcomrep_28_007 February 13, 2019 8:34AM Carrier: M. Ruby InsertLC : 19.041 5.01005 Title: 03000

REPORT OF STANDING COMMITTEE HB 1283: Human Services Committee (Rep. Weisz, Chairman) recommends AMENDMENTS AS FOLLOWS and when so amended , recommends DO PASS (11 YEAS, 1 NAYS, 2 ABSENT AND NOT VOTING). HB 1283 was placed on the Sixth order on the calendar.

Page 1, line 1, remove "create and enact a new section to chapter 19-24.1 of the North Dakota"

Page 1, line 2, remove "Century Code, relating to medical marijuana written certifications; and to"

Page 1, line 3, remove "subsections 3 and 40 of'

Page 1, line 5, after "marijuana" insert "; and to declare an emergency"

Page 1, remove lines 7 through 23

Page 2, replace lines 1 through 11 with:

"SECTION 1. AMENDMENT. Section 19-24.1-01 of the North Dakota Century Code is amended and reenacted as follows:

19-24.1-01. Definitions.

As used in this chapter, unless the context indicates otherwise:

1. "Advanced practice registered nurse" means an advanced practice registered nurse defined under section 43-12.1-02.

b. A registered qualifying patient may not purchase or have purchased by a registered designated caregiver more than the maximum concentration or amount of tetrahydrocannabinol permitted in a thirty-day period. The maximum concentration or amount of tetrahydrocannabinol permitted in a thirty-day period for a cannabinoid concentrate or medical cannabinoid product, or the cumulative total of both, is two thousand milligrams.

3. "Bona fide provider-patient relationship" means a treatment or counseling relationship between a health care provider and patient in which all the following are present:

( 1) DESK (3) COMMITTEE Page 1 h_stcomrep_28_007 Com Standing Committee Report Module ID: h_stcomrep_28_007 February 13, 2019 8:34AM Carrier: M. Ruby InsertLC: 19.0415.01005 Title: 03000

b. The health care provider has created and maintained records of the patient's condition in accordance with medically accepted standards.

c. The patient is under the health care provider's continued care for the debilitating medical condition that qualifies the patient for the medical use of marijuana.

d. The health care provider has a reasonable expectation that provider will continue to provide followup care to the patient to monitor the medical use of marijuana as a treatment of the patient's debilitating medical condition.

e. The relationship is not for the sole purpose of providing written certification for the medical use of marijuana.

4. "Cannabinoid" means a chemical compound that is one of the active constituents of marijuana.

6. "Cannabinoid concentrate" means a concentrate or extract obtained by separating cannabinoids from marijuana by a mechanical, chemical, or other process.

7. "Cannabinoid edible product" means a food or potable liquid into which a cannabinoid concentrate or the dried leaves or flowers of the plant of the genus cannabis is incorporated.

8. "Cannabinoid tincture" means a solution of alcohol, cannabinoid concentrate, and other ingredients intended for consumption.

11. "Cardholder" means a qualifying patient, designated caregiver, or compassion center agent who has been issued and possesses a valid registry identification card .

12. "Compassion center" means a manufacturing facility or dispensary.

13. "Compassion center agent" means a principal officer, board member, member, manager, governor, employee, volunteer, or agent of a compassion center.

14. "Contaminated" means made impure or inferior by extraneous substances.

15. "Debilitating medical condition" means one of the following:

a. Cancer;

(1) DESK (3) COMMITTEE Page 2 h_stcomrep_28_007 Com Standing Committee Report Module ID: h_stcomrep_28_007 February 13, 2019 8:34AM Carrier: M. Ruby InsertLC : 19.0415.01005 Title: 03000

b. Positive status for human immunodeficiency virus;

c. Acquired immune deficiency syndrome;

d. Decompensated cirrhosis caused by hepatitis C;

e. Amyotrophic lateral sclerosis;

f. Posttraumatic stress disorder;

g. Agitation of Alzheimer's disease or related dementia;

h. Crohn's disease;

i. Fibromyalgia;

j. Spinal stenosis or chronic back pain, including neuropathy or damage to the nervous tissue of the spinal cord with objective neurological indication of intractable spasticity;

k. Glaucoma;

I. Epilepsy;

m. A terminal illness; and

n. A chronic or debilitating disease or medical condition or treatment for such disease or medical condition that produces one or more of the following:

( 1 ) Cachexia or wasting syndrome;

(2) Severe debilitating pain that has not responded to previously prescribed medication or surgical measures for more than three months or for which other treatment options produced serious side effects;

(3) Intractable nausea;

(4) Seizures; or

(5) Severe and persistent muscle spasms, including those characteristic of multiple sclerosis.

16. "Department" means the state department of health.

17. "Designated caregiver" means an individual who agrees to manage the well-being of a registered qualifying patient with respect to the qualifying patient's medical use of marijuana.

18. "Dispensary" means an entity registered by the department as a compassion center authorized to dispense usable marijuana to a registered qualifying patient and a registered designated caregiver.

20. "Health care provider" means a physician, a physician assistant,or an advanced practice registered nurse.

( 1) DESK (3) COMMITTEE Page 3 h_stcomrep_28_007 Com Standing Committee Report Module ID: h_stcomrep_28_007 February 13, 2019 8:34AM Carrier: M. Ruby InsertLC: 19.0415.01005 Title: 03000

21. "Manufacturing facility" means an entity registered by the department as a compassion center authorized to produce and process and to sell usable marijuana to a dispensary.

24. "Medical cannabinoid product" means a product intended for human consumption or use which contains cannabinoids.

a. Medical cannabinoid products are limited to the following forms:

(1) Cannabinoid tincture;

(2) Cannabinoid capsule;

(3) Cannabinoid transdermal patch; and

(4) Cannabinoid topical.

b. "Medical cannabinoid product" does not include:

( 1 ) A cannabinoid edible product;

(2) A cannabinoid concentrate by itself; or

(3) The dried leaves or flowers of the plant of the genus cannabis by itself.

25. "Med ical marijuana product" means a cannabinoid concentrate or a medical cannabinoid product.

27. "Medical use of marijuana" means the acquisition, use, and possession of usable marijuana to treat or alleviate a qualifying patient's debilitating medical condition.

28. "Minor" means an individual under the age of nineteen.

29. "North Dakota identification" means a North Dakota driver's license or comparable state of North Dakota or federal issued photo identification card verifying North Dakota residence.

30. "Pediatric medical marijuana" means a medical marijuana product containing cannabidiol which may not contain a maximum concentration or amount of tetrahydrocannabinol of more than six percent.

31. "Physician" means a physician licensed under chapter 43-17 to practice medicine in the state of North Dakota.

(1) DESK (3) COMMITTEE Page 4 h_stcomrep_28_007 Com Standing Committee Report Module ID: h_stcomrep_28_007 February 13, 2019 8:34AM Carrier: M. Ruby Insert LC: 19.0415.01005 Title: 03000

32. "Physician assistant" means an individual licensed under chapter 43-17 to practice as a physician assistant in the state.

�34. "Processing" or "process" means the compounding or conversion of marijuana into a medical marijuana product.

d4:-35. "Producing", "produce", or "production" mean the planting, cultivating, growing, trimming, or harvesting of the plant of the genus cannabis or the drying of the leaves or flowers of the plant of the genus cannabis.

&36. "Qualifying patient" means an individual who has been diagnosed by a health care provider as having a debilitating medical condition.

�37. "Registry identification card" means a document issued by the department which identifies an individual as a registered qualifying patient, registered designated caregiver, or registered compassion center agent.

�38. "Terminal illness" means a disease, illness, or condition of a patient:

a. For which there is not a reasonable medical expectation of recovery;

b. Which as a medical probability, will result in the death of the patient, regardless of the use or discontinuance of medical treatment implemented for the purpose of sustaining life or the life processes; and

c. As a result of which, the patient's health care provider would not be surprised if death were to occur within six months.

�39. "Usable marijuana" means a medical marijuana product or the dried leaves or flowers of the plant of the genus cannabis in a combustible delivery form. However, the term does not include the dried leaves or flowers unless authorized through a written certification and does not include a cannabinoid edible product. In the case of a registered qualifying patient who is a minor, "usable marijuana" is limited to pediatric medical marijuana.

�0. "Verification system" means the system maintained by the department under section 19-24. 1-31 for verification of registry identification cards.

*-4___L "Written certification" means a form established by the department which is executed, dated, and signed by a health care provider within ninety calendar days of the date of application, stating that in the health oare provider's professional opinion the patient is likely to reoeive therapeutio or palliative benefitfrom the medioal use of marijuana to treat or alle1,iate the patient'sthe patient has a debilitating medical condition. A health care provider may authorize the use of dried leaves or flowers of the plant of the genus cannabis in a combustible delivery form to treat or alleviate the patient's debilitating medical condition. A written certification may not be made except in the course of a bona fide provider-patient relationship."

Page 3, remove lines 29 and 30

Page 4, replace lines 1 through 4 with:

( 1) DESK (3) COMMITTEE Page 5 h_stcomrep_28_007 Com Standing Committee Report Module ID: h_stcomrep_?8_007 February 13, 2019 8:34AM Carrier: M. Ruby InsertLC: 19.0415.01005 Title: 03000

"SECTION 4. EMERGENCY. This Act is declared to be an emergency measure."

Renumber accordingly

(1) DESK (3) COMMITTEE Page 6 h_stcomrep_28_007 2019 SENATE HUMAN SERVICES

HB 1283

2019 SENATE STANDING COMMITTEE MINUTES

Human Services Committee Red River Room, State Capitol

HB 1283 3/5/2019 Job # 33223

☐ Subcommittee ☐ Conference Committee

Committee Clerk: Justin Velez

Explanation or reason for introduction of bill/resolution:

Relating to access to medical marijuana.

Minutes: Attachments #1-6

Madam Chair Lee opens the hearing on HB 1283.

(01:30-09:00) Representative Kathy Skroch, District 26. Introduces HB 1283 and provides testimony. Please see Attachment #1 for testimony.

Madam Chair Lee: I want to know why PA’s (Physician Assistants) are included.

Representative Skroch: They were not included in the original bill.

Madam Chair Lee: I don’t see advanced practice RN’s (Registered Nurse), am I missing it?

Representative Skroch: They are included in this bill.

Madam Chair Lee: Okay but, PA’s are not independent practitioners who by nature of the title that they carry work for and underneath the supervision of a physician. Are you comfortable with PA’s diagnosing?

Representative Skroch: They would not be a part of the diagnosing.

Madam Chair Lee: You’re just saying that they can sign the card.

Representative Skroch: Yes.

Madam Chair Lee: It makes a difference to me whether they can just sign the card or whether they get to say, you have east widget disease and now you can go get the card.

Representative Skroch: It would go back to the medical records of that individual and documented within those medical records, they would have to be able to see the qualifying diagnoses within those medical records and then by that justifying sign off on the certificate. Senate Human Services Committee HB 1283 3/5/2019 Page 2

Madam Chair Lee: A primary care provider who was an independent practitioner would be making that decision, is that what you are telling me?

Representative Skroch: I’m telling you that the diagnoses would not be made by the PA.

Madam Chair Lee: Okay.

(12:10-13:41) Courtney Koebele, Executive Director of the North Dakota Medical Association. Testifying in support of HB 1283. Please see Attachment #2 for testimony.

Senator K. Roers: I’m hearing you say that a PA can diagnose.

Courtney Koebele: Yes.

Madam Chair Lee: I didn’t think they could. I though the bill that is coming before us is going to say that they can, I didn’t think that they already could.

Courtney Koebele: That is correct. What HB 1175 is talking about just removes the written supervising agreement.

Madam Chair Lee: no collaborative agreement?

Courtney Koebele: Correct. We do not represent them on that bill.

Senator Hogan: Do you know if there is any training in medical school or the PA training on medical marijuana at all at this point in time.

Courtney Koebele: I do not think so, but I could check on that.

Senator O. Larsen: There are extensive trainings on the conditions listed though, correct?

Courtney Koebele: Correct.

(15:24-19:27) Jason Wahl, Executive Director of the Division of Medical Marijuana for the Department of Health. Testifying in support of HB 1283. Please see Attachment #3 for testimony.

Madam Chair Lee: I know they also have a hybrid healthcare arrangement for veterans in which they can get their drugs through the VA but they may see other providers not in the veteran’s clinic as part of their care as well. It isn’t just all or nothing for the VA healthcare. There are other things that veterans participate in as well and we want to make sure that we have those folks covered.

Jason Wahl: I think that is a very good point and if the committee would like to see what an amendment to the law would look like we would be able to provide that.

Senator O. Larsen: Would you be open to opening that to Medicaid as well? Senate Human Services Committee HB 1283 3/5/2019 Page 3

Jason Wahl: We would need to do a lot more review on that to see what impact it would have on the program.

Madam Chair Lee: Who are limited to VA higher docs and providers whereas the Medicaid population would be using private sector docs. I think we need to be able to consider that amendment.

(23:16-26:47) Tina Lingen, North Dakota Citizen. Testifying in support of HB 1283. Please see Attachment #4 for testimony.

Madam Chair Lee: I wanted to point out that we can’t use the prescribe for it because it is still a federal schedule 1 drug.

Tina Lingen: Correct.

Senator O. Larsen: What is the cost of therapy in Minnesota?

Tina Lingen: I do know that the cost to register with the department of health is higher than North Dakota. I believe it less than 100 dollars but it is more than 50 dollars. I believe it depends on what type because, they do sell oils, pill form, and in lotion. I received it in oil form and it was rather expensive. I am one of the lucky people who are able to afford that medication but I don’t have the exact dollar amount but for an estimate maybe 300 dollars a month out of pocket.

(28:35-31:50) Justin Wilhelm-Lorenz, North Dakota Citizen. Testifying in support of HB 1283. Testimony is as follows: I am in support in actually all the bills that are up today. I was in a severe car accident four years ago and I have had several conditions. I have chronic nerve pain in my back, cadaver vertebrate I have plates holding it together, my nerve was severed in my arm so I basically have phantom pains like someone would have with a lost limb. I do also think that amputees should be included in the list of patients because there is no medication that can take care of a phantom pain right now and I actually have an uncle that lives in Arizona and he refuses to come back here because he has a lost limb and he can’t get medical marijuana here. One thing he has always said was, “I can’t imagine the difference between me and you, where you look at your limb and it’s still there but you’re having a pain that is not real”. I am on such a high amount of opioids; I have been talking to my doctor about this since measure 5 passed. A year and a half ago I got put on such strong opioids that I was prescribed 15 vials of Narcan prescribed to me along with my medication. I refused every single increase on opioids since that point. Now I live in constant pain but having to have a vial of Narcan with me at all time for a prescribed amount of opioids that I am taking so, I am prescribed an antidote for my death with my prescriptions and I would love to have another option available rather than something is going to kill me. I have three children I need to be around for them. I have not found a physician that will help me, my actual physician is from Canada and he thinks it would be a great option for me but the directors of Trinity Medical Center won’t allow him to fill out an application.

Madam Chair Lee: Unless he is licensed in North Dakota.

Senate Human Services Committee HB 1283 3/5/2019 Page 4

Justin Wilhelm-Lorenz: He is licensed in North Dakota. Madam Chair Lee: But he’s not affiliated with a medical facility in North Dakota?

Justin Wilhelm-Lorenz: Yes, he works for Trinity Medical Clinic but the directors of that clinic will not allow any of their doctors to help with the medical application.

