BILL ANALYSIS                                                                                                                                                                                                    







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        |Hearing Date:April 21, 2014        |Bill No:SB                         |
        |                                   |1262                               |
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                      SENATE COMMITTEE ON BUSINESS, PROFESSIONS 
                               AND ECONOMIC DEVELOPMENT
                              Senator Ted W. Lieu, Chair
                                           

                         Bill No:        SB 1262Author:Correa
                        As Amended:  April 21, 2014Fiscal:  Yes


        SUBJECT:  Medical marijuana: regulation of physicians, dispensaries,  
        and cultivation sites.
        
        SUMMARY:  Places certain practice restrictions and requirements on a  
        physician and surgeon who recommends medical marijuana to a patient;  
        requires medical marijuana dispensaries and cultivation facilities to  
        be licensed by the California Department of Public Health; provides  
        for enforcement of the licensing provisions by county health  
        departments; specifies that nothing shall prevent a city or other  
        local governing body from adopting local ordinances that regulate the  
        location, operation, or establishment of a medical marijuana  
        cooperative or collective.

        Existing law:
        
       1)Licenses and regulates physicians and surgeons under the Medical  
          Practice Act (Act) by the Medical Board of California (MBC) within  
          the Department of Consumer Affairs (DCA).  (Business and Professions  
          Code (BPC)  2000 et seq.)

           a)   Provides that the MBC shall take action against a physician  
             who is charged with unprofessional conduct, as specified.  (BPC   
             2234)

           b)   Requires the MBC to prioritize its investigative and  
             prosecutorial resources to ensure that physicians representing  
             the greatest threat of harm are identified and disciplined  
             expeditiously and includes in that prioritization list:   
             "Repeated acts of clearly excessive prescribing, furnishing, or  
             administering of controlled substances, or repeated acts of  





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             prescribing, dispensing, or furnishing of controlled substances  
             without a good faith prior examination of the patient and medical  
             reason therefor."  (BPC  2220.05)

       1)The Compassionate Use Act of 1996 (CUA), an initiative measure,  
          prohibits prosecution for the possession or cultivation of marijuana  
          of a patient or a patient's primary caregiver who possesses or  
          cultivates marijuana for the personal medical purposes of the  
          patient upon the written or oral recommendation or approval of a  
          physician.  (Health and Safety Code (HSC)  11362.5)

       2)Declares that the purposes of the CUA are:

           a)   To ensure that seriously ill Californians have the right to  
             obtain and use marijuana for medical purposes where that medical  
             use is deemed appropriate and has been recommended by a physician  
             who has determined that the person's health would benefit from  
             the use of marijuana in the treatment of cancer, anorexia, AIDS,  
             chronic pain, spasticity, glaucoma, arthritis, migraine, or any  
             other illness for which marijuana provides relief.

           b)   To insure that patients and their primary caregivers, who  
             obtain and use marijuana for medical purposes upon the  
             recommendation of a physician, are not subject to criminal  
             prosecution or sanction. 

           c)   To encourage the Federal and State governments to implement a  
             plan to provide for the safe and affordable distribution of  
             marijuana to all patients in medical need of marijuana.  (HSC   
             11362.5 (b) (1) (A) to (C))

       3)States that nothing in the CUA shall be construed to supersede  
          legislation prohibiting persons from engaging in conduct that  
          endangers others, or to condone the diversion of marijuana for  
          non-medical purposes.  (HSC  11362.5 (b) (2))

       4)Provides that, notwithstanding any other provision of law, no  
          physician in California shall be punished, or denied any right or  
          privilege, for having recommended marijuana to a patient for medical  
          purposes.  (HSC  11362.5 (c))

       5)States existing law, relating to the possession and the cultivation  
          of marijuana, shall not apply to a patient, or to a patient's  
          primary caregiver, who possesses or cultivates marijuana for the  
          personal medical purposes of the patient upon the written or oral  
          recommendation or approval of a physician.  (HSC Section 11362.5  





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          (d))

       6)Defines "primary caregiver" for purposes of the CUA as the individual  
          designated by a patient who has consistently assumed responsibility  
          for the housing, health, or safety of that person.  (HSC   
          11362.5(e).

       7)Requires the California Department of Public Health to establish and  
          maintain a voluntary Medical Marijuana Program (Program) for  
          qualified patients to apply for identification cards, and county  
          health departments to issue identification cards to qualified  
          patients and their caregivers.  (HSC  11362.7, et. seq.)

       8)Provides that qualified patients, persons with valid identification  
          cards, and the designated primary caregivers of qualified patients  
          and persons with identification cards who associate within the State  
          of California in order to cultivate marijuana for medical purposes,  
          collectively or cooperatively, shall not, solely on that basis, be  
          subject to state criminal sanctions for the possession, sale,  
          transport, or other proscribed acts relating to marijuana.  
       (HSC  11362.775)

       9)Makes it a misdemeanor offense to, among other things,  fraudulently  
          represent a medical condition or provide any material misinformation  
          to a physician, health department designee, or to law enforcement,  
          for the purpose or falsely obtaining an identification card;  
          fraudulently use any person's identification card in order to  
          acquire, possess, cultivate, transport, use, produce, or distribute  
          marijuana; counterfeit, tamper with, or fraudulently produce an  
          identification card; breach any confidentiality requirements  
          pertaining to an identification card program.  (HSC  11362.81) 

       10)Requires a person who seeks an identification card to pay a fee and  
          provide to the county health department the person's name, proof of  
          residency, written doctor's recommendation, doctor's name and  
          contact information, caregiver's name and duties, and patient's and  
          caregiver's government issued photo identification card.  (HSC   
          11362.715 (a)) 

