Senate File 205 - Introduced SENATE FILE 205 BY BOLKCOM , DOTZLER , HOGG , PETERSEN , QUIRMBACH , BOULTON , TAYLOR , HART , ALLEN , JOCHUM , LYKAM , MATHIS , and RAGAN A BILL FOR An Act relating to the medical cannabis Act, reclassifying 1 marijuana, including tetrahydrocannabinols, from a 2 schedule I controlled substance to a schedule II controlled 3 substance, and providing for civil and criminal penalties 4 and fees. 5 BE IT ENACTED BY THE GENERAL ASSEMBLY OF THE STATE OF IOWA: 6 TLSB 1406XS (7) 87 rh/rj

S.F. 205 Section 1. Section 124.204, subsection 4, paragraphs m and 1 u, Code 2017, are amended by striking the paragraphs. 2 Sec. 2. Section 124.204, subsection 7, Code 2017, is amended 3 by striking the subsection. 4 Sec. 3. Section 124.206, subsection 7, Code 2017, is amended 5 to read as follows: 6 7. Hallucinogenic substances. Unless specifically excepted 7 or unless listed in another schedule, any material, compound, 8 mixture, or preparation which contains any quantity of the 9 following substances , or, for purposes of paragraphs “a” and 10 “b” , which contains any of its salts, isomers, or salts of 11 isomers whenever the existence of such salts, isomers, or salts 12 of isomers is possible within the specific chemical designation 13 (for purposes of this paragraph only, the term “isomer” includes 14 the optical, positional, and geometric isomers) : 15 a. Marijuana when used for medicinal purposes pursuant to 16 rules of the board . 17 b. Tetrahydrocannabinols, meaning tetrahydrocannabinols 18 naturally contained in a plant of the genus Cannabis (Cannabis 19 plant) as well as synthetic equivalents of the substances 20 contained in the Cannabis plant, or in the resinous extractives 21 of such plant, and synthetic substances, derivatives, and their 22 isomers with similar chemical structure and pharmacological 23 activity to those substances contained in the plant, such as 24 the following: 25 (1) 1 cis or trans tetrahydrocannabinol, and their optical 26 isomers. 27 (2) 6 cis or trans tetrahydrocannabinol, and their optical 28 isomers. 29 (3) 3,4 cis or trans tetrahydrocannabinol, and their 30 optical isomers. (Since nomenclature of these substances 31 is not internationally standardized, compounds of these 32 structures, regardless of numerical designation of atomic 33 positions covered.) 34 b. c. Nabilone [another name for nabilone: (+-) - 35 -1- LSB 1406XS (7) 87 rh/rj 1/ 26

S.F. 205 trans-3-(1,1-dimethylheptyl)-6,6a,7,8,10,10a-hexahydro-1- 1 hydroxy-6,6-dimethyl-9H-dibenzo[b,d]pyran-9-one]. 2 Sec. 4. Section 124.401, subsection 5, unnumbered paragraph 3 3, Code 2017, is amended to read as follows: 4 A person may knowingly or intentionally recommend the use 5 of , process, produce, package, possess, cultivate, harvest, 6 use, dispense, deliver, transport, supply, or administer 7 cannabidiol medical cannabis if the recommendation, processing, 8 production, packaging, possession, use, cultivating, 9 harvesting, dispensing, delivery, transporting, supplying, or 10 administering is in accordance with the provisions of chapter 11 124D 124E . For purposes of this paragraph, “cannabidiol” 12 “medical cannabis” means the same as defined in section 124D.2 13 124E.2 . 14 Sec. 5. NEW SECTION . 124E.1 Short title. 15 This chapter shall be known and may be cited as the “Medical 16 Cannabis Act” . 17 Sec. 6. NEW SECTION . 124E.2 Definitions. 18 As used in this chapter: 19 1. “Debilitating medical condition” means any of the 20 following: 21 a. Cancer. 22 b. Multiple sclerosis. 23 c. Epilepsy. 24 d. AIDS or HIV as defined in section 141A.1. 25 e. Glaucoma. 26 f. Hepatitis C. 27 g. Crohn’s disease or ulcerative colitis. 28 h. Amyotrophic lateral sclerosis. 29 i. Ehlers-danlos syndrome. 30 j. Post-traumatic stress disorder. 31 k. Severe, chronic pain caused by an underlying medical 32 condition that is not responsive to conventional treatment or 33 conventional treatment that produces debilitating side effects. 34 l. Any other chronic or debilitating disease or medical 35 -2- LSB 1406XS (7) 87 rh/rj 2/ 26

