HOUSE OF REPRESENTATIVES	H.B. NO.	1082
THIRTY-SECOND LEGISLATURE, 2023		H.D. 3
STATE OF HAWAII		S.D. 2

A BILL FOR AN ACT

RELATING TO MEDICAL CANNABIS.

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

SECTION 1. Section 329-121, Hawaii Revised Statutes, is amended by amending the definition of "written certification" to read as follows:

""Written certification" means the qualifying patient's medical records or a statement signed by a qualifying patient's physician or advanced practice registered nurse, stating that in the physician's or advanced practice registered nurse's professional opinion, the qualifying patient has a debilitating medical condition and the potential benefits of the medical use of cannabis would likely outweigh the health risks for the qualifying patient. The department of health may require, through its rulemaking authority, that all written certifications comply with a designated form. "Written certifications" are valid for one year from the time of signing; provided that the department of health may allow for the validity of any written certification for [up to] three years if the qualifying patient's physician or advanced practice registered nurse states that the patient's debilitating medical condition is chronic in nature."

SECTION 2. Section 329-123, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) Physicians or advanced practice registered nurses who issue written certifications shall provide, in each written certification, the name, address, patient identification number, and other identifying information of the qualifying patient. The department of health shall require, in rules adopted pursuant to chapter 91, that all written certifications comply with a designated form completed by or on behalf of a qualifying patient. The form shall require information from the applicant, primary caregiver, and physician or advanced practice registered nurse as specifically required or permitted by this chapter. The form shall require the address of the location where the cannabis is grown and shall appear on the registry card issued by the department of health. The certifying physician or advanced practice registered nurse shall be required to have a [bona fide] physician-patient relationship or [bona fide] advanced practice registered nurse-patient relationship, as applicable, with the qualifying patient. All current active medical cannabis permits shall be honored through their expiration date."

SECTION 3. Section 329-126, Hawaii Revised Statutes, is amended to read as follows:

"§329-126 Protections afforded to a treating physician or advanced practice registered nurse. (a) No physician or advanced practice registered nurse shall be subject to arrest or prosecution, penalized in any manner, or denied any right or privilege for providing written certification for the medical use of cannabis for a qualifying patient; provided that:

(1) The physician or advanced practice registered nurse has diagnosed the patient as having a debilitating medical condition, as defined in section 329-121;

(2) The physician or advanced practice registered nurse has explained the potential risks and benefits of the medical use of cannabis, as required under section 329-122;

(3) The written certification is based upon the physician's or advanced practice registered nurse's professional opinion after having completed a full assessment of the patient's medical history and current medical condition made in the course of a [bona fide] physician-patient relationship or [bona fide] advanced practice registered nurse-patient relationship, as applicable; and

(4) The physician or advanced practice registered nurse has complied with the registration requirements of section 329-123.

(b) For purposes of this section, a [bona fide] physician-patient relationship may be established via telehealth, as defined in section 453-1.3(j), and a [bona fide] advanced practice registered nurse-patient relationship may be established via telehealth, as defined in section 457-2; provided that treatment recommendations that include certifying a patient for the medical use of cannabis via telehealth shall be allowed only after an initial in-person consultation between the certifying physician or advanced practice registered nurse and the patient."

SECTION 4. Section 329D-1, Hawaii Revised Statutes, is amended as follows:

1. By adding a new definition to be appropriately inserted and to read as follows:

""Waiting room" means a designated area at the public entrance of a retail dispensing location that may be accessed by a member of the general public who is waiting for, assisting, or accompanying a qualifying patient, primary caregiver, qualifying out-of-state patient, or caregiver of a qualifying out-of-state patient who enters or remains on the premises of a retail dispensing location for the purpose of a transaction conducted pursuant to sections 329D-6 and 329D-13, provided that the storage, display, and retail sale of cannabis and manufactured cannabis products shall be prohibited within the waiting room area."