Madam Chair Lee: That is what we are trying to fix now so, that should not be your problem anymore we hope.

Justin Wilhelm-Lorenz: Yes, that is why I am in support of this so I can get those changes to not have to carry these vials of Narcan around anymore.

Senator O. Larsen: Your doctor is from Canada, have you been to Canada since the legalization there?

Justin Wilhelm-Lorenz: No, my doctor is originally from Canada but he is in Williston at Mercy Medical Center.

(32:25-32:59) Steven James Peterson, Committee for Compassionate Care of North Dakota, Testifying in support of HB 1283. Please see Attachment #5 for testimony.

Senator Anderson: Your group was behind the initiated measure is that my understanding?

Steven James Peterson: Negative sir. The group that was behind measure 5 would have been the Morgan’s who were the two primary sponsors of that and they had their own committee and my group was also not involved with the creation of measure 3.

Senator Anderson: It was very clear in the initiated measure that they wanted the physician to say that this should help the patient and now already just a few days after we started now we want to change all of that and I am trying to get my heard around why we wanted it that way and now we wanted to change it.

Steven James Peterson: If you would allow I’m going to bring someone up who is going to be more equipped to answer that question for you.

Marnie Walth, Sanford Health: Your question is why medical providers want to remove that box?

Senator Anderson: No, my question was why the initiated measure people wanted the doctor to be involved in this when we passed the initiated measure 5 and now all of a sudden they don’t want the doctor any more.

Marnie Walth: Then I apologize, I am not qualified to answer that question.

Mary Rennich, Sponsor of Measure 5: We are primarily in the Bismarck/Mandan region educating, getting talks, bringing speakers that were experts from out of state, and I also worked on the signatures. I can tell you that a lot of the language that was put into the measure was hoping to fit the best possible scenario for law makers in our state, hoping that Senate Human Services Committee HB 1283 3/5/2019 Page 5 a lot of our language that had been tried and true in other states and had become successful. At that time what we had was part of that language, so we put that in there and we knew that there needed to be some tweaking but at that time it seemed like the best possible scenario for our state.

Senator Anderson: It maybe wouldn’t have passed if the doctor wasn’t included in that right?

Mary Rennich: We felt that we needed to have some restrictions because if we made it completely liberal and open without some barriers, rules, and boundaries, you’re probably right.

Senator Anderson: I heard several references to Minnesota today and they have a very narrow medical marijuana provision. Only one product is available in Minnesota and you get access to that. You don’t get to smoke it or eat it but yet we are hearing that Minnesota’s program might be better so maybe we should change North Dakota’s to what Minnesota has.

Mary Rennich: I can tell you that from my own research and extensive reading, I find our program in ND will become a gold standard and the possibility of profit margin in North Dakota and income being brought in to some of the entities involved. I know that Minnesota’s program has struggled to cover costs because it is such a narrow program. I think because they have Mayo Clinic, that has made a difference. Doing research and having studies ongoing and they are able to use some of those products and the CBD for one that I know of. I think North Dakota’s program is turning out to be a successful program and having variety and a wide span of ways that you can utilize the medicine is going to be of upmost importance. My oldest son has Autism, my youngest son who has a feeding tube and has epilepsy and can’t take anything by mouth so there has to be different options for different patients and I think that the patch is one of the things I always promoted thinking that would be such a wonderful thing for patients that can’t ingest, have trouble swallowing, continuous vomiting, and aspiration problems. Many time patches are used in hospitals for other medications so I think that will be a really great product.

(39:00-44:35) Chris Nolden, Bismarck Citizen. Testifying in support of HB 1283. Testimony is as follows: I stand in favor of HB 1283. A big part of the reason I stand for it is because, I am a Christian who believes in god and I believe my meeting with Representative Skroch was somehow intervened by god. I know that seems strange to some people but how we met and how we ran into each other in the hallway it seemed a little bit more than chance to both of us. I have heard some of the concerns from the committee and I understand the concerns. We need to ask ourselves, is there a problem here with how it is currently written and is that causing an issue for people to get certified. I can tell you as a North Dakota resident with conditions that I have also had extreme difficulties finding doctors that will be on board. What their reasons are, those vary. A very good question was brought up about the doctors don’t have to say that it is going to beneficial to the patient and I don’t necessarily agree with that. I believe that this thing that we are trying to address here, at some level I feel it has been dealt with at the Supreme Court of the United States already in 1998 about 1-2 years after California’s state program went live. One of the opinions from the Supreme Court was that doctors have the first amendment right to free speech and they do have the right to discuss this with their patients and they do have the rights to discuss the possible benefits and the possible side effects. Who wants to go to the doctor to be recommended or certified Senate Human Services Committee HB 1283 3/5/2019 Page 6 something that the doctor doesn’t think will help, what is the point? Even right now with the medications that we have available, they state that they think it is going to help. I am a survivor of the opioid crisis. I was 111lbs. and nothing I was doing was illegal however, when they prescribed that medication to me they stated that it might help me. I wish I would of known what I know now because the research has come to show that with opioids for long term chronic pain use, they are not helpful at all. They can actually be adverse and the science is there to say that. I think there are some common sense things within the language that we can change that would make logical sense to a doctor because right now when I look at this it looks illogical. I do think there are some other changes in these sections that do need to happen. I know that Mr. Wahl mentioned the conglomeration of all of them and switching throughout the century code to make proper changes and I just hope that we could do that. I hope that we could look at this objectively and say, okay this makes sense and this doesn’t make sense and let the Supreme Court guide us. I stand in support of this bill and I do stand in support for adding the P.A.’s.

(45:10-45:45) Dustin Peyer, Nonpartisan League. Testifying in support of HB 1283. Testimony is as follows: I am just an organizer for many things and these are testimony from folks who couldn’t be here today and I have also e-mailed the committee. I was a sponsor of Measure 3 and I signed and voted for Measure 5 and I’ll continue to organize people until it is fixed and I support all of the bills this morning.

Madam Chair Lee closes the hearing on HB 1283.

Please see Attachment #6 for additional testimonies provided by Dustin Peyer.

2019 SENATE STANDING COMMITTEE MINUTES

Human Services Committee Red River Room, State Capitol

HB 1283 3/13/2019 Job #33683

☐ Subcommittee ☐ Conference Committee

Committee Clerk: Justin Velez

Explanation or reason for introduction of bill/resolution:

Relating to access to medical marijuana.

Minutes: Attachments #1-2

Madam Chair Lee opens the discussion on HB 1283.

Madam Chair Lee: Access to medical marijuana. The first two parts of the amendments and this would be from Tara as well. Would you like to go through those with us?

Tara Brandner, Assistant Attorney General and General Counsel to the Department of Health. Please see Attachment #1 for proposed amendments: The amendments that you have in front of you are .03001, the amendments primarily relate to removal of information that was skipped on the house side. The primary purpose of HB 1283 is to remove language that relates to a healthcare providers need to attest to the benefits of marijuana. That language was removed in a number of many different sections and it was mistakenly left in other sections so these amendments just remove it from the sections from where it was inadvertently left. I did Representative Skroch’s amendments (Attachment #2) and the Department of Health did work with her in drafting those amendments. The amendments before you do not include Representative Skroch’s amendments.

Madam Chair Lee: We will visit with Jason about those amendments. Any questions about Tara’s amendments? If there are no questions, thanks for standing up for us.

Jason Wahl, Division of Medical Marijuana: The other amendment that you have in front of you is one that I mentioned to the committee the other day about where the department would like to add a reasonable accommodation for veterans whose primary healthcare provider is the federal VA. This would create a new section under the chapter of law, that would allow us to use their medical records from the VA in lieu of the written certification and they would be able to complete the rest of the application just like the other patients would, just the written certification portion of that application, this then would take the place of that.

Madam Chair Lee: We added the PA’s to certify and then diagnosing and recommending is on that one, we had that part and, the emergency clause. The bona fide relationship is on Senate Human Services Committee HB 1283 3/13/2019 Page 2 here as well. Let’s just go back up before we get the VA part, on her testimony on page 2 after talking about section 4, the emergency clause. It says; “The bona fide provider relationship” needs to be removed.

Jason Wahl: I’m not sure when Representative Skroch would have provided that information to you?

Madam Chair Lee: She brought us house testimony.

Jason Wahl: Due to recent events, the informal discussion I had with Representative Skroch prior to committee hearing yesterday, she had some reservations about making any changes to the bona fide provider/patient relationship. We would bring to the committee’s attention, we are aware of certain medical providers starting to pop up in the state, advertising in regards to completing the written certification for patients for a certain dollar amount. We are aware of that and monitoring that situation accordingly. Representative Skroch is aware of it and was very concerned and had reservations about whether or not her original proposed amendment for bona fide provider/patient relationship changes should really now take place given the current circumstances we are seeing in the state.

Senator Anderson: It might be a good time to insert my comments relative to the practitioner recommending this might help the patient. The reason I say that is; you heard the lady admit that the initiated measure wouldn’t have passed if they hadn’t had the physician in there recommending it to the patient also, information that I have received and I put one thing in your books there about the two University of Minnesota physicians who use it for specific cases. They do actually recommend it to the patient and they talk about the benefits and the risks that the patient might incur by using this and also there are risks when you decide to use medical marijuana instead of some other treatment which might be more appropriate for you so, personally I am not in favor of taking out that portion that says the practitioner should say that this might help you because that is how the measure got passed and that is how we protect the patient a little bit. At least the practitioner has the opportunity to discuss it with the patient because they have to say that and, if they don’t feel they can say that then you don’t have the physician or PA or nurse practitioner who says, yes this might help.

Senator K. Roers: I actually take the opposite side of that in that, she may have said that is the only way it got passed but I worked on the anti-campaign and people did not read the text of the bill close enough to understand that so I don’t think she had any information that could have told her one way or another that was the reason it would or would not have passed. I think she may have misspoken on that. The other piece is, I think that if we don’t remove this that we are going to continue to see the type of providers that he is talking about continuing to pop up because from the medical provider’s aspect this is the one thing they want is to have that removed. They don’t feel like they are protected when they have to answer that question.

Madam Chair Lee: I have had people informally tell me from two large providers in different systems that they would be comfortable recommending if they don’t have to state that it is going to help because no one knows for sure. I think if the interest is in making it work and I think that is what people wanted and voted for. I don’t disagree with the logic that Senator Senate Human Services Committee HB 1283 3/13/2019 Page 3

Anderson has but I wish it could be that way but I think if we really want people to get referrals we are going to have to move that. Senator O. Larsen: I’m looking at this and the scenario is; I’m a veteran at the VA hospital and I have my packet of my medical records sitting on my coffee table and I would send that to the department and the department would say, he has PTSD and then he would be able to get the medical marijuana, correct?

Jason Wahl: We would work on internally what records we would like to see so we don’t require this.

Senator O. Larsen: So they are sending you a page that has their qualifying condition on it, why don’t we do that for everybody? Everyone has access to their medical records, why don’t we just do it that way and get rid of all of that if we are going to do this carve out for the VA.

Jason Wahl: The reason for this combination for veterans is due to the fact that their primary care is with a federal entity who is unable to sign whether they wanted to or not the written certification form. These are the veterans that are most vulnerable in regards to healthcare, financial assistance wise, and being able to find proper healthcare that they need. We believed it was a reasonable accommodation in regards to setting this up for those individuals as they won’t have the means to go outside the VA using some kind of private insurance or another healthcare provider. If the legislature wants to make a changes similar to that, that would be a policy making decision and whatever the legislature sets up in regards to the program, we are going to implement.

Senator O. Larsen: You are saying these people are popping up. They are licensed in North Dakota, correct? They are physicians or a provider that is here?

Jason Wahl: They may be, or they may not be. It is going to depend on from the Department of Health’s perspective. When we get the application, it doesn’t matter to me if they are registered or not, it’s when they sign the written certification. That is when we need to find out when they actually are or aren’t. For example; advertising and working on getting licensing in North Dakota, they just couldn’t sign any written certifications until now. If they are advertising and they are currently licensed, they need to maintain that license at the time that they sign the written certification. We haven’t looked up in the board of medicine every single one that we are aware of at this time, we are just aware of and monitoring the situation as best we can.

Madam Chair Lee: When I was in Florida last winter, the farmers market had a tent both where you could get your card. Two folding tables and a white tent and you could get whatever you wanted there. You couldn’t but the pot there but you could buy the card. This is not what I anticipated when I sent this through.

Senator Anderson: It is what I anticipated.

Senator Hogan: Senator O. Larsen I really like your idea of, this could maybe be a pilot project for simplifying the process in the long term, so maybe let’s do it for the VA this year and then look at it long term.

Senate Human Services Committee HB 1283 3/13/2019 Page 4

Jason Wahl: We certainly could track data specifically related to it similar to a pilot project to be able to provide information during the interim or the next session. Senator O. Larsen: My thought is that if you are not going to the doctor to get this, you’re not spending any money so it will be cheaper in the long run. If I went to the doctor at some point in time and had Fibromyalgia and I have that on a piece of paper I should just be able to shoot that to you guys.

Senator K. Roers: The one downside that I can see about that is when I think of drug interactions and I think about there are certain times when you do want someone to have that advanced knowledge to be able to say this could be dangerous if you mix these two things and I wouldn’t want to put that on the Department of Health to have to notice that.

Senator Anderson: But you just told us that the doc wanted out of it.

Senator K. Roers: The doc wants out of saying the patient will benefit, not that they want out of the whole process.

Senator Anderson: I’m not sure what they are contributing other than they sign the card.

Madam Chair Lee: If the provider is in the loop, one would to have some ongoing communication between that patient and that physician because if they have one condition they may have two.

Senator O. Larsen: I can see that we are in the compact and Colorado or whoever has this compact, word will get out that this is the doctor to go to and telemedicine will say the same and hears my little sheet and give me 200 bucks for the deal.

Madam Chair Lee: The amendments that we have that Tara provided for us that removed the responsibility of the provider, you are okay with how that is done?

Jason Wahl: Correct.

Madam Chair Lee: So the only other one in looking at Representative Skroch’s testimony as well that we would be looking at then is the VA change?

Jason Wahl: That would be correct.

Madam Chair Lee: Tara would be able to work with Jason on putting together something that would plug into these others that would deal with that. The people who are just VA patients are generally people who don’t have much discretionary income or at least in our area they are going to be in a partnership deal where they may go to a local doc but they get their drugs through the VA. It makes a difference for somebody who has some discretionary income may not even be using the VA but someone who is using it solely is likely to be a low income person.

Jason Wahl: I think we would generally agree with that statement based on the conversations that we had the Department of Veteran Affairs about this reasonable accommodation for veterans. We did work with them and they were nice enough to go and Senate Human Services Committee HB 1283 3/13/2019 Page 5 meet with the VA hospital in Fargo to discuss this to make sure that we had some of the right language and that they would be comfortable in regards to how this process could work. They obviously tight lipped in regards to not being able to discuss marijuana for veterans. One of the concerns that came up in regards to their healthcare provider may not know that they are actually using marijuana. We are currently working on getting in the PDMP an identifier that the person has a medical marijuana card. The VA hospital would be able to look up their patients in the PDMP and they would see that they have an active card. In regard to working with Tara, we worked with Tara on that amendment, we just left it out of the other bill so you could see it as it was. The two of those could be blended together as far as we are concerned.

Madam Chair Lee: I would be perfectly fine with that, if that is okay. Does that sound like a plan to the rest of the committee? I’m seeing nods and thumbs and things.