S.F. 205 condition or its medical treatment approved by the department 1 pursuant to rule. 2 2. “Department” means the department of public health. 3 3. “Disqualifying felony offense” means a violation under 4 federal or state law of a felony offense, which has as an 5 element the possession, use, or distribution of a controlled 6 substance, as defined in 21 U.S.C. §802(6). 7 4. “Enclosed, locked facility” means a closet, room, 8 greenhouse, or other enclosed area equipped with locks or other 9 security devices that permit access only by a cardholder. 10 5. “Health care practitioner” means an individual licensed 11 under chapter 148 to practice medicine and surgery or 12 osteopathic medicine and surgery, a physician assistant 13 licensed under chapter 148C, or an advanced registered nurse 14 practitioner licensed pursuant to chapter 152 or 152E. 15 6. “Medical cannabis” means any species of the genus 16 Cannabis plant, or any mixture or preparation of them, 17 including whole plant extracts and resins. 18 7. “Medical cannabis dispensary” means an entity licensed 19 by the department that acquires medical cannabis from a 20 medical cannabis manufacturer in this state for the purpose 21 of dispensing medical cannabis in this state pursuant to this 22 chapter. 23 8. “Medical cannabis manufacturer” means an entity licensed 24 by the department to manufacture and to possess, cultivate, 25 harvest, transport, package, process, or supply medical 26 cannabis pursuant to the provisions of this chapter. 27 9. “Primary caregiver” means a person, at least eighteen 28 years of age, who has been designated by a patient’s health 29 care practitioner or a person having custody of a patient, as 30 a necessary caretaker taking responsibility for managing the 31 well-being of the patient with respect to the use of medical 32 cannabis pursuant to the provisions of this chapter. 33 10. “Written certification” means a document signed by a 34 health care practitioner, with whom the patient has established 35 -3- LSB 1406XS (7) 87 rh/rj 3/ 26

S.F. 205 a patient-provider relationship, which states that the patient 1 has a debilitating medical condition and identifies that 2 condition and provides any other relevant information. 3 Sec. 7. NEW SECTION . 124E.3 Health care practitioner 4 certification —— duties. 5 1. Prior to a patient’s submission of an application for a 6 medical cannabis card pursuant to section 124E.4, a health care 7 practitioner shall do all of the following: 8 a. Determine, in the health care practitioner’s medical 9 judgment, whether the patient whom the health care practitioner 10 has examined and treated suffers from a debilitating medical 11 condition that qualifies for the use of medical cannabis under 12 this chapter, and if so determined, provide the patient with a 13 written certification of that diagnosis. 14 b. Provide explanatory information as provided by the 15 department to the patient about the therapeutic use of medical 16 cannabis. 17 c. Determine, on an annual basis, if the patient continues 18 to suffer from a debilitating medical condition and, if so, 19 issue the patient a new certification of that diagnosis. 20 d. Otherwise comply with all requirements established by the 21 department pursuant to rule. 22 2. A health care practitioner may provide, but has no duty 23 to provide, a written certification pursuant to this section. 24 Sec. 8. NEW SECTION . 124E.4 Medical cannabis registration 25 card. 26 1. Issuance to patient. The department may approve the 27 issuance of a medical cannabis registration card by the 28 department of transportation to a patient who: 29 a. Is at least eighteen years of age. 30 b. Is a permanent resident of this state. 31 c. Submits a written certification to the department signed 32 by the patient’s health care practitioner that the patient is 33 suffering from a debilitating medical condition. 34 d. Submits an application to the department, on a form 35 -4- LSB 1406XS (7) 87 rh/rj 4/ 26

S.F. 205 created by the department, in consultation with the department 1 of transportation, that contains all of the following: 2 (1) The patient’s full name, Iowa residence address, date 3 of birth, and telephone number. 4 (2) A copy of the patient’s valid photograph 5 identification. 6 (3) Full name, address, and telephone number of the 7 patient’s health care practitioner. 8 (4) Full name, residence address, date of birth, and 9 telephone number of each primary caregiver of the patient, if 10 any. 11 (5) Any other information required by rule. 12 e. Submits a medical cannabis registration card fee of one 13 hundred dollars to the department. If the patient attests to 14 receiving social security disability benefits, supplemental 15 security insurance payments, or being enrolled in medical 16 assistance, the fee shall be twenty-five dollars. 17 2. Patient card contents. A medical cannabis registration 18 card issued to a patient by the department of transportation 19 pursuant to subsection 1 shall contain, at a minimum, all of 20 the following: 21 a. The patient’s full name, Iowa residence address, and date 22 of birth. 23 b. The patient’s photograph. 24 c. The date of issuance and expiration of the registration 25 card. 26 d. Any other information required by rule. 27 3. Issuance to primary caregiver. For a patient in a 28 primary caregiver’s care, the department may approve the 29 issuance of a medical cannabis registration card by the 30 department of transportation to the primary caregiver who: 31 a. Is at least eighteen years of age. 32 b. Submits a written certification to the department signed 33 by the patient’s health care practitioner that the patient in 34 the primary caregiver’s care is suffering from a debilitating 35 -5- LSB 1406XS (7) 87 rh/rj 5/ 26

