An Act relating to the medical use of marijuana; and providing for an effective date.

The following is a sectional analysis of Committee Substitute for House Bill 213 (1-LS0892\G), introduced on April 27, 1999. CSHB 213 proposes several amendments to AS 17.37.010 - 17.37.070, the "Medical Uses of Marijuana for Persons Suffering from Debilitating Medical Conditions Act," approved by voters as "Ballot Measure No. 8" in November 1998.

This analysis addresses substantive changes only. CSHB 213 also incorporates dozens of minor changes affecting the style, grammar, and sentence structure of the new marijuana law. These alterations are designed to add clarity and bring the initiative language into conformity with the drafting style of Alaska statutes. Unless a proposed amendment involves a substantive change to the law, it will not be addressed in this document. CSHB 213 (1-LS0892|G) mirrors SSSB 94(1-LS0524\M)

In the interest of brevity, the statute created by Ballot Measure No. 8 will hereinafter be referred to as the "Medical Marijuana Act" or simply "MMA."

Section 1

This establishes a new section under Title 11 (Criminal Statutes), Chapter 71 (Controlled Substances). It provides that a defendant charged with violating Alaska's controlled substance law may utilize as an "affirmative defense" the fact that the defendant is a patient or a caregiver permitted to use or possess marijuana under the terms of the Medical Marijuana Act.

This affirmative defense provision replaces the broad-based immunity language now found in Sec. 17.37.030(a)-(b) of the Medical Marijuana Act (see page 8, lines 15-31 & page 9, lines 1-5). It also replaces the broad "exception clause" that MMA added to the state's controlled substances law at AS 11.71.190(b), i.e., "Marijuana is a schedule VIA controlled substance except for marijuana possessed for medical purposes under AS 17.37." The language emphasized in italics is deleted in Section 2 of CSHB 213 (see page 2, lines 23-24).

The affirmative defense requirement proposed in CSHB 213 closely follows the model of state law relating to concealed weapons at AS 11.61.220(b). That statute provides that a person who "knowingly possesses a deadly weapon ... that is concealed on the person" is guilty of a Class B misdemeanor. However, a person charged with this offense may invoke as an "affirmative defense" the fact that he or she is "the holder of a valid permit to carry a concealed handgun."

Under state law at Sec. 11.81.900(b)(1), the term "affirmative defense" means that "some evidence must be admitted which places in issue the defense" and that "the defendant has the burden of establishing the defense by a preponderance of the evidence." This is appropriate in circumstances where the defendant has special custody of, or access to information (e.g., a registration card, written medical diagnosis, etc.), that would clearly demonstrate to law enforcement officials that the person is protected by a statutory exception.

Some have criticized the "affirmative defense" approach in CSHB 213 on the grounds that it places the burden of proof on the defendant rather than law enforcement. However, this is consistent with how Alaska law is applied to all other cases involving drugs on the controlled substance list, whether the substance is legal to prescribe or not. The burden of proof in all cases involving controlled substances is set out clearly in AS 11.71.350, which has been law since 1982: "It is not necessary for the state to negate an exemption or exception provided for in this chapter in a complaint, information, indictment, or other pleading or at a trial, hearing, or other proceeding under this chapter or AS 17.30. The defendant has the burden of proving by a preponderance of the evidence any exemption or exception claimed by the defendant" (emphasis added).

Law enforcement officials and gun owners have stated that the "affirmative defense" structure used in Alaska's concealed-carry permit law works very well because it removes any ambiguity about who is allowed to carry a concealed weapon. In similar fashion, CSHB 213 will remove any ambiguity about who is entitled to use marijuana. It establishes what the U.S. Supreme Court has called the "bright line" that will help police distinguish between legitimate and illegitimate users of marijuana. It will help protect medical marijuana patients from being victims of mistaken arrest, and it will likewise allow the state to continue enforcing the state law that prohibits recreational use of marijuana. Alaskans voted to recriminalize possession of marijuana when they approved Ballot Measure No. 2 in 1990.

