Two bills approved this year by the Legislature are Hawaii’s first steps toward handling medical marijuana as a health issue rather than a law enforcement problem.

Although Hawaii was the first state to pass legislation approving the use of medicinal marijuana — seven other states had done so previously through ballot measures — advocates say the state has fallen behind others that have begun managing their initiatives as health programs.

"We’ve made a fundamental change in the way we’re dealing with the program," Sen. Josh Green (D, Naalehu-Kailua-Kona), chairman of the Senate Health Committee and one of the main backers of the bills, said last week. "It used to be a public safety, law enforcement-focused program. By moving it to the Department of Health, it is now going to be an exclusively health-focused program."

The lack of change in the law since its inception in 2000 had discouraged many patients who felt they would never see any improvements, said Pamela Lichty, president of the Drug Policy Action Group, a local advocacy group.

"It’s been our belief, really since the law was enacted, that a health-related bill like this was more appropriately administered by the Department of Health," she said. "It seems, finally, everybody recognizes, including the director of public safety, that it’s more appropriately housed in Health."

House Bill 668 would transfer administration of the medical marijuana program to the Department of Health from the Department of Public Safety. Changes would not take effect until Jan. 1, 2015, giving the Health Department and the Legislature time to study proposed rules and a structure for how the program would be administered.

Senate Bill 642 would make more substantive amendments, such as changing the amounts of the plant patients may possess. The measure would allow patients to have an "adequate supply" of 4 ounces and seven total plants, regardless of the plants’ maturity.

Under current law, qualifying patients may possess a total of three mature plants, four immature plants and 1 ounce of usable marijuana per each mature plant.

The bills also would allow a patient to obtain a medical marijuana certificate from a primary-care physician who specifies the patient suffers from a debilitating illness such that the potential benefits of marijuana use would outweigh any health risks. Patients still would have to register with the Department of Health, and law enforcement agencies would be allowed to inquire about a patient’s registration status at any time.

Both measures are subject to action by the governor, who has until July 9 to decide on all bills. He must inform the Legislature by June 24 of which bills he might veto. A two-thirds vote in both the House and Senate is required to override a veto — but both marijuana bills passed with substantially more than two-thirds’ approval.

A spokeswoman for the governor says the bills are being reviewed and evaluated.

The administration was split on the bills during the session — in support of the transfer, but opposed to many of the changes proposed in SB 642.

"It is more appropriate for the Department of Health to administer the program," Department of Public Safety Director Ted Sakai said in an email last week. "We started the program more than 10 years ago when the Legislature designated us to administer it. … However we are a law enforcement agency, so philosophically the program will be better placed with Health."

Most county police departments, however, opposed the transfer of authority, saying the Department of Health is ill-equipped to enforce the rules of the medical marijuana program.

The attorney general’s office was among those leading opposition to changes proposed in SB 642, saying many of the new provisions would make enforcement "problematic."

Sen. Green, a doctor, said lawmakers worked closely with the Health and Public Safety departments to address such concerns.

"Fundamentally, the question is not about enforcement but is about the health of Hawaii’s patients," he said. "The attorney general’s comments were focused more on enforcement concerns rather than health concerns, which is why we made the fundamental changes to the program to clarify it is a health matter."

Lichty, of the Drug Policy Action Group, credited Rep. Della Au Belatti (D, Moiliili-Makiki-Tantalus), the House Health Committee chairwoman, with studying the efforts of other states and trying to come up with a middle ground for Hawaii. The District of Columbia and 18 states allow marijuana for medicinal use. All programs, except in Hawaii and Vermont, are overseen by a public health agency.

"I think we’re just simply aligning with best practices," Belatti said. "It shows we’re moving toward how other states are handling the programs."

Green said efforts have been made to ensure none of the estimated 12,000 Hawaii medical marijuana patients would lose access.

"No one, from what we did, will lose any continuity of care," he said.

Green noted the new legislation would allow patients seeing a specialist to designate that person as a primary-care physician for purposes of administering a certificate. And he has asked the Health Department to ensure that any U.S. Department of Veterans Affairs hospital patient would be able to gain access to the program through his doctor or another physician. Some VA doctors are hesitant to discuss medical marijuana with patients because the drug remains illegal under federal law.

Advocates say placing the program in the Department of Health should alleviate concerns of physicians and patients who previously might have been afraid to discuss medical marijuana for fear of being stigmatized.

"There are some physicians who wouldn’t touch this issue with their patients," said Charlie Cook, a community organizer for the Drug Policy Action Group.

"They wouldn’t bring it up. If their patients brought it up, they didn’t want to discuss it.

"It made patients feel like criminals. That really is not good for people who are sick with cancer or advanced stages of HIV or going through extreme pain. These are sick people. We should be doing things that alleviate their symptoms and not make them feel ashamed of what they’re doing to relieve their pain or discomfort."