Pubdate: Sun, 14 Jun 2015
Source: Honolulu Star-Advertiser (HI)
Copyright: 2015 Star Advertiser
Contact: 
http://www.staradvertiser.com/info/Star-Advertiser_Letter_to_the_Editor.html
Website: http://www.staradvertiser.com/
Details: http://www.mapinc.org/media/5154
Author: Virginia Pressler
Note: Virginia Pressler, M.D., is director of the Hawaii Department of Health.

DOH MAKES SAFETY A TOP PROGRAM GOAL

In 2000, Act 28 made Hawaii one of the first states to authorize the 
use of marijuana to treat certain debilitating medical conditions. 
Act 28, however, was silent on how to legally obtain a patient or 
caregiver's first seed to cultivate their crop or otherwise legally 
acquire medical marijuana, leaving patients and even law enforcement 
in a conundrum.

Fast forward 15 years and Hawaii may soon join a growing number of 
states that have authorized dispensaries to distribute marijuana for 
medical use if House Bill 321, Relating to Medical Marijuana, is 
enacted. The 2015 state Legislature, based on remarks from opening 
day ceremonies, set as a goal to close the gap between the authorized 
use of medical marijuana and the legal means of acquiring it. A 
well-regulated dispensaries system may address both patient and law 
enforcement needs.

In 2012, the Legislature proposed transferring the medical marijuana 
patient registry program from the Department of Public Safety to the 
Department of Health (DOH). After successfully standing up the 
program in January 2015, DOH was once again called on by the 
Legislature to regulate a dispensaries program.

The department's testimony on HB 321 emphasized public health and 
safety as a top priority. The rationale for this was simple: unlike 
prescription or over-the-counter medications, no formally recognized 
standards exist for the medical use of marijuana.

The U.S. Food and Drug Administration, which is responsible for 
assuring the safety and efficacy of medications, has not reviewed or 
approved medical marijuana due to its classification as a Schedule I 
drug under the Controlled Substances Act of 1974. Along with heroin, 
LSD, and other substances, Schedule I drugs are "defined as drugs 
with no currently accepted medical use and a high potential for 
abuse. Schedule I drugs are the most dangerous drugs of all the drug 
schedules with potentially severe psychological or physical dependence."

In order to protect Hawaii's vulnerable patients, who by definition 
are suffering from debilitating medical conditions, the Department of 
Health must establish its own guidelines for medical marijuana. 
Patients expect and have a right to know the potency and purity of 
their medication. Several other states are now grappling with patient 
demand for independent quality oversight as an after-thought, which 
is something Hawaii intends to avoid.

In addition to patient safety, the department's implementation will 
be guided by the "Cole Memorandum" issued by the U.S. Department of 
Justice in August 2013. Public sentiment may have evolved on medical 
marijuana, but this memorandum makes clear that marijuana remains an 
illegal drug under the Controlled Substances Act and establishes 
priorities for enforcement.

Hawaii and other states with medical marijuana programs must 
establish strict regulatory schemes that protect federal interests. 
Inter-island transport is strictly forbidden by HB 321, for example, 
in deference to federal priorities.

Other issues will factor into the implementation and beyond, 
including the desire for greater clinical research and need for 
epidemiological studies (for example on the relationship of medical 
marijuana use to motor vehicle accidents, falls, or injuries). 
Numerous other issues requiring the coordination of other state, 
county and private entities will also be addressed, such as physical 
security, inventory control and pesticide regulation, to name a few.

However, with dispensaries operating or soon to be operating in about 
onethird of the country, Hawaii is in a good position to review 
lessons learned and adopt the best practices of other jurisdictions. 
As with all the programs administered by the Hawaii Department of 
Health, the department's team will use its experience in working with 
patients and public health issues to successfully implement the 
dispensary program.
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MAP posted-by: Jay Bergstrom