The affirmative defense provision in CSHB 213 contains appropriate safeguards to ensure marijuana will be legally used only for valid medical reasons and not for "recreational" use. Under Alaska's existing controlled substance law, a person can be charged with the following marijuana-related offenses:

1. manufacture
2. delivery
3. possession
4. possession with intent to manufacture or deliver
5. use
6. display

For any of the six charges referenced above, CSHB 213 requires a person to meet all of the following requirements to establish a valid affirmative defense:

1. Person must be a patient, primary caregiver for a patient, or alternative caregiver for a patient.
2. The patient must be currently registered with the Department of Health & Social Services as a person entitled to use marijuana to address a debilitating medical condition.
3. The entire amount of marijuana in question must have been intended for medical use by the patient in accordance with a physician's recommendation as described in AS 17.37.010(c) (see page 3, lines 28-31 and page 4, lines 1-9).
4. The person's use of marijuana must comply with all requirements of AS 17.37, the Medical Marijuana Act. Among these requirements: prohibition on using marijuana in a public place; prohibition on using marijuana in a manner that endangers the health or safety of any person; prohibition on selling or distributing marijuana to any person other than an exchange between the patient and his or her primary caregiver; and possession limits of one ounce of marijuana in usable form and six plants (see page 10, lines 21-31 & page 11, lines 1-13).
5. If the defendant is a primary caregiver or alternative caregiver for a patient, the person must be in physical possession of the caregiver registry identification card issued by DHSS.

Section 1 of CSHB 213 concludes with a series of definitional references (see page 2, lines 15-21). Some of the definitions are changed slightly from those used in the Medical Marijuana Act. The changes are discussed in Section 7 of this analysis.

Section 2

As described earlier in this analysis, Section 2 of CSHB 213 eliminates the broad exception clause the Medical Marijuana Act tacked on to the state's Controlled Substances Act: "Marijuana is a schedule VIA controlled substance [EXCEPT FOR MARIJUANA POSSESSED FOR MEDICAL PURPOSES UNDER AS 17.37.]. Thus, CSHB 213 restores medical marijuana to the list of controlled substances.

It is not necessary or even wise to remove medical marijuana from Alaska's list of controlled substances - which includes other medications that are available for prescription by doctors. Our law should recognize that marijuana, like morphine or any other prescription drug, is a controlled substance, regardless of how it is used. Indeed, one of the duties of the state's Controlled Substances Advisory Committee is to "recommend regulations ... to prevent excessive prescription of controlled substances and the diversion of prescription drugs into illicit channels" (emphasis added) (see AS 11.71.110).

By completely deleting medical marijuana from Alaska's list of controlled substances, the new Medical Marijuana Act has effectively removed this substance from the reach of any legal or regulatory authority under the Controlled Substances Act (Title 11, Chapter 71). At least for this portion of state law, "medical marijuana" now has no more legal significance than a can of soda, a stick of chewing gum, or a jar of peanut butter. It is difficult to fathom how this serves a public health interest.

Section 3

This section of CSHB 213 proposes several amendments to AS 17.37.010, which establishes a registry under DHSS of patients entitled to use marijuana.

1. To be listed on the registry, a patient must provide the department with a signed statement from his or her physician stating that the patient has been diagnosed with a debilitating medical condition, specifying the nature of the patient's symptoms, and concluding that the patient might benefit from the medical use of marijuana. In the statement, the doctor must certify that he or she personally examined the patient in the context of a "bona-fide physician-patient relationship."
   
   
2. The physician's statement described above in (1) must also include a statement that the physician has "considered other approved medications and treatments that might provide relief, that are reasonably available to the patient, and that can be tolerated by the patient, and that the physician has concluded that the patient might benefit from the medical use of marijuana." This additional requirement, not found in the original MMA, establishes a level of accountability from physicians who recommend use of marijuana. This higher level of accountability is prudent given the following facts related to the medical use of marijuana:
   
   
1. A recent report from the National Academy of Sciences' Institute of Medicine recommended that short-term marijuana use by certain patients could be accepted only if the "failure of all approved medications to provide relief has been documented." (See Recommendation #6 of the Institute of Medicine Report, "Marijuana & Medicine: Assessing the Science Base," published by National Academy Press, Washington, D.C., 1999).
   
   This requirement was deemed prudent by the Institute of Medicine because of the harmful effects of smoking marijuana. As noted in the Institute report, "Although marijuana smoke delivers THC and other cannabinoids to the body, it also delivers harmful substances, including most of those found in tobacco smoke. In addition, plants contain a variable mixture of biologically-active compounds and cannot be expected to provide a precisely defined drug effect. For these reasons, the report concludes that the future of cannabinoid drugs lies not in smoked marijuana ..." In a separate section devoted to the "physiological risks" of marijuana use, the Institute of Medicine noted: "Marijuana smoking is associated with abnormalities of cells lining the human respiratory tract. Marijuana smoke, like tobacco smoke, is associated with increased risk of cancer, lung damage, and poor pregnancy outcomes ... Numerous studies suggest that marijuana smoke is an important risk factor in the development of respiratory disease."
   
