On May 17, 2021, Alabama Governor Kay Ivey signed into law the Darren Wesley 'Ato' Hall Compassion Act (the "Medical Marijuana Law"), regulating the cultivation, processing, transporting, testing, distribution, sale, taxation, and use of medical cannabis in Alabama. In passing the Medical Marijuana Law, the Alabama legislature found that medical use of cannabis will not only benefit patients by providing relief to pain and other debilitating symptoms, but will also provide opportunities for such patients to function and have better quality of life, while providing employment and business opportunities for farmers and other residents of Alabama and revenue to state and local governments.
The Medical Marijuana Law creates the Alabama Medical Cannabis Commission (the "Commission"), which is tasked with implementing, administering, regulating, and adopting rules of the Medical Marijuana Law. Many rules still need to be established, and applications for business licenses in the seed to sale process will first be accepted on September 1, 2022. Therefore, even though the Medical Marijuana Law was signed into law, we would not anticipate medical cannabis to be available until late 2022, at the earliest.
Below is an overview of key terms of the Medical Marijuana Law:
Who qualifies to buy and use medical cannabis?
Residents of Alabama who: (i) are 19 or older; (ii) have a Qualifying Medical Condition; (iii) have been issued a Physician Certification by a Registered Certifying Physician; and (iv) have been issued a valid Medical Cannabis Card by the Commission. Minors who meet the same requirements and who have a Qualified Designated Caregiver also qualify.
What are the requirements for a doctor to become a Registered Certifying Physician?
The physician must hold an active license to practice medicine in the state of Alabama; complete a four hour medical cannabis course and subsequent examination (course not to exceed $500); pay an initial registration fee to the Alabama Board of Medical Examiners (not to exceed $300); and meet additional qualifications established by the Alabama Board of Medical Examiners. Upon meeting the requirements, the Alabama Board of Medical Examiners will issue a registration certificate and number to the physician, and the physician will be listed as a Registered Certifying Physician on the Alabama Board of Medical Examiner's website.
What are the requirements for issuing a Physician Certification to a Qualifying Patient?
In order to issue a Physician Certification to a Qualifying Patient, a Registered Certifying Physician must diagnose the Qualifying Patient with at least one Qualifying Medical Condition or confirm that the Qualifying Patient has been medically diagnosed with at least one Qualifying Medical Condition. The Alabama Board of Medical Examiners will establish the rules for issuing a Physician Certification to a patient (including duration of the certification, which shall not exceed 12 months).
What are Qualifying Medical Conditions?
Autism; Cancer-related cachexia, nausea or vomiting, weight loss, or chronic pain; Crohn's disease; Depression; Epilepsy or condition causing seizures; HIV/AIDS-related nausea or weight loss; Panic disorder; Parkinson's Disease; Persistent nausea not significantly responsive to traditional treatment (except nausea related to pregnancy, cannabis-induced cyclical vomiting syndrome, or cannabinoid hyperemesis syndrome); PTSD; Sickle Cell Anemia; Spasticity associated with motor neuron disease, including ALS; Spasticity associated with Multiple Sclerosis or spinal cord injury; Terminal illnesses; Tourette's Syndrome; or a condition causing chronic or intractable pain in which conventional therapies and opiates is contraindicated or has proven ineffective.
How does a Qualifying Patient receive a Medical Cannabis Card?
Once a Qualifying Patient receives a Physician Certification, the Qualifying Patient and, if applicable, the Qualifying Patient's caregiver, must register in the Patient Registry created by the Commission. The Commission will create an application form (and renewal process) setting forth eligibility requirements, and there will be an application fee (maximum of $65). If the Qualifying Patient or designated caregiver meets the criteria for registration, the Commission will place him or her in the Patient Registry and issue him or her a Medical Cannabis Card.
What is the Patient Registry?
Prior to September 1, 2022, the Commission must create an electronic Alabama Medical Cannabis Patient Registry System that will, among other things, receive, record, and track the following: (i) Physician Certifications; (ii) patient registrations (including Qualifying Medical Conditions, Registered Certifying Physician, and recommended dosage); (iii) designated caregivers; and (iv) patient purchases of medical cannabis by location, date, time, amount, and type. Access to the Patient Registry is restricted to: (i) Registered Certifying Physicians; (ii) health care practitioners licensed to prescribe prescription drugs; (iii) licensed pharmacists; (iv) dispensaries; (v) the Alabama Board of Medical Examiners; and (vi) state and local law enforcement agencies (subject to probable cause or reasonable suspicion of a violation of a controlled substance law or DUI, and certain other restrictions).