       11)Requires county health departments to issue serially numbered  
          identification cards to patients and caregivers containing: a unique  
          user identification number, an expiration date, the county health  
          department's name and telephone number, photo identification of the  
          cardholder, and a toll-free Department of Public Health telephone  
          number enabling state and local law enforcement officers to  
          immediately verify the card's validity.  (HSC Section 11362.735 (a))





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       12)Prohibits state or local law enforcement officers from refusing to  
          accept an identification card unless the officer has reasonable  
          cause to believe that the card is being used fraudulently or its  
          information is false or fraudulent.  (HSC  11362.78)

       13)Provides that qualified patients, persons with valid identification  
          cards, and their designated primary caregivers who associate in  
          order to collectively or cooperatively to cultivate marijuana are  
          not subject to criminal liability on that basis.  (HSC  11362.775)

       14)Prohibits medical marijuana dispensaries that possess, cultivate, or  
          distribute medical marijuana from being located within a 600 foot  
          radius of a school, and authorizes cities and counties to further  
          restrict the locations of medical marijuana collectives.  (HSC   
          11362.768)

       15)Lists marijuana as a hallucinogenic substance in Schedule I of the  
          California Uniform Controlled Substances Act.  (HSC  11054 (d))

        This bill:

       1)States legislative intent to the following:

           a)   The broad authority granted by the California Constitution to  
             cities and counties to determine, the appropriate uses of land  
             within their borders, allows each city and county to determine  
             whether or not a medical marijuana dispensary or other facility  
             that makes medical marijuana available may operate within its  
             borders.

           b)   If, pursuant to this authority, a city or county determines  
             that a dispensary or other facility that makes medical marijuana  
             available may operate within its borders, then there is a need  
             for the state to license and regulate these dispensaries and  
             other facilities.  A licensing requirement is not intended to  
             preempt local ordinances regarding the sale and use of medical  
             marijuana, including, but not limited to, security, signage,  
             lighting, and inspections.

           c)   The following elements are necessary to uphold important state  
             goals:

             1.     Strict provisions to prevent the potential diversion of  
               marijuana for recreational use.






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             2.     An effective means of restricting access to medical  
               marijuana by persons under 
             21 years of age.

           a)   The act shall not be construed to promote or facilitate the  
             non-medical, recreational possession, sale, or use of marijuana.

                Physician and Surgeon / Medical Board Provisions (MBC)
        
       2)Prior to recommending medical marijuana to a patient, a physician and  
          surgeon shall meet the following requirements: 

           b)   Have a doctor-patient relationship.

           c)   Conduct an appropriate prior examination of the patient to  
             establish that medical use of marijuana is appropriate.

           d)   Consult with the patient as necessary and periodically review  
             the treatment's efficacy.

       3)Requires a physician recommending medical marijuana to do the  
          following: 

           e)   Include a discussion of the side effects.

           f)   Address in the recommendation what kind of marijuana to  
             obtain, including high tetrahydrocannabinol (THC) levels, low THC  
             levels, high cannabidiol (CBD) levels, low CBD levels, and  
             explain the reason for recommending the particular strain.  Also  
             prohibits a physician and surgeon from recommending butane hash  
             oil.

           g)   Maintain records for individual patient supporting the  
             decision to recommend medical marijuana.

       4)Makes specified requirements for any recommendation for medical  
          marijuana to a person under 21 years of age: 

           h)   The recommendation must be approved by a board certified  
             pediatrician.

           i)   The recommendation must be for high CBD marijuana.

           j)   All recommendations must be for non-smoking delivery.

        5) Makes it a crime (misdemeanor) for a physician who recommends  





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           marijuana to a patient for a medical purpose to accept, solicit or  
           offer any form of remuneration from or to a licensed facility if  
           the physician or his or her immediate family has a financial  
           interest as specified.

        6) Requires MBC by January 1, 2016, to convene a task force of experts  
           on the use of medical marijuana, to review and update as necessary  
           physician guidelines for recommending medical marijuana to ensure  
           the competent review in cases concerning the recommendation of  
           marijuana for medical purposes.

        7) Makes it unprofessional conduct (thus subject to disciplinary  
           action by the MBC), for a physician to recommend marijuana to a  
           patient for a medical purpose without an appropriate 


        prior examination and a medical indication, or to recommend marijuana  
           for non-medical purposes.

          California Department of Public Health (CDPH) Licensing Provisions
        
       8) Requires the CDPH to license dispensing facilities and cultivation  
          sites, and: 

           a)   Prohibits a person from selling or providing marijuana other  
             than at a licensed dispensing facility.

           b)   Prohibits a person from growing or processing marijuana other  
             than at a licensed cultivation site.

       1)Defines the following terms:

           a)   "Licensed cultivation site" means a facility that grows or  
             grows and processes marijuana for medical use and that is  
             licensed, as specified.

           b)   "Licensed dispensing facility" means a dispensary, mobile  
             dispensary, marijuana processing facility, or other facility that  
             provides marijuana for medical use that is licensed, as  
             specified.

           c)   "Minor" means a person who is under 21 years of age.

       1)Prior to issuing a license to a dispensing facility or a cultivation  
          site, CDPH must require from each proposed facility: 






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           a)   The name of the owner or owners and the address and telephone  
             number of the proposed facility.

           b)   A description of the scope of the proposed business.

           c)   A certified copy of the local jurisdiction's approval to  
             operate within its borders.

           d)   A completed application required by CDPH.

           e)   Payment of a fee, in an amount determined by CDPH, sufficient  
             to cover but not exceed the actual costs of the administration of  
             the licensing provisions.

           f)   Any other information required by CDPH.