   
2. The principle authors of the Institute of Medicine report reiterated their findings in an editorial published in The Standard-Times (Massachusetts) on April 13, 1999: "In deciding whether marijuana should be smoked as medicine, society must weigh the reality of this crude drug-delivery system against the benefits it might bestow. Chronic smoking of marijuana increases a person's chances of developing cancer, lung damage, and problems with pregnancies, including low birth weight. Therefore, it is simply not an acceptable long-term option. Smoking should be allowed only for short-term use among patients with debilitating symptoms, or who are terminally ill and do not respond well to approved medications." (emphasis added). The principle authors of the report (and the editorial) are Dr. John A. Benson, Dean and Professor of Medicine Emeritus at the Oregon Health Sciences University School of Medicine in Portland; and Dr. Stanley J. Watson, Jr., Co-Director and Research Scientist at the Mental Health Research Institute, University of Michigan, Ann Arbor.
   
   
3. The federal government classifies marijuana as a "Schedule I" drug: dangerous, addictive, and without medical benefit. Under federal law, it cannot be legally prescribed, grown, or sold - regardless of what Alaska statutes say. A doctor who recommends use of marijuana is effectively advising the patient to engage in activity that is prohibited by law. Out of concern for the welfare of the patient, it is reasonable to require that other legal treatments be considered first. Nothing in state law can protect a patient (or a physician) from enforcement action by the federal Drug Enforcement Administration.
   
   
4. The main psychoactive ingredient in marijuana, Delta-9-tetrahydrocannabinol (THC), is already available in synthetic form in the drug Marinol, which can be legally prescribed. Unlike marijuana, it is "pure" and can be administered in precise, controlled doses. As the American Medical Association has stated, "Marijuana doesn't fit neatly into traditional protocols because the dosage is inexact, the quality and strength of marijuana varies, and each puff contains more than 400 chemicals, not just a single agent to be isolated." (Source: editorial of American Medical News, April 7, 1997)
   
   
5. The American Medical Association has recommended that marijuana remain classified as a prohibited, Schedule I drug (i.e., illegal to prescribe) until further research can demonstrate whether the substance has any medical utility: "What patients and physicians deserve now is some much-needed clinical research that will decide the issue of whether medical marijuana is even worth talking about ... Certainly medical marijuana has a loyal following of patients. As the ballot measures indicate, it has also captured the imagination of the public at large. Unfortunately, unproven therapies often do." (Source: Report 10 of the Council on Scientific Affairs, American Medical Association & editorial of American Medical News, April 7, 1997)
   
   
6. The American Cancer Society has questioned the efficacy of medical marijuana: "Marijuana has also been suggested as a treatment for pain, loss of appetite and depression associated with cancer. To date, there is no scientific evidence that marijuana is as useful as currently available medications in controlling these symptoms. Claims that marijuana smoking can improve some patients' general sense of well-being cannot be readily verified by scientific research. Some states have recently passed legislation intended to promote access to marijuana for patients with cancer and other serious diseases. Evaluation of any medication involves weighing its benefits against adverse effects and other disadvantages. As a medication for controlling nausea and vomiting associated with cancer chemotherapy, smoked marijuana appears to offer little if any benefit over legally available medications (including dronabinol)." (Source: statement posted on the American Cancer Society web page, available at http://www.cancer.org/murphy/week2.html)
   
   
7. Marijuana is a dangerous substance and it is the most commonly abused illegal drug in the United States: "Today's street version [of marijuana], however, is 10 times more potent than what was available a decade or two ago. And it is that many times more dangerous. Marijuana ... is far from harmless. It contains more harmful chemicals than cigarettes. The chemical ingredients can stay in the body for up to a month after the smoking of a single joint (marijuana cigarette). Marijuana affects every tissue in the body. It slows down brain activity and impairs concentration, depth perception, reaction time, and the ability to evaluate situations and outcomes. It can damage short-term memory and bring on a totally 'I don't care' attitude ... Meanwhile, the smoke from one marijuana joint causes more lung damage than that from a whole pack of cigarettes. Over time the chemicals and smoke can cause lung cancer and emphysema. The body's ability to fight infection may be lowered because marijuana often lowers the white blood cell count." (Source: "The Perils of Pot," by Dr. Richard Heyman, Chairman of the Committee on Substance Abuse of the American Academy of Pediatrics, published in the American Medical Association book "Teen Talk.")
   