S.F. 205 medical condition. 1 c. Submits an application to the department, on a form 2 created by the department, in consultation with the department 3 of transportation, that contains all of the following: 4 (1) The primary caregiver’s full name, residence address, 5 date of birth, and telephone number. 6 (2) The patient’s full name. 7 (3) A copy of the primary caregiver’s valid photograph 8 identification. 9 (4) Full name, address, and telephone number of the 10 patient’s health care practitioner. 11 (5) Any other information required by rule. 12 d. Submits a medical cannabis registration card fee of 13 twenty-five dollars to the department. 14 4. Primary caregiver card contents. A medical cannabis 15 registration card issued by the department of transportation to 16 a primary caregiver pursuant to subsection 3 shall contain, at 17 a minimum, all of the following: 18 a. The primary caregiver’s full name, residence address, and 19 date of birth. 20 b. The primary caregiver’s photo. 21 c. The date of issuance and expiration of the registration 22 card. 23 d. The registration card number of each patient in the 24 primary caregiver’s care. If the patient in the primary 25 caregiver’s care is under the age of eighteen, the full name of 26 the patient’s parent or legal guardian. 27 e. Any other information required by rule. 28 5. Expiration date of card. A medical cannabis registration 29 card issued pursuant to this section shall expire one year 30 after the date of issuance and may be renewed. 31 6. Card issuance —— department of transportation. The 32 department may enter into a chapter 28E agreement with the 33 department of transportation to facilitate the issuance of 34 medical cannabis registration cards pursuant to subsections 1 35 -6- LSB 1406XS (7) 87 rh/rj 6/ 26

S.F. 205 and 3. 1 Sec. 9. NEW SECTION . 124E.5 Medical advisory council—— 2 duties. 3 1. No later than August 15, 2017, the director of public 4 health shall establish a medical advisory council consisting of 5 nine practitioners representing the fields of neurology, pain 6 management, gastroenterology, oncology, psychiatry, pediatrics, 7 infectious disease, family medicine, and pharmacy, and three 8 patients with valid medical cannabis registration cards. The 9 practitioners shall be nationally board-certified in their 10 area of specialty and knowledgeable about the use of medical 11 cannabis. 12 2. A quorum of the advisory council shall consist of seven 13 members. 14 3. The duties of the advisory council shall include but not 15 be limited to the following: 16 a. Reviewing and recommending to the department for 17 approval additional chronic or debilitating diseases or 18 medical conditions or their treatments as debilitating medical 19 conditions that qualify for the use of medical cannabis under 20 this chapter. 21 b. Accepting and reviewing petitions to add chronic or 22 debilitating diseases or medical conditions or their medical 23 treatments to the list of debilitating medical conditions that 24 qualify for the use of medical cannabis under this chapter. 25 c. Advising the department regarding the location of 26 medical cannabis dispensaries throughout the state, the form 27 and quantity of allowable medical cannabis to be dispensed 28 to a patient or primary caregiver, and the general oversight 29 of medical cannabis manufacturers and medical cannabis 30 dispensaries in this state. 31 d. Convening at least twice per year to conduct public 32 hearings and to review and recommend for approval petitions, 33 which shall be maintained as confidential personal health 34 information, to add chronic or debilitating diseases or 35 -7- LSB 1406XS (7) 87 rh/rj 7/ 26

