BILL ANALYSIS Ó AB 258 Page 1 ASSEMBLY THIRD READING AB 258 (Levine) As Amended March 25, 2015 Majority vote --------------------------------------------------------------------- |Committee |Votes |Ayes |Noes | |----------------+------+----------------------+----------------------| |Health |13-3 |Bonta, Bonilla, |Maienschein, | | | |Burke, Chávez, Chiu, |Patterson, Steinorth | | | |Gomez, Lackey, | | | | |Nazarian, Rodriguez, | | | | |Santiago, Thurmond, | | | | |Waldron, Wood | | | | | | | | | | | | --------------------------------------------------------------------- SUMMARY: Prohibits a potential recipient of an organ transplant from being denied based solely on their use of medical marijuana (MM). Allows for an exception to this if the patient's use of MM, based on a case-by-case evaluation by a physician or surgeon, is found to be medically significant to the provision of the anatomical gift. 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 AB 258 Page 2 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 COMMENTS: The Organ Procurement and Transplantation Network (OPTN) is a public-private partnership that links all professionals involved in the United States (U.S.) 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 U.S. 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. 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 AB 258 Page 3 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 acquired immune deficiency syndrome (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. 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. 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 medicinal marijuana (MM) AB 258 Page 4 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 MM use and organ transplants vary at each institution. 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. 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 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. AB 258 Page 5 Analysis Prepared by: Lara Flynn / HEALTH / (916) 319-2097 FN: 0000114