   
3. The registry must include not only the patient, but also the patient's primary caregiver and alternative caregiver, if either is designated. Only one primary caregiver and alternative caregiver can be listed for each patient. To be listed as a caregiver, a person must submit a sworn statement to DHSS stating that the applicant is at least 21 years of age, not currently on probation or parole, and has never been convicted of a felony violation of the drug laws of Alaska or another state. The patient must include the following information about the primary and alternative caregivers in his or her application: name, address, date of birth, Alaska drivers license or identification card number. A person can be a caregiver for only one patient at a time, except in circumstances in which the person is caring for two or more patients who reside in the same household as the caregiver and these patients are related to the caregiver by at least the fourth degree of kinship by blood or marriage.
   
   
4. If the patient is a minor, the registry application must be filed by the parent or guardian. The application must include a statement by the minor's parent or guardian that the physician has explained the risks and benefits of medical use of marijuana and that the parent or guardian consents to serve as the primary caregiver for the patient. CSHB 213 further requires that the parent or guardian "control the acquisition, possession, dosage, and frequency of use of marijuana by the patient."
   
   
5. CSHB 213 deletes much of the sweeping confidentiality language at AS 17.37.010(b) because it unreasonably restricts the ability of law enforcement to access registry information for official purposes (see page 3, lines 13-24). In its place, CSHB 213 stipulates that registry information is confidential and not considered a public record under AS 09.25.100 - 09.25.220 (the public records statute under the Code of Civil Procedure). However, law enforcement personnel are permitted to access registry information while "in the course of a criminal investigation." This specific type of access is not currently permitted under MMA.
   
   
6. DHSS is permitted to deny a registration card to a patient who "is not ... qualified to be registered" (see page 5, lines 15-16). This authority is somewhat broader than what is currently permitted under the Medical Marijuana Act, which authorizes a denial only if the patient (1) did not provide the required information; or (2) provided information that was falsified.
   
   
7. If a patient's application designates a caregiver and DHSS determines that the caregiver does not meet the statutory requirements to be listed, the department shall proceed to review the patient's application as if there were no designation of a caregiver. The patient may apply to have a new primary caregiver or alternate caregiver listed at any time.
   
   
8. When an application is approved, the department will issue a registration card for the patient and a duplicate card for the patient's primary caregiver, if one has been listed. The duplicate card will be clearly identified as the caregiver registry identification card.
   
   
9. The Medical Marijuana Act states that if DHSS fails to act on an application within 35 days of receipt, then the application is considered to have been automatically approved. CSHB 213 retains this provision, but adds a stipulation that if the department subsequently registers or denies registration to a patient or caregiver, this action revokes or supersedes the previous "automatic" approval.
   
   
10. A patient or primary caregiver who is questioned by a law enforcement officer regarding the medical use of marijuana must present proper identification to the official, and also one of the following documents: (1) the person's registry identification card; or (2) a copy of an application that has been pending before the department for more than 35 days without being approved or denied, along with proof of the date of delivery to the department.
    
    
11. The MMA states that a denial of a registry identification card is considered a final agency action subject to judicial review, and that only the patient has the standing to contest the denial. CSHB 213 amends this language to state that, in addition to a denial, the revocation of a registry identification card or the removal of a person from the registry (e.g., a primary caregiver) also constitutes a final action subject to judicial review. In addition to the patient, a parent or guardian of a patient who is a minor also has standing to contest the agency action.
    
    
12. The MMA requires a patient to notify the department within 10 days of any changes in the patient's name, address, physician, or primary caregiver. CSHB 213 expands this 10-day notice requirement to include any changes in name or address of the primary caregiver.
    
    
13. The MMA requires the patient to return his or her registry identification card within 24 hours of receiving a physician's diagnosis that the patient no longer has a debilitating condition. CSHB 213 expands this requirement to also require the primary caregiver to return his or her registration card within 24 hours of the new diagnosis.
    