Senator K. Roers: I move to ADOPT AMENDTMENT .03001 amendments plus the V.A. exemption. Seconded by Senator Hogan

Senator O. Larsen: My confusing vote is going to be that, if we are going to have the doctors involved, I want to keep them involved and not have the pilot thing and if we are going to have the pilot thing and the VA gets to hand in their one sheet, I want everybody to be able to do that, get rid of the doctors entirely so I don’t think I’m going to support the amendment.

Senator Clemens: You are moving these two together, and we are voting to approve the combined amendment?

Madam Chair Lee: Yes.

Senator Clemens: I guess I’m not sure on where I’m going with this. This marijuana thing is a big deal to me and is this affecting the physician and stuff?

Madam Chair Lee: The physicians will still have to recommend it and they have to certify that I have a condition which is listed and has been indicated as possibly benefiting for using medical marijuana.

Senator K. Roers: We are just taking away the check box that says; I believe that the patient will benefit from medical marijuana. They still have to say yes, they are my patient and they have this condition. They just no longer have to say that they are going to benefit.

Senator Clemens: Because there is not enough research to back that up?

Senator K. Roers: Correct.

Senator O. Larsen: The other part of the amendment I can just have my little sheet saying that I have Fibromyalgia here you go Department of Health and they go okay he has it on there, he gets a free pass.

Senator K. Roers: If the federal government were to make marijuana legal, we wouldn’t have to make these exceptions but because the federal government does and that population Senate Human Services Committee HB 1283 3/13/2019 Page 6 of people have a restriction that they can only go to a federal healthcare worker, they cannot have their doctor check those first two boxes. That is the reason for the exception. Senator Clemens: It’s protecting the doctor but at the same time realizing it is probably going to allow more people to get an application?

Madam Chair Lee: For example, the CHI hospitals have a policy that they don’t want their providers to do it and Sanford has said that it is up to the provider. The liability of recommending in this case a federally illegal drug puts an onus on them for liability. If they have Fibromyalgia or whatever condition that is on the approved conditions list maybe it will help and the doctor is saying yes, maybe it will help. They can’t state for sure because they don’t know, until we are able to do some really good research when it is legal so it can be in the research universities we can’t rely on it.

Senator Clemens: They are approving the patient for the application based on what conditions are listed.

Madam Chair Lee: Exactly, and the VA one they have to provide their medical records, they don’t just put it on the back of a napkin and say they have this qualifying condition. There would be an opportunity for the health department to set up procedure for evaluating those health records to indicate that patient had that condition.

Senator Anderson: I believe this amendment that we have here, section 4 in subsection 7, if we are going to accept that change then we might as well delete the whole section. If you read it, it says; “A registered qualifying patient certifying healthcare provider shall notify the department in writing if the healthcare providers registered qualifying patient no longer has a debilitating condition.” That means shall notify so the provider has to keep a list of patients that have a debilitating condition and if they cure them then they notify the department or if the and here is where we have changed it “the provider may notify the department if a bona fide provider/patient relationship ceases to exist.” Now the only case where a provider would do that is if they didn’t pay their bill and the provider was mad at them, otherwise they are not going to bother to notify the department about that. Would you agree?

Jason Wahl: The reason that section is using “may” came through a lengthy discussion between Tara and myself in regard to various scenarios that have been popping up. For example, that written certification on their card has an expiration date of one year, ten months after signing that healthcare provider has moved to a different facility and that patient is not moving to the city that the healthcare provider is going. If it said “shall” they would be required in that scenario to notify us that relationship no longer exists and that patients card then, under sections of the law, require us to void that card immediately and that could have a detrimental impact on that patient because through no fault of their own, they are sitting there without their card as they are trying to establish a new relationship. What we are looking for is the “may”, obviously if a healthcare provider no longer has that patient however many months it may be, we are trying to make sure that it wasn’t a “shall” requirement, that it was a “may” if a healthcare provider in that type of scenario. Where do you draw that line, I can’t tell you but that was definitely a part of the discussion in the scenarios of that current definition not being met and the “shall” did raise some concerns from a programmatic standpoint and from fairness to the patient standpoint.

Senate Human Services Committee HB 1283 3/13/2019 Page 7

Senator K. Roers: Can you explain to me the certification, is this good for life that card or do you have to be re-certified every two years? Jason Wahl: Right now, the law states that the written certification is good for up to a year unless they have marked a shorter time period. We have seen shorter time periods written on the certification form for whatever reason the healthcare provider wasn’t going to be allowed for a year.

Senator K. Roers: I think I agree that this section really isn’t needed if you have to get re- certified every year anyways. It’s not like this is an indefinite card and we need to make sure, I feel that is a lot of onus on that provider to remember to go back in and say they no longer have this conditions.

Jason Wahl: That is the reason for the “may” they aren’t required to. Under that one, if they are aware in regards to no longer that requirement. I think the law in relation to that’s why upfront, if I know you are going to be through treatment and I believe that cancer you should be in remission six months from now, I may have that written certification good for six months. It still allows the opportunity for them to get another card after six months if they still have cancer, it’s just that they would need to fill out the application again in regards to that. If the committee wants to look at a change in regards to that, certainly open to that discussion.

Madam Chair Lee: The first one seems to me it deals with the condition and the second one deals with the relationship between the provider and the patient. They are different.

Jason Wahl: Correct. The other thing I would mention, in a number of the presentations to the healthcare providers and the major facilities a number of questions come up about what if I do sign this form and in six months from now, im not seeing that patient or not able to continue a relationship because they are not coming back to see me and it seems like the whole reason they established care with me was in order to get their card. From our standpoint, part of that being in there still puts in the hands of the medical community and give them an opportunity to rescind that written certification if they believe it needs to be rescinded.

Senator Clemens: The emphasis is that we protect the physicians in any way that we can.

Senator K. Roers: I’m wondering about how you feel about in seven changing both to “may” instead of a “shall” and a “may”.

Jason Wahl: No issue from my perspective. I’m looking both the medical, lawyer, and CEOO side. We would have no problem.

Madam Chair Lee: We can’t hear your heads rattle on the tape here so might have to actually talk, we are looking at Cortney Koebele and Tara Brandner who are saying “may” is ok.

Senator K. Roers: What I meant to say was to move the revised amendment

Madam Chair Lee: Does everyone approve the revised amendment, adding the “may”? (The committee agreed to add the change from “shall” to “may” to amendment .03001)

Senate Human Services Committee HB 1283 3/13/2019 Page 8

Madam Chair Lee: Anything further because we want to make sure we have this tidy. We voted on adding the “may”, do you want to now have an opportunity to vote the amended amendment? I would ask for a voice vote on whether or not you approve on the amended amendment which changes “shall” to “may”.

VOICE VOTE TAKEN MOTION CARRIES

Madam Chair Lee: Do you wish to see the amendment before we vote on it, engross it in this and vote for the bill so that she can actually put it in the system?

Senator Clemens: I think I would like to look at it.

Madam Chair Lee and the Senate Human Services Committee move on to discuss HB 1417.

2019 SENATE STANDING COMMITTEE MINUTES

Human Services Committee Red River Room, State Capitol

HB 1283 3/18/2019 Job #33866

☐ Subcommittee ☐ Conference Committee

Committee Clerk: Justin Velez

Explanation or reason for introduction of bill/resolution:

Relating to access to medical marijuana.

Minutes: No Attachments

Madam Chair Lee opens the discussion on HB 1283.

Madam Chair Lee: We got rid of the palliative affect that it is recognized as it being helpful and Tara was going to work with Jason on the VA exemption.

Jason Wahl: We provided that amendment but we are just waiting on the final word.

Madam Chair Lee: We got all of that one together we are just waiting for the Christmas tree bill.

(01:18-end of recording) Madam Chair Lee and the committee go over what bills that the intern has amendments and Christmas tree bills ready for and which bill to have committee work on next.

2019 SENATE STANDING COMMITTEE MINUTES

Human Services Committee Red River Room, State Capitol

HB 1283 3/18/2019 Job #33875

☐ Subcommittee ☐ Conference Committee

Committee Clerk: Justin Velez

Explanation or reason for introduction of bill/resolution:

Relating to access to medical marijuana.

Minutes: No Attachments

Madam Chair Lee opens the discussion on HB 1283.

(00:00-01:58) The committee tries to find a way to get copies of the Christmas tree bill without printing malfunctions. The intern sends copies to the clerk and puts the Christmas tree bill on the TV’s for the committee to review.

Madam Chair Lee: Okay, lets scroll down to where we had something green or red.

(02:40-04:12) The committee notices a discrepancy in the Christmas tree bill where HB 1285’s amendments were transferred into the HB 1283’s version of the Christmas tree bill provided to the committee.

Madam Chair Lee: So the conditions that are in this one are just the original ones.

Jason Wahl, Division of Medical Marijuana: Do you remember HB 1283 when it came over from the house we did a number of additional revisions in regards to removing language in one section but they didn’t catch it all in the other sections of the chapter so, that is where it is making it consistent throughout in regards to the language above the “benefit of the medical use of marijuana” and then we introduced the amendment for “in lieu of a written certification for a veteran going to the federal VA entities”.

Senator Hogan: So sections 3 and 4 are kind of technical corrections?

Jason Wahl: Correct.

Senator K. Roers: I just didn’t remember talking about pediatrics and maybe its just that it was fixing the language.

Senate Human Services Committee HB 1283 3/18/2019 Page 2

Jason Wahl: Correct, the current law requires them to discuss with the parent or legal guardian the benefits and risks of marijuana and with the benefit language coming out we thought it was best to benefit to that discussion, you are required to discuss the risks of the medical use of marijuana to the legal guardian or parent of a minor patient.

Madam Chair Lee: We have an extra “u” in days on line 35, just a typo, they will catch that. What I have on the amendment page which was provided is consistency of not having to say that it is going to alleviate a debilitating condition. “May notify the department if a bona fide provider/patient relationship ceases to exist” in that section 4 we changed “Shall to may” and then in section 6 it was back to the therapeutic discussion. Now section 6 on our amendment page is section 7 in the Christmas tree.

Senator K. Roers: If we are no longer asking about benefit, do we want to use it?

Senator Anderson: I think it doesn’t hurt.

Madam Chair Lee: I would like to ask the people in the gallery if you are ok with the amendments as they are presented in this document now? Would you like a chance to look it over? We can actually make sure we get a printed page for you if that is better. If you don’t feel you have the opportunity to look that language over carefully because I want you all to be able to do that, we can set this aside and get printed copies for you as well for us and do this tomorrow as well?

Senator Hogan: I would.

Madam Chair Lee: I would too so, let’s do that.

Madam Chair Lee closes the discussion on HB 1283. 2019 SENATE STANDING COMMITTEE MINUTES

Human Services Committee Red River Room, State Capitol

HB 1283 3/18/2019 Job #33896

☐ Subcommittee ☐ Conference Committee

Committee Clerk: Justin Velez

Explanation or reason for introduction of bill/resolution:

Relating to access to medical marijuana.

Minutes: No Attachments

Madam Chair Lee opens the discussion on HB 1283.

Madam Chair Lee: Okay, for eliminating so much we still have a lot left still.

Jason Wahl, Division of Medical Marijuana: Tara thinks that we are going to need a revision on this.

Madam Chair Lee: Would you like to step up Mrs. Brandner?

Jason Wahl: I think she needs a little bit more time.

Madam Chair Lee: We are doing this on Monday because we have two days more. Would you be more comfortable with our conversations today having a little time to review these and then you can come back. We can talk about it tomorrow as well. We do have some PBM stuff tomorrow, we have a couple folks who couldn’t come in today for the hearing. I don’t want anybody to feel like they didn’t have a chance to read it.

Madam Chair Lee closes the discussion on HB 1283. 2019 SENATE STANDING COMMITTEE MINUTES

Human Services Committee Red River Room, State Capitol

HB 1283 3/18/2019 Job #33904

☐ Subcommittee ☐ Conference Committee

Committee Clerk: Justin Velez

Explanation or reason for introduction of bill/resolution:

Relating to access to medical marijuana.

Minutes: No Attachments

Madam Chair Lee opens the discussion on HB 1283.

Madam Chair Lee: We have amended it but we did not move on it. So HB 1283, the first engrossment which should be 3000 version. Tara Brandner said that HB 1283 was good, the 3000 version, correct?

Tara Brandner, Assistant Attorney General: If that is the one you just did then yes.

Senator Hogan: I move DO PASS, AS AMENDED. Seconded by Senator K. Roers

Madam Chair Lee: Is there any further discussion? If not, please call the roll.

ROLL CALL VOTE TAKEN

5 YEA, 1 NAY, 0 ABSENT MOTION CARRIES DO PASS AS AMENDED Senator Hogan will carry HB 1283 to the floor.

Madam Chair Lee closes the discussion on HB 1283. 19.0415.03002 Prepared by the Legislative Council staff for Title.04000 the Senate Human Services Committee March 18, 2019

PROPOSED AMENDMENTS TO ENGROSSED HOUSE BILL NO. 1283 Page 1, line 1, after"Act" insert"to create and enact section 19-24.1-03.1 of the NorthDakota Century Code, relating to access to medical marijuana;" Page 1, line 2, replace "and" with "subdivision a of subsection 5 of section 19-24.1-05, subsection 7 of section 19-24.1-10," Page 1, line 2, after "19-24.1-11" insert ", and subsection 10 of section 19-24.1-32" Page 8, after line 17, insert: "SECTION 3. Section 19-24.1-03.1 of the North Dakota Century Code is created and enacted as follows: 19-24.1-03.1. Qualifying patients - Veterans.

In lieu of the written certification required under section 19-24.1-03, a veteran receiving treatment from a federal veterans' affairs entity may submit to the department a copy of the veterans' affairs medical records identifying a diagnosis of a debilitating medical condition and a copy of military discharge documents. The department may use the medical records and discharge documents in place of a written certification to approve or deny the application under section 19-24.1-05. The department shall issue a registry identification card within thirty calendar days of approving an application under this section.

SECTION 4. AMENDMENT. Subdivision a of subsection 5 of section 19-24.1-05 of the North Dakota Century Code is amended and reenacted as follows:

7. A registered qualifying patient's certifying health care provider shall notify the department in writing if the health care provider's registered qualifying

patient no longer has a debilitating1 medical condition or if the. The health care provider no longer belie t'esthe patient will reeeive therapeutieor palliativebene fitfrom the medieal use of marijuanamay notify the department if a bona fide provider-patient relationship ceases to exist. The qualifying patient's registry identification card becomes void immediately upon the health care provider's notification of the department and the registered qualifying patient shall dispose of any usable marijuana in the cardholder's possession within fifteen calendar days, in accordance with rules adopted under this chapter."

Page 8, after line 22, insert:

Page No. 1 19.0415.03002 "SECTION 7. AMENDMENT. Subsection 10 of section 19-24.1-32 of the North Dakota Century Code is amended and reenacted as follows:

10. A health care provider is not subject to arrest or prosecution or the denial of any right or privilege, including a civil penalty or disciplinary action by a court or occupational or professional regulating entity, solely for providing a written certification or for other.vise stating in the health care provider's professional opinion a patient is likely to receive therapeutic or palliative benefit from the medical use of usable marijuana to treat or alleviate the patient's debilitating medical condition or for refusing to provide written certification or a statement. This chapter does not release a health care provider from the duty to exercise a professional standard of care for evaluating or treating a patient's medical condition."