Where will Qualified Patients buy medical cannabis products?
At dispensing sites licensed by the Commission. Up to 27 dispensing sites may be established, which number could be expanded by the Commission based on patient pool size and underserved areas one year after all of the initial 27 authorized dispensing sites are operating.
What form of medical cannabis is permitted?
Allowed: Oral tablets, capsules, tinctures, or non-sugarcoated gel cubes or lozenges. Gel, oil, creams, or other topical preparation. Suppositories, transdermal patches, nebulizers, or liquids or oils for use in an inhaler.
Not Allowed: Raw plant material, products administered by smoking, combustion, or vaping, or food products with medical cannabis baked, mixed, or infused (such as cookies or candies).
What are the limits on THC content?
The Commission is tasked with making rules specifying the form, THC content, and maximum daily dosage that may be recommended for each Qualifying Medical Condition. The maximum daily dosage of THC is initially set at 50mg. The maximum daily dosage can be increased to 75mg if, after 90 days, the Registered Certifying Physician determines a higher daily dosage is medically appropriate. Also, a Registered Certifying Physician may increase a patient's dosage if the patient has been diagnosed with a terminal illness; provided, however, that if the recommended daily dosage exceeds 75mg the Registered Certifying Physician must notify the patient that the patient's driver's license will be suspended. Minors cannot be recommended or use medical cannabis with a potency greater than three percent THC.
Will businesses be licensed and regulated from seed to sale?
Yes. The Commission will license and regulate processors, dispensaries, secure transporters, and testing laboratories. The Alabama Department of Agriculture and Industries will license and regulate the cultivation of cannabis. Beginning September 1, 2022, applications can be submitted for a license for an integrated facility, or for an individual license for one of the following: cultivator, processor, secure transporter, state testing laboratory, or dispensary. A non-refundable application fee of $2,500 is required. Each application is subject to numerous disclosures and requirements, including that a majority of a licensee's ownership is by individuals who have continuous residence in Alabama for no less than 15 years preceding the application date. No more than 12 cultivator licenses will be issued. No more than four processor licenses will be issued. No more than four dispensary licenses will be issued, although each licensee can operate up to three dispensing sites (each of which must be in a different county from any other dispensing site). No more than five integrated facility licenses will be issued, although each integrated facility licensee can operate up to three dispensing sites (each of which must be in a different county from any other dispensing site). One-Fourth (1/4) of all licenses (other than integrated facility licenses for which the requirement is 1/5) must be awarded to minority group owned / controlled businesses (minority group meaning individuals of African American, Native American, Asian, or Hispanic descent).
Is the operation of a dispensing site subject to approval by the applicable municipality or county?
Yes. Operation of a dispensing site in any municipality or unincorporated area of a county is subject to approval by such municipality (by ordinance by its governing body) or county (by resolution by its county commission).
Are Registered Certifying Physicians subject to any restrictions?
Yes. Registered Certifying Physicians are subject to certain restrictions such as not accepting remuneration in exchange for issuing a Physician Certification to a patient or for referring patients to a dispensary, not advertising in a dispensary, and not advertising that such physician is a "medical cannabis" or "medical marijuana" physician or doctor other than including a statement that such doctor is qualified by the State of Alabama to certify patients for medical cannabis under the Alabama Compassion Act. Registered Certifying Physicians are also restricted from owning a direct or indirect economic interest in a cultivator, processor, secure transporter, state testing laboratory, dispensary, or integrated facility licensed by the Commission.
Are insurance plans required to cover or reimburse costs of medical cannabis?
No. Insurance and government programs are not required to reimburse costs for medical cannabis.
Are employers required to allow use of medical marijuana by employees?
No. The Medical Marijuana Law specifies that employers are not restricted from establishing or enforcing a drug testing policy, nor are employers required to accommodate or allow the use of medical cannabis by its employees, nor are employers prohibited from refusing to hire, disciplining, or discharging an employee as a result of using medical cannabis (regardless of impairment).
Anthony Romano practices with Burr & Forman LLP in the firm's Health Care Industry Group. Anthony may be reached at aromano@burr.com or (205) 458-5210.