S.F. 205 medical conditions or their medical treatments to the list of 1 debilitating medical conditions that qualify for the use of 2 medical cannabis under this chapter. 3 Sec. 10. NEW SECTION . 124E.6 Medical cannabis manufacturer 4 licensure. 5 1. a. The department shall license four medical cannabis 6 manufacturers to manufacture and to possess, cultivate, 7 harvest, transport, package, process, or supply medical 8 cannabis within this state consistent with the provisions of 9 this chapter by December 1, 2017. The department shall license 10 new medical cannabis manufacturers or relicense the existing 11 medical cannabis manufacturers by December 1 of each year. 12 b. Information submitted during the application process 13 shall be confidential until the medical cannabis manufacturer 14 is licensed by the department unless otherwise protected from 15 disclosure under state or federal law. 16 2. As a condition for licensure, a medical cannabis 17 manufacturer must agree to begin supplying medical cannabis to 18 medical cannabis dispensaries in this state by July 1, 2018. 19 3. The department shall consider the following factors in 20 determining whether to license a medical cannabis manufacturer: 21 a. The technical expertise of the medical cannabis 22 manufacturer regarding medical cannabis. 23 b. The qualifications of the medical cannabis manufacturer’s 24 employees. 25 c. The long-term financial stability of the medical cannabis 26 manufacturer. 27 d. The ability to provide appropriate security measures on 28 the premises of the medical cannabis manufacturer. 29 e. Whether the medical cannabis manufacturer has 30 demonstrated an ability to meet certain medical cannabis 31 production needs for medical use regarding the range of 32 recommended dosages for each debilitating medical condition, 33 the range of chemical compositions of any plant of the genus 34 cannabis that will likely be medically beneficial for each 35 -8- LSB 1406XS (7) 87 rh/rj 8/ 26

S.F. 205 of the debilitating medical conditions, and the form of the 1 medical cannabis in the manner determined by the department 2 pursuant to rule. 3 f. The medical cannabis manufacturer’s projection of and 4 ongoing assessment of fees on patients with debilitating 5 medical conditions. 6 4. The department shall require each medical cannabis 7 manufacturer to contract with the state hygienic laboratory 8 at the university of Iowa in Iowa City to test the medical 9 cannabis produced by the manufacturer as provided in section 10 124E.7. The department shall require that the laboratory 11 report testing results to the manufacturer in a manner 12 determined by the department pursuant to rule. 13 5. Each entity submitting an application for licensure 14 as a medical cannabis manufacturer shall pay a nonrefundable 15 application fee of seven thousand five hundred dollars to the 16 department. 17 Sec. 11. NEW SECTION . 124E.7 Medical cannabis 18 manufacturers. 19 1. A medical cannabis manufacturer shall contract with the 20 state hygienic laboratory at the university of Iowa in Iowa 21 City for purposes of testing the medical cannabis manufactured 22 by the medical cannabis manufacturer as to content, 23 contamination, and consistency. The cost of all laboratory 24 testing shall be paid by the medical cannabis manufacturer. 25 2. The operating documents of a medical cannabis 26 manufacturer shall include all of the following: 27 a. Procedures for the oversight of the medical cannabis 28 manufacturer and procedures to ensure accurate recordkeeping. 29 b. Procedures for the implementation of appropriate security 30 measures to deter and prevent the theft of medical cannabis and 31 unauthorized entrance into areas containing medical cannabis. 32 3. A medical cannabis manufacturer shall implement security 33 requirements, including requirements for protection of each 34 location by a fully operational security alarm system, facility 35 -9- LSB 1406XS (7) 87 rh/rj 9/ 26

S.F. 205 access controls, perimeter intrusion detection systems, and a 1 personnel identification system. 2 4. A medical cannabis manufacturer shall not share 3 office space with, refer patients to, or have any financial 4 relationship with a health care practitioner. 5 5. A medical cannabis manufacturer shall not permit any 6 person to consume medical cannabis on the property of the 7 medical cannabis manufacturer. 8 6. A medical cannabis manufacturer is subject to reasonable 9 inspection by the department. 10 7. A medical cannabis manufacturer shall not employ a 11 person who is under eighteen years of age or who has been 12 convicted of a disqualifying felony offense. An employee 13 of a medical cannabis manufacturer shall be subject to a 14 background investigation conducted by the division of criminal 15 investigation of the department of public safety and a national 16 criminal history background check. 17 8. A medical cannabis manufacturer shall not operate in any 18 location, whether for manufacturing, possessing, cultivating, 19 harvesting, transporting, packaging, processing, or supplying 20 within one thousand feet of a public or private school existing 21 before the date of the medical cannabis manufacturer’s 22 licensure by the department. 23 9. A medical cannabis manufacturer shall comply with 24 reasonable restrictions set by the department relating to 25 signage, marketing, display, and advertising of medical 26 cannabis. 27 10. a. A medical cannabis manufacturer shall provide a 28 reliable and ongoing supply of medical cannabis to medical 29 cannabis dispensaries pursuant to this chapter. 30 b. All manufacturing, cultivating, harvesting, packaging, 31 and processing of medical cannabis shall take place in an 32 enclosed, locked facility at a physical address provided to the 33 department during the licensure process. 34 c. A medical cannabis manufacturer shall not manufacture 35 -10- LSB 1406XS (7) 87 rh/rj 10/ 26