Renumber accordingly

Page No. 2 19.0415.03002 / Date: 3 13 J ICf Roll Call Vote #: /

2019 SENATE STANDING COMMITTEE ROLL CALL VOTES BILL/RESOLUTION NO. 12-13

Senate Human Services Committee

□ Subcommittee -�h�t, /} Amendment LC# or Description: �03WI Cwt.d ·\). ,g. -e:,1,,eMt7J.lot') and f-l-f ltU( +o �\ (/",hyI. Recommendation: cg_Adopt Amendment □ Do Pass □ Do Not Pass □ Without Committee Recommendation □ As Amended □ Rerefer to Appropriations □ Place on Consent Calendar Other Actions: □ Reconsider □

Motion Made By �Y' · �- aaer5 Seconded By

Senators Yes No Senators Yes No Sen. Judy Lee Sen. Kathy Hogan Sen. Oley Larsen Sen. Howard C. Anderson Sen. David Clemens ./" Sen. Kristin Roers /r VJ r-.. '\�LI .,,,.-, ' /' I-<\/) "\,n'-' (\ � \ '-"' l'I.. '\ \J

Total (Yes) ------No

Absent

Floor Assignment

If the vote is on an amendment, briefly indicate intent: Date: 311 fS / I Cf Roll Call Vote #: J

2019 SENATE STANDING COMMITTEE ROLL CALL VOTES BILL/RESOLUTION NO. I )�3

Senate Human Services Committee

□ Subcommittee

Amendment LC# or Description: ------

Recommendation: □ Adopt Amendment gJ Do Pass □ Do Not Pass □ Without Committee Recommendation �As Amended □ Rerefer to Appropriations □ Place on Consent Calendar Other Actions: □ Reconsider □

Motion Made By __0�<� \/\�- �H-- o_.�-+-°'-� V'\.�--- Seconded By

Senators Yes No Senators Yes No X. Sen. Judy Lee Sen. Kathy Hogan ..x Sen. Oley Larsen � Sen. Howard C. Anderson X Sen. David Clemens .x Sen. Kristin Roers z

Total (Yes) ------5" No

Absent

Floor Assignment

If the vote is on an amendment, briefly indicate intent: Com Standing Committee Report Module ID: s_stcomrep_48_0 27 March 19, 2019 4:10PM Carrier: Hogan InsertLC : 19.0415.03002 Title: 04000

REPORT OF STANDING COMMITTEE HB 1283, as engrossed: Human Services Committee (Sen. J. Lee, Chairman) recommends AMENDMENTS AS FOLLOWS and when so amended , recommends DO PASS (5 YEAS, 1 NAYS, 0 ABSENT AND NOT VOTING). Engrossed HB 1283 was placed on the Sixth order on the calendar.

Page 1, line 1, after "Act" insert "to create and enact section 19-24.1-03.1 of the North Dakota Century Code, relating to access to medical marijuana;"

Page 1, line 2, replace "and" with "subdivision a of subsection 5 of section 19-24.1-05, subsection 7 of section 19-24. 1-1 0,"

Page 1, line 2, after "19-24. 1-11" insert ", and subsection 10 of section 19-24.1 -32"

Page 8, after line 17, insert:

"SECTION 3. Section 19-24. 1-03.1 of the North Dakota Century Code is created and enacted as follows:

19-24.1-03.1. Qualifying patients - Veterans.

In lieu of the written certification required under section 19-24.1 -03, a veteran receiving treatment from a federal veterans' affairs entity may submit to the department a copy of the veterans' affairs medical records identifying a diagnosis of a debilitating medical condition and a copy of military discharge documents. The department may use the medical records and discharge documents in place of a written certification to approve or deny the application under section 19-24.1-05. The department shall issue a registry identification card within thirty calendar days of approving an application under this section.

SECTION 4. AMENDMENT. Subdivision a of subsection 5 of section 19-24.1-05 of the North Dakota Century Code is amended and reenacted as follows:

SECTION 5. AMENDMENT. Subsection 7 of section 19-24. 1-10 of the North Dakota Century Code is amended and reenacted as follows:

7. A registered qualifying patient's certifying health care provider shall notify the department in writing if the health care provider's registered qualifying patient no longer has a debilitating medical condition or if the. The health care provider no longer believes the patient will receive therapeutio or palliative benefitfrom the medioal use of marijuanamay notify the department if a bona fide provider-patient relationship ceases to exist. The qualifying patient's registry identification card becomes void immediately upon the health care provider's notification of the department and the registered qualifying patient shall dispose of any usable marijuana in the cardholder's possession within fifteen calendar days, in accordance with rules adopted under this chapter."

Page 8, after line 22, insert:

"SECTION 7. AMENDMENT. Subsection 10 of section 19-24.1-32 of the North Dakota Century Code is amended and reenacted as follows:

10. A health care provider is not subject to arrest or prosecution or the denial of any right or privilege, including a civil penalty or disciplinary action by a

( 1) DESK (3) COMMITTEE Page 1 s_stcomrep_48_027 Com Standing Committee Report Module ID: s_stcomrep_ 48_027 March 19, 2019 4:10PM Carrier: Hogan InsertLC : 19.0415.03002 Title: 04000

court or occupational or professional regulating entity, solely for providing a written certification or for otherwise stating in the health care provider's professional opinion a patient is likely to receive therapeutic or palliative benefit from the medical use of usable marijuana to treat or alleviate the patient's debilitating medical condition or for refusing to provide written certification or a statement. This chapter does not release a health care provider from the duty to exercise a professional standard of care for evaluating or treating a patient's medical condition."

Renumber accord ingly

(1) DESK (3) COMMITTEE Page 2 s_stcomrep_48_027

2019 CONFERENCE COMMITTEE

HB 1283

2019 HOUSE STANDING COMMITTEE MINUTES

Human Services Committee Fort Union Room, State Capitol

HB 1283 4/12/2019 34722

☐ Subcommittee ☒ Conference Committee

Committee Clerk: Nicole Klaman

Explanation or reason for introduction of bill/resolution:

Relating to medical marijuana written certifications and to access to medical marijuana

Minutes: 1

Chairman M. Ruby: Opened meeting. We were actually planning on fighting a little bit with shall vs may but it was resolved in another one. We like what you’ve done. I’ve put an amendment before you and what we did. If you look at page 8 line 13 insert the disclosure in there on another bill for energy and natural resources, we added where BCI had access to the data base. The worry was they would start pulling concealed weapons without any due process and that failed. So what we decided to do instead, is a disclosure taking the I didn’t know argument out of it placing it back to personal responsibility. That is what this does. A disclosure stating “possession of a firearm by a person who possesses marijuana maybe a violation of Federal Law. What I would like the discussion to be around is instead of maybe change to is. There is no black and white there that is the Federal Law.

Senator Anderson: I don’t have a problem with the “maybe” and the Federal Law can change. It gives person notice that it is against the law. If you say “is” and in a year something changes, we do not want to have to change the Legislation. I’m comfortable with the maybe as it gives the person notice that they need to think about it. If they ask anyone, among their own group or law enforcement.

Senator Roers: As I read it I’m trying to think how this can be picked apart. Help me understand. Is it that I can own a firearm but cannot be in physical possession of it or is it (firearm) being in my house and I have marijuana? Where is the line on that?

Chairman M. Ruby: Most of our discussion went around the concealed weapons. I don’t know that last time you bought a gun but there is always the box that says have you ever been convicted of marijuana. The Federal Law does say to be in possession of a firearm and marijuana is a felony.

Senator Roers: I’m wondering if that disclosure might be confusing to people if they own a gun, but don’t plan on using it. Just to make sure that the wording of it is clear to insure there isn’t any confusion. House Human Services Committee HB 1283 4/12/19 Page 2

Rep. Damschen: Our main concern was that we would lose reciprocity with other states if we didn’t address the issue. I don’t know if they can take your gun because you are using marijuana but you cannot have a concealed weapons permit.

Senator Roers: I would assume it’s physical control.

Steven Peterson, Lobbyist: Rep. Porter and I discussed this yesterday. Within the scope, ownership and use of a black powder rifle is not restricted on the Federal Law, as far as cannabis possession is concerned. Bow hunting is not and if you qualify for a cross bow, that’s not a problem. As far as the concealed weapons permit, correct. Carrying a concealed weapons permit would be a criminal act. So if there is a patient with a concealed weapons permit they are going to have to make the choice of one or the other. This letter gives them the opportunity to rectify this without getting to the point of worry where BCI going to people’s homes. We have one patient that has already moved all of his firearms out of his house, in anticipation of his card. They are all at his fathers locked in a safe. As far as he’s concerned, as long as he has the card those will go to his brother if anything happens to him. Any questions?

Senator Anderson: It’s really about those with a concealed weapons card. When you filled out the application you checked, I do not use any illegal drugs. That is a federal application. It’s very unlikely anyone is going to come to your home and take your guns, as they aren’t supposed to know you even have them, right? If someone were to get a concealed weapons permit, which is good for three years, and later get a card, this would be a reminder that they may be breaking the law. That’s the difference, I think.

Rep. Damschen: If you were caught with marijuana and a concealed weapons is that an offense that would make you illegally owning any guns you have?

Chairman M. Ruby: I’m not positive but I am almost certain you would lose your concealed weapons license. But if you don’t have a weapon, I don’t think you are guilty of felonious activity.

Senator Anderson: If you have marijuana and a concealed weapons, you either lied on the card application or subsequently you have forgotten you shouldn’t be using illegal drugs.

Senator Hogan: Steve could you answer my question of how are other states dealing with this particular issue?

Steven Peterson, Lobbyist: Some states are allowing their medical marijuana patients to get concealed weapons permits. However, that is only 1 or 2 states in the union. Other states are taking a blind eye to the matter, Colorado is treading very lightly on that. But again, most of the people that are in the medical program knew a long time ago, they can’t have both. I sold all my firearms and advocated my concealed weapons permits so I could be compliant within the program. How the future unrolls at this point, it depends. Some states are saying yes, as long as you are within the scope of the law, you may possess. I’m sure there will be legal challenge, at some point, with this. On the Federal level, it’s clear, firearm possession not including black House Human Services Committee HB 1283 4/12/19 Page 3 powder, bow, etc. is federally illegal at this point. The patients will have to make a choice. Previous amendment was bad because of lack of due process. Here we are giving the people the chance to advocate their CWP, make the choice, get their card and deal with their firearms.

Senator Hogan: I was wondering about other states as I suspect this issue will be before us again.

Steven Peterson: Admittedly

Senator Anderson: Chairman Ruby, I move that we, the Senate, recede from their amendments and re-amend with what you have here. See attachment 1: 19.0415.03006

Senator Roers: Second

Roll Call Vote: 6 Yes 0 No 0 Absent Motion Carries Carriers: Senator Hogan and Rep. M. Ruby

Chairman M. Ruby: Closes meeting ])@ i.///Zlh

19.0415.03006 Prepared by the Legislative Council staff for I c) ;) Title.06000 Representative M. Ruby April 11, 2019

PROPOSED AMENDMENTS TO ENGROSSED HOUSE BILL NO. 1283 That the Senate recede from its amendments as printed on pages 1308 and 1309 of the House Journal and pages 1041 and 1042 of the Senate Journal and that Engrossed House Bill No. 1283 be amended as follows: Page 1, line 1, after "Act" insert "to create and enact section 19-24.1-03.1 and a new paragraph to subdivision b of subsection 2 of section 19-24.1-04 of the North Dakota Century Code, relating to access to medical marijuana;" Page 1, line 2, replace "and" with "subdivision a of subsection 5 of section 19-24.1-05, subsection 7 of section 19-24.1-10," Page 1, line 2, after "19-24.1-11" insert ", and subsection 10 of section 19-24.1-32" Page 8, after line 13, insert:

"@ A disclosure that possession of a firearm by a person who possesses marijuana may be a violation of federal law." Page 8, after line 17, insert: "SECTION 3. Section 19-24.1-03.1 of the North Dakota Century Code is created and enacted as follows:

19-24.1-03.1. Qualifying patients - Veterans.

In lieu of the written certification required under section 19-24.1-03, a veteran receiving treatment from a federal veterans' affairs entity may submit to the department a copy of the veterans' affairs medical records identifying a diagnosis of a debilitating medical condition and a copy of militarydischarge documents. The department may use the medical records and discharge documents in place of a written certification to approve or deny the application under section 19-24.1-05. The department shall issue a registryidentification card within thirtycalendar days of approving an application under this section.

SECTION 4. A new paragraph to subdivision b of subsection 2 of section 19-24.1-04 of the North Dakota Century Code is created and enacted as follows:

A disclosure that possession of a firearm by a person who possesses marijuana may be a violation of federal law. SECTION 5. AMENDMENT. Subdivision a of subsection 5 of section 19-24.1-05 of the NorthDakota Century Code is amended and reenacted as follows:

Page No. 1 19.0415.03006 00 �/fz/ 7. A registered qualifying patient's certifying health care provider SRa#may c) c,.f notify the department in writing if the health care provider's registered J qualifying patient no longer has a debilitating medical condition or if the.:. The health care provider no longer believes the patient will reeeive therapeutie or palliativebenefit from the medieal use of marijuanamay notify the department if a bona fide provider-patient relationship ceases to exist. The qualifying patient's registry identification card becomes void immediately upon the health care provider's notification of the department and the registered qualifying patient shall dispose of any usable marijuana in the cardholder's possession within fifteen calendar days, in accordance with rules adopted under this chapter."

Page 8, after line 22, insert: "SECTION 8. AMENDMENT. Subsection 10 of section 19-24.1-32 of the North Dakota Century Code is amended and reenacted as follows:

10. A health care provider is not subject to arrest or prosecution or the denial of any right or privilege, including a civil penalty or disciplinary action by a court or occupational or professional regulating entity, solely for providing a written certification or for otherwise stating in the health care provider's professional opinion a patient is likely to receive therapeutic or palliative benefit from the medical use of usable marijuana to treat or alleviate the patient's debilitating medical condition or for refusing to provide written certification or a statement. This chapter does not release a health care provider from the duty to exercise a professional standard of care for evaluating or treating a patient's medical condition."

Renumber accordingly

Page No. 2 19.0415.03006 Date: 4/12/2019 Roll Call Vote #:1

2019 HOUSE CONFERENCE COMMITTEE ROLL CALL VOTES

BILL NO. HB 1283 as (re) engrossed

House Human Service Committee Action Taken □ HOUSE accede to Senate Amendments □ HOUSE accede to Senate Amendments and further amend □ SENATE recede from Senate amendments IZI SENATE recede from Senate amendments and amend as follows

□ Unable to agree, recommends that the comm ittee be discharged and a new committee be appointed

Motion Made by: Senator Anderson Seconded by: Senator K. Roers

Representatives 4/1 2 Yes No Senators 4/1 2 Yes No

Chair M.Ruby X X Senator Roers X X Rep Devlin X X Senator Hogan X X Rep Damschen X X Senator Anderson X X

Total Rep. Vote 3 0 Total Senate Vote 3 0

Vote Count Yes: 6 No: 0 Absent: 0

House Carrier _R_e.....,p_._M _._R_ u_b__._y ______Senate Carrier Senator K. Hogan LC Number ------19.0415 03006 of amendment

LC Number 19.0415 . ------06000 of engrossment Emergency clause added or deleted

Statement of purpose of amendment Com Conference Committee Report Module ID: h_cfcomrep_67 _001 April 15, 2019 9:40AM InsertLC : 19.0415.03006 House Carrier: M. Ruby Senate Carrier: Hogan

REPORT OF CONFERENCE COMMITTEE HB 1283, as engrossed: Yo ur conference committee (Sens. K. Roers, Hogan, Anderson and Reps. M. Ruby, Devlin, Damschen) recommends that the SENATE RECEDE from the Senate amendments as printed on HJ pages 1308-1309, adopt amendments as follows, and place HB 1283 on the Seventh order:

That the Senate recede from its amendments as printed on pages 1308 and 1309 of the House Journal and pages 1041 and 1042 of the Senate Journal and that Engrossed House Bill No. 1283 be amended as follows:

Page 1, line 1, after "Act" insert "to create and enact section 19-24.1-03.1 and a new paragraph to subdivision b of subsection 2 of section 19-24.1 -04 of the North Dakota Century Code, relating to access to medical marijuana;"

Page 1, line 2, replace "and" with "subdivision a of subsection 5 of section 19-24.1-05, subsection 7 of section 19-24. 1-1 0,"

Page 1, line 2, after "19-24. 1-11" insert ", and subsection 10 of section 19-24.1 -32"

Page 8, after line 13, insert:

".{fil A disclosure that possession of a firearm by a person who possesses marijuana may be a violation of federal law."