       1)Requires CDPH, after consulting with outside entities, to establish  
          standards for quality   assurance testing of medical marijuana, to  
          ensure protection against microbiological contaminants, and  
          prohibits non-organic pesticide use in any marijuana cultivation  
          site.

       2)Imposes certain requirements and prohibitions upon a licensed  
          dispensing facility, including:

           a)   Prohibits acquiring, possessing, cultivating, delivering,  
             transferring, transporting, or dispensing marijuana for any  
             purpose other than those authorized by Article 2.5 (commencing  
             with Section 11362.7) of Chapter 6 of Division 10.

           b)   Prohibits acquiring marijuana plants or products except  
             through the cultivation of marijuana by that facility, if the  
             facility is a licensed cultivation site, or another licensed  
             cultivation site.

       1)Prohibits a licensed facility from issuing a marijuana product to any  
          patient without first verifying that the recommending physician is  
          licensed to practice medicine in California.

       2)Prohibits the distribution of any form of advertising for physician  
          recommendation of medicinal  marijuana unless the advertisement  
          contains the following notice:

             "NOTICE TO CONSUMERS:  The Compassionate Use Act of 1996 ensures  
             that seriously ill Californians have the right to obtain and use  
             marijuana for medical purposes where medical use is deemed  





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             appropriate and has been recommended by a physician who has  
             determined that the person's health would benefit from the use  
             of marijuana.  Physicians arrive at the decision to make this  
             recommendation in accordance with accepted standards of medical  
             responsibility and are licensed and regulated by the Medical  
             Board of California.  California law prohibits advertising that  
             includes statements of bait, discount, premiums, gifts, or any  
             statements of a similar nature."

       3)Requires any advertising for physician recommendation for medicinal  
          marijuana to meet the advertising requirements of the Medical  
          Practice Act, and specifically prohibits fraudulent, deceitful, or  
          misleading statements, including statements or advertisements of  
          bait, discount, premiums, gifts, or any statements of a similar  
          nature.

        4) Requires implementing sufficient security measures to deter and  
           prevent unauthorized entrance into areas containing marijuana and  
           theft of marijuana at those facilities.  The security measures  
           shall include:  limiting access to the facility to only registered  
           qualifying patients, personal caregivers, and facility agents;  
           preventing unauthorized individuals from remaining on the premises;  
           establishing limited access areas accessible only to authorized  
           facility personnel; and storing marijuana in a secure, locked safe  
           or vault to prevent diversion, theft, and loss. 

       5)Requires a licensed facility to notify law enforcement within 24  
          hours after discovering  discrepancies during the inventory,  
          diversion, theft, loss, or any criminal activity involving the  
          facility or a facility agent, any loss or unauthorized alteration of  
          facility records, and any breach of security.

       6)Requires a licensed cultivation site to weigh, inventory, and video,  
          all medical marijuana to be transported prior to its leaving its  
          origination location.  Requires a licensed dispensing facility,  
          within eight hours after arrival at the destination, to re-weigh,  
          re-inventory, and video, all transported marijuana.

                              Local Government Provisions
        
       7)Provides for enforcement by the county health department, with  
          oversight by the CDPH.

       8)Authorizes an county enforcement officer to enter a facility during  
          the facility's hours of operation and other reasonable times to:






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           a)   Conduct inspections, issue citations, and secure samples,  
             photographs, or other evidence at a licensed facility or at a  
             facility suspected of being a dispensing facility or cultivation  
             site.

           b)   Obtain evidence, including documents, or copies of documents,  
             including inventories, or any record, file, paper, process,  
             invoice, video, or receipt in order to determine compliance with  
             the chapter.

       1)Requires a county enforcement officer to make a written report and  
          furnish a copy to the facility owner upon the completion of an  
          inspection or investigation.

       2)Requires local governments, upon request by CDPH, to provide reports  
          on the number and types of facilities operating within their  
          jurisdiction.

       3)Makes a facility license subject to the restrictions of the local  
          jurisdiction in which the facility operates or proposes to operate.   
          Specifies that even if a license has been granted by CDPH, a  
          facility shall not operate in a local jurisdiction that prohibits  
          the establishment of that type of business.

       4)Makes violation of the licensing provisions punishable by a civil  
          fine of up to $35,000 for each individual violation.

       5)Specifies that nothing shall prevent a city or other local governing  
          body from:

           a)   Adopting local ordinances that regulate the location,  
             operation, or establishment of a medical marijuana cooperative or  
             collective.

           b)   The civil and criminal enforcement of those local ordinances.

           c)   Enacting other laws consistent with the licensing provisions.
        

        FISCAL EFFECT:  Unknown.  This bill has been keyed "fiscal" by  
        Legislative Counsel.
        

        COMMENTS:
        
       1.Purpose.  This bill is sponsored by  California Police Chiefs  





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          Association  and  League of California Cities  (Sponsors) to establish  
          a regulatory framework for medical marijuana that prioritizes public  
          safety and local control.

       According to the Author, SB 1262 is aimed at setting tighter  
          regulations on doctors who issue medical marijuana recommendations,  
          including recommendations to minors.  The bill would require all  
          marijuana dispensing facilities and cultivations sites to be  
          licensed by the Department of Public Health (DPH).  Approval from  
          local jurisdictions would be required as part of the state license.   
          The Author states that the bill also upholds local governments'  
          ability to ban medical marijuana dispensaries and all related  
          facilities, sets uniform health and safety 

       standards to be administered by counties with oversight by the DPH, and  
          outlines security measures for all medical marijuana facilities.

