Michigan Department of Licensing and Regulatory Affairs (MDLARA)

STATE OF MICHIGAN RICK SNYDER DEPARTMENT OF LICENSING AND REGULATORY AFFAIRS STEVEN H. HILFINGER GOVERNOR DIRECTOR LANSING

OFFICIAL

Michigan Department of Licensing and Regulatory Affairs (MDLARA) Michigan Rehabilitation Services (MRS) Informational Memorandum MRS-IM-12-01

DATE: October 17, 2011

TO: All MRS Staff

FROM: Jaye N. Porter, Bureau Director

SUBJECT: Informational Memorandum (IM): MRS-IM-12-01 – Medical Marijuana

Purpose: The purpose of this memorandum is to provide guidance to staff serving individuals who are certified medical marijuana users or who are in the process of applying for certification.

Background: In November 2008, voters passed the “Michigan Medical Marihuana Act” (MMMA). Passage of this Act decriminalized the possession and use of marijuana for medicinal purposes to treat debilitating and chronic health conditions.

Section 333.26422 Findings, declaration of the MMMA states: “The people of the State of Michigan find and declare that: (a) Modern medical research, including as found by the National Academy of Sciences' Institute of Medicine in a March 1999 report, has discovered beneficial uses for marihuana in treating or alleviating the pain, nausea, and other symptoms associated with a variety of debilitating medical conditions. (b) Data from the Federal Bureau of Investigation Uniform Crime Reports and the Compendium of Federal Justice Statistics show that approximately 99 out of every 100 marihuana arrests in the United States are made under state law, rather than under federal law. Consequently, changing state law will have the practical effect of protecting from arrest the vast majority of seriously ill people who have a medical need to use marihuana. (c) Although federal law currently prohibits any use of marihuana except under very limited circumstances, states are not required to enforce federal law or prosecute people for engaging in activities prohibited by federal law.

LARA is an equal opportunity employer/program. Auxiliary aids, services and other reasonable accommodations are available upon request to individuals with disabilities. MICHIGAN REHABILITATION SERVICES 201 N. Washington  P.O. BOX 30010  LANSING, MICHIGAN 48909  www.michigan.gov/lara  (517) 373-3390 The laws of Alaska, California, Colorado, Hawaii, Maine, Montana, Nevada, New Mexico, Oregon, Vermont, Rhode Island, and Washington do not penalize the medical use and cultivation of marihuana. Michigan joins in this effort for the health and welfare of its citizens.” Since the passage of the MMMA in Michigan, New Jersey recently passed a similar law bringing the number of states with medical marijuana laws to fourteen. What is a debilitating medical condition? The Act states that a “debilitating medical condition" means one or more of the following: (1) Cancer, glaucoma, positive status for human immunodeficiency virus, acquired immune deficiency syndrome, hepatitis C, amyotrophic lateral sclerosis, Crohn's disease, agitation of Alzheimer's disease, nail patella, or the treatment of these conditions. (2) A chronic or debilitating disease or medical condition or its treatment that produces 1 or more of the following: cachexia or wasting syndrome; severe and chronic pain; severe nausea; seizures, including but not limited to those characteristic of epilepsy; or severe and persistent muscle spasms, including but not limited to those characteristic of multiple sclerosis. (3) Any other medical condition or its treatment approved by the department, as provided for in section 5(a).” How has the MMMA affected MRS? Since the MMMA took effect in April 2009, individuals receiving services from Michigan Rehabilitation Services (MRS) with the above cited conditions have been certified for medical marijuana usage. As such, questions have increasingly arisen regarding the impact of medical marijuana usage upon achievement of employment outcomes. Inquiries have surfaced regarding whether customers certified for medical marijuana can be eligible for MRS services. Other staff question how a job goal can be selected when there is a strong possibility that upon readiness for placement, the individual using medical marijuana would likely undergo drug screening and not get the job due to a positive screen. Others wonder if the MMMA offers employment protections for individuals certified for medical marijuana. This memorandum will address elements of the MMMA that affect our work with customers in achieving employment. It will also offer guidance as you engage your customers in the vocational counseling process. This information memo will likely not answer all your questions in serving a customer who is certified for medical marijuana but hopefully it will provide some familiarity with the MMMA and create a framework for considering and addressing issues associated with planning and providing services. For more information about the MMMA or the Michigan Medical Marijuana Program you may visit the LARA web site at http://www.michigan.gov/lara/0,4601,7-154-27417_51869---,00.html. For your convenience and easy reference the Frequently Asked Questions (FAQ) about the MMMA is attached. Policy Individuals seeking to apply for MRS services who may be certified to use Guidance medical marijuana may not, by virtue of this certification, be determined Application/ ineligible for services or denied the right to apply. The assessment of Eligibility: eligibility must proceed in accordance with MRS policy and procedures. Eligibility criteria must be examined and applied consistently in all cases. Medical marijuana is a treatment for a disabling condition. Functional limitations and vocational barriers associated with the impairment(s) must be assessed before rendering an eligibility determination.

