BILL ANALYSIS Ó
AB 258
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Date of Hearing: April 7, 2015
ASSEMBLY COMMITTEE ON HEALTH
Bonta, Chair
AB
258 (Levine) - As Amended March 25, 2015
SUBJECT: Organ transplants: medical marijuana: qualified
patients.
SUMMARY: Prohibits a potential recipient of an organ transplant
from being denied based solely on their use of medical marijuana
(MM). Specifically, this bill:
1)Prohibits a hospital, physician and surgeon, procurement
organization, or other person from denying the recipient of an
anatomical gift based solely on a potential recipient's status
as a patient whose physician has recommended MM, or based
solely on a positive test for the use of MM.
2)Allows for an exception to the provisions in 1) if the
patient's use of MM, based on a case-by-case evaluation by a
physician or surgeon, has been found to be medically
significant to the provision of the anatomical gift.
3)Applies the provisions in 1) above to each part of the organ
transplant process, including, but not limited to:
a) The referral from a primary care provider to a
specialist;
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b) The referral from a specialist to a transplant center;
c) The evaluation of the patient for the transplant by the
transplant center; and,
d) The consideration of the patient for placement on the
official waiting list.
4)Requires the court to accord priority on its calendar and
handle expeditiously any action brought to seek any remedy
authorized by law for purposes of enforcing compliance with
this section.
EXISTING LAW:
1)The Compassionate Use Act, enacted by the approval of
Proposition 215 at the November 6, 1996 statewide general
election established the right of patients and their primary
caregivers to obtain and use MM, as recommended by a
physician, in the treatment of cancer, anorexia, AIDS, chronic
pain, spasticity, glaucoma, arthritis, migraine, or any other
illness for which MM provides relief.
2)The Uniform Anatomical Gift Act regulates the making and
distribution of organ donations.
FISCAL EFFECT: None.
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COMMENTS:
1)PURPOSE OF THIS
BILL. According to the author, arcane public health policies
treat medical cannabis patients as drug abusers and as a
result, too often, patients are denied a life-saving organ
transplant solely because they are recommended medical
cannabis. The author notes that many of these patients have
died after being dropped from the list, and many more are in
jeopardy right now and contends that this bill will save lives
by ensuring medical cannabis patients are not discriminated
against in the organ transplant process.
2)BACKGROUND. The Organ Procurement and Transplantation Network (OPTN) is
a unique public-private partnership that links all
professionals involved in the United States donation and
transplantation system. The United Network for Organ Sharing
(UNOS) serves as the OPTN under contract with the Health
Resources and Services Administration of the U.S. Department
of Health and Human Services. UNOS is a private, non-profit
organization. Currently, every transplant hospital program
and organ procurement organization in the United States is an
OPTN member. Membership means that their transplant programs
are certified by UNOS, and that they play an active role in
forming the policies that govern the transplant community. In
California there are 21 transplant centers (hospitals) and
four Organ Procurement Organizations (OPOs), organizations
authorized by the Centers for Medicare and Medicaid Services
to procure organs for transplantation.
Each individual hospital comes up with their own policies
regarding how they evaluate a patient to determine whether or
not they are eligible to receive an organ transplant. UNOS
develops the policies to determine how available organs are
distributed among eligible patients waiting for a transplant.
According to OPTN there are currently 123,288 people in the
United States waiting for a life-saving organ transplant, and
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every 10 minutes another person is added to that list.
According to the UNOS, approximately 23,000 Californians are
on the waiting list for an organ transplant.
a) Substance use vs. abuse. A 2011 study published in the
University of Michigan Journal of Law Reform, "Transplant
Candidates and Substance Use: Adopting Rational Health
Policy for Resource Allocation," notes that the autonomy
OPOs and hospitals have in determining selection criteria
for transplant recipients has led to striking differences
in selection tactics with regard to individuals who present
issues of substance use and abuse, and one of the greatest
areas of regulation that lacks medical and policy
foundation is medicinal marijuana use and cigarette
smoking. The evidence of cigarette smoking harm is clear.