2. By amending the definition of "manufactured cannabis product" to read as follows:

""Manufactured cannabis product" means [any]:

(1) Any capsule, lozenge, oil or oil extract, tincture, ointment or skin lotion, pill, transdermal patch, or pre-filled and sealed container used to aerosolize and deliver cannabis orally[,] or by inhalation, such as an inhaler [or], nebulizer, or device that provides safe pulmonary administration, that has been manufactured using cannabis[,];

(2) Edible cannabis products;

(3) Pre-rolled cannabis flower products; or [any]

(4) Any other products as specified by the department pursuant to section 329D-10(a)(11)."

SECTION 5. Section 329D-6, Hawaii Revised Statutes, is amended by amending subsection (r) to read as follows:

"(r) The department may authorize a dispensary to purchase cannabis and manufactured cannabis products from another dispensary in a manner prescribed by the department by rules adopted pursuant to [this chapter and chapter 91;] section 329D-27; provided that:

(1) The purchasing dispensary establishes to the department's satisfaction that:

(A) The purchase is necessary to ensure that qualifying patients have continuous access to cannabis for medical use; or

(B) The cannabis and manufactured cannabis products are for medical, scientific, or other legitimate purposes approved by the State;

(2) The selling dispensary may transport no more than eight hundred ounces of cannabis or manufactured cannabis products to the purchasing dispensary within a thirty-day period[;] or other amounts with prior approval by the department;

(3) The cannabis and manufactured cannabis products are transported between the dispensaries for medical, scientific, or other legitimate purposes approved by the State; and

(4) Nothing in this subsection shall relieve any dispensary of its responsibilities and obligations under this chapter and chapter 329."

SECTION 6. Section 329D-7, Hawaii Revised Statutes, is amended to read as follows:

"§329D-7 Medical cannabis dispensary rules. The department shall establish standards with respect to:

(1) The number of medical cannabis dispensaries that shall be permitted to operate in the State;

(2) A fee structure for:

(A) The submission of applications and renewals of licenses to dispensaries; provided that the department shall consider the market conditions in each county in determining the license renewal fee amounts;

(B) The submission of applications for each additional production center; and

(C) Dispensary-to-dispensary sales authorized by section 329D-6(r);

(3) Criteria and procedures for the consideration and selection, based on merit, of applications for licensure of dispensaries; provided that the criteria shall include but not be limited to an applicant's:

(A) Ability to operate a business;

(B) Financial stability and access to financial resources; provided that applicants for medical cannabis dispensary licenses shall provide documentation that demonstrates control of not less than $1,000,000 in the form of escrow accounts, letters of credit, surety bonds, bank statements, lines of credit, or the equivalent to begin operating the dispensary;

(C) Ability to comply with the security requirements developed pursuant to paragraph (6);

(D) Capacity to meet the needs of qualifying patients and qualifying out-of-state patients;

(E) Ability to comply with criminal background check requirements developed pursuant to paragraph (8); and

(F) Ability to comply with inventory controls developed pursuant to paragraph (13);

(4) Specific requirements regarding annual audits and reports required from each production center and dispensary licensed pursuant to this chapter;

(5) Procedures for announced and unannounced inspections by the department or its agents of production centers and dispensaries licensed pursuant to this chapter; provided that inspections for license renewals shall be unannounced;

(6) Security requirements for the operation of production centers and retail dispensing locations; provided that, at a minimum, the following shall be required:

(A) For production centers:

(i) Video monitoring and recording of the premises; provided that recordings shall be retained for fifty days;

(ii) Fencing that surrounds the premises and that is sufficient to reasonably deter intruders and prevent anyone outside the premises from viewing any cannabis in any form;

(iii) An alarm system; and

(iv) Other reasonable security measures to deter or prevent intruders, as deemed necessary by the department;

(B) For retail dispensing locations:

(i) Presentation of a valid government-issued photo identification and a valid identification as issued by the department pursuant to section 329-123 by a qualifying patient or caregiver, or section 329-123.5 by a qualifying out-of-state patient or caregiver of a qualifying out-of-state patient, upon entering the premises;