Page 8, after line 17, insert:

"SECTION 3. Section 19-24.1-03.1 of the North Dakota Century Code is created and enacted as follows:

19-24.1-03.1. Qualifying patients - Veterans.

In lieu of the written certification required under section 19-24.1 -03. a veteran receiving treatment from a federal veterans' affairs entity may submit to the department a copy of the veterans' affairs medical records identifying a diagnosis of a debilitating medical condition and a copy of military discharge documents. The department may use the medical records and discharge documents in place of a written certification to approve or deny the application under section 19-24.1-05. The department shall issue a registry identification card within thirty calendar days of approving an application under this section.

SECTION 4. A new paragraph to subdivision b of subsection 2 of section 19-24.1 -04 of the North Dakota Century Code is created and enacted as follows:

A disclosure that possession of a firearm by a person who possesses marijuana may be a violation of federal law.

SECTION 5. AMENDMENT. Subdivision a of subsection 5 of section 19-24.1-05 of the North Dakota Century Code is amended and reenacted as follows:

a. The department receives documentation the minor"s health care provider has explained to the parent or legal guardian with responsibility forheal th care decisions for the minor the potential riskc and benefits of the use of pediatric medical marijuana to treat or alleviate the debilitating medioal oondition; and

SECTION 6. AMENDMENT. Subsection 7 of section 19-24. 1-10 of the North Dakota Century Code is amended and reenacted as follows:

(1) DESK (2) COMMITTEE Page 1 h_cfcomrep_67_00 1 Com Conference Committee Report Module ID: h_cfcomrep_67 _001 April 15, 2019 9:40AM InsertLC : 19.041 5.03006 House Carrier: M. Ruby Senate Carrier: Hogan

7. A registered qualifying patient's certifying health care provider Sfl-aUmay notify the department in writing if the health care provider's registered qualifying patient no longer has a debilitating medical condition or if the� The health care provider no longer believes the patient will receive therapeuticor palliativebenefit from the medical use of marijuanamay notify the department if a bona fide provider-patient relationship ceases to exist. The qualifying patient's registry identification card becomes void immediately upon the health care provider's notification of the department and the registered qualifying patient shall dispose of any usable marijuana in the cardholder's possession within fifteen calendar days, in accordance with rules adopted under this chapter."

Page 8, after line 22, insert:

"SECTION 8. AMENDMENT. Subsection 10 of section 19-24.1-32 of the North Dakota Century Code is amended and reenacted as follows:

10. A health care provider is not subject to arrest or prosecution or the denial of any right or privilege, including a civil penalty or disciplinary action by a court or occupational or professional regulating entity, solely for providing a written certification or for otherwise stating in the health care provider's professional opinion a patient is likely to receive therapeutic or palliative benefit from the medical use of usable marijuana to treat or alleviate the patient's debilitating medical condition or for refusing to provide written certification or a statement. This chapter does not release a health care provider from the duty to exercise a professional standard of care for evaluating or treating a patient's medical condition."

Renumber accordingly

Engrossed HB 1283 was placed on the Seventh order of business on the calendar.

(1) DESK (2) COMMITTEE Page 2 h_cfcomrep_67_00 1 2019 TESTIMONY

HB 1283 J House Bill 1283, Medical Marijuana Testimony from Representative Kathy Skroch House Human Services Committee, Jan. 14, 2019

Chairman Weisz and members of the House Human Services Committee. I am Representative Kathy Skroch. I appear before you today to introduce House Bill 1283. This bill makes changes to Chapter 12-24 of the North Dakota Century Code related to Medical Marijuana {MM). These changes were draftedby my request to the ND Legislative Council. HB 1283 will address issues that have arisen during the application process for certification for the use of Medical Marijuana. I have received multiple complaints from constituent who, have suffered for years from all types of chronic illnesses and chronic pain, are seeking relief from MM. Since the rollout of MM applications, patients have been complaining about being unable to find any medical providers who will sign the application. They are frustrated by delays to accessing MM, in particular, by the inability to complete the application process. (see emails) As the MM application process was rolled out in late October, early November of 2018, complaints from applicants revealed that some doctors and medical providers were concerned about losing their licenses to practice and would not allow for the signatures of MM applications on behalf of their patients. After discussing the issues patients were having with the Department Head of the Division of MM, I visited with Legislative Council. The changes offered in HB 1283 are the result.

(1) Changes proposed: Language struck in Section 1, subsection 3, line 10 simplifies the definition of a "Bona fide" provider. As was described by a staff person at the MM Division, [every person is free and has the right to seek fo r whomever they feel will act in their best interest to meet their health care needs. A "Bona fide " relationship can be established in the firstdo ctor/patient visit.] Also, b, c, d and e are struck because they all link the doctor to the recommending the benefits of or prescribing of MM, a level 1 controlled substance. Section 1 will then only request doctors to confirm a diagnosis. Changes to Section 2-lines 5, 6, 7, 10, 11; Section 3-lines 20 and 30 and Section 4- lines 26 and 27, remove language that link doctors to prescribing MM or require them to state that MM would benefit their patient. These changes will alleviate the fear of losing licenses. {Further, in the practice of medicine, there are no assurances of outcomes when treatments are prescribed.) Finally, Section 5 is a new section that authorizes the North Dakota Department of Health to create a certificate that will allow the application process to be completed, applying these changes in code, while also protecting against fraudulent certificates. Just aside note, May of201 8, my sister passed away from metastatic cancer. She had battled forov er 15 years. Her cancer had spread to her lungs, other organs, bones and spine. Her last months, she was able to manage her pain with prescribed medications including fentanyl. Her last weeks, those even failed. Reaching out to help her, I called the Minnesota Department ofHea lth, Medical Marijuana Division. Within 24 hours, my sisterreceived her first doses of MM and received relief from her incredible pain and passed peacefully. Thank you, Chairman Weisz and members of the committee. I will stand for questions. By Rep. Kathy Skroch H cJ� \ ,

From: Skroch, Kathy [email protected] Subject: Fwd: My provider won't get involved! Date: Jan 14, 2019 at 8:35:08 AM To: Skroch, Kathy [email protected]

Representative Kathy Skroch District 26

Begin forwarded message:

Date: October 26, 2018 at 9:51 :32 AM CDT

Subject: My provider won't get involved!

CAUTION: This email originated from an outside source. Do not click links or open attachments unless you know they are safe.

I asked my provider(Doctor) at Wahpeton Sanford Clinic to sign the Medical Marijuana form that will be available on Monday October 29, 2018. The following is the reply I received.

Received 10/26/2018 9:36 AM COT -- ·----· -·------·--- -·---· Enterprise wide at Sanford our provider's will not be prescribing or signing offon medical marijuana at this time.

Just wanted you to know that I wasn't making this up. Now with the bono fide rules of relationship between provider and patients, it is impossible for me to apply for a medical marijuana card. Hi?I� R.3

From: Skroch, Kathy [email protected] ,,j:t3 Subject: Fwd: Certificates Date: Jan 14, 2019 at 7:51:00 AM To: Skroch, Kathy [email protected]

Representative Kathy Skroch District 26

Representative Kat hy Skroct1 District 26

The bono fide rul ing needs to ne taken off the info on ND medica l marijuana. The health department nurse said the legislators need to vote on changing the bono hie : uiing.

I know the prescription statement is confusing . l asked my dr if he would sign the form with a dir�1nos1s for me to get a medica l mariJuana card. Sandford provider said no. But I have not seen the form :x1cause I won 1t signed up for a medical card because I don't have a prov1dc")r that wi!I sign the form. Plus I won't sign over my medical record�, to t1t: f\J D health department.

My RA (rheun1atoid arthritis) cir said she would still treat me but would not siqn_off on medical rnad; iaria. I knew over a year ago that Scmford provides would not sign off on medical marijuana for their patie11ts I tnought I would just go to a dr that would be ok with medical marijuana. I have not found one person who will sign their name for med ical marijuana .

ND medical marijuana law must oe read th1 ough again. And adjusted accordingly. ,· HcBId,). "_:;j -t;r 3 / - 1'-f-19 The big huge problem is tl10 providers are on a locked down position on signing medical marijuana dir1�Jnosis forms.

I came up with lh's icJc,a to so·ve the problem. I don1 t think the 1egis1ators V'v Ii be in favor of this idea,but what the heck!

The state will hire Drs around the state to sign the necessary medical marijuana forrns if patients car provide medical summaries of their health records not their f..111 rn 'dica ,ecnrds of a required diagnosis for medical marijuana caret Most patients can obtaff1 thl:,r :;urnmary of their health records. Then the state hired doctors wil1 signc1d the required documents tor medical marijuana, Then once a year the nust summit an update of medical summary not full medical recorrls clc :troriical iy, just a summary of diagnosis. icier'. t! 0 l]t1 vour iegislators. nuthinf� to lou',f' nut everything to gain.

On Novern ber 61 history II IJe change for ND. ND has the potential of having recreational n ·uan::i rneasurt� 3 being passed because medica l marijuana is being seen as a failure for patients.

Thanks for addressing i-r,,s ;,�qJE'.

Sincerely1 (Anonymous) • North Dakota House Human Services Committee January 14th 2019 Chairman Weisz and members of the Committee, my name is Steven James Peterson of The Committee for Compassionate Care of North Dakota. The Committee forCo mpassionate Care is a patient advocacy group seeking to enable fair and reasonable access to medical marijuana in the state of North Dakota. I am in support of House Bill 1283 I am available for any questions about this bill. Steven James Peterson 701-936-4362 [email protected] /-f4-L1 • Representatives and Senators, I am a disabled veteran that served in 7.5 years Active duty in the Navy, and I wouldn't change a thing. During my service I deployed three times on-board the USS Two Jima, at an intelligence agency, and in Afghanistan. My service has leftme disabled, I have suffered fromchr onic pain in my back and knees, PTSD, and other conditions. I have tried numerous pharmaceuticals including Benzodiazepines, S. S. R. I.s, Opiates, sleeping drugs, and other pharmaceuticals all prescribed to me by the VA or when I was on active duty. Some of the pharmaceuticals I was prescribed have dangerous side effects, frompsychoti c episodes to literally suicidal thoughts or suicide. After my service while living in Colorado I discovered, with the help of a few great people, the great benefits to medical cannabis. While in Colorado, I was able to stop taking the dangerous drugs the VA was prescribing with the help of cannabis and deal with my issues rather than just buryingthem under pills.

Cannabis allowed me to have healthy emotion again, move on, and love rather than live in a shell. With the help of cannabis since my service, I have earneda Mechanical Engineering degree, started a wonderfulcareer, learneda lot about myself, and fe ll in love with a beautiful woman. All of this would not be possible without medical cannabis.

As a Veteran who receives care at the VA and chairs ND Veterans forsafe ac cess to cannabis, our providers (the VA) are not supposed to speak to Veterans about possible uses of medical cannabis. We have to many Veterans that this safe alternativecan provide, much needed relief.We ask fora safealterna tive to prescriptions. Many of us got involved in Measure 3 because it would get us access to quality safe medicine quickly. - We need your help! I am asking for expanding medical access and making it easier to get the medicine that will greatly help a lot of us. For fullbenefit we need access to safe, clean, and specificstrains of cannabis, with a THC to CBD ratio and specificTerpen es; the knowledge is there now. We are asking forsafe and cost-effective access to this medicine. We ask forthe ability to grow forours elves or to have a caregiver professionally and charitably grow forus (not a dispensary). We also ask to eliminate the requirement of a pattern of care (the VA doctors are not allowed to even discuss cannabis). If the legislature can expand access and have it be cost effective, I know it will help a lot of vets.

Sincerely,

Christopher Howell US Navy 2005-2013 OEF 201 1-2012 ND Vets For safe access- Chair [email protected] Fargo,ND • • Submitted by: Kristin Klein 1119 University Drive Lot 509 Bismarck, ND 58504 (701) 269-7677 [email protected]

I have been chronically ill and lower functioning for 9 yrs as of this October 2018. My official diagnosis is Post Mono Chronic Epstein Barr, Myalgic Encephalomyelitis /Chronic Fatigue , Fibromyalgia. Underneath these diagnosis' are an uncountable list of underlying medical conditions and symptoms that I suffer from ranging from moderate to severe. I need to have easier access to the full spectrum of medical cannabis products in order to combat my illness and have a better quality of life , both for myself and my children. I need to have better access to becoming a certified medical cannabis patient. I have been fed pharmaceuticals such as opiates for nearly a decade now. I am tired of it. I can assure you that this is no way - to live and thrive. There is no cure for my disease, the only option I have is to manage my symptoms. I need safer options. Med ical cannabis will be incredibly life changing for so many suffering. Dealing with these debilitating illnesses as a 36 year old single working mother is not for the fa int of heart. I implore you carefully consider the testimonies you've read today. I have yet to be certified, but I have been in good standing with each one of my specialists since the onset of my illness. There is something gravely wrong with this picture. It is my basic human right to t,e able to have access through certification as soon as possible. Access to a safe, non addictive, non life threatening treatment option.

Thank you for your time and consideration

Sincerely, - Kristin Klein n p _j:l 7 , -- 1 \f - ( CJ • My name is Dustin Forrest, I am 36 years old, and I just moved back to my home state here of wonderful North Dakota early spring of 2018. I was living in Denver, CO for some time and it was there that the medical marijuana movement whole heartedly helped me. I suffer from Bi-Polar, Anxiety, IBS, Migraines, Manic Depression, Panic Attacks, Cataplexy (sudden loss of muscle control due to extreme emotion and stress), Alcoholism, and ADHD. I have been on numerous amounts of medication from age 9 to age 33. All expensive and actually caused more harm than the medications did help. While living in Colorado, I was introduced to Medical marijuana ( edibles, flower, and CBD/THC) and I found what worked for me. With the help of a medical professional, we weaned me off the pharmaceutical medications and onto a • THC regime. MY LIFE CHANGED SO MUCH! I could see the results of this change and I couldn't be happier. My family saw a change in me, my friends saw a change in me, I SAW A CHANGE IN ME. I never thought I would live a productive life such as the one I am living now. I just got married 2 weeks ago on December 28th, 201 8 and we are planning to adopt here soon. I cannot say enough how happy I am in life thanks to what the medical marijuana industry in Colorado showed me. I truly hope North Dakota can pass the bills that will allow the same help to be given to our wonderful citizens of North Dakota! Please please please, let's progress, not regress. - LI,, ; :,1. u� NORTH r •V / House Bill 1283 Health Human Services Committee Dakota p January 14, 201 9 • Be Legendary.'" Good morning Chairman Weisz and members of the Human Services Committee. My name is Jason Wahl, the Director of the Division of Medical Marijuana within the Department of Health. I am here to provide information related to House Bill 1283 and identify a concern the Department of Health has with a pro posed change to language within the Medical Marijuana chapter of state law.