       The Author writes, "While medical marijuana is legal in California, the  
          industry is poorly regulated.  Existing laws lack appropriate  
          standards for medical marijuana recommendations, cultivation,  
          processing and sales.  SB 1262 will set needed health and safety  
          standards, require licensing, protect local authority, and establish  
          security measures for the sale of medical marijuana."

       2.Background.  Since the approval of the CUA by voters in 1996,  
          commonly known as Proposition 215, state law has allowed  
          Californians access to marijuana for medical purposes, and  
          prohibited punitive action against physicians for making medical  
          marijuana recommendations.  SB 420 (Vasconcellos, Chapter 875,  
          Statutes of 2003), allowed patients and primary caregivers to  
          cultivate marijuana for personal use and established in the CDPH a  
          medical marijuana card program for patients to use on a voluntary  
          basis.

       In the intervening 11 years, although there have been several  
          legislative attempts, no broader, feasible regulatory structure has  
          been established, and the implementation of the CUA has been marked  
          by conflicting authorities, regulatory chaos, intermittent federal  
          enforcement action, and a series of lawsuits which have tested the  
          limits of the CUA, and focused on the extent of the authority of  
          local government.

       The Author indicates that most attempts at medical marijuana  
          legislation in California have been geared toward state pre-emption,  
          and unsympathetic to the authority of local government.  None have  
          been health-based, despite the medical rationale that spawned the  





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          CUA.  None have sought to impose any health and safety standards,  
          despite the fact that the regulatory structure they tried to  
          establish would have exercised oversight over what is known to be a  
          psychotropic substance.  And finally, no legislation has squarely  
          addressed the many public safety concerns triggered by such a  
          regulatory scheme, according to the Author.

       3.Compassionate Use Act of 1996.  California voters passed the CUA in  
          1996.  The CUA established the right of patients to obtain and use  
          marijuana to treat specified illnesses and any other illness for  
          which marijuana provides relief.  Additionally, the CUA specifically  
                                                        protects physicians who recommend the use of marijuana to patients  
          for medical purposes and exempts qualified patients and their  
          primary caregivers from California drug laws prohibiting possession  
          and cultivation of marijuana.

       The CUA is a broadly-framed law.  It establishes the right of a patient  
          to obtain medical marijuana pursuant to a physician's  
          recommendation.  The initiative then simply encourages the state and  
          federal governments to "implement a plan for safe and affordable  
          distribution of marijuana [to qualified patients]."  It has been  
          argued that very little has been done to implement the initiative.   
          Instead of a comprehensive implementation plan, numerous  
          uncoordinated bills have been introduced in the Legislature.   
          Further, the courts have only provided a small measure of clarity  
          and certainty in this area.

       4.CDPH Medical Marijuana Program.  The California Department of Public  
          Health, Medical Marijuana Program (MMP) was specifically established  
          by SB 420 (Vasconcellos, Chapter 875, Statutes of 2003) to create a  
          State-authorized medical marijuana identification card (MMIC), along  
          with a registry database for verification of qualified patients and  
          their primary caregivers.  Participation by patients and primary  
          caregivers in this identification card program is voluntary.  The  
          MMP Web-based registry allows law enforcement and the public to  
          verify the validity of a qualified patient or primary caregiver's  
          MMIC as authorization to possess, grow, transport, and/or use  
          medical marijuana within California.  A qualified patient or primary  
          caregiver may possess no more than 8 ounces of dried marijuana per  
          qualified patient (HSC  11362.77).  Under the MMP, a patient or  
          qualified caregiver with a recommendation for medical marijuana from  
          a licensed California physician can for a MMIC through the local  
          County Public Health Department.  Fees for the card registration  
          vary from county to county and the card is valid for one year, after  
          which the card must be renewed.  A primary caregiver card will  
          expire when the patient's card expires.  





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       In order to apply for a MMP, a patient or qualified caregiver must  
          reside in the county where they apply, present the physician  
          recommendation for medical marijuana, and pay the fee required by  
          the county.  Upon issuance of the MMIC, the card is registered into  
          an online database which law enforcement can use to verify whether a  
          MMIC is valid.  

       The MMP is a voluntary registration program.  A patient or a qualified  
          caregiver is not required to obtain a MMIC or to participate in the  
          MMP in order to use medical marijuana upon the recommendation of a  
          physician under the CUA.

       5.California Attorney General's Compassionate Use Guidelines.  In 2003,  
          SB 420 additionally required the California Attorney General to  
          adopt "guidelines to ensure the security and non-diversion of  
          marijuana grown for medical use" (HSC  11362.81 (d)).  To fulfill  
          this mandate, in August of 2008, the Attorney General published  
          Guidelines for the Security and Non-Diversion of Marijuana Grown for  
          Medical Use (California Attorney General. August 2008) (Guidelines).  
           The Guidelines are intended to:  (1) ensure that marijuana grown  
          for medical purposes remains secure and does not find its way to  
          non-patients or illicit markets, (2) help law enforcement agencies  
          perform their duties effectively and in accordance with California  
          law, and (3) help patients and primary caregivers understand how  
          they may cultivate, transport, possess, and use medical marijuana  
          under California law.

       6.Marijuana - A Schedule 1 Drug.  Even though California voters enacted  
          the CUA to permit the use of marijuana for medical purposes by  
          persons deemed qualified by their physicians, marijuana still is an  
          illegal drug both under federal and state law, and its use,  
          possession, distribution, cultivation, or sale carries criminal  
          penalties.  Under California law, marijuana is listed as a  
          hallucinogenic substance in Schedule I of the California Uniform  
          Controlled Substances Act (HSC  11054 (d)).  Under federal law,  
          possession of marijuana, even by medical users, continues to be a  
          crime.  The federal Controlled Substances Act specifies that, except  
          as provided, it is unlawful for any person knowingly or  
          intentionally to manufacture, distribute, or dispense, or possess  
          with intent to manufacture, distribute, or dispense a controlled  
          substance.  (21 U.S.C. Sec. 841(a))  The only exception provided in  
          the Controlled Substances Act for marijuana, a Schedule I drug, is  
          for its use in government-controlled research projects.