(ii) Video monitoring and recording of the premises; provided that recording shall be retained for fifty days;

(iii) An alarm system;

(iv) Exterior lighting; and

(v) Other reasonable security measures as deemed necessary by the department;

(7) Security requirements for the transportation of cannabis and manufactured cannabis products between production centers and retail dispensing locations and between a production center, retail dispensing location, qualifying patient, primary caregiver, qualifying out-of-state patient, or caregiver of a qualifying out-of-state patient and a certified laboratory, pursuant to section 329-122(f);

(8) Standards and criminal background checks to ensure the reputable and responsible character and fitness of all license applicants, licensees, employees, subcontractors and their employees, and prospective employees of medical cannabis dispensaries to operate a dispensary; provided that the standards, at a minimum, shall exclude from licensure or employment any person convicted of any felony;

(9) The training and certification of operators and employees of production centers and dispensaries;

(10) The types of manufactured cannabis products that dispensaries shall be authorized to manufacture and sell pursuant to sections 329D-9 and 329D-10;

(11) Laboratory standards related to testing cannabis and manufactured cannabis products for content, contamination, and consistency;

(12) The quantities of cannabis and manufactured cannabis products that a dispensary may sell or provide to a qualifying patient, primary caregiver, qualifying out-of-state patient, or caregiver of a qualifying out-of-state patient; provided that no dispensary shall sell or provide to a qualifying patient, primary caregiver, qualifying out-of-state patient, or caregiver of a qualifying out-of-state patient any combination of cannabis and manufactured products that:

(A) During a period of fifteen consecutive days, exceeds the equivalent of four ounces of cannabis; or

(B) During a period of thirty consecutive days, exceeds the equivalent of eight ounces of cannabis;

(13) Dispensary and production center inventory controls to prevent the unauthorized diversion of cannabis or manufactured cannabis products or the distribution of cannabis or manufactured cannabis products to a qualifying patient, primary caregiver, qualifying out-of-state patient, or caregiver of a qualifying out-of-state patient in quantities that exceed limits established by this chapter; provided that the controls, at a minimum, shall include:

(A) A computer software tracking system as specified in section 329D-6(j) and (k); and

(B) Product packaging standards sufficient to allow law enforcement personnel to reasonably determine the contents of an unopened package;

(14) Limitation to the size or format of signs placed outside a retail dispensing location or production center; provided that the signage limitations, at a minimum, shall comply with section 329D-6(o)(2) and shall not include the image of a cartoon character or other design intended to appeal to children;

(15) The disposal or destruction of unwanted or unused cannabis and manufactured cannabis products;

(16) The enforcement of the following prohibitions against:

(A) The sale or provision of cannabis or manufactured cannabis products to unauthorized persons;

(B) The sale or provision of cannabis or manufactured cannabis products to a qualifying patient, primary caregiver, qualifying out-of-state patient, or caregiver of a qualifying out-of-state patient in quantities that exceed limits established by this chapter;

(C) Any use or consumption of cannabis or manufactured cannabis products on the premises of a retail dispensing location or production center; and

(D) The distribution of cannabis or manufactured cannabis products, for free, on the premises of a retail dispensing location or production center;

(17) The establishment of a range of penalties for violations of this chapter or rule adopted thereto; [and]

(18) A process to recognize and register patients who are authorized to purchase, possess, and use medical cannabis in another state, a United States territory, or the District of Columbia as qualifying out-of-state patients; provided that this registration process may commence no sooner than January 1, 2018[.]; and

(19) Security requirements and restrictions regarding waiting rooms, including but not limited to:

(A) Security measures to prevent unauthorized access to any area within the retail dispensing location outside of the waiting room;

(B) Restrictions on marketing and advertising within the waiting room;

(C) Restrictions on signage within the waiting room; and

(D) Other reasonable security measures or restrictions as deemed necessary by the department."

