APP 2013 Honors: Evaluation of the Medical Marijuana Program in Washington DC
By: Stephen Collett, Thomas Gariffo, Marisa Hernandez-Morgan
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When the voters of the District of Columbia passed the Legalization of Marijuana for Medical Treatment Initiative in 1998, the jurisdiction became one of the first in the nation to approve medical marijuana. Although intervention by Congress delayed further progress until July 2010, officials are now in the process of implementing the law. Goals include facilitating patient access, ensuring safety and privacy, preventing diversion of marijuana for purposes outside the allowed provisions of the law, and demonstrating sufficient care and respect to prevent interference by federal authorities.
The Office of the Attorney General and other Washington, D.C. policy makers face decisions that include a trade-off between the goal of preventing diversion, the goal of facilitating patient access and goals that seek to accomplish other objectives. In order to assist in making these decisions, this report includes an analysis and comparison of the D.C. medical marijuana program to that of other states, identification of likely points of diversion for non-medical purposes, suggested alternatives to prevent diversion, and recommendations with respect to other matters including patient access and formation of the Medical Marijuana Advisory Committee.
- In contrast to other jurisdictions where the Governor or law enforcement officials have opposed implementation of medical marijuana programs, officials in the Washington, D.C. Department of Health, Metropolitan Police, and Office of the Attorney General have all expressed agreement as to the importance of following the will of the voters, preventing diversion, and demonstrating respect for federal concerns in order to make the program a success.
- Comparison of the program in the District of Columbia with that of the 18 states that have enacted medical marijuana laws to date concludes that the D.C. program is the most regulated. In every category we examined, including qualifying medical conditions, regulation of cultivation and dispensaries, possession limits, required patient, doctor and caregiver procedures, and risk of diversion, the District of Columbia is equally or more restrictive than other jurisdictions.
- The limited number of qualifying medical conditions, along with an initial number of only three dispensaries spread out geographically in the city, provides for a relatively small program. This makes regulation economically and administratively feasible.
- We estimated that medical marijuana will initially compose approximately 3% of the total market for marijuana in Washington, D.C. This limits the impact that any amount of diversion would have on overall marijuana consumption.
- The restrictive characteristics of the program result in a trade-off between preventing diversion and providing patient access to medicine. The narrow list of qualifying conditions, lack of allowed home cultivation, and limited number of cultivation centers and dispensaries will prevent some patients from being able to obtain medicine conveniently and economically, and they may resort to the black market.
- While the well-regulated program is likely to deter diversion, the high-profile location in the nation’s capital suggests that every step that could reasonably prevent diversion be considered. The Department of Health should consider regularly scheduled inspections of cultivation centers and dispensaries, including a physical inventory and comparison to the recorded inventory, purchase and sales records. The inspector should also consider an occasional unannounced surprise inventory.
- Depending on perceived levels of diversion, consideration should be given to initiating undercover attempts to obtain false marijuana recommendations, or unauthorized purchases from cultivation centers, dispensaries or patients. Cultivators, dispensaries and doctors all fear any activities that will jeopardize their valuable licenses. Patients fear loss of access to medicine. Well-publicized plans for such undercover operations should make all parties additionally careful not to divert.
- Physician recommendations are required to be submitted to the Department of Health; therefore, the department should review these recommendations with particular attention to doctors with a high number of recommendations. Consideration should be given to requiring a medical marijuana training program for physicians who write more than a set number of recommendations, while also encouraging similar training for all D.C. physicians.
- As with prescription drugs, diversion by patients who choose to either share their medicine with others or consume their drug recreationally is extremely difficult to prevent from both a privacy and administrative cost standpoint. Although the restrictive nature of the program also limits the volume of patient diversion, district officials should monitor black market and medical marijuana prices to gauge the propensity to divert, and consider patient education requirements to discourage such activities.
- Consideration should be given to requiring cultivation centers and/or dispensaries to test for and label product with measures of potency such as percent THC and THC to cannabidiol ratio. This information will better enable physicians to make adjustments to their recommendations in the same way they do prescription medications, and will improve patient safety by allowing patients to know what they are taking.
- With respect to the Medical Marijuana Advisory Committee provided for under the Act, the group should be established as designated by the mayor as soon as possible. Members should include patients, physicians, officials from law enforcement, the Department of Health and experts such as those who provided the required D.C. training programs already conducted for employees of cultivation centers and dispensaries. The Committee should meet early in the implementation process to identify and resolve any problems that might jeopardize the program.
The small size of the medical marijuana program in the District of Columbia offers an opportunity for strict regulation and prevention of diversion. Continued determination to make the program a success, and cooperation among the Office of the Attorney General, the Department of Health, Metropolitan Police, providers, patients and physicians offer the potential for it to become a model program for providing safe and effective medical marijuana in the United States.