Policy Working closely with the customer during needs assessment toward selection Guidance of an employment goal and development of the IPE will be a crucial step in Needs the rehabilitation process. The customer will need to understand that the Assessment/ MMMA does not offer employment protections -- only protection from IPE prosecution for using marijuana to treat a medical condition. Use of Development: marijuana on the job or being under the influence at work would not have to be tolerated or accommodated. Factors to consider in the planning process.

 In selecting the employment goal, evaluate and discuss the impact medical marijuana usage might have upon the prospect for employment when the customer is employment ready. Does the occupation or profession require drug screening?

 Follow up with the individual’s physician to explore functional limitations/capacities in relationship to the proposed employment goal. Examine safety factors associated with performing the occupation if the customer anticipates continued usage of medical marijuana for treatment.

 Explore other possible treatments to meet the customer’s medical need if use of medical marijuana might jeopardize the prospect for employment. Marinal, for example, is a legal prescribed form of THC that might be considered. Other options might also include consulting the customer’s medical practitioner or arranging for an assessment to evaluate alternative pain management strategies

 If MCTI East or West attendance is considered, the customer must be notified that medical marijuana cannot be dispensed or used on campus. This policy is consistent with prohibitions at other postsecondary public institutions, i.e. CMU, MSU and Western.  MRS cannot support, supply, or assist with any business entities associated with the distribution, growing or selling of marijuana.

 The Act prohibits the operation of a motor vehicle while under the influence of Marijuana. The MRS customer should be advised of this prohibition especially if MRS assists with transportation services such as authorizing for mileage in support of a rehabilitation objective. The counselor should document that the conversation occurred in a case note and that the customer agreed to the terms. Since marijuana is not a prescribed medication, instructions for usage or information regarding possible side effects are not available. Serious caution should be given before authorizing for transportation services that involve the customer driving.

Lastly, as always, do not approve an IPE that is not compatible with the customer’s limitations or capacities or would present a danger to self or others. The IPE must be consistent with MRS policy and likely to result in an employment outcome. Determining whether the employment goal will likely result in successful employment must be based on objective facts and information – not assumptions.

Other The federal government classifies marijuana as a Schedule 1 drug Important meaning that licensed medical practitioners cannot prescribe it. A physician Information: must provide written certification of a "debilitating medical condition" and can only recommend the use of medical marijuana. Hence, a government medical assistance program or commercial or non-profit health insurer is not required to reimburse a person for cost associated with its use. Therefore, MRS shall not assist with the purchase of Medical Marijuana.

Registry and identification are renewed on an annual basis to maintain an active status as a registered qualifying patient or caregiver. The Medical Marijuana Program can provide information on the validity of a card with a written release from the individual.

The MMMA accepts valid medical marijuana patients certified by another state’s law. A registry identification card or equivalent issued by another state is permitted and has the same force and effect as a registry identification card issued in Michigan.

Policy: Rehabilitation Services Manual (RSM) Item 3050 – Application, RSM Item 3100 – Eligibility Criteria, RSM 3125 – Eligibility Assessment, RSM Item 3200 – Determination of Eligibility and Priority Category, RSM 3275 – Vocational Needs Assessment, RSM 5000 – Development of the Individualized Plan for Employment, RSM 5025 – Employment Goal and Outcome, RSM 6450 – Job Placement, RSM 6775 – Transportation Services, Miscellaneous, RSM 8050 -- MCTI Policy Basis: Section 333.26422 of the Michigan Medical Marihuana Act (MMMA), 34 CFR 361.41 -- Processing referrals and applications, 34 CFR 361.42 – Assessment for determining eligibility and priority for services, 34 CFR 361.45 – Development of the individualized plan for employment, 34 CFR 361.46 – Content of the individualized plan for employment, 361.56 – requirements for closing the record of services of an individual who has achieved an employment outcome.

Action: The attached Informational Memorandum should be comprehensively reviewed.

Inquiries: Inquiries from staff should be directed to Deb Wiese at 517-335-0389 or [email protected]; or Winona Potter at 517-241-5025 or [email protected]; or Karsten Bekemeier at 517-373-4038 or [email protected].

Effective Date: Immediately

Signature ______Jaye N. Porter Michigan Rehabilitation Services Bureau Director