SECTION 7. Section 329D-10, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) The types of medical cannabis products that may be manufactured and distributed pursuant to this chapter shall be limited to:

(1) Capsules;

(2) Lozenges;

(3) Pills;

(4) Oils and oil extracts;

(5) Tinctures;

(6) Ointments and skin lotions;

(7) Transdermal patches;

(8) Pre-filled and sealed containers used to aerosolize and deliver cannabis orally[,] or by inhalation, such as [with] an inhaler [or], nebulizer[;], or device that provides safe pulmonary administration; provided that [containers]:

(A) Containers need not be manufactured by the licensed dispensary but shall be filled with cannabis, cannabis oils, or cannabis extracts manufactured by the licensed dispensary[;] or purchased from another dispensary pursuant to section 329D-6(r); but shall not contain nicotine, tobacco-related products, or any other non-cannabis derived products; and [shall be designed to be used with devices used to provide safe pulmonary administration of manufactured cannabis products;

(9) Devices]

(B) For devices that provide safe pulmonary administration[; provided that]:

[(A)] (i) The heating element of the device, if any, [is] shall be made of inert materials such as glass, ceramic, or stainless steel, and not of plastic or rubber;

[(B)] (ii) The device [is] shall be distributed solely for use with single-use, pre-filled, tamper-resistant, sealed containers that do not contain nicotine or other tobacco products;

[(C) The device is used to aerosolize and deliver cannabis by inhalation, such as an inhaler, medical-grade nebulizer, or other similar medical grade volitization device;

(D)] (iii) There [is] shall be a temperature control on the device that is regulated to prevent the combustion of cannabis oil; and

[(E)] (iv) The device need not be manufactured by the licensed dispensary;

(9) Pre-rolled cannabis flower products, as specified by the department;

(10) [Other products, including edible] Edible cannabis products, as specified by the department; and

(11) Other products as specified by the department."

SECTION 8. Section 329D-15, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) No person shall intentionally or knowingly enter or remain upon the premises of a medical cannabis retail dispensing location unless the individual is:

(1) An individual licensee or registered employee of the dispensary;

(2) A qualifying patient, primary caregiver, qualifying out-of-state patient, or caregiver of a qualifying out-of-state patient;

(3) A government employee or official acting in the person's official capacity; or

(4) Previously included on a current department-approved list provided to the department by the licensee of those persons who are allowed into that dispensary's facilities for a specific purpose for that dispensary, including but not limited to construction, maintenance, repairs, legal counsel, providers of paratransit or other assistive services required by a qualifying patient, primary caregiver, qualifying out-of-state patient, or caregiver of a qualifying out-of-state patient to access a retail dispensary location, or investors; provided that;

(A) The person has been individually approved by the department to be included on the list;

(B) The person is at least twenty-one years of age, as verified by a valid government issued identification card;

(C) The department has confirmed that the person has no felony convictions;

(D) The person is escorted by an individual licensee or registered employee of the dispensary at all times while in the dispensary facility;

(E) The person is only permitted within those portions of the dispensary facility as necessary to fulfill the person's purpose for entering;

(F) The person is only permitted within the dispensary facility during the times and for the duration necessary to fulfill the person's purpose for entering;

(G) The dispensary shall keep an accurate record of each person's first and last name, date and times upon entering and exiting the dispensary facility, purpose for entering, and the identity of the escort; and

(H) The approved list shall be effective for one year from the date of the department approval[.];

provided that a member of the general public may enter or remain within the waiting room of a retail dispensing location."

SECTION 9. Section 329D-21, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows:

"(b) Any person who violates any of the provisions of this chapter or the rules adopted pursuant thereto shall be fined not less than $100 nor more than $1,000 for each [violation.] separate violation. Each day on which a violation occurs or continues shall be counted as a separate violation."

SECTION 10. Section 329D-26, Hawaii Revised Statutes, is amended to read as follows:

"[[]§329D-26[]] Public education. [(a) The department] Medical cannabis dispensaries, in conjunction with physicians and advanced practice registered nurses who issue written certifications pursuant to section 329-123, shall conduct a continuing education and training program to explain and clarify the purposes and requirements of this chapter or to provide substance abuse prevention and education. The program shall target community partner agencies, physicians and other health care providers, patients and caregivers, law enforcement agencies, law and policy makers, and the general public.

