BILL ANALYSIS Ó
AB 258
Page 1
ASSEMBLY THIRD READING
AB
258 (Levine)
As Amended March 25, 2015
Majority vote
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|Committee |Votes |Ayes |Noes |
|----------------+------+----------------------+----------------------|
|Health |13-3 |Bonta, Bonilla, |Maienschein, |
| | |Burke, Chávez, Chiu, |Patterson, Steinorth |
| | |Gomez, Lackey, | |
| | |Nazarian, Rodriguez, | |
| | |Santiago, Thurmond, | |
| | |Waldron, Wood | |
| | | | |
| | | | |
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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
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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
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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)
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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.
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Analysis Prepared by:
Lara Flynn / HEALTH / (916) 319-2097 FN: 0000114