    
14. CSHB 213 adds a new provision in subsection (m) designed to prevent abuse of the registration system: "A copy of a registry identification card is not valid. A registry identification card is not valid if the card has been altered, mutilated in a way that impairs its legibility, or laminated." (see page 7, lines 25-27)
    
    
15. CSHB 213 adds a new subsection (n) permitting DHSS to revoke a patient's registration if the department determines that the patient has violated a provision of AS 17.37 (the Medical Marijuana Act) or AS 11.71 (Controlled Substances Act). (see page 7, lines 28-29)
    
    
16. CSHB 213 also adds a new subsection (o) allowing DHSS to remove a primary or alternate caregiver from the state registry if it is determined that the caregiver is not qualified to be listed or has violated a provision of AS 17.37 (Medical Marijuana Act) or AS 11.71 (Controlled Substances Act). (see page 7, lines 30-31 & page 8, lines 1-2)
    
    

Section 4

This section of CSHB 213 proposes several amendments to Sec. 17.37.030 of the MMA, entitled "Privileged medical use of marijuana."

1. In subsection (a), all material from the original MMA is deleted and replaced with new language (see page 8, lines 12-30). The language proposed for deletion is the most problematic in the Medical Marijuana Act, as it grants sweeping immunity to both patients and primary caregivers claiming a medical need for marijuana, even if the patient and primary caregiver are not registered with DHSS. Along with the MMA's removal of "medical marijuana" from Alaska's list of controlled substances (see page 2, lines 23-24), this provision effectively places the burden on law enforcement to prove that a person being questioned about marijuana use is NOT using it for a medical purpose. This shifting of the burden of proof will likely cause police to not bother making arrests in many situations because of the ambiguities in the law. This problematic language is replaced by the new "affirmative defense" provision described in Section 1 of this analysis. The new subsection (a) reads as follows: "A patient, primary caregiver, or alternate caregiver registered with the department under this chapter has an affirmative defense to a criminal prosecution related to marijuana to the extent provided in AS 11.71.090."
   
   
2. The next subsection (b) begins on page 8, line 31. In its original form, as part of the MMA, this subsection grants sweeping immunity from prosecution related to the medical use of marijuana, though at least this subsection limits the protection to those who are in "lawful possession of a registry identification card." Similar to the change in subsection (a), CSHB 213 deletes the general immunity language in this subsection because protection for medical marijuana use is covered by the affirmative defense provision in Section 1. However, the revised subsection retains the immunity language insofar as it relates to the specific act of applying to be listed on the state registry: "Except as otherwise provided by law, a person is not subject to arrest, prosecution, or penalty in any manner for applying to have the person's name placed on the confidential registry maintained by the department under AS 17.37.010."
   
   
3. The next subsection (c) in the Medical Marijuana Act (beginning on page 9, line 6) provides that a physician who advises a patient regarding the medical use of marijuana shall not be subject to prosecution or other disciplinary action for providing such advice, provided certain conditions are met. CSHB 213 adds a new condition to those already listed - specifically, that the physician's advice must be based on a contemporaneous assessment of "other approved medications and treatments that might provide relief and that are reasonably available to the patient and that can be tolerated by the patient."
   
   
4. The next subsection (d) of MMA (beginning on page 9, line 28) contains an exclusionary clause stating that a person is not "entitled to the protection of this section" (i.e., AS 17.37.030) for the non-medical use of marijuana. CSHB 213 expands the scope of this exclusionary clause to state that no person is "entitled to the protection of this chapter" (i.e., AS 17.37 in its entirety) for the non-medical use of marijuana. In other words, a person's use of marijuana for non-medical purposes makes that person ineligible for the protections in the entire Medical Marijuana Act, not merely the protections of one section.
   
   
5. CSHB 213 deletes the next subsection (e) of the MMA (see page 10, lines 2-19). This subsection contains cumbersome language addressing issues of forfeiture of property arising from seizures of medical marijuana. The deletion of this language was the result of an amendment adopted in the HESS Committee at the recommendation of the Department of Law and Department of Public Safety. Alaska law already includes comprehensive guidelines for seizures and forfeiture of property in the area of controlled substances. These procedures are set out in AS 17.30.100 - 17.37.126, and they apply to all cases involving seizure of drugs on Alaska's list of controlled substances. There is no need to have a separate seizure and forfeiture law that applies exclusively to marijuana used for medical purposes. In addition, the provisions of CSHB 213 requiring registration and the carrying of a registry ID card make it extremely unlikely there will be any cases in which law enforcement officials mistakenly seize marijuana and other paraphernalia from a patient who is legally entitled to possess or use it.
   