[(b) The department shall employ at least one full-time staff member whose qualifications and duties include the provision of medical cannabis health education.]"

SECTION 11. (a) The office of medical cannabis control and regulation, in collaboration with the chairpersons of the senate committee on health and human services and the house of representatives committee on health and homelessness, shall convene a medical and adult use of cannabis working group to research, develop, and finalize recommendations for the creation of a dual use regulatory system allowing access to medical cannabis and cannabis for adult use.

(b) The medical and adult use of cannabis working group shall include the following:

(1) The chairperson of the senate committee on health and human services, or the chairperson's designee;

(2) The chairperson of the house of representatives committee on health and homelessness, or the chairperson's designee;

(3) The chairperson of the senate committee on agriculture and environment, or the chairperson's designee;

(4) The chairperson of the house of representatives committee on agriculture and food systems, or the chairperson's designee;

(5) The attorney general, or the attorney general's designee;

(6) The director of health, or the director's designee;

(7) The chairperson of the board of agriculture, or the chairperson's designee;

(8) The director of taxation, or the director's designee;

(9) The prosecuting attorney of the city and county of Honolulu, or the prosecuting attorney's designee;

(10) A police chief chosen by the Law Enforcement and Security Coalition of Hawaii, or the police chief's designee;

(11) A representative of the Drug Policy Forum of Hawaii;

(12) A representative from the Coalition for a Drug-Free Hawaii;

(13) Four participants in Hawaii's medical marijuana program, one of whom is a patient over the age of eighteen, one of whom is a patient or guardian of a patient who is under the age of ten, one of whom is a named caregiver of a patient, and one of whom is a representative of a licensed dispensary; and

(14) Any other participants identified in consultation with the office of medical cannabis control and regulation, and the chairpersons of the senate committee on health and human services and the house of representatives committee on health and homelessness.

(c) The medical and adult use of cannabis working group shall submit a report of its findings and recommendations, including any proposed legislation, to the legislature no later than ten days prior to the convening of the regular session of 2024.

SECTION 12. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 13. This Act shall take effect on June 30, 2050.

Report Title:

Medical Cannabis Dispensary System; Physician-Patient Relationship; Advanced Practice Registered Nurse-Patient Relationship; Written Certification; Waiting room; Violations; Continuing Education; Working Group

Description:

Requires that written certifications for a patient with a chronic condition be valid for three years. Removes the requirement that a certifying physician or advanced practice registered nurse have a "bona fide" physician-patient or advanced practice registered nurse-patient relationship to certify that a patient has a debilitating medical condition pursuant to chapter 329, Hawaii Revised Statutes. Amends the definition of "manufactured cannabis product" to include devices that provides safe pulmonary administration, edible cannabis products, and pre-rolled cannabis flower products. Defines "waiting room" within a medical cannabis retail dispensary. Allows primary caregivers, qualifying out-of-state patients, and caregivers of a qualifying out-of-state patient to access the waiting room. Allows selling dispensaries to transport not more than eight hundred ounces of cannabis or manufactured cannabis products to purchasing dispensaries within a thirty-day period, or other amounts with prior approval of the Department of Health. Clarifies the types of medical cannabis products that may be manufactured and distributed pursuant to the State's medical cannabis dispensary system. Clarifies that each day of a violation of chapter 329D, Hawaii Revised Statutes, is a separate violation. Amends the rule-making authority for dispensary-to-dispensary sales. Requires medical cannabis dispensaries, in conjunction with physicians and advanced practice registered nurses who issue written certifications pursuant to section 329-123, Hawaii Revised Statutes, to conduct the continuing education and training program required by section 329D-26, Hawaii Revised Statutes, rather than the Department of Health. Establishes a Medical and Adult Use of Cannabis Working Group. Effective 6/30/2050. (SD2)

The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.