The bill would make changes to the bona fide provider-patient relationship and the written certification form. While we weren't requested to provide a fiscal note for the proposed changes, we believe the changes would 1 not require a significant expenditure to have the information technology • system updated.

Section 5 of the bill would .establish a new section of state law. The Department of Health opposes the addition of this section to state law for the following reasons: • The requirement for the Department to establish a written certification already exists under NDCC Section 19-24.1-01, Subsection 40 and this bill does not change this language. • The requirement to make the written certification form available to physicians and members of the public creates concerns and raises risks of fraudulent forms being submitted to the Department. The form is • currently available for completion as part of our online application 1 *� HB 1�3 p µt.·;\ , - ( � - 1 9 process. The form does not exist in a paper format. Having the form available online helps us track information, conduct verification work in • a more efficient manner, assists in maintaining the integrity of the program, and provides assurance to the medical community that a health care provider's name and license number is not being inappropriately used. Providing the form to the public would increase costs to the program and increase risks for fraudulent forms. • The language that states "a written certification may not be made except in the course of a bona fide provider-patient relationship" currently exists under NDCC Section 19-24.1-01, Subsection 40. This bill would remove the language from Subsection 40. We believe that language should remain as it currently is written.

I would like to point out for the Committee's attention that if this bill • were to be approved, a change to the use of the term 'physicians' under Section 5 (line 3, page 4) to 'health care provider' should be made to reflect other terminology use in state law.

This concludes my testimony. I am happy to answer any questions you may have.

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Division of Medical Marijuana

Med ical Marijuana Program Annual Report Fiscal Year 2018

: NORTH DAl

Honorable Doug Burgum, Governor

Members of the North Dakota Legislative Assembly

I am pleased to submit the first Annual Report for the Medical Marijuana Program. This reportis required pursuant to North Dakota Century Code Section 19-24.1 -39. In addition, this report includes information related to a study of debilitating medical conditions as required by Chapter 171 of the 2017 Session Laws.

The Medical Marijuana Program was being implemented at the time of this report. Due to this, most of the data elements required to be reported are not included as no manufacturing facilities or dispensaries were registered by the end of fiscal year 2018. Subsequent Annual Reports will include all required reporting information.

If you have questions related to the report or other aspects of the program, please contact the Division of Medical Marijuana at 328-1 311.

Sincerely, yft? ,/1/J., WiJI

Jason M. Wahl Director, Division of Medical Marijuana Table of Contents

Background Information and Status of the Program ...... 2

State Law Reporting Requirements ...... 3

Session Law Study Requirement ...... 4

Glossary

(Terms as defined in NDCC Section 19-24.1-01)

Cardholder: means a qualifying patient, designated caregiver, or compassion center agent who has been issued and possesses a valid registry identification card.

Compassion Center: means a manufacturing facility or dispensary.

Designated Caregiver: means an individual who agrees to manage the well-being of a registered qualifying patient with respect to the qualifying patient's medical use of marijuana.

Dispensary: means an entity registered by the department as a compassion center authorized to dispense usable marijuana to a registered qualifying patient and a registered designated caregiver.

Health Care Provider: means a physician or an advanced practice registered nurse.

Manufacturing Facility: means an entity registered by the department as a compassion center authorized to produce and process and to sell usable marijuana to a dispensary.

Qualifying Patient: means an individual who has been diagnosed by a health care provider as having a debilitating medical condition.

Registry Identification Card: means a document issued by the department which identifies an individual as a registered qualifying patient, registered designated caregiver, or registered compassion center agent.

Usable marijuana: means a medical marijuana product or the dried leaves or flowers of the plant of the genus cannabis in a combustible delivery form. However, the term does not include the dried leaves or flowers unless authorized through a written certification and does not include a cannabinoid edible product. In the case of a registered qualifying patient who is a minor, "usable marijuana" is limited to pediatric medical marijuana.

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Background Information and Status of the Program In November 2016, an initiated measure, known as the "North Dakota Compassionate Care Act," was approved by voters. On January 26, 2017, the provisions of the North Dakota Compassionate Care Act were suspended through legislation passed by the Legislative Assembly. On April 18, 2017, a new state law became effective requiring the Department of Health (DoH) to establish and implement a Medical Marijuana Program allowing for the production and processing, sale and dispensing of usable marijuana, and medical use of marijuana. Since the effective date of the new state law, the DoH has been committed to implementing a well-regulated program that would protect the health and safety of qualifying patients and the public.

The chart below provides information related to the major steps in implementing the program:

Lab selected to conducttesti ng -•------May 2018------�-----�------· Manufacturing facilities selected (2) May 2018 ---�------·--·----- .,.______Manufacturing facility application period opens March 2018 Legislative review of administrative rules March 2018 Information Management System selected (BioTrackTHC) February 2018 Administrative rules drafted (NDAC Chapter 33-44-01} November 2017 Law effective(N DCC Chapter 19-24.1) April 2017

State law specifies that the DoH is to register no more than two manufacturing facilities and eight dispensaries unless the DoH determines additional entities are necessary to increase access to usable marijuana by registered qualifying patients and registered designated caregivers . An open application period for manufacturing facilities started in March 2018. There were 19 applications submitted. Following an evaluation of nine complete applications, two entities were selected to move forward with the registration process. One entity, Pure Dakota LLC, will locate their facility in Bismarck while the other entity, Grassroots Cannabis (legal name GR Vending ND, LLC), will be located in Fargo.

The DoH has established eight regions in the state where dispensaries may be located. Regions are comprised of a 50-mile radius from certain cities. On July 10, 2018, an application period was opened to accept applications from entities to become a registered dispensary in the

2 Bismarck/Mandan region and in the Fargo region. The selection of an applicant to move forward in the registration process in each region is anticipated to be complete near the end of September.

By the end of September, an application period will open for the Grand Forks region and Williston region. The selection of an applicant to move forward in each of these two regions is anticipated to be complete by the end of December. An open application period for the four remaining dispensary regions is expected to occur in January 2019.

By the end of October 2018, it is anticipated applications will be available for qualifying patients and designated caregivers. An online application process will be used in the registration process.

Following a formal procurement process, a contract was entered into with BioTrackTHC for an information management system that includes a seed-to-sale inventory tracking system as well as a registration system. In addition, another formal procurement process was used to select a vendor to conduct compliance testing as required by administrative rules. Keystone State Testing {dba Dakota State Testing) is expected to have their laboratory located in Fargo.

State Law Reporting Requirements

NDCC Section 19-24.1-39 requires the DoH to submit an annual report that contains the fo llowing information: 1. The number of registry identification card applications and renewals; 2. The number of registered qualifying patients and registered designated caregivers; 3. The nature of the debilitating medical conditions of the registered qualifying patients; 4. The number of registry identification cards revoked; 5. The number of health care providers providing written certifications for qualifying patients; 6. The number of compassionate care centers ; and 7. Any expenses incurred and revenues generated by the department from the medical marijuana program.

At the time of this report, no data exists related to items 1 through 5 as listed above. There are two entities who have been selected to move forward with the registration process to become registered manufacturing facilities. Expense and revenue information follow:

Fiscal Year 2018 Expenditures Salaries and Waqes $269,289 Operatinq $94,137 Total Expenditures $363,426

General Funds $345,651 Special Funds $17,775

Fiscal Year 2018 Revenue Medical Mari"uana Fees* $95,000 * All revenue is from the nonrefundable application fee ($5,000) paid by entities submitting manufacturing facility applications.

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Session Law Study Requirement Chapter 171 of the 2017 Session Laws required the DoH to conduct a study of the feasibility arid desirability of adding identified medical conditions or providing for an administrative process to add identified medical conditions to the definitions of "debilitating medical condition" under the Medical Marijuana Program. Since the program was still being implemented in fiscal year 2018, we conducted a review and analysis of states' medical marijuana qualifying medical conditions and compared the results with the debilitating medical conditions included in North Dakota Century Code (NDCC) Chapter 19-24.1. The debilitating medical conditions under NDCC Chapter 19-24.1 are:

a. Cancer; b. Positive status for human immunodeficiency virus; c. Acquired immune deficiency syndrome; d. Decompensated cirrhosis caused by hepatitis C; e. Amyotrophic lateral sclerosis; f. Posttraumatic stress disorder; g. Agitation of Alzheimer's disease or related dementia; h. Crohn's disease; i. Fibromyalgia; j. Spinal stenosis or chronic back pain, including neuropathy or damage to the nervous tissue of the spinal cord with objective neurological indication of intractable spasticity; k. Glaucoma; I. Epilepsy; m. A terminal illness; and n. A chronic or debilitating disease or medical condition or treatment for such disease or medical condition that produces one or more of the following: (1) Cachexia or wasting syndrome; (2) Severe debilitating pain that has not responded to previously prescribed medication or surgical measures for more than three months or for which other treatment options produced serious side effects; (3) Intractable nausea; (4) Seizures; or (5) Severe and persistent muscle spasms, including those characteristic of multiple sclerosis.

Several medical conditions exist in other states' programs that are identical to the debilitating medical conditions in the North Dakota program . Also, similarities exist with the terminology used in other states' medical conditions and the conditions within the North Dakota program. However, differences in terminology included in various states made it difficult to categorize certain medical conditions to compare among states and to North Dakota. Examples include: • While a medical condition is included in another state's program, there may be an additional requirement or symptom needed to qualify. For example, two states include cancer as a medical condition and require an individual to have one or more associated symptoms such as severe or chronic pain or severe nausea. For analysis purposes, the two states were included in the 'Cancer' category. • Within state law, the last listed debilitating medical condition in the North Dakota program is a chronic or debilitating disease or medical condition or treatment for such disease or medical condition that produces one or more of five listed items. For analysis purposes, we categorized the five items (cachexia or wasting syndrome, seizures, etc.) into specific categories.

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We attempted to consistently use information identified in other states' laws to categorize medical conditions for comparison purposes. Information regarding other states' medical conditions were reviewed as of July 2018. We identify 29 other states with laws related to a medical marijuana program. This does not include Oklahoma who had passed a ballot measure in late June 201 8 to establish medical marijuana laws. We used the information reviewed to create the following two charts.

Number of States with ND Qualifying Medical Conditions*

SEIZURES/EPILEPSY

CANCER

ACQUIRED IMMUNE DEFICIENCY SYNDROME I AIDS)

POSITIVE STATUS FOR HUMAN IMMUNODfflCIE,\JCYVIRUS !HIV)

POST-TRAUMATIC STRESS DISORDER IPTSD)

GLAUCOMA/ELEVATED INTRAOCULARPRESSURE (/) C 0 SEVERE/CHRONIC/INTRACTABLE/DEBILITATING PAIN E "O C CACHEXIA/WASTING SYNDROME 0 0 SEVERE/PERSISTENT MUSCLE SPASMS/RELATED DISORDERS

INFLAMMATORY BOWEL DISEASE AND RELATEDCONDIT IONS :E 0) NAUSEA/VOMITING � iii AMYOTROPHIC LATERAL SCLEROSIS IALS) :, ALZHEIMER'S

TERMINAL ILLNESS

SPINALCORD RELATED CONDITIONS

elSROMYALG!A

0 LO 15 20 25 30 Number ofStates '------* Data includes a review of 29 other states' medical conditions. One of North Dakota's debilitating medical conditions, decompensated cirrhosis caused by Hepatitis C, was not specifically included in other states' programs. However, Delaware includes decompensated cirrhosis and 11 other states include Hepatitis C.

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Top10 Conditions Not Specifically Listed in ND Law*

MULTIPLE SCLEROSIS

PARKINSON'S DISEASE

HEPATITIS C (/) C: 0 :;::; NEUROPATHY RELATED CONDITIONS C: 0 0 ca TOURETTE'S SYNDROME u '5 Q) � TRAUMATIC BRAIN INJURY/POST-CONCUSSION SYNOROfo/l E Ol .::: � SICKLE CELL ANEMIA cu:::i MUSCULAR DYSTROPHY

HUNTINGTON'S DISEASE

AUTISM

0 10 15 20 Number of Other States

* It should be noted while North Dakota's program does not identify certain medical conditions listed in the above chart as a specific condition, individuals with such conditions may still be eligible to be a registered qualifying patient. Within state law, a listed debilitating medical condition includes a chronic or debilitating disease or medical condition or treatment for such disease or medical condition that produces one or more of five listed items (such as cachexia or wasting syndrome, seizures, and severe and persistent muscle spasms). Thus, an individual with a medical condition such as multiple sclerosis, Parkinson's disease, or Huntington's disease having severe and persistent mascle spasms could have a debilitating medical condition under the North Dakota program. However, certain medical conditions identified in other states and not in North Dakota's program such as autism would not appear to allow an individual with such conditions to be eligible.

Other states have various ways of adding qualifying medical conditions to the list of eligible conditions. Certain states allow a department commissioner or a specific department to add conditions, certain states provide for a petition process, and other states use an advisory committee to review information regarding medical conditions and make recommendations to an appropriate body.

Conclusion Our review identified most of the debilitating medical conditions for the North Dakota program are included in several of the other states' programs. We did identify medical conditions included in other states' programs that are not specifically listed in North Dakota's law. However, symptoms associated with specific medical conditions identified in other states may still allow an individual

6 To Whom it may concern; ·,:J �3J y1 7 My name is Kimberly R. Dworshak and I am writing in regards to HB l�: My primary care Is part of Northland Clinic, a clinic that has chosen not to allow their care provider's to participate in certifying patients for Medical Cannabis. I have 5 qualifying illnesses, one that is extremely rare, lschemic Optic Neuropathy there is no known treatment and steroids are the only option at this time. I also have Rheumatoid Arthritis and have gone through both types of treatments with no results. My specialist is located in Rochester Minn. Mayo Clinic, all of the research I have done indicates that Medical Cannabis might help I would like to try I have exhausted all other options, medication, surgeries, therapies .ai acupuncture, physical, aqua. I would like to be able to find a physician in North Dakota that would be willing to work with me along with my other care providers. Thank you for your consideration.

Respectfully;

Kimberly R. Dworshak (701)340-6503 H6 1'2-t3 �J �/Jq 4},(PJ. I House Bill 1283, Medical Marijuana Testimony from Representative Kathy Skroch Senate Human Services Committee, Jan. 14, 2019 Madam Chair Lee and members of the Senate Human Services Committee, I am Representative Kathy Skroch, representing portions of Dickey, Richland, Ransom and all of Sargent Counties of southeastern North Dakota . I appear before you today to introduce House Bill 1283. This bill makes changes to the North Dakota Century Code related to Medical Marijuana {MM). The original bill was drafted by the ND Legislative Council at my request to address multiple complaints received from constituents. HB 1283 addresses issues that have arisen during the application process for obtaining a registered Medical Marijuana card. Application forms were made available in October of 2018. Since then patients have been complaining about being unable to find medical providers (doctors) who will sign the application. Constituents, who in many cases have suffered for years from a variety of qualifying chronic illnesses and chronic pain, are seeking relief through the use of medical marijuana. They are frustrated by delays in gaining access, in particular, by the inability to complete the application process. (see email) As the medical marijuana application process rolled out complaints received from patients. It appeared that doctors were concerned about the loss of medical licenses and were refusing to sign applications on behalf of their patients. After discussing these issues with the Department Head of the Division of MM, I visited with Legislative Council. The changes offered in HB 1283 will hopefully fix these problems. To the bill-Changes proposed: On page 5, subsection 32, lines 28 & 29: Physician Assistants are added to those healthcare professionals who are authorized to sign a certificate application.