   

Section 5

In this section, CSHB 213 proposes several amendments to Sec. 17.37.040 of the Medical Marijuana Act, entitled "Restrictions on medical use of marijuana" (see page 10, lines 21-31; page 11, lines 1-31; & page 12, line 1). Unfortunately, as the analysis below demonstrates, the "restrictions" in MMA are illusory:

1. The existing Medical Marijuana Act, now in force, provides in subsection (a) that a patient "in lawful possession of a registry identification card" shall not:
   
   
   1. use medical marijuana "in a way that endangers the health or well-being of any person."
      
      
   2. use medical marijuana "in plain view of, or in a place open to, the general public."
      
      
   3. knowingly sell or distribute marijuana to any person not in lawful possession of a registry identification card, or eligible to possess such a card.
      
      
   Curiously, the limitations above do not apply to:
   
   
   1. a primary caregiver; or
      
      
   2. a patient who is not in "lawful possession of a registry identification card."
      
      
   Therefore, under the terms of MMA, a primary caregiver and a patient who qualifies for medical use of marijuana, but who refuses to participate in the optional registration process, is not prohibited by this section from: (1) using marijuana in a public place; (2) using marijuana in a way that endangers the health and safety of another person; or (3) selling/distributing marijuana to persons who are not in lawful possession of a registry identification card or eligible for such a card.
   
   CSHB 213 corrects these problems: it applies the restrictions to both patients and primary caregivers, and the restrictions apply regardless of whether one has a registration card or not. Also, to help the medical marijuana law work better for patients and caregivers, CSHB 213 adds an exception to the public use prohibition, stating that it is not a violation to carry less than one ounce of marijuana in a public place, provided the drug is kept in a closed container, carried on the person, is not visible to anyone other than the patient or primary caregiver, and the possession is limited to what is necessary to transport the marijuana to a place where the patient and caregiver can lawfully use the substance.
   
   CSHB 213 also adds new requirements to subsection (a) to prohibit the sale or distribution of marijuana to any person, except that marijuana can be transferred between the patient and primary caregiver. It also sets possession limits of one ounce in usable form and six plants, of which no more than three can be mature and flowering and capable of producing usable marijuana at any one time (see page 11, lines 7-13).
   
   
2. Subsection (d) of MMA (beginning on page 11, line 25) states that "nothing in this section shall require any accommodation of any medical use of marijuana" in a place of employment, a correctional facility, school bus, etc. Once again, the MMA employs the word "section" instead of the word "chapter" - which effectively renders the restrictions meaningless and creates a gaping loophole. CSHB 213 corrects this problem by deleting "section" and inserting "chapter" in its place. In addition, CSHB 213 adds a new provision stating that marijuana use need not be accommodated in a "medical facility, or facility monitored by the department of the Dept. of Administration" (e.g., juvenile detention facility, Pioneer Home, etc.). These terms are defined on page 13, lines 14-31 & page 14, lines 1-4.
   
   

Section 6

This section of CSHB 213 amends Sec. 17.37.060 of the marijuana initiative, entitled "Addition of debilitating medical conditions."

The Medical Marijuana Act requires DHSS to adopt regulations governing the manner in which new debilitating medical conditions eligible for treatment with marijuana can be added "to the list provided in this section" (see page 12, lines 3-7). However, this statement is meaningless because there is no list of medical conditions in "this section," which is Sec. 17.37.060. Presumably, the drafters of MMA meant to refer to the list provided in the subsequent section, 17.37.070. To provide clarity, CSHB 213 amends this section to refer specifically to the list of debilitating conditions defined in Sec. 17.37.070 (see page 12, lines 27-31 & page 13, lines 1-11).

Section 7

Marijuana Act (AS 17.37.070).

1. CSHB 213 adds a new definition of "alternate caregiver," as the original MMA does not provide for alternate caregivers. The alternate caregiver, when in possession of the caregiver ID card, is able to carry out the responsibilities of the primary caregiver when that person is unable to fulfill them (such as during travel out of state).
   
   
2. CSHB 213 adds a definition of the term "bona fide physician-patient relationship." Although this term is used in the MMA at AS 17.37.030(c)(2), the drafters of the initiative neglected to include a definition. CSHB 213 defines the term as a relationship in which "the physician obtained a patient history, performed an in-person physical examination of the patient, and documented written findings, diagnoses, recommendations, and prescriptions in written patient medical records maintained by the physician."
   