According to the World Health Organization tobacco use
causes 8.8% of deaths worldwide and kills more than 430,000
U.S. citizens each year - more than alcohol, cocaine,
heroin, homicide, suicide, car accidents, fire, and AIDS
combined. According to a 2008 study of substance abuse
policies for liver transplant candidates, those who smoke
cigarettes are much more readily accepted by liver
transplant centers than those who use marijuana, even
though marijuana has been found to have beneficial health
care uses, including relieving pain and curbing nausea.
b) The effect of MM on organ transplant recipients. A 2009
study published in the American Journal of Transplantation,
"Marijuana Use in Potential Liver Transplant Candidates",
notes that tetrahydrocannabinol, commonly known as THC, the
active component in marijuana, may contribute to the
development of various liver diseases and could exacerbate
liver disease, however the study also notes that
cannabinoids have been shown to help regulate immune system
functions, and anti-inflammatory properties, potentially
reducing the risk of rejection. The study finds that
overall, the survival of marijuana users with chronic liver
disease who present for transplant evaluation is not
significantly different from marijuana non-users, and from
those findings, the study concludes that marijuana users
are not systematically exposed to excess risk of mortality.
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However, a 2011 article in the American Journal of Hospice
& Palliative Medicine, "Medical Marijuana and Organ
Transplantation: Drug of Abuse, or Medical Necessity?"
examined the case of a patient at a state-funded hospital,
in a state where MM is legal, who was disqualified as a
transplant recipient for his use of MM, even though it was
recommended by his primary care physician. The patient
subsequently died. The authors of the article concluded
that this case shows the need for more research on the
medical use of marijuana and for states that have made
marijuana legal to examine how the laws affect the policies
for state-funded hospitals.
According to the California Hospital Association, policies
regarding the criteria for medicinal marijuana use and
organ transplants vary at each institution. The
eligibility to receive an organ depends upon the type of
transplant in question and often includes active alcohol
and drug abuse as a disqualifier for candidacy. Some
institutions allow patients with a history of alcohol or
substance abuse dependency to be given the opportunity to
re-apply for transplantation after documented compliance
with conditions such as abstinence, attending substance
abuse treatment, and demonstrating negative drug tests.
Many institutions make exceptions to their illicit
substance use policies for MM when lawfully recommended by
a physician for medical purposes prior to evaluation.
However, some institutions make the distinction between
smoking medicinal marijuana and ingesting medicinal
marijuana due to the risk of the mold aspergillus, which
can grow on cannabis products and when smoked can lead to
fatal infections for those with compromised immune systems.
The California Medical Association passed a resolution in
December 2014 urging transplant programs to clearly
indicate their policies on the use of cannabis to waiting
list candidates prior to evaluation of candidacy and
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opposing blanket restrictions of potential organ transplant
donors and recipients based solely on reported or detected
marijuana use.
Currently six other states provide legal medical cannabis
patients the protections proposed in this bill: Arizona,
Delaware, Illinois, Minnesota, New Hampshire, and
Washington.
3)SUPPORT. Americans for Safe Access (ASA), the sponsors of the measure
state that this bill will extend the same protections to legal
medical cannabis patients that already exist under California
law for patients with mental and physical disabilities. ASA
also notes that some clinical research shows that medical
cannabis and compounds in medical cannabis have beneficial
immune-suppressive and anti-inflammatory effects. ASA
estimates that there are approximately 1,150 Californians that
are at risk for being denied an organ transplant due to their
cannabis use.
Health, Education & Legal Patients' Rights (HELPR) notes it
has been 18 years since the Compassionate Use Act was passed,
however our medical industry and the state Legislature have
not kept up with the current times and protecting those rights
for the patients that use medical cannabis. HELPR contends
that cannabis patients should no longer be discriminated
against.
4)PREVIOUS
LEGISLATION.a)
a) AB 1689 (Lieber and Berryhill), Chapter 629, Statutes of
2007, specifies, among other things, that the eligibility
of a patient on the organ transplant waiting list shall not
by determined by his or her physical or mental disability.
b) SB 108 (Speier), Chapter 740, Statutes of 2001, creates
the Organ and Tissue Donor Registry in the California
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Health and Human Services Agency and required the
Department of Motor Vehicles to provide information and a
standardized form to applicants for drivers' licenses and
identification cards who wish to become organ donors.
REGISTERED SUPPORT / OPPOSITION:
Support
Americans for Safe Access (sponsor)
California Cannabis Industry Association
California Chapter of the National Organization for the Reform
of Marijuana Laws
Crusaders for Patients' Rights
Emerald Growers Association
Health, Education & Legal Patients' Rights
Legal Services for Prisoners with Children
Marijuana Policy Project
Two individuals
Opposition
None on file.
Analysis Prepared
by: Lara Flynn / HEALTH / (916) 319-2097
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