       Thus far, calls to reclassify marijuana to remove it from the list of  





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          Schedule I drugs have not resulted in any change in classification.   
          Since marijuana is a Schedule I drug, the medical community is  
          unable to do any substantive clinical trials, controlled studies or  
          peer-reviewed research.  Therefore, it is difficult, if not  
          impossible, for a physician to make recommendations about what kind  
          of marijuana to obtain (high THC, high CBD, low CBD) and explain the  
          reason for recommending the particular strain of marijuana.  A lack  
          of evidence-based medicine further makes it difficult for a  
          physician to evaluate the efficacy of a patient's course of  
          treatment with medical marijuana.  These are both elements of this  
          bill which may well prove problematic within the field of the  
          practice of medicine.  

       7.U. S. Department of Justice Guidance Rewarding Marijuana Enforcement.  
           In August of 2013, the U.S. Department of Justice (USDOJ) issued a  
          memorandum titled "Guidance Regarding Marijuana Enforcement" to all  
          U.S. Attorneys.  The memorandum updated the prior guidance given by  
          USDOJ regarding marijuana enforcement under the federal Controlled  
          Substances Act, in light of state ballot initiatives that legalize  
          marijuana under state laws and that provide for the possession and  
          use of small amounts of marijuana.  

       While affirming that marijuana is still, at the federal level,  
          considered a dangerous drug and that the illegal distribution and  
          sale of marijuana is a serious crime, the memorandum outlines  
          enforcement priorities that are particularly important to the  
          federal government, including:  preventing distribution to minors;  
          preventing revenue from marijuana from going to criminal  
          enterprises; preventing diversion to other states where marijuana is  
          not legal under state law; preventing state-authorized marijuana  
          from being a cover for trafficking in other illegal drugs or illegal  
          activity; preventing violence in cultivating and distributing  
          marijuana; preventing drugged driving and other public health  
          problems from marijuana use; and preventing growing, possessing or  
          using marijuana on public lands or on federal property

       The document clearly lays out the federal expectation for the states  
          that have legalized marijuana, even if only for medical purposes,  
          that they will develop a robust system of regulation and  
          enforcement, and that such a system will reduce the likelihood of  
          federal enforcement activity.

       8.Local Control of Medical Marijuana Dispensaries.  In 2013, the  
          California Supreme Court in City of Riverside v. Inland Empire  
          Patients, upheld that local governments have inherent zoning power.   
          The issue in this case was whether California's medical marijuana  





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          statutes preempt a local ban on facilities that distribute medical  
          marijuana.  The Court concluded they do not and upheld the City of  
          Riverside's implementation of a ban on medical marijuana  
          dispensaries and on any facility that is prohibited by federal or  
          state law. 

       9.Related Legislation.   AB 604  (Ammiano, 2013) creates a Division of  
          Medical Cannabis Regulation and Enforcement within the Department of  
          Alcoholic Beverage Control with exclusive power to register persons  
          for the cultivation, manufacture, testing, transportation, storage,  
          distribution, and sale of medical cannabis within the state subject  
          to specified exemptions for a city or county.  Provides that a  
          commercial registrant and its employees regarding medical cannabis  
          are not unlawful, as specified, and establishes requirements for the  
          transportation of medical cannabis.  Specifies that its provisions  
          do not affect local zoning ordinances or laws of general  
          application.  Makes a physician recommending marijuana to patients  
          without a good faith examination and medical reason to be  
          unprofessional conduct and should be given priority for  
          investigation and prosecution by the MBC.  (  Status  :  Referred to  
          Senate Public Safety Committee.)

        SB 439  (Steinberg, 2013) exempts medical-marijuana collectives and  
          cooperatives from criminal liability for possession, cultivation,  
          possession for sale, sale, transport, importation, and furnishing  
          marijuana.  Clarifies MBC enforcement of medical marijuana  
          recommendations, what constitutes unprofessional conduct, and the  
          bar on the corporate practice of medicine.  (Status:  Referred to  
          Assembly Health Committee.)

        AB 473  (Ammiano, 2013) enacted the Medical Marijuana Regulation and  
          Control Act, and create a Division of Medical Marijuana Regulation  
          and Enforcement in the in the Department of Alcoholic Beverage  
          Control to regulate the cultivation, manufacture, testing,  
          transportation, distribution, and sale of medical marijuana.   
          (  Status  :  This measure failed passage on the Assembly Floor.)

        AB 2312  (Ammiano, 2012) established a nine-member Board of Medical  
          Marijuana Enforcement within the Department of Consumer Affairs to  
          regulate the medical marijuana industry and to collect fees from  
          medical marijuana businesses to be deposited into a new Medical  
          Marijuana Fund.  The bill would have authorized local taxes on  
          medical marijuana up to 5%.  (  Status  :  This bill died in Senate  
          BP&ED.)

        AB 2465  (Campos, 2012) made medical marijuana patient and caregiver  





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          identification cards mandatory, and required medical marijuana  
          collectives to keep copies of members' identification cards.   
          (  Status  :  This bill died without hearing in Assembly Public Safety  
          Committee.)

