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Missourians will have three options for legalizing medical marijuana on November ballot


The Show-Me State will get the chance in November to decide whether or not to join the plethora of other states in legalizing medical marijuana. And voters will not be shy of options, with three initiative petitions submitting enough signatures to be certified for the general election ballot.

Though illegal on a federal level, the legalization of marijuana for medical purposes has become of growing movement with 30 states in the U.S., including Oklahoma and Arkansas, passing laws giving patients with certain illness access to cannabis.

“Americans views on the subject are shifting and shifting fast,” said Travis Brown, with Missourians for Patient Care, a group that put forward one of the initiative petitions.

On June 25, 2018, the U.S. Food and Drug Administration took a momentous step in approving a drug derived from marijuana to treat severe forms of epilepsy. That move signaled that even though cannabis in all forms is considered a Schedule I drug — a drug without medical uses — the plant has medical uses.

“Missourians really want to put the doctor and the patient back in charge of making decisions on medical treatment options, not bureaucrats and politicians,” said Jack Cardetti with New Approach Missouri, a group that put forward one of the initiative petitions.

And now voters in the Show-Me State are going to be presented with the question of if medical marijuana should be legal, and if so, just how they want to do so.

“In November, Missourians will choose whether or not to create a program to allow access to marijuana for a wide range of ailments,” said NCADA’s Executive Director, Nichole Dawsey, in a news release. “This will be the first time Missourians have voted on whether or not something constitutes a medicine. Due to the unprecedented nature of these efforts, it’s crucial that Missourians be informed of the details of each initiative.”

The three options Missourians will be presented with legalizing medical marijuana are vastly different. Two are Constitutional amendments, one is a statutory change. Tax rates range from 2 percent to 15 percent, cost of administration runs between $500,000 to $10 million, and revenue generation estimates vary from $10 million to $66 million.

If more than one measure is passed by voters, state law states that “the largest affirmative vote shall prevail, even if that amendment did not receive the greatest majority of affirmative votes.”

Here is a breakdown of the three measures:

Proposition C

Unique within the medical marijuana measures is the Missouri Patient Care Act, which is a statutory change instead of a constitutional amendment.

In drafting the measure, Brown said that “there was a lot of deference given to state laws that have worked, or are viewed to have worked.”

The measure creates a framework where physicians with a “bona fide” relationship with the patient may recommend marijuana or marijuana products to treat qualifying conditions. Some of the illnesses specified in language are cancer, epilepsy, glaucoma, intractable migraines unresponsive to other treatment, multiple sclerosis, PTSD, and seizures. It contains a provision allowing “any other chronic, debilitating or other medical condition…” at the professional judgment of the physician.

Oversight of the program would fall to the Division of Alcohol and Tobacco. An individual would be able to possess 2.5 ounces as a 14 day supply and may possess up to a 60 day supply at a time.

Medical marijuana would be taxed at 2 percent, the lowest of the proposals.

This statute requires local municipalities to pass regulating ordinances and requirements for licensure. Local municipalities would be able to prohibit the cultivation and sale of marijuana with a 2/3 vote in the general election.

Licensed entities must be at least 60 percent owned by individuals who have been Missouri residents for a minimum of three years. No provision allows for individuals to cultivate marijuana in their residence and sale hours are limited.

According to estimates provided to the Secretary of State’s Office, state government entities estimate initial and one-time costs of $2.6 million, annual costs of $10 million, and annual revenues of at least $10 million. Local government entities estimate no annual costs and are expected to have at least $152,000 in annual revenues.

As a statutory amendment, it allows the Missouri General Assembly to revise the law and make improvements as necessary.

“For this particular industry, the kinds of investors, and the marketplace that is growing very rapidly we felt like a statutory approach is more appropriate than a constitutional approach because the probability that you might need to tweak something at some point is relatively high,” said Brown. He said that the chance of being a perfect day one is pretty low.

But the advantage the measure has as a statutory change could also be considered a disadvantage: the legislature can make changes. If Missouri’s lawmakers choose to, they could strip away a majority of the law, as legislators in other states are in the process of.

Amendment 2

The constitutional amendment put forth by New Approach Missouri will be the first marijuana-related question to show up on the ballot.

“Of the three initiative petitions, we are the first on the ballot which was a strategic move,” said Cardetti. “New Approach Missouri and the backers of Amendment 2 are a coalition of veterans, health care providers, and patients with one very important goal: make Missouri the 31st state that allows state licensed physicians to recommend medical marijuana to patients with serious and debilitating disease.”

The measure creates a framework where physicians may recommend marijuana or marijuana products to treat nine qualifying conditions — such as PTSD, seizures, cancer, and epilepsy — and “any other chronic, debilitating or other medical condition…” at the professional judgment of the physician.

Oversight of the program would fall to the Department of Health and Senior Services. The department would be able to limit purchases to 4 ounces of marijuana per patient every 30 days, with exceptions if doctors recommend a higher dose.

“This is a medical marijuana program. [DHSS] has experience working with health care providers and that is exactly what they would be doing here,” said Cardetti.

Patients would be required to obtain a medical marijuana card, at a cost of $25 annually, to enable access to treatment. A 4 percent excise tax in addition to local and state sales tax would be added to all marijuana products. The excise tax would go directly to the Missouri Veterans Health and Care Fund and all other excise taxes would be prohibited.

This measure would require DHSS to approve 1 cultivation center per 100,000 residents, 1 manufacturing facility per 70,000 residents, and at least 24 dispensaries in every congressional district. Cultivation, manufacturing, and dispensing facilities may not be established within 1,000 feet of a church, school, or daycare.

Those with medical marijuana cards would be able to cultivate up to 6 flowering plants for personal use.

According to estimates provided to the Secretary of State’s Office, this proposal could generate annual taxes and fees of $18 million for state operating costs and veterans programs, and $6 million for local governments. Annual state operating costs are estimated to be $7 million.

“Missourians want certainty on this issue, patients want certainty on this issue,” said Cardetti. “Ours is the only initiative that would put funding towards helping veterans in Missouri, and we think that is desperately needed.”

Amendment 3

Also called the Bradshaw Amendment, the proposal spearheaded by Springfield attorney and physician Brad Bradshaw would legalize medical marijuana and imposed the largest tax of any of the proposed measures.

This constitutional amendment would create the Biomedical Research and Drug Development Institute, which would oversee medical marijuana research in Missouri. The research board would be composed of nine members — all physicians, pharmacists, or holding a doctorate in a related field — receiving an annual salary equal to that of the Missouri Supreme Court Chief Justice.

It would be up to the board to determine which ailments would enable a person to have access to medical marijuana.

The research board may limit marijuana purchases, but not less than 3 ounces every 30 days. The board must issue at least 50 manufacturing licenses and allow one dispensary for every 20,000 residents in a county.

Patients would pay $100 annually for identification cards. A 15 percent excise tax would be charged at the retail level. A separate excise tax of $9.25 per ounce on flowers and buds and $2.75 per ounce on leaves would be charged.

Only 25 percent of a physician’s income would be allowed to come from treating qualifying patients. Physicians would not be able to issue certifications in excess of 25 percent of prescriptions written in the previous year.

According to estimates provided to the Secretary of State’s Office, this proposal could generate annual taxes and fees of $66 million. State governmental entities estimate initial implementation costs of $186,000 and increased annual operating costs of $500,000.