In 2000, Act 28 made Hawaii one of the first states to authorize the use of marijuana to treat certain debilitating medical conditions. Act 28, however, was silent on how to legally obtain a patient or caregiver’s first seed to cultivate their crop or otherwise legally acquire medical marijuana, leaving patients and even law enforcement in a conundrum.

Fast forward 15 years and Hawaii may soon join a growing number of states that have authorized dispensaries to distribute marijuana for medical use if House Bill 321, Relating to Medical Marijuana, is enacted. The 2015 state Legislature, based on remarks from opening day ceremonies, set as a goal to close the gap between the authorized use of medical marijuana and the legal means of acquiring it. A well-regulated dispensaries system may address both patient and law enforcement needs.

In 2012, the Legislature proposed transferring the medical marijuana patient registry program from the Department of Public Safety to the Department of Health (DOH). After successfully standing up the program in January 2015, DOH was once again called on by the Legislature to regulate a dispensaries program.

The department’s testimony on HB 321 emphasized public health and safety as a top priority. The rationale for this was simple: unlike prescription or over-the-counter medications, no formally recognized standards exist for the medical use of marijuana.

The U.S. Food and Drug Administration, which is responsible for assuring the safety and efficacy of medications, has not reviewed or approved medical marijuana due to its classification as a Schedule I drug under the Controlled Substances Act of 1974. Along with heroin, LSD, and other substances, Schedule I drugs are "defined as drugs with no currently accepted medical use and a high potential for abuse. Schedule I drugs are the most dangerous drugs of all the drug schedules with potentially severe psychological or physical dependence."

In order to protect Hawaii’s vulnerable patients, who by definition are suffering from debilitating medical conditions, the Department of Health must establish its own guidelines for medical marijuana. Patients expect and have a right to know the potency and purity of their medication. Several other states are now grappling with patient demand for independent quality oversight as an after-thought, which is something Hawaii intends to avoid.

In addition to patient safety, the department’s implementation will be guided by the "Cole Memorandum" issued by the U.S. Department of Justice in August 2013. Public sentiment may have evolved on medical marijuana, but this memorandum makes clear that marijuana remains an illegal drug under the Controlled Substances Act and establishes priorities for enforcement.

Hawaii and other states with medical marijuana programs must establish strict regulatory schemes that protect federal interests. Inter-island transport is strictly forbidden by HB 321, for example, in deference to federal priorities.

Other issues will factor into the implementation and beyond, including the desire for greater clinical research and need for epidemiological studies (for example on the relationship of medical marijuana use to motor vehicle accidents, falls, or injuries). Numerous other issues requiring the coordination of other state, county and private entities will also be addressed, such as physical security, inventory control and pesticide regulation, to name a few.

However, with dispensaries operating or soon to be operating in about one-third of the country, Hawaii is in a good position to review lessons learned and adopt the best practices of other jurisdictions. As with all the programs administered by the Hawaii Department of Health, the department’s team will use its experience in working with patients and public health issues to successfully implement the dispensary program.

8 licenses, 16 dispensaries, 6,000 plants

Under the new proposed state law, the Hawaii Department of Health will issue eight dispensary licenses. Each license holder will be allowed to operate up to two retail dispensaries for a total of 16 statewide. Geographically, they will be spread out across the state: six dispensaries on Oahu, four each in Hawaii Island and Maui Counties, and two in Kauai County.

Each license holder will be allowed to grow up to 6,000 plants and operate two production centers to convert harvested material into products that can be sold to registered patients. The license shall allow production, manufacturing and dispensing of marijuana and manufactured marijuana products only in the county for which the license is granted.

FAQs about medical marijuana, now online

The medical marijuana patient registration program was transferred from the state Department of Public Safety to the state Department of Health in January 2015, as part of Act 177. The Department of Health has introduced its own medical marijuana website, which includes frequently asked question and is the main portal for the public to learn about the program and coming developments.

Also now available is an online application process for physicians and a confidential online system than can be used by law enforcement officials to verify that those found growing or using marijuana are certified medical marijuana patients.

— State Department of Health