        SB 1182  (Leno, 2012) provided that a cooperative or collective that  
          operates within the Attorney General's (AG) shall not be subject to  
          prosecution for marijuana possession or commerce, as specified; and  
          provided that where such an entity operates within the AG's  
          guidelines, the entity and its employees, officers and members shall  
          not be subject to prosecution for marijuana commerce because the  
          entity or its employees, officers, or members received compensation  
          for actual expenses incurred in carrying out activities in  
          compliance with the guidelines.  (  Status :  This bill died on Senate  
          Floor.)

        SB 129  (Leno, 2012) prohibited employment discrimination on the basis  
          of a person's status as a qualified patient (medical marijuana user)  
          or on the basis of the person's positive drug test for marijuana,  
          provided the person is a qualified patient and the medical use of  
          marijuana does not occur at the place of employment or during hours  
          of employment.  (  Status  :  This bill died on Senate Inactive File.)

        AB 1300  (Blumenfield, Chapter, 196, Statutes of 2011) provided that a  
          local government may enact an ordinance regulating the location,  
          operation or establishment of a medical marijuana cooperative or  
          collective.  Authorized a local government to enforce such  
          ordinances through civil or criminal remedies and actions; and  
          authorized the local government to enact any ordinance that is  
          consistent with the Medical Marijuana Program, which is intended to  
          implement the CUA.

        AB 1017  (Ammiano, 2011) made the cultivation of marijuana alternatively  
          punishable as a misdemeanor with a penalty of imprisonment in a  
          county jail for a period of not more than one year.  (  Status  :  This  
          bill failed passage on Assembly Floor.) 

        AB 223  (Ammiano, 2011) provided that the CUA does not authorize a  
          qualified patient or person with an identification card to engage in  
          the smoking of medical marijuana within 600 feet of the grounds of a  
          school, recreation center, or youth center, unless the medical use 

       occurs within a residence or within a medical marijuana cooperative,  
          collective, or dispensary.  (  Status  :  This bill died in Assembly  
          Public Safety Committee.)






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        SB 626  (Calderon, 2011) would require the Board of Equalization (BOE)  
          to establish a nine-member task force to conduct a study to  
          determine ways to enhance collections of sales and use taxes on  
          retail sales of marijuana and ensure proper regulation of the  
          cultivation, transportation, and distribution of marijuana and  
          marijuana products.  (  Status  :  This bill was held in Senate  
          Appropriations Committee.) 

        SB 847  (Correa, 2011) prohibited any medical marijuana entity that  
          possesses, cultivates, or distributes medical marijuana from  
          locating within 600 feet of a residential area unless a local  
          ordinance has been adopted to specifically regulate the location of  
          these entities in relation to residential use.  (  Status  :  This bill  
          was vetoed by Governor Brown.)

        AB 2650  (Buchanan, Chapter 603, Stats. 2010) prohibited operation or  
          establishment of a medical marijuana cooperative, collective,  
          dispensary or provider within 600 feet of a school; provided that  
          ordinances adopted prior to January 1, 2011 regulating the location  
          or establishment of such a medical marijuana entity shall not be  
          preempted by the bill; authorized a local entity to only adopt an  
          ordinance that restricts the location or establishment of a medical  
          marijuana entity at a further distance than is restricted by the  
          bill.

        SB 1098  (Migden, 2008) required the State Board of Equalization to  
          administer a tax amnesty program, as specified, for medical  
          marijuana dispensaries, as defined.  (  Status  :  This bill died in  
          Senate Revenue and Taxation Committee.)

        SB 529  (Migden, 2007) required the Board of Equalization to administer  
          a tax amnesty program, as specified, for medical marijuana  
          dispensaries.  (  Status  :  This bill was gutted and amended to  
          different subject.)

        SB 420  (Vasconcellos, Chapter 875, Statutes of 2003) established the  
          Medical Marijuana Program Act, a statewide, voluntary program for  
          the issuance of identification cards to identify persons authorized  
          to engage in the medical use of marijuana under the CUA. 

       10.Arguments in Support.  In sponsoring the bill, the  League of  
          California Cities  writes that in 2013, the League and the California  
          Police Chiefs Association "joined forces to defeat no fewer than  
          four bills in the California Legislature that sought to regulate  
          medical marijuana.  We opposed each of the bills over concerns they  
          would have preempted local control, ignored significant public  





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          safety concerns, and failed to address important health and safety  
          issues."  The League states that SB 1262, "which has been carefully  
          vetted with city attorneys, police chiefs, and the League's Public  
          Safety Policy Committee, provides what California has lacked since  
          the passage of Proposition 215 in 1996:  a reasonable public safety  
          and health-based approach to implementing this proposition in a  
          state with great size and diversity."

       The  California Police Chiefs Association  argues that the bill  
          establishes an improved regulatory structure to ensure that  
          Proposition 215 works as originally envisioned to assist patients  
          with legitimate medical needs, in a manner that works for law  
          enforcement, city and county governments, local community  
          organizations, and medical professionals.  "As police chiefs and  
          local government leaders, we believe it is time to address the flaws  
          associated with 

       Proposition 215 implementation in a responsible, realistic and  
          health-based fashion while also protecting the needs of legitimate  
          medical patients."

       A number of  California cities  and  city police associations  have  
          written, voicing support for the bill, stating that previous  
          legislation sought to pre-empt or undermine local control, only  
          partially addressed the significant public safety concerns raised by  
          medical marijuana, and failed to address important health and safety  
          issues that are inevitably triggered by a regulatory process for any  
          medicine.  The supporters state that municipal governments, are on  
          the front lines on this issue along with local police departments,  
          and have to cope with the effects of the current chaotic regulatory  
          structure for medical marijuana on a daily basis.  These supporters  
          believe that the bill puts a responsible regulatory structure in  
          place that protects patient access while protecting local control  
          and addressing public safety issues.

