There is a great deal of discussion about legalizing marijuana in the state of Kentucky. Pegasus Institute has not taken a position on marijuana legalization, and does not intend to. We do acknowledge that the conversation surrounding such legalization has ignored the very complex nature of creating a gray market for an illicit substance, which remains a schedule 1 drug under the Controlled Substances Act, meaning that the Federal Government does not currently accept medical use in treatment for marijuana and that there is a lack of accepted safety for use of the drug. Listed below are outstanding questions that lawmakers should consider before Kentucky can move forward with an efforts to legalize marijuana.

Regarding Licensing of Producers, Sellers, and Patients

1. How will licenses for medical marijuana cultivation facilities, processing facilities, testing facilities, and dispensaries be selected? The application processes for medical marijuana growing and dispensary licenses in other states have often required application fees ranging between ten-thousand and over a hundred-thousand dollars and resources of over a million dollars – which would disqualify many potential growers in rural areas of the state.

a. Will the public be able to object to specific license applications?

2. What restrictions will be placed on who can be employed at medical marijuana cultivation facilities, processing facilities, testing facilities, and dispensaries?

3. Will marijuana handlers be required to register or obtain permits?

4. Will licensed pharmacists be required to work at dispensaries to fill recommendations?

5. What are the requirements for patients to apply to use medical marijuana? Will the application process protect their confidentiality?

a. Will the state allow personal caregivers to apply to assist medical marijuana pa-

tients?

b. Will minors be eligible to use medical marijuana with the consent of their parent

or guardian?

Regarding Marijuana-Related Businesses

1. Are banks operating in Kentucky willing to provide financial services to marijuana growers and dispensaries?

2. Will insurance agencies or Medicaid subsidize medical marijuana for their patients? If not, will the costs be prohibitive for potential patients?

3. How will marijuana inventories across cultivation facilities, processing facilities, testing facilities, and dispensaries be tracked?

4. What are the security requirements for medical marijuana cultivation facilities, processing facilities, testing facilities, and dispensaries?

a. Who will be permitted to enter medical marijuana dispensaries?

5. Will Kentucky cultivation facilities, processing facilities, testing facilities, and dispensaries be able to support the demand in Kentucky for medical marijuana products?

Regarding Zoning Restrictions

1. What zoning restrictions will be placed on medical marijuana cultivation facilities, processing facilities, testing facilities, and dispensaries? Will there be a buffer zone for proximity of these facilities to schools, youth or recreation centers, religious buildings, or correctional facilities?

2. Will individual communities be able to opt out of allowing medical marijuana cultivation facilities, processing facilities, testing facilities, and dispensaries?

3. Where can medical marijuana be used? Can it be used in the presence of minors?

4. What restrictions will be in place for commercial transport? Labeling/Packaging? Shipping?

Regarding Patients

1. What restrictions will be in place for personal possession or use?

2. What are the accepted conditions for which medical marijuana can be recommended? Can patients petition to treat other medical conditions with medical marijuana?

3. Will medical marijuana users be permitted to own or possess a firearm?

4. If a patient’s main doctor will not recommend medical marijuana, are there other avenues for that patient to get a recommendation?

5. Some prescribed medications – for example isotretinoin, commonly used to treat serious cases of acne – can cause serious birth defects, so patients are required by law to use two acceptable forms of birth control for one month before treatment and during treatment. Studies have suggested that marijuana use during pregnancy has been tied to premature birth, low birthweight, anencephaly (a neural tube defect), anemia, brain development problems, and stillbirth. If a woman may potentially become pregnant while she is using medical marijuana, will she be required to use birth control before and during treatment?

6. Is a patient using medical marijuana prohibited from breastfeeding?

7. When doctors prescribed opioids at high rates to patients, opioid abuse disorders still went unnoticed. Will doctors be required to monitor their patients for marijuana abuse disorders?

Regarding Minors

1. Will foster parents be able to use medical marijuana while they are fostering children?

2. Will Child Protective Services be allowed to remove children from their parents if their parents are medical marijuana users?

3. Is medical marijuana use permitted in the presence of minors?

4. Are there storage or child-proofing requirements for medical marijuana so children cannot consume it?

5. Will the legalization of medical marijuana increase minors’ access to marijuana and other drugs?

6. Will minors be permitted to use medical marijuana with the recommendation of a medical professional?

a. Is there a minimum age requirement?

Regarding Housing

1. Can property owners ban someone from possessing, growing, or consuming medical marijuana on their private property? Can they restrict the types of medical marijuana used by the patient?

2. Will medical marijuana users have to notify the owners of their property?

Regarding Employment

1. Can employers prohibit employees from possessing, growing, or consuming medical marijuana?

2. Can an employer decide not to hire someone, decide to fire someone, or penalize someone because they are qualified to use medical marijuana?