S.F. 205 edible medical cannabis products utilizing food coloring. 1 Sec. 12. NEW SECTION . 124E.8 Medical cannabis dispensary 2 licensure. 3 1. a. The department shall license by April 1, 2018, twelve 4 medical cannabis dispensaries to dispense medical cannabis 5 within this state consistent with the provisions of this 6 chapter. The department shall license new medical cannabis 7 dispensaries or relicense the existing medical cannabis 8 manufacturers by December 1 of each year. 9 b. Information submitted during the application process 10 shall be confidential until the medical cannabis dispensary 11 is licensed by the department unless otherwise protected from 12 disclosure under state or federal law. 13 2. As a condition for licensure, a medical cannabis 14 dispensary must agree to begin supplying medical cannabis to 15 patients by July 1, 2018. 16 3. The department shall consider the following factors in 17 determining whether to license a medical cannabis dispensary: 18 a. The technical expertise of the medical cannabis 19 dispensary regarding medical cannabis. 20 b. The qualifications of the medical cannabis dispensary’s 21 employees. 22 c. The long-term financial stability of the medical cannabis 23 dispensary. 24 d. The ability to provide appropriate security measures on 25 the premises of the medical cannabis dispensary. 26 e. The medical cannabis dispensary’s projection and ongoing 27 assessment of fees for the purchase of medical cannabis on 28 patients with debilitating medical conditions. 29 4. Each entity submitting an application for licensure 30 as a medical cannabis dispensary shall pay a nonrefundable 31 application fee of five thousand dollars to the department. 32 Sec. 13. NEW SECTION . 124E.9 Medical cannabis dispensaries. 33 1. a. The medical cannabis dispensaries shall be located 34 based on geographical need throughout the state to improve 35 -11- LSB 1406XS (7) 87 rh/rj 11/ 26

S.F. 205 patient access. 1 b. A medical cannabis dispensary may dispense medical 2 cannabis pursuant to the provisions of this chapter but shall 3 not dispense any medical cannabis in a form or quantity other 4 than the form or quantity allowed by the department pursuant 5 to rule. 6 2. The operating documents of a medical cannabis dispensary 7 shall include all of the following: 8 a. Procedures for the oversight of the medical cannabis 9 dispensary and procedures to ensure accurate recordkeeping. 10 b. Procedures for the implementation of appropriate security 11 measures to deter and prevent the theft of medical cannabis and 12 unauthorized entrance into areas containing medical cannabis. 13 3. A medical cannabis dispensary shall implement security 14 requirements, including requirements for protection by a fully 15 operational security alarm system, facility access controls, 16 perimeter intrusion detection systems, and a personnel 17 identification system. 18 4. A medical cannabis dispensary shall not share office 19 space with, refer patients to, or have any financial 20 relationship with a health care practitioner. 21 5. A medical cannabis dispensary shall not permit any person 22 to consume medical cannabis on the property of the medical 23 cannabis dispensary. 24 6. A medical cannabis dispensary is subject to reasonable 25 inspection by the department. 26 7. A medical cannabis dispensary shall not employ a 27 person who is under eighteen years of age or who has been 28 convicted of a disqualifying felony offense. An employee 29 of a medical cannabis dispensary shall be subject to a 30 background investigation conducted by the division of criminal 31 investigation of the department of public safety and a national 32 criminal history background check. 33 8. A medical cannabis dispensary shall not operate in any 34 location within one thousand feet of a public or private school 35 -12- LSB 1406XS (7) 87 rh/rj 12/ 26

S.F. 205 existing before the date of the medical cannabis dispensary’s 1 licensure by the department. 2 9. A medical cannabis dispensary shall comply with 3 reasonable restrictions set by the department relating to 4 signage, marketing, display, and advertising of medical 5 cannabis. 6 10. Prior to dispensing of any medical cannabis, a medical 7 cannabis dispensary shall do all of the following: 8 a. Verify that the medical cannabis dispensary has received 9 a valid medical cannabis registration card from a patient or a 10 patient’s primary caregiver, if applicable. 11 b. Assign a tracking number to any medical cannabis 12 dispensed from the medical cannabis dispensary. 13 c. (1) Properly package medical cannabis in compliance with 14 federal law regarding child resistant packaging and exemptions 15 for packaging for elderly patients, and label medical cannabis 16 with a list of all active ingredients and individually 17 identifying information, including all of the following: 18 (a) The name and date of birth of the patient and the 19 patient’s primary caregiver, if appropriate. 20 (b) The medical cannabis registration card numbers of the 21 patient and the patient’s primary caregiver, if applicable. 22 (c) The chemical composition of the medical cannabis. 23 (2) Proper packaging of medical cannabis shall include but 24 not be limited to all of the following: 25 (a) Warning labels regarding the use of medical cannabis by 26 a woman during pregnancy and while breastfeeding. 27 (b) Clearly labeled packaging indicating that an edible 28 medical cannabis product contains medical cannabis and which 29 packaging shall not imitate candy products or in any way make 30 the product marketable to children. 31 11. A medical cannabis dispensary shall employ a pharmacist 32 licensed pursuant to chapter 155A. 33 Sec. 14. NEW SECTION . 124E.10 Fees. 34 Medical cannabis registration card fees and medical cannabis 35 -13- LSB 1406XS (7) 87 rh/rj 13/ 26