        International Faith Based Coalition  (IFBC) states its strong support of  
          the bill stating "The sad fact is that anyone who simply wants to  
          get high can obtain a marijuana recommendation from a compliant  
          doctor.  Here in Sacramento the infamous 'Dr. Skype' was churning  
          out medical recommendations in a 42 second time-frame.  Those 42  
          seconds included a 'consultation' conducted on Skype.  Unhappily,  
          the "Dr. Skype" example is not an isolated one, as this practice of  
          recommendations for everyone pervades the state."  The IFBC writes  
          that requiring the existence of a bona-fide doctor-patient  
          relationship in order to issue a medical marijuana recommendation  
          assures that people who need to obtain a recommendation for  





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          legitimate medical purposes may obtain one, while eliminating the  
          deplorable practices that have been taking place.

       The  Association For Los Angeles Deputy Sheriffs  ;  Association Of Orange  
          County Deputy Sheriffs  ;  California Fraternal Order Of Police  ;  
           California Police Chiefs Association  ;  Long Beach Police Officers  
          Association  ;  Los Angeles County Professional Peace Officers  
          Association  ;  Los Angeles Police Protective League  ;  Riverside  
          Sheriffs Association  ;  Sacramento County Deputy Sheriffs Association  ;  
           Santa Ana Police Officers Association write in support that what  
          voters did not have in mind is what we have today:  A state of  
          affairs where medical marijuana recommendation fraud is so rampant  
          that virtually anyone in California may obtain a recommendation to  
          use marijuana.  

       11.Arguments in Opposition.   Butte County  opposes the bill, stating  
          that the bill would specifically assign enforcement responsibilities  
          on county health departments, and argues that this assignment of  
          enforcement responsibilities weakens local control.  

       12.Oppose Unless Amended.   California Medical Association  (CMA) opposes  
          the bill unless amended, stating that generally speaking, the issues  
          of inappropriate recommendations of medical marijuana stem from a  
          lack of enforcement of existing and widely accepted community  
          standards of care involving medical marijuana.  CMA states that it  
          has been working with the Author and recommends amendments to make  
          enforcement of the medicinal marijuana recommendations an  
          enforcement priority of the MBC, and in addition recommends six  
          other consumer protections that would make a meaningful impact on  
          inappropriate recommendations.  CMA states that several provisions  
          of the bill could subject physicians to federal enforcement action  
          due to the Schedule I federal classification of marijuana.  The bill  
          would require physicians to include in the recommendation the type  
          and strength of marijuana to use, despite the fact that this  
          information is generally not available due to the federal Schedule I  
          designation.  CMA states that the bill would create additional and  
          significant hurdles for children who suffer from epilepsy, seizures,  
          and other neurological conditions, despite promising outcomes that  
          have been reported.  

        California National Organization for the Reform of Marijuana Laws  (Cal  
          NORML) strongly opposes the bill unless it is amended.  Cal NORML  
          contends the bill restricts recommendations to a patient's primary  
          care physician or a physician referred by his or her primary care  
          physician.  Committee staff notes that the Author has removed this  
          provision in the latest amendments.  Cal NORML believes the bill  





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          restricts a physician's right to recommend contrary to the CUA.  The  
          bill would further restrict recommendations for minors to  
          pediatricians only.  Cal NORML recommends the bill be amended to  
          provide for separately regulates processing facilities, and that the  
          physician referral restrictions be removed from the bill.

        Law Enforcement Against Prohibition  (LEAP) opposes SB1262's provisions  
          restricting physician recommendations, and has taken an oppose  
          unless amended position on the bill.  At the same time LEAP regards  
          the remainder of the bill as a first step towards legal regulation,  
          in keeping with the CUA, for a system of safe and affordable  
          distribution of marijuana to all patients in medical need.

        Yolo County Board of Supervisors  opposes the bill unless amended, and  
          writes that while the County welcomes more regulation of the medical  
          marijuana industry, it cannot support the bill as written, since the  
          bill currently imposes a state-mandated local program by designating  
          county health departments as the enforcement agencies for medical  
          marijuana dispensary licensing.  "County health departments do not  
          have the funding, staff, or expertise to act as the enforcement  
          agencies for medical marijuana dispensary licensing."

        Americans for Safe Access (ASA)  , recommends amendments to ensure that  
          the interests of legal medical marijuana patients are respected,  
          including:  establishing incentives for local jurisdictions that  
          choose to regulate medical marijuana cultivation, processing,  
          provision, and testing; providing sliding scale licensing fees to  
          protect smaller cooperative patient cultivation; including language  
          to ensure that cooperatives and collectives qualified to operate  
                                           under Measure D, in Los Angeles in 2013, and other similar local  
          ordinances will also be qualified under the bill; significantly  
          revising the provisions for doctors who recommend medical marijuana  
          to ensure that the bill does not inadvertently choke off access to  
          medicine for legitimate patients.

        Greater Los Angeles Collective Alliance  (GLACA) states that changes  
          need to be made to the bill to reflect the realities of how those  
          who use medical cannabis obtain recommendations from doctors.  CLACA  
          states:  "Without these changes, you will have cut off access to  
          medical cannabis for the sickest and most vulnerable of the  
          population; those with terminal illnesses who have been thrown into  
          poverty as their disease progressed."  