   
3. The definition of "correctional facility" in MMA is deleted in favor of a more comprehensive definition already in Alaska law under Title 33, Chapter 30, entitled "Prison Facilities and Prisoners" (see Section 901): "a prison, jail, camp, farm, half-way house, group home, or other placement designated by the commissioner for the custody, care, and discipline of prisoners."
   
   
4. CSHB 213 includes a new definition of "facility monitored by the department or the Department of Administration." This definition is necessary because CSHB 213 states at AS 17.37.040(d)(2) that the medical use of marijuana is not required to be accommodated at any of these facilities (see page 11, lines 28-29). The definition includes any "institution, building, office, or home" operated, funded, inspected, licensed, designated, or under contract with DHSS or the Department of Administration for the care of juveniles, the elderly, and the mentally ill (see page 13, lines 14-31).
   
   
5. A new definition of "medical facility" is included, for the same reason identified in (4) above - namely, that CSHB 213 requires no accommodation for the use of medical marijuana in these facilities (page 11, line 28). Medical facility is defined as an "institution, building, office, or home providing medical services, and includes a hospital, clinic, physician's office, or health facility as defined in AS 47.07.900, and a facility providing hospice care or rehabilitative services, as those terms are defined in AS 47.07.900."
   
   
6. "Medical use" of marijuana is redefined for greater clarity. The existing definition in the Medical Marijuana Act defines "medical use" as marijuana used, manufactured, etc., to "address the symptoms or effects of a debilitating medical condition." CSHB 213 defines medical use in more concise terms, as marijuana used to "alleviate a debilitating medical condition."
   
   
7. CSHB 213 changes the definition of "primary caregiver" to add greater clarity and prevent abuse: "primary caregiver means a person listed as a primary caregiver under AS 17.37.010 and in physical possession of a caregiver registry identification card; 'primary caregiver' also includes an alternate caregiver when the alternate caregiver is in physical possession of the caregiver registry identification card."
   
   
8. The definition of "prisoner" contained in MMA is deleted by CSHB 213. The need for this definition is not apparent, since the term is not employed anywhere in the main body of the initiative language. The only reference to the word "prisoner" is found in the definitions section, under "correctional facility." Since CSHB 213 proposes to use the standard definition of "correctional facility" contained in state statute at AS 33.30.901(4), there appears to be no need for a unique, tailor-made definition of prisoner. State law already defines the term "prisoner" at AS 33.30.901(12).
   
   
9. CSHB 213 deletes the definition of "registry identification card" because it is superfluous. The meaning of this term is self-evident in CSHB 213 at Sec. 3, AS 17.37.010(e) (see page 5, lines 26-31 & page 6, lines 1-12).
   
   
10. CSHB 213 deletes the definition of "written documentation" as the meaning of this term is self-evident in Sections 1 & 3 (see page 3, lines 28-31; page 4, lines 1-9).
    
    

Section 8

This section of CSHB 213 deletes two sections of the Medical Marijuana Act - AS 17.37.020 and 17.37.050.

1. Section 17.37.020 of MMA, entitled "Medical Use of Marijuana," establishes limits on the amount of marijuana a patient can "use" for medical purposes - no more than one ounce in usable form, and no more than six marijuana plants, with only three mature and flowering. In this context, it is odd that the MMA employs the term "use" rather than "possess." If the language is taken literally, it appears a patient could "possess" an unlimited quantity of marijuana, as long as the patient is currently "using" no more than one ounce in usable form. In fact, the next paragraph of this section [AS 17.37.020(b)] allows even these ill-defined limits to be exceeded if the patient or primary caregiver can prove by a preponderance of evidence that "any greater amount was medically justified to address the patient's debilitating medical condition." CSHB 213 deletes this entire section of MMA, and restates the limits on possession of marijuana in Section 5 (see page 11, lines 10-13). These limits are restated strictly in terms of "possession," not "use."
   
   
2. Section 17.37.050 of the marijuana initiative is entitled, "Medical use of marijuana by a minor." It states requirements that must be met if a minor is to use medical marijuana. CSHB 213 deletes this entire section and instead addresses the use of marijuana by minors in Section 3 of the bill (see page 3, lines 25-27; page 4, lines 21-25; and page 7, lines 9-11).
   
   

Section 9

This section of CSHB 213 provides for an immediate effective date, in accordance with AS 01.10.070(c).