S.F. 205 manufacturer and medical cannabis dispensary application 1 and annual fees collected by the department pursuant to 2 this chapter shall be retained by the department, shall be 3 considered repayment receipts as defined in section 8.2, and 4 shall be used for the purpose of regulating medical cannabis 5 manufacturers and medical cannabis dispensaries and for other 6 expenses necessary for the administration of this chapter. 7 Sec. 15. NEW SECTION . 124E.11 Department duties —— rules. 8 1. a. The department shall maintain a confidential file 9 of the names of each patient to or for whom the department 10 issues a medical cannabis registration card and the name of 11 each primary caregiver to whom the department issues a medical 12 cannabis registration card under section 124E.4. 13 b. Individual names contained in the file shall be 14 confidential and shall not be subject to disclosure, except as 15 provided in subparagraph (1). 16 (1) Information in the confidential file maintained 17 pursuant to paragraph “a” may be released on an individual basis 18 to the following persons under the following circumstances: 19 (a) To authorized employees or agents of the department and 20 the department of transportation as necessary to perform the 21 duties of the department and the department of transportation 22 pursuant to this chapter. 23 (b) To authorized employees of state or local law 24 enforcement agencies, but only for the purpose of verifying 25 that a person is lawfully in possession of a medical cannabis 26 registration card issued pursuant to this chapter. 27 (c) To authorized employees of a medical cannabis 28 dispensary, but only for the purpose of verifying that a person 29 is lawfully in possession of a medical cannabis registration 30 card issued pursuant to this chapter. 31 (2) Release of information pursuant to subparagraph 32 (1) shall be consistent with the federal Health Insurance 33 Portability and Accountability Act of 1996, Pub. L. No. 34 104-191. 35 -14- LSB 1406XS (7) 87 rh/rj 14/ 26

S.F. 205 2. The department shall adopt rules pursuant to chapter 1 17A to administer this chapter which shall include but not be 2 limited to rules to do all of the following: 3 a. Govern the manner in which the department shall consider 4 applications for new and renewal medical cannabis registration 5 cards. 6 b. Identify criteria and set forth procedures for 7 including additional chronic or debilitating diseases or 8 medical conditions or their medical treatments on the list of 9 debilitating medical conditions that qualify for the use of 10 medical cannabis. Procedures shall include a petition process 11 and shall allow for public comment and public hearings before 12 the medical advisory council. 13 c. Set forth additional chronic or debilitating diseases or 14 medical conditions or their medical treatments for inclusion 15 on the list of debilitating medical conditions that qualify 16 for the use of medical cannabis as recommended by the medical 17 advisory council. 18 d. Establish the form and quantity of medical cannabis 19 allowed to be dispensed to a patient or primary caregiver 20 pursuant to this chapter. The form and quantity of medical 21 cannabis shall be appropriate to serve the medical needs of 22 patients with debilitating medical conditions. 23 e. Establish requirements for the licensure of medical 24 cannabis manufacturers and medical cannabis dispensaries and 25 set forth procedures for medical cannabis manufacturers and 26 medical cannabis dispensaries to obtain licenses. 27 f. Develop a dispensing system for medical cannabis within 28 this state that provides for all of the following: 29 (1) Medical cannabis dispensaries within this state housed 30 on secured grounds and operated by licensed medical cannabis 31 dispensaries. 32 (2) The dispensing of medical cannabis to patients and 33 their primary caregivers to occur at locations designated by 34 the department. 35 -15- LSB 1406XS (7) 87 rh/rj 15/ 26