        Rural County Representatives of California  (RCRC) has an oppose unless  
          amended position and states that the issue of marijuana cultivation  
          is of particular focus to RCRC's member counties, and in the absence  





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          of state policies, a number of counties have adopted ordinances  
          banning dispensaries and restricting/banning growing marijuana.   
          RCRC states that the bill takes a completely different perspective  
          than RCRC's policies which advocates a strong regulatory scheme at  
          the state level which is administered by a state agency.  Although  
          local agencies must retain their police power, particularly over  
          land use, counties expect to have minimal involvement in the  
          administration of the state's medical marijuana regulatory scheme.   
          RCRC states that the bill as drafted places new requirements on a  
          number of county entities (environmental health, agricultural  
          commissioners, sheriff's departments) to perform a number of  
          regulatory activities.  The resulting new responsibilities would  
          require a dramatic restructuring to limit a county's role and  
          responsibilities and place the day-to-day regulation of medical  
          marijuana with the State of California.

       13.Policy Issues.  Several policy concerns are noted in regard to this  
          bill which the Author and Sponsors should address in the event that  
          the bill moves forward.  

           a.   Apparent lack of enforcement. In stating the need for the  
             bill, proponents have raised a number of anecdotal accounts of  
             problems with physicians making recommendations for patients to  
             use medical marijuana.  These range from the so called "Dr.  
             Skype" in Sacramento who spent an average of 42 seconds meeting  
             with a patient over an Internet video connection before  
             recommending medical marijuana, to advertising for physician  
             referrals by bikini-clad roller skaters on beach boardwalks, to  
             guarantees in advertising that "you will get a marijuana card or  
             your money back," to handing out discount cards at hemp  
             festivals, to doctors who will recommend medical marijuana for  
             virtually any medical condition alleged by a patient with little  
             or no verification by the physician.  It appears that these cases  
             are not only egregious but are also currently in violation of the  
             standard of care for a physician under the law.  This appears to  
             be an argument that there is a current lack of enforcement by  
             state regulatory agencies, in particularly by the MBC.

           b.   Pediatrician referrals for persons under 21.  The bill  
             requires medical marijuana referrals for persons under 21 years  
             of age to be made by board certified pediatricians.  Typically  
             pediatricians see children only up to 18 years of age.  Thus, the  
             bill leaves a gap in who can recommend medical marijuana for  
             persons between 18 and 21 years old.

           c.   Physician recommendations for specific strains of medical  





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             marijuana.  The bill requires a physician recommendation to  
             address what kind of marijuana to obtain, including high THC  
             levels, low THC levels, high CBD levels, low CBD levels, and  
             explain the reason for recommending the particular strain of  
             marijuana, and prohibits a physician from recommending butane  
             hash oil.  Since there is an admitted paucity of clinical data  
             and empirical studies regarding specific uses and types of  
             applications of medical marijuana, these requirements may be  
             misplaced.  The Committee may wish the Author or Sponsors to  
             address this issue.

           d.   Criminal background checks.  Admittedly, the emergence of  
             medical marijuana has a strong likelihood of attracting a  
             criminal element to the cultivation, processing or dispensary  
             components of the regulated practice.  However, it does not  
             appear that there are any provisions for criminal background  
             checks by the CDPH in licensing dispensaries or cultivation  
             facilities or by their employees or agents.

           e.   Enforcement and licensing.  The bill requires dispensaries and  
             cultivation facilities to be licensed by CDPH, and provides for  
             enforcement of the licensing provisions to be carried out by  
             county health departments.  This arrangement appears to create a  
             disconnect between the licensing and enforcement agencies, and  
             increases the likelihood of the agencies moving in divergent  
             directions.  The Committee may wish the Author or Sponsors to  
             discuss how these issues might best be addressed in the bill.

         NOTE :  Double-referral to Health Committee (Second).  Any amendments  
        to this bill should be made in Senate Health Committee.

        
        SUPPORT AND OPPOSITION:
        
         Support  :

        California Police Chiefs Association (Sponsor)
        League of California Cities (Sponsor)
        Association for Los Angeles Deputy Sheriffs
        Association of Orange County Deputy Sheriffs
        California Association of Code Enforcement Officers
        California Fraternal Order of Police
        City of Adelanto
        City of Beaumont
        City of Canyon Lake
        City of Chowchilla





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        City of Covina
        City of Encinitas
        City of Etna
        City of Fortuna
        City of Gardena
        City of Glendora
        City of Hemet
        City of Highland
        City of La Palma
        City of Lathrop
        City of Lodi
        City of Merced
        City of Norwalk
        City of Rancho Cordova
        City of Rancho Cucamonga
        City of Rancho Mirage
        City of Rosemead
        City of Sacramento
        City of San Carlos
        City of Woodland
        Covina Police Department
        El Monte, South El Monte Chamber of Commerce
        International Faith Based Coalition
        Long Beach Police Officers Association
        Los Angeles County Police Professional Peace Officers Association
        Los Angeles Police Protective League
        Mammoth Lakes Police Department
        Riverside Sheriffs Association
        Sacramento County Deputy Sheriffs Association
        San Diego County District Attorney
        San Diego District Attorney
        Santa Ana Police Officers Association
        Smart Approaches to Marijuana (Project SAM)
        Town of Colma Police Department
        Town of Danville

         Support if Amended  :
         
         Patient Advocacy Network

         Opposition  :

        Butte County Board of Supervisors

         Oppose Unless Amended  :  
         





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        American Academy of Cannabinoid Medicine
        Americans for Safe Access
        California Medical Association
        California National Organization for Reform of Marijuana Laws (oppose  
        unless amended)
        California National Organization for the Reform of Marijuana Laws (Cal  
        NORML)
        Drug Policy Alliance
        Law Enforcement Against Prohibition
        Rural County Representatives of California
        The Greater Los Angeles Collective Alliance
        Yolo County



        Consultant:G. V. Ayers