(1) H� 1;;>, 13 3/'f"/J'f # I /l� -J

On page 6, subsection 41, lines 31 into page 7, lines 1 & 2: This language needs to be struck because of the link to diagnosing or recommending medical marijuana. Section 2, lines 24-27, language is struck for the same reason. On page 8, Section 3, subsection 3, language relating to the written certification is struck because once again it connects the provider to the recommendation of the benefits from the medical use of marijuana. Lastly, Section 4 is the emergency measure clause. Amendments for the committee to consider: On page 2, subsection 3. "Bona fide provider relationship" definitions: Language in subsection c. (p.2, lines 11 & 12) are problematic and need to be removed due to the difficulty of that standard being maintained. People move, providers move. A cancer diagnosis may cause care to be transferred to a different provider, (Mayo Clinic or Roger Maris etc.) to see specialists, or after a terminal diagnosis, to a hospice care provider. I would encourage the committee to amend the bill by removing subsection (c). In Subsection (d) I ask the committee to amend by striking the language after the word patient. Doctors continue to be unwilling to sign applications because they fear the loss of their licenses. This language requires them to directly monitor a patient's use of medical marijuana as a treatment and its benefits. This puts them in the position of supervising and documenting about a level 1 controlled substance and therefore is problematic. Providers were recommending that staff not sign applications because of their concerned about the consequences to staff signing off on medical marijuana certification applications. Subsection (e), lines 16-17 is important language in statute to prevent "doctor shopping". May of 2018, my sister passed away from metastatic cancer. She had battled for over 15 years. Her cancer had spread to her lungs, other organs, bones and spine. Her last months, she was able to manage her pain with prescribed medications includingfen tanyl. Her last weeks, those even failed. Reaching out to help her, I called the Minnesota Department of Health, Medical Marijuana Division. Within 24 hours, my sister received her first doses of MM and received relief from her incredible pain and passed peacefully. Thank you, Chair Lee and members of the committee. I will stand for questions. By Rep. Kathy Skroch (2) From: Skroch, Kathy [email protected] 1jf3 IZ'f3 Subject: Fwd: Testimony in support of HB1 283 3/s-J,c, Date: Feb 27, 2019 at 11 :03:01 AM To: Skroch, Kathy [email protected] 4}-I f5·3

TESTIMONY IN SUPPORT OF HB1 283 SANDY BANISH Representative Kathy Skroch District 26

On Sunday, February 24, 2019, 2:36 AM, Sandy Banish wrote:

The bona-fide clause in the current North Dakota Medical Marijuana law is preventing patients including myself from obtaining a North Dakota Medical marijuana card. At this time, I have no Bona-fide relationship with a medical individual that is willing to sign the medical marijuana certificate. If the bona-fide clause would be remove from the ND Medical Marijuana Law, I would be able to go to another Dr for the sole purpose of signing the ND Medical Marijuana certificate. As long as I have my medical records in hand showing the non bono-fide individual that I have the required illness/disease for requesting the medical individual signature for the medical marijuana certificate. No medical records would be required by the state due to the required medical records were already submitted and approved by the medical individual that signed the ND Medical Marijuana certificate. These above changes would give me the right to be able to get a ND Medical Marijuana Card with keeping my privacy from others and keeping my dignity as I continue living with my painful disease. Sincerely, Sandra Banish +M 1213 3/s-JJ 1 From: Skroch, Kathy [email protected] .J}) Pj . L{ Subject: Fwd: My provider won't get involved! Date: Jan 14, 2019 at 8:35:08 AM To: Skroch, Kathy [email protected]

Representative Kathy Skroch District 26

Begin forwarded message:

Date: October 261 2018 at 9:51 :32 AM CDT

Subject: My provider won't get involved!

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I asked my provider(Doctor) at Wahpeton Sanford Clinic to sign the Medical Marijuana form that will be available on Monday October 29, 2018. The following is the reply I received. -•ltVV .._,, I ..... ,, ,.._,,� ,._ .__1 11..... I JJ OYILJ Received 10/26/2018 9:36 AM CDT

Enterprise wide at Sanford our provider's will not be prescribing or signing offon medical marijuana at this time.

Just wanted you to know that I wasn't making this up. Now with the bona fide rules of relationship between provider and patients, it is impossible for me to apply for a medical marijuana card.

H!3 12'63 3/�/lq JlJ p5. ((I t+t>12 'f3 3/�Jt q #2- f5 · I C"t, NDMA C'�E,1.1ss1 NORTH DAKOTA MEDICAL ASSOCIATION

Senate Human Services Comm ittee HB 1283 March 5, 2019

Good morning Chair Lee and Committee Members. I am Courtney Koebele and I serve as executive director of the North Dakota Medical Association. The North Dakota Medical Association is the professional membership organization for North Dakota physicians, residents, and medical students. NOMA also represents the ND Academy of Physician Assistants (ND APA) Both NOMA and ND APA support HB 1283, as amended , which removes the language that "in the health care provider's professional opinion the patient is likely to receive therapeutic or palliative benefit from the medical use of marijuana to treat or alleviate the patient's condition." We believe this may allow more providers to feel comfortable recommending medical marijuana. Both groups support including Physician Assistants as providers who may certify. Physician assistants (PAs) undergo rigorous medical training and must graduate from an accredited PA program in order to take the national certifying exam to be licensed. Like physicians and nurse practitioners, PAs must complete extensive continuing medical education throughout their careers. PAs are licensed healthcare providers that practice medicine to include the diagnosis and treatment of medical conditions, ordering of diagnostic studies, and have prescriptive privileges for medications. Physician assistants also are primary care providers like physicians and advanced practice registered nurses. Adding this type of primary care provider to the list of providers would increase access for those patients.

Thank you for your time today. I would be happy to answer any questions. rf-8 ru"3 3/5'// q NORTH House Bill 1283 -#.-3 fJ' · J Health Human Services Committee Dakota March 5, 2019 Be Legendary."

Good morning Madam Chair Lee and members of the Human Services Committee. My name is Jason Wahl, the Director of the Division of Med ical Marijuana within the Department of Health. I am here to support and provide information on House Bill 1283 related to changing definitions of a written certification and health care provider within the Med ical Marijuana chapter of state law.

The bill would add physician assistants to the definition of health care provider. We do support the addition of physician assistants to the list of individuals authorized to complete a written certification.

The bill would modify the definition of written certification by removing language currently requiring a health care provider to state in their professional opinion the patient is likely to receive therapeutic or palliative benefit from the medical use of marijuana. We do support this change to the law as we have heard from the med ical community this requirement may be limiting the number of health care providers willing to complete a written certification.

With the current language in House Bill 1283, there are other sections under NDCC Chapter 19-24.1 that require amendments to provide consistency. For example, NDCC Section 19-24.1-10, Subsection 7 references a health care provider no longer believing a patient will receive a benefit and is not amended under House Bill 1283. This would cause a conflict in statute. We would be H-8 1zi3 3/'S{ /q #3 P5-� willing to work with our legal counsel or Legislative Council to introduce an amendment to the bill to address all necessary revisions for the Committee's consideration.

Based on the changes to the written certification definition and information we are aware of related to veterans, we would ask the Committee to consider an additional change for the benefit of veterans. In some cases, a veterans only health care provider is the federal Veterans Affairs health care facility. Veterans receiving their care at such a facility will not have the ability to have this federal health care provider complete a written certification as marijuana is still illegal under federal law. This would require veterans to attempt to establish care outside the federal health care system to have a written certification form completed. Some veterans may not have the financial resources or ability to do this.

Making a change to the medical marijuanala ws to allow the Department of Health to accept medical records of veterans in lieu of a written certification may be beneficial for veterans. According to the VA National Suicide Data Report 2005-2076 (dated September 201 8), there were more than 6,000 veteran suicides each year from 2008 to 2016. In 2016, the suicide rate was 1.5 times greater for veterans than for non-veteran adults (after adjusting for age and gender). The state of Illinois has a similar provision to allow for VA medical records to be submitted instead of a physician certification.

This concludes my testimony. I am happy to answer any questions you may have.

2 �B 12q3 3}s-/J '1 � If fs,/

Tina Lingen

I suffer from a chronic illness where the main symptom is debilitating chronic pain. As a result, I require management of my pain to maintain a fully functioning and productive life . Managing a pain condition is difficult as pain is subjective. My illness qualifies as a "debilitating medical condition" for which medical use of marijuana may be recommended by a health care professional.

To provide context, I had been living in Minnesota for the past few years until this past July of 2018 to complete my graduate studies. My pain management physician in Minnesota felt I was a candidate for medical marijuana and that it would benefit me more than the use of daily opioid therapy. As it is more safe and efficacious medication than opioid therapy.

Although my physician recommended the use of medical marijuana, he could not write the prescription due to what he deemed "department politics". However, he referred me to a family practice physician who was willing to see patients for the sole purpose of providing certification for the use of medical marijuana. I did not have to follow up with the prescriber. The provider submitted my medical history to the MN department of health and within a few days, I was able to visit a dispensary and pharmacist to discuss what would be most effective to treat my condition. I benefitted greatly from the use of medical marijuana while living in Minnesota.

Upon my return to North Dakota in July of 2018, I established care with a family practice physician. He stated that my only option for treatment of my pain was with opioid therapy. Although, he states his practice receives monthly education about medical marijuana he stated he still does not know enough about the use of marijuana for medical purposes. My visit several weeks ago added to my frustration as the physician stated to me "good luck finding a physician to prescribe medical marijuana. Just because the legislature passes, a bill does not mean a doctor will "prescribe".

This is alarming as a patient as this physician is willing to write a prescription for opioids, an addictive and dangerous drug but is unwilling to prescribe or recommend a safer alternative for pain management in medical marijuana. I support HB 1283 as under Section 1 subsections c, d and e patients like myself will be able to obtain medical marijuana card. These three subsections applied to me in Minnesota I did not need to be under the provider's continued care, follow up with the provider, and the visit was for the sole purpose of obtaining certification for the medical use of marijuana. I left Minnesota with my pain adequately and safely managed to being told the only option I have in North Dakota is opioid thera py. I feel like the health care system in North Dakota has not only fa iled me but thousands of others who could benefit from the use of medical marijuana. H-6 (Z/�/,q -J:1: � p5 . I

North Dakota Senate Human Services Committee March 5th 2019 Madam Chairwoman Lee and members of the Committee, my name is Steven James Peterson of The Committee for Compassionate Care of North Dakota. The Committee fo r Compassionate Care is a patient advocacy group seeking to enable fair and reasonable access to medical marijuana in the state of North Dakota. I am in support of House Bill 1283 ► We completely support the addition of Physician Assistants ► Our concerns are that this amended bill language doesn't go far enough to get doctors to sign for patients who completely qualify under current law and the proposed changes in the other bills being discussed by this committee. I am available for any questions about this bill. Steven James Peterson 701-936-4362 [email protected] He 12r3 3/�//q Dear Senators, -#t, fJ'· I

My name is And rew Jager from district 29. Please DO PASS these bills that expand the conditions and qualifying providers. I suffer from major anxiety, depression and have a substance use disorder. I have been addicted to methamphetamine for most of my adult life. My addiction has been a never ending battle since day one and I none of the other medication is helping me. Marijuana helps with my anxiety better than benzodiazepines and is far less dangerous. Thank you from district 29. Andrew Jager. H--.8 I ').�3 3/�/Jq �h fJ . ;J._ My name is Dustin Forrest, I am 36 years old, and I just moved back to my home state here of wonderful North Dakota early spring of 2018. I was living in Denver, CO for some time and it was there that the medical marijuana movement whole heartedly helped me. I suffer from Bi-Polar, Anxiety, IBS, Migraines, Manic Depression, Panic Attacks, Cataplexy ( sudden loss of muscle control due to extreme emotion and stress), Alcoholism, and ADHD. I have been on numerous amounts of medication from age 9 to age 33. All expensive and actually caused more harm than the medications did help. While living in Colorado, I was introduced to Medical marijuana ( edibles, flower, and CBD/THC) and I found what worked for me. With the help of a medical professional, we weaned me offth e pharmaceutical medications and onto a THC regime. MY LIFE CHANGED SO MUCH! I could see the results of this change and I couldn't be happier. My family saw a change in me, my friends saw a change in me, I SAW A CHANGE IN ME. I never thought I would live a productive life such as the one I am living now. I just got married 2 weeks ago on December 28th, 2018 and we are planning to adopt here soon. I cannot say enough how happy I am in life thanks to what the medical marijuana industry in Colorado showed me. I truly hope North Dakota can pass the bills that will allow the same help to be given to our wonderful citizens of North Dakota! Please please please, let's progress, not regress. U,J3 �f 3 o/s--lJCf fJ·3 Attention Legislators, #t, I feel there should be a lot more illnesses on the list. It should include any illness a doctor thinks a patient would benefit from since it has little to side effects and NO chance of overdose. If you are serious about impacting the opioid crisis medical cannabis should be considered for any condition in which pain control is needed, among other benefits such as relaxing body and mind. Even relief from withdrawal symptoms from drug like meth and heroin. There should be a way to add illnesses and conditions without going through legislature every time. It should be up to the doctor and patient what treatment plan is best for them. I also think edibles should be allowed. Not all patients will be able to smoke it or might not want to. Again, that should left up to patient and doctor.

Thanks, Kimberly Dominiak HB 11."13 3/ S-/11 I., To all who will listen 41= fJ . '-I

I became politically charged in 2016. I am willing to come testify for any reforms in Cannabis, Hemp, and CBD. I was a proud sponsor of measure 3 and have always supported criminal justice reform and freedom. Over 90% of the people I met on the measure 3 trail were in it for medical reasons. That is the honest to God truth. This legislative session I am asking for more freedom in North Dakota Medical Cannabis program. Expansion of the number of plants to be grown, Expansion of the list of illnesses covered, return self grow, restore edibles, give specific coverage to North Dakota's health professionals who certify illnesses, and protect 2nd Amendment rights for cannabis patients. I look forward to this years legislative session and supporting, those who will deliver North Dakotans the medicine and freedom they deserve.

Dustin Peyer North Dakota Cannabis Caucus Compassionate Care Committee HB l�t3 3/s-/Jtj �ill fj·S I supporth . b.1155 ...

Patrick M. Dominiak Jr. District 21. It£ 1�«3 3/s-Jtq #u .p5 . b Ladies and Gentlemen of the Committee, I am writing this testimony today to urge you to give a recommendation of "Do Pass" to HB 1519, while I do something that in the past was a struggle for myself, the simple act of eating a meal.

When we talk about medial marijuana, far too frequently we focus on mental health issues which may seem immediately obvious; depression, anxiety, or PTSD but far too frequently people do not understand that while these illnesses may be problematic, they are often hidden by symptoms that can become fatal. For myself and many other men and women in all age demogra phics and socio-economic statuses, the symptoms have manifested as bulimia and anorexia nervosa, diseases which cause stressed individuals to refuse to fully digest food, and it is why I am thankful that today I am able to eat a meal as mentioned before and am on the path to become one of the lucky ones.