S.F. 205 g. Establish and collect annual fees from medical cannabis 1 manufacturers and medical cannabis dispensaries to cover 2 the costs associated with regulating and inspecting medical 3 cannabis manufacturers and medical cannabis dispensaries. 4 h. Specify and implement procedures that address public 5 safety including security procedures and product quality 6 including measures to ensure contaminant-free cultivation of 7 medical cannabis, safety, and labeling. 8 i. Establish and implement a real-time, statewide 9 medical cannabis registry management sale tracking system 10 that is available to medical cannabis dispensaries on a 11 twenty-four-hour-day, seven-day-a-week basis for the purpose of 12 verifying that a person is lawfully in possession of a medical 13 cannabis registration card issued pursuant to this chapter 14 and for tracking the date of the sale and quantity of medical 15 cannabis purchased by a patient or a primary caregiver. 16 j. Establish and implement a medical cannabis inventory 17 and delivery tracking system to track medical cannabis 18 from production by a medical cannabis manufacturer through 19 dispensing at a medical cannabis dispensary. 20 Sec. 16. NEW SECTION . 124E.12 Reciprocity. 21 A valid medical cannabis registration card, or its 22 equivalent, issued under the laws of another state that allows 23 an out-of-state patient to possess or use medical cannabis in 24 the jurisdiction of issuance shall have the same force and 25 effect as a valid medical cannabis registration card issued 26 pursuant to this chapter, except that an out-of-state patient 27 in this state shall not obtain medical cannabis from a medical 28 cannabis dispensary in this state. 29 Sec. 17. NEW SECTION . 124E.13 Use of medical cannabis —— 30 smoking prohibited. 31 A patient shall not consume medical cannabis possessed or 32 used as authorized by this chapter by smoking medical cannabis. 33 Sec. 18. NEW SECTION . 124E.14 Use of medical cannabis —— 34 affirmative defenses. 35 -16- LSB 1406XS (7) 87 rh/rj 16/ 26

S.F. 205 1. A health care practitioner, including any authorized 1 agent or employee thereof, shall not be subject to 2 prosecution for the unlawful certification, possession, or 3 administration of marijuana under the laws of this state for 4 activities arising directly out of or directly related to the 5 certification or use of medical cannabis in the treatment of 6 a patient diagnosed with a debilitating medical condition as 7 authorized by this chapter. 8 2. A medical cannabis manufacturer, including any 9 authorized agent or employee thereof, shall not be subject 10 to prosecution for manufacturing, possessing, cultivating, 11 harvesting, transporting, packaging, processing, or supplying 12 medical cannabis pursuant to this chapter. 13 3. A medical cannabis dispensary, including any authorized 14 agent or employee thereof, shall not be subject to prosecution 15 for dispensing medical cannabis pursuant to this chapter. 16 a. In a prosecution for the unlawful possession of marijuana 17 under the laws of this state, including but not limited to 18 chapters 124 and 453B, it is an affirmative and complete 19 defense to the prosecution that the patient has been diagnosed 20 with a debilitating medical condition, used or possessed 21 medical cannabis pursuant to a certification by a health care 22 practitioner as authorized under this chapter, and, for a 23 patient eighteen years of age or older, is in possession of a 24 valid medical cannabis registration card. 25 b. In a prosecution for the unlawful possession of marijuana 26 under the laws of this state, including but not limited to 27 chapters 124 and 453B, it is an affirmative and complete 28 defense to the prosecution that the person possessed medical 29 cannabis because the person is a primary caregiver of a patient 30 who has been diagnosed with a debilitating medical condition 31 and is in possession of a valid medical cannabis registration 32 card, and where the primary caregiver’s possession of the 33 medical cannabis is on behalf of the patient and for the 34 patient’s use only as authorized under this chapter. 35 -17- LSB 1406XS (7) 87 rh/rj 17/ 26

S.F. 205 c. If a patient or primary caregiver is charged with the 1 commission of a crime and is not in possession of the person’s 2 medical cannabis registration card, any charge or charges filed 3 against the person shall be dismissed by the court if the 4 person produces to the court prior to or at the person’s trial 5 a medical cannabis registration card issued to that person and 6 valid at the time the person was charged. 7 4. An agency of this state or a political subdivision 8 thereof, including any law enforcement agency, shall not remove 9 or initiate proceedings to remove a patient under the age 10 of eighteen from the home of a parent based solely upon the 11 parent’s or patient’s possession or use of medical cannabis as 12 authorized under this chapter. 13 Sec. 19. NEW SECTION . 124E.15 Penalties. 14 1. A person who knowingly or intentionally possesses or 15 uses medical cannabis in violation of the requirements of this 16 chapter is subject to the penalties provided under chapters 124 17 and 453B. 18 2. A medical cannabis manufacturer or a medical cannabis 19 dispensary shall be assessed a civil penalty of up to one 20 thousand dollars per violation for any violation of this 21 chapter in addition to any other applicable penalties. 22 Sec. 20. EMERGENCY RULES. The department may adopt 23 emergency rules under section 17A.4, subsection 3, and section 24 17A.5, subsection 2, paragraph “b”, to implement the provisions 25 of this Act and the rules shall be effective immediately upon 26 filing unless a later date is specified in the rules. Any 27 rules adopted in accordance with this section shall also be 28 published as a notice of intended action as provided in section 29 17A.4. 30 Sec. 21. TRANSITION PROVISIONS. A medical cannabis 31 registration card issued under chapter 124D prior to the 32 effective date of this Act remains effective and continues 33 in effect as issued for the twelve-month period following 34 its issuance. This Act does not preclude the permit holder 35 -18- LSB 1406XS (7) 87 rh/rj 18/ 26

