In November, Mississippi voted to establish a medical cannabis program while New Jersey, Arizona, South Dakota and Montana legalized cannabis for adults over 21, bringing the number of states with some degree of legalization to 35. The Alabama State Legislature plans to consider medical cannabis in this year's session which began February 2nd.
The first medical cannabis bill in Alabama was actually introduced in 2019 by Republican Senator Tim Melson, MD, who serves District 1, which includes Huntsville, Athens and Florence. Melson, an anesthesiologist practicing in Sheffield, was initially opposed to medical cannabis but changed his mind after reviewing research that showed benefits for some patients with chronic pain and other conditions.
After the 2019 Senate-approved bill was stalled in the House, lawmakers established a commission to study medical cannabis and make a recommendation to the legislature. The 15-member commission, which included representatives from medicine, law enforcement, addiction treatment, agriculture, pharmacy and others, held several public hearings and examined the regulations of the federal and state governments relating to the medical use of cannabis. In December 2019, the commission voted to support the passage of a bill that would establish a medical cannabis program. This bill again passed the Senate in the spring 2020 session, but the COVID-19 pandemic stymied efforts to bring the bill for a vote in the House. The bill will be re-introduced this year.
"SB 165 - the Alabama Compassion Act -establishes a process by which a patient with a qualifying condition would see a doctor," said Whitt Steineker, who is co-chair of Bradley's Cannabis Industry team in Birmingham. "The doctor will examine the patient, and when appropriate, issue them a physician's certification which enables them to access a medical cannabis card. Then they bring the card to a dispensary to fill their prescription."
The qualifying conditions are anxiety or panic disorder; autism; cancer-related pain, nausea, or weight loss; Crohn's; epilepsy; fibromyalgia; HIV/AIDS-related nausea; persistent nausea unrelated to pregnancy; PTSD; Tourette's; spasticity related to a motor neuron disease, multiple sclerosis, or spinal cord injury; terminal illness; menopause; premenstrual syndrome; intractable or chronic pain in which conventional therapeutic intervention and opiate therapy is contraindicated or has proved ineffective.
The bill sets up the Alabama Medical Cannabis Commission to regulate the program. Their duties include creating an electronic registry and issuing medical cannabis ID cards. The commission will also determine the maximum daily dosage of THC that can be recommended for each qualifying condition, but the maximum dosage cannot exceed 75 milligrams of THC per day.
The Medical Cannabis Commission will license no more than four cultivators, four processors, and four dispensaries, as well as five integrated facilities. Majority ownership in the integrated licenses and cultivator licenses must be by residents of Alabama for at least eight years. Dispensaries cannot locate within 1,000 feet of schools, and their staff must be trained and certified by the commission.
The State Board of Medical Examiners will license doctors to participate in the program. In order to be eligible, doctors will need to complete a medical cannabis CME course.
It remains to be seen whether or not this bill becomes law. "There are two tailwinds that could help the legislation," Steineker said. "First, it is a new source of revenue to help cover budget shortfalls because of COVID. The second positive factor is that more states have passed it, including Mississippi. A lot of people were surprised by the overwhelming support in Mississippi, with over 70 percent of the population voting in favor of it. They had it as a ballot initiative. Voters had three choices: to vote no; to vote for the citizen proposal that was put on the ballot by petition; or to vote for a competing medical cannabis proposal put forth by the legislature that was much more restrictive than the citizen proposal. For either the citizen or legislature's proposals to pass, they had to get over 50 percent of the total votes. And the citizen's proposal, which again was the more robust proposal, did that.
"I haven't seen any polling in Alabama on the subject, but given the relative similar populations of the two states, it stands to reason that it could have strong citizen support in our state."