My path towards recovery has included both outpatient and partial hospitalization programs. During my three partialhosp italizations, I participated in group therapy. Group therapy created many friendships and together we would witness each other's ups and downs, progress and regression, which in the case of our diseases can result in death. As a result, I have learned of women passing away due to the destruction this disease does to the body. While working towards recovery, I spent countless hours researching how others have successfully recovered and marijuana was frequently mentioned as a potential treatment option for patients residing in legal states such as Colorado.

At first, I was skeptical but reading about how marijuana has helped those struggling to eat even the smallest bite of food, become weight restored, is fascinating. Individuals who previously barely had enough energy to take a shower now have heathy, productive lives. I ask you to support legal medical marijuana because it gives those who are battling anorexia and bulimia another treatment option and there is no reason to deny someone facing life or death the opportunity to enjoy life. As more knowledge becomes available every single day, it becomes clearer to all that this medicine works, it saves lives, and I can't help but wonder how many North Dakotans would still be here today if they had been given access to medical marijuana.

-Lacey

West Fargo, ND He JJ� 3/C/ I'} =#-IP fJ·7 Submitted by: Kristin Klein 1119 University Drive Lot 509 Bismarck, ND 58504 (701) 269-7677 myonlystorielove@g mai I. com

I have been chronically ill and lower functioning for 9 yrs as of this October 201 8. My official diagnosis is Post Mono Chronic Epstein Barr, Myalgic Encephalomyelitis /Chronic Fatigue , Fibromyalgia. Underneath these diagnosis' are an uncountable list of underlying medical conditions and symptoms that I suffer from ranging from moderate to severe. I need to have easier access to the full spectrum of medical cannabis products in order to combat my illness and have a better quality of life, both for myself and my children. I need to have better access to becoming a certified medical cannabis patient. I have been fed pharmaceuticals such as opiates for nearly a decade now. I am tired of it. I can assure you that this is no way to live and thrive. There is no cure for my disease, the only option I have is to manage my symptoms. I need safer options. Medical cannabis will be incredibly life changing for so many suffering. Dealing with these debilitating illnesses as a 36 year old single working mother is not for the faint of heart. I implore you carefully consider the testimonies you've read today. I have yet to be certified, but I have been in good standing with each one of my specialists since the onset of my illness. There is something gravely wrong with this picture. It is my basic human right to be able to have access through certification as soon as possible. Access to a safe, non addictive, non life threatening treatment option.

Thank you for your time and consideration

Sincerely, Kristin Klein H-'8 /�€;3 3/�/Jq -=#�fJ -1 To all who will Ii I wanted to be there & fight with you all but can't be. I can't get there cuz the pain is so bad I can't sit or lay that long or i will throw up & poo. I have fibromyalgia & am in the midst of a really bad flare. Im taking diazepam & toradol for pain & I'm a zombie right now. I took another nasty fall out of bed the other morning (one of many I fall all the time) & my fiance had to pick me up & put me back in bed. I've sort of learned how to fall & usually get my face covered but sometimes I can't. Im very sore & its so hard to walk. I also injured my right arm & & bruised my elbow & will have to go back to the chiropractor which is excruciatingly painful to the point that I throw up & poo. Thats been my life for almost 17 years now. I started having alot of flu like pain around early 2000. It was getting so bad I had my then husband take me to the ER in Bismarck where they prescribed me Flexeril. My arms were stuck, muscles completely rigid. From that point on I've been to countless doctors & on every narcotic pain pill probably made & there was never any relief. There were countless times I was so out of it I'd pee, poo & throw up & not even know it. I've done cortisone shots in my hips which didn't really help either. I had a doctor, his name is Effrain Perez who did a spinal tap & lots of other tests & bloodwork & concluded what I had was Stiff Man (Person) Syndrome. I spent my life in excruciating pain & a drugged out zombie, i had trouble doing everything- bathing, eating, dressing myself years ago. About 4 years ago, I was having horrible trouble walking & was falling a lot getting skinnier by the day. My family & friends thought i was starvingmyself or bulimic but i wasn't. Aftergoing through excruciating testing at Mayo Clinic in Rochester, MN my doctor determined it was Fibromyalgia I had not Stiffper son Syndrome. So, i was on all the wrong meds for years & years & it atrophied my muscles throughout my body severely. I was on about 11 medications I didn't even need. The damage from them was cognitive issues, neuropathy & extremely weak atrophied muscles. I remember crying when Dr. Andrew McKean told me it was Fibromyalgia. I cried then the next day i got extremely angry angry that I was taking all those meds i didn't even need. The collateral damage is irreversible. Yearsof my life had been stolen from me. I had a correct diagnosis finally & i wasn't going to die from it, as i was told I would from the other false diagnosis. Little did I know what the Fibromyalgia disease was going to do to me physically & mentally. There were times I wanted to die so i I didn't have to hurt anymore. I had the thoughts but have had extensive psychological therapy, which i still am doing. I was told my muscles were like old rubber bands. I was sent to physical therapy & when i started I was at 30% mobility. Every year since then, I've been declining losing more & more mobility. I am depressed, anxious & angry alot. I feel like a prisoner in my own body. The things i enjoyed so much were taken away. Right now as I type this my sciatic nerve in my leg is shooting horrific pain & trying to walk is difficult & sometimes impossible. I am very bruised & sore from 2 falls in week. My knees are swollen & bruised so is my right elbow. I have not been able to work without special accommodations for a long time now. I've been turned down by disability 3 times to which I appealed & now we have a court hearing February 7th. I was instructed long ago to go south for the winters as the cold is excruciating, especially when the weather changes. I want a life & do not want to be in a wheelchair, which is a good possibility sadly. I believe Marijuana will give me back-I've seen the statistics, stories & research done. The opiates are going to kill me & I want to live. Please do what's right for me & get marijuana implemented so myself along with countless others who are suffering can have the help we need & deserve. Thank you foryo ur time. Sincerely, Jackie D. Johnson. Enclosed are some pictures of my injuries from falling. I may not die from the Fibromyalgia but I certainly can from falling sadly. Jackie Johnson ND Cannabis Caucus Compassionate Care Committee HB JJ1> 3/5/11 � PJ -'1 I am writing this to ask you to please support 1283 and all of the medical marijuana patient reforms in the hopes that Medical Marijuana becomes easier to access for qualifying patients. I have fibromyalgia, one of the many conditions that medical cannabis is approved for. Fibromyalgia is a constant battle. Not only am I dealing with debilitating pain and digestive issues but am now battling side effects from the seven prescription drugs that I am taking on a daily basis. I am a single mother with two boys and I am so desperate to get my life back, my boys want their mother back. When fibromyalgia set in and took a hold of me I stopped living and feel like I am just existing. I think that anyone living with a chronic illness and chronic pain can relate to this. It is so sad that the medications that are supposed to help you feel better come with such harsh side effects. I am now suffering severe depression, anxiety, hair loss, sleeplessness, and stomach issues that have caused me to lose over 30 pounds. I wake up in the morning so nauseous that I can barely eat and each day I pray that the pain isn't so great that I can push through. I wear a Quell pain device on my leg and sleep with an Oska pulsed electromagnetic device to try and numb my back, neck, shoulder and hip pain. On top of the seven daily prescriptions I take I also attend Physical therapy, go to the chiropractor, and have weekly ozone treatments with my Doctor to try and heal my body. I have also had five rounds of steroid injections. So far nothing has been able to touch my pain. Medical Cannabis could be my saving grace. It could help with not only my pain, anxiety, and stomach problems but could help me sleep again without waking up multiple times at night in agony. This medicine could give me my life back and could provide so much relief for not only myself but all of the North Dakotans who need it. I have exhausted all other options and this is my last chance. The problem I am now having is getting my Doctors to sign offon a referral even though they do think that I would benefit from this medication. The State of ND has made it nearly impossible for me to have access to this medicine because Doctors are afraid of the repercussions. I am asking you to please support these bills and all the medical marijuana bills on the table so that people like myself have an easier time to get a certification and can have a better quality of life. Thank you, Sara Holzer 4505 Glenwood Dr Bismarck, ND 58504 [email protected] 406-451-1531 1-/:B IJ�3 3/S-/I C/ ,#u fj·1D I've resided and voted within the 21-02 for 20 yrs. I am a unwavering supporter for full legalization. Please, join the resounding yes votes in the House;So they can expand access to medical cannabis in North Dakota. I feel we shouldn't be pandering or feet dragging this issue any longer. We all have loved ones who would thrive and defy the odds with this available.Do the Right thing and vote yes on-[HB1283,HB1364, HB141 7,HB1519] Sincerely,Greg Wilson 3/4/2019 New Doc 2019-03-04 20.30.24.jpg

https://mail.google.com/mail/u/2/?tab=wm#inbox?projector=1 1/1 tf6 IJ/(3 3 / /3 / I '! 19.0415.03001 Prepared by the Legislative Council staff for # I f9 . / Title. Senator J. Lee March 7, 2019

PROPOSED AMENDMENTS TO ENGROSSED HOUSE BILL NO. 1283 Page 1, line 2, replace "and" with "subdivision a of subsection 5 of section 19-24.1 -05, subsection 7 of section 19-24. 1-10," Page 1, line 2, after "19-24.1- 11" insert ", and subsection 1 O of section 19-24.1 -32" Page 8, after line 17, insert: Subdivision a of subsection 5 of section "SECTION 3. AMENDMENT. 19-24.1-05 of the North Dakota Century Code is amended and reenacted as follows:

7. A registered qualifying patient's certifying health care provider shall notify the department in writing if the health care provider's registered qualifying patient no longer has a debilitating medical condition or if the. The health care provider no longer believes the patient will receive therapeuticor palliative benefit from the medical use of marijuanamay notify the department if a bona fide provider-patient relationship ceases to exist. The qualifying patient's registry identification card becomes void immediately upon the health care provider's notification of the department and the registered qualifying patient shall dispose of any usable marijuana in the cardholder's possession within fifteen calendar days, in accordance with rules adopted under this chapter."

Page 8, after line 22, insert: Subsection 10 of section 19-24.1 -32 of the North "SECTION 6. AMENDMENT. Dakota Century Code is amended and reenacted as follows:

1 O. A health care provider is not subject to arrest or prosecution or the denial of any right or privilege, including a civil penalty or disciplinary action by a court or occupational or professional regulating entity, solely for providing a written certification or for otherwise stating in the health care provider's professional opinion a patient is likely to receive therapeutic or palliative benefit from the medical use of usable marijuana to treat or alleviate the patient's debilitating medical condition or for refusing to provide written certification or a statement. This chapter does not release a health care provider from the duty to exercise a professional standard of care for evaluating or treating a patient's medical condition."

Renumber accordingly

Page No. 1 19.041 5.03001 t-16 ar.3 3/13/t'J lt2 f;.J PROPOSED AMENDMENTS TO ENGROSSED HOUSE BILL NO. 1283

Page 8, after line 22, insert:

SECTION 3. AMENDMENT. Subsection 19-24.1-03.1 of the North Dakota Century

Code is created and enacted as follows:

Qualifying patients - Veterans. In lieu of the written certification required under section

19-24.1 -03, a veteran receiving treatment froma federal veterans' affairs entity may

submit to the department a copy of the veterans' affairs medical records identifying a

diagnosis of a debilitating medical condition under this chapter and a copy of military

discharge documents. The department may use such medical records and documents in

place of a written certification to approve or deny the application under section 19-24.1-

05. The department shall issue a registry identification card within thirty calendar days of

approving an application under this section. A registry identification card issued upon

approval under this section authorizes the qualifyingpa tient to be dispensed usable

man1uana. 19.0415.03006 Prepared by the Legislative Council staff for Title. Representative M. Ruby April 11 , 2019

• PROPOSED AMENDMENTS TO ENGROSSED HOUSE BILL NO. 1283 That the Senate recede from its amendments as printed on pages 1308 and 1309 of the House Journal and pages 1041 and 1042 of the Senate Journal and that Engrossed House Bill No. 1283 be amended as follows: Page 1, line 1, after "Act" insert "to create and enact section 19-24.1-03.1 and a new paragraph to subdivision b of subsection 2 of section 19-24.1-04 of the North Dakota Century Code, relating to access to medical marijuana;" Page 1, line 2, replace "and" with "subdivision a of subsection 5 of section 19-24.1-05, subsection 7 of section 19-24.1-10," Page 1, line 2, after "19-24.1-11" insert ", and subsection 1 O of section 19-24.1-32" Page 8, after line 13, insert:

.(fil A disclosure that possession of a firearm by a person who possesses marijuana may be a violation of federal law. Page 8, after line 17, insert: "SECTION 3. Section 19-24.1-03.1 of the North Dakota Century Code is created and enacted as follows:

19-24.1-03.1. Qualifying patients - Veterans.

• In lieu of the written certification required under section 19-24.1-03, a veteran receiving treatment from a federal veterans' affairs entity may submit to the department a copy of the veterans' affairs medical records identifying a diagnosis of a debilitating medical condition and a copy of military discharge documents. The department may use the medical records and discharge documents in place of a written certification to approve or deny the application under section 19-24.1-05. The department shall issue a registry identification card within thirty calendar days of approving an application under this section.

SECTION 4. A new paragraph to subdivision b of subsection 2 of section 19-24.1-04 of the North Dakota Century Code is created and enacted as follows:

A disclosure that possession of a firearm by a person who possesses marijuana may be a violation of federal law. SECTION 5. AMENDMENT. Subdivision a of subsection 5 of section 19-24.1-05 of the North Dakota Century Code is amended and reenacted as follows:

a. The department receives documentation the minor's health care provider has explained to the parent or legal guardian with responsibility for health care decisions for the minor the potential risks and benefits of the use of pediatric medical marijuana to treat or alleviate the debilitating medical condition; and SECTION 6. AMENDMENT. Subsection 7 of section 19-24.1-10 of the North • Dakota Century Code is amended and reenacted as follows: e 19.0415.03006 :f { HPJ IJ.�7; 7. A registered qualifying patient's certifying health care provider shaUmay tf(t �/tii notify the department in writing if the health care provider's registered qualifying patient no longer has a debilitating medical condition or if the.,_ The health care provider no longer believes the patient willreceive therapeutic or palliative benefit fromthe medical use of marijuanamay • notify the department if a bona fide provider-patient relationship ceases to exist. The qualifying patient's registry identification card becomes void immediately upon the health care provider's notification of the department and the registered qualifying patient shall dispose of any usable marijuana in the cardholder's possession within fifteen calendar days, in accordance with rules adopted under this chapter."

Page 8, after line 22, insert: "SECTION 8. AMENDMENT. Subsection 10 of section 19-24.1-32 of the North Dakota Century Code is amended and reenacted as follows:

10. A health care provider is not subject to arrest or prosecution or the denial of any right or privilege, including a civil penalty or disciplinary action by a court or occupational or professional regulating entity, solely for providing a written certification or for otherwise stating in the health care provider's professional opinion a patient is likely to receive therapeutic or palliative benefit from the medical use of usable marijuana to treat or alleviate the patient's debilitating medical condition or for refusing to provide written certification or a statement. This chapter does not release a health care provider from the duty to exercise a professional standard of care for evaluating or treating a patient's medical condition." Renumber accordingly •

• 19.0415.03006