3. Will employers be prohibited from testing for marijuana use?

4. The federal government has not legalized marijuana for medical use. How will medical marijuana affect the large number of federal contracts and federal employees in Kentucky?

Regarding Schools and Students

1. Can a school or university refuse to enroll or penalize someone because they are qualified to use medical marijuana?

2. If a student has a recommendation for medical marijuana, how will school officials determine what drug the student may be under the influence of? Are there specific field sobriety indicators for medical marijuana?

3. How will medical marijuana affect a schools’ drug-testing policies for athletics?

a. Can a student be penalized for testing positive for marijuana if they have a doc-

tor’s recommendation for medical marijuana?

4. Will students, teachers, or school employees with doctor’s recommendations for medical marijuana be permitted to use or possess medical marijuana at or near the school?

Regarding Medical Professionals

1. Will medical professionals be required to write medical marijuana recommendations for patients with one of the listed acceptable conditions?

2. Can medical professionals only recommend the use of medical marijuana for one of the approved conditions?

3. How many medical professionals must recommend medical marijuana treatment for a patient to be able to apply for medical marijuana use?

4. Which medical professionals are able to issue recommendations?

5. Will the state verify written certifications with the medical professionals that provided them?

6. Is there a requirement of a “bona fide physician-patient relationship” between the patient and the recommending medical professional?

7. Will medical practitioners be required to take any course, training, or CE on the medical use of marijuana before being permitted to issue recommendations for medical marijuana?

a. Who would provide the instruction?

b. How many hours would be required?

8. Will medical professionals be required to register with the state to issue recommendations for the use of medical marijuana?

9. Will there be a test period for the recommending medical professional to evaluate the effectiveness of medical marijuana for the patient?

10. Can medical professionals rescind a recommendation? For what reasons?

11. Would recommendations be entered into KASPER as other prescriptions are?

a. Would medical professionals be able to check for interactions between medical

marijuana and other medications otherwise?

12. Will recommendations for the use of medical marijuana expire? Will they need to be renewed?

Regarding Product Testing and Potency

1. Will medical marijuana be tested for potency and contamination before distribution? Will the testing facilities and processes be independent from cultivation facilities, processing facilities, and dispensaries?

2. What restrictions will be placed on marijuana potency, THC content, and dosage in each form of medical marijuana?

3. The federal government recognizes marijuana as a Schedule I drug, so the Food and Drug Administration cannot regulate which pesticides when used on marijuana could be harmful. Would state regulatory agencies be able to work with national pesticide companies to

create experimental labels for pesticide use on medical marijuana plants?

a. How will Kentucky regulate the procedures used to grow medical marijuana?

Regarding Edibles

1. Will the production and sale of edible be subject to the same food safety regulations and inspections as other foods in Kentucky?

a. Many of the food safety regulations in place are set by the Food and Drug Admin-

istration. Marijuana is still a Schedule I drug under federal law, so the Food and Drug Administration has not set specific standards. Who will set the standards for

edibles in Kentucky?

2. Where will patients be permitted to use edibles?

3. Will edibles be sold with a nutrition label detailing the non-marijuana ingredients?

Regarding Home Growth

Regarding Home Growth

1. How many plants would one patient be allowed to grow? Would this number vary by patient depending on how much is recommended by their doctor?

2. Where will patients get the medical marijuana plants to grow?

3. How will plant inventories be tracked?

4. How would medical professionals be able to verify the dosage that patients are receiving if patients are not receiving a controlled supply from a dispensary?

5. Would patients be able to test the potency and THC content of the marijuana they grow themselves?

6. Would Kentucky provide guidelines for patients growing their own medical marijuana? How would patients know which fertilizers and chemicals may be dangerous to use on their marijuana plants?

Regarding Criminality

1. Even if medical marijuana users were given identification cards, how would law enforcement officials distinguish between marijuana that was purchased legally or illicitly? Will patients be prohibited from selling, bartering, sharing, or otherwise distributing medical marijuana?

2. How will those legally certified to work at medical marijuana cultivation facilities, processing facilities, testing facilities, and dispensaries be identifiable to law enforcement?

3. How will those legally certified to use medical marijuana be identifiable to law enforcement?

4. How will police be able to identify plants being grown?

Miscellaneous

1. In states where marijuana has been legalized for medical use, it has generally been grown and processed in warehouses in cities. In Kentucky, will the proceeds from medical marijuana growing and processing also go to urban areas?

2. Is medical marijuana use for qualified users considered legal or illegal for the purposes of the Americans with Disabilities Act which excludes current illegal drug users from the coverage of the Act?

We will continue to update this list as we get more feedback from stakeholders.