S.F. 205 from seeking to renew the permit under this Act prior to the 1 expiration of the twelve-month period. 2 EXPLANATION 3 The inclusion of this explanation does not constitute agreement with 4 the explanation’s substance by the members of the general assembly. 5 This bill creates the medical cannabis Act, reclassifies 6 marijuana, including tetrahydrocannabinols, from a schedule I 7 controlled substance to a schedule II controlled substance, and 8 provides for civil and criminal penalties and fees. 9 OVERVIEW. The bill allows a patient with a debilitating 10 medical condition who receives written certification from 11 the patient’s health care practitioner that the patient has 12 a debilitating medical condition and who submits the written 13 certification along with an application to the department of 14 public health (department) for a medical cannabis registration 15 card to allow for the lawful use of medical cannabis to treat 16 the patient’s debilitating medical condition. A patient who 17 is issued a medical cannabis registration card will be able 18 to receive medical cannabis directly from a medical cannabis 19 dispensary operated and licensed in this state. 20 RECLASSIFICATION. The bill reclassifies marijuana, 21 including tetrahydrocannabinols, as a schedule II controlled 22 substance instead of a schedule I controlled substance and 23 strikes references to the authority of the board of pharmacy to 24 adopt rules for the use of marijuana or tetrahydrocannabinols 25 for medicinal purposes. 26 A schedule I controlled substance is a highly addictive 27 substance that has no accepted medical use in the United States 28 and a schedule II controlled substance is a highly addictive 29 substance that has an accepted medical use in the United 30 States. The reclassification of marijuana from a schedule I 31 controlled substance to a schedule II controlled substance 32 would allow a physician to issue a prescription for marijuana 33 under state law. However, federal regulations may conflict 34 with such prescription authority. 35 -19- LSB 1406XS (7) 87 rh/rj 19/ 26

S.F. 205 The penalties remain unchanged for violations involving 1 marijuana under the bill. The penalties under Code section 2 124.401 range from a class “B” felony punishable by up to 50 3 years of confinement to a serious misdemeanor punishable by 4 up to six months of confinement depending on the amount of 5 marijuana involved in the offense. 6 DEFINITIONS. The bill provides the following definitions: 7 “Debilitating medical condition” means cancer, multiple 8 sclerosis, epilepsy, AIDS or HIV, glaucoma, hepatitis C, 9 Crohn’s disease or ulcerative colitis, amyotrophic lateral 10 sclerosis, Ehlers-danlos syndrome, post-traumatic stress 11 disorder, severe, chronic pain caused by an underlying medical 12 condition, and any other chronic or debilitating disease or 13 medical condition or its medical treatment approved by the 14 department by rule. 15 “Health care practitioner” means an individual licensed 16 under Code chapter 148 to practice medicine and surgery 17 or osteopathic medicine and surgery, a physician assistant 18 licensed under Code chapter 148C, or an advanced registered 19 nurse practitioner licensed pursuant to Code chapter 152 or 20 152E. 21 “Medical cannabis” means any species of the genus Cannabis 22 plant, or any mixture or preparation of them, including whole 23 plant extracts and resins. 24 “Medical cannabis dispensary” means an entity licensed under 25 the bill that acquires medical cannabis from a medical cannabis 26 manufacturer in this state for the purpose of dispensing 27 medical cannabis in this state pursuant to the bill. 28 “Medical cannabis manufacturer” means an entity licensed 29 by the department to manufacture and to possess, cultivate, 30 harvest, transport, package, process, or supply medical 31 cannabis pursuant to the bill. 32 “Primary caregiver” means a person, at least 18 years of age, 33 who has been designated by a patient’s health care practitioner 34 or a person having custody of a patient, as a necessary 35 -20- LSB 1406XS (7) 87 rh/rj 20/ 26