Hawaii lawmakers have overwhelmingly approved a historic shift in how the state manages its medical marijuana program after years of failed efforts to reform it.

House Bill 668 authorizes the transfer of the program from the Department of Public Safety to the Department of Health. DPS has managed the program since its inception in 2000.

Senate Bill 642 increases “adequate supply” to seven pot plants, immature or mature, and allows a patient to have up to four ounces of usable marijuana at any given time. It also requires patients to get prescriptions from their primary care physician — a controversial provision aimed at combatting fly-by-night doctors blamed for abuse.

Both bills, which the Legislature approved Tuesday, are set to take effect January 2015. Lawmakers appropriated $300,000 over the next two years to help the departments make the transition.

Sen. Josh Green, a key proponent along with Rep. Della Au Belatti, said the legislation marks a “fundamental” change in how Hawaii manages its medical marijuana program.

“They’re going to look at this as the day we moved out of the dark ages of abuse and into the idea that it’s really a health question,” he said Friday after securing passage of the bills in a heated conference committee hearing.

Green, an emergency room physician, has tried for the past few years to get the Legislature to reform the program. He was met with resistance until this session.

Under the new House leadership, which tapped Belatti to chair the Health Committee, he found a partner to move the bills forward. In years past, some of the relevant committee chairs had refused to even hear the bills.

Sideline support from Gov. Neil Abercrombie and the directors of DPH and DOH were also critical to getting the bills passed, lawmakers and supporters said.

DPS Director Ted Sakai said in his testimony that the primary focus of the program should be on the health of qualifying patients. As such, he said DOH is better suited for managing it.

But even with their support, getting the bills through was hard.

Green had to overcome lawmakers who wouldn’t hear the bills. And he had to hang himself out there in the face of staunch opposition from patients who remain concerned that they will be unable to get prescriptions from their primary care physicians.

“As long as we had people flying in and willy-nilly prescribing, they were going to be the target of abuse questions, the target of inappropriate use,” Green said. “There will not be that challenge when someone has a relationship with their Hawaii physician, their primary care physician.”

He said the concern isn’t so much over how many of these traveling physicians come to Hawaii, but of volume.

“One person could come in and in the course of a month prescribe to many, many people that they didn’t know. That’s not good medicine,” Green said. “We had one gentleman who would fly in from Oregon and get a hotel room and a medical license and prescribe, staying in a four-star hotel.”

He understands the concern from some who might see it as an attack on their right to access medical marijuana, but stresses that it’s exactly the opposite.

“It preserves a person’s right because once something is ensconced between a doctor and a patient, no one can penetrate that right,” Green said.

The concern is still out there, but some advocates are coming around to the idea in large part because they have 20 months before the law takes effect to work with the Department of Health on its rules or even with lawmakers again next session.

Pam Lichty, who heads the Drug Policy Action Group and co-chaired a working group that submitted recommendations to the Legislature in 2010, said Wednesday that after talking to physicians and lawyers the language doesn’t appear to be as problematic as it seemed.

“A lot of patients are extremely upset about this, but there’s a lot that can be done between now and then,” she said.

Testimony poured in from doctors and patients since the bills were introduced in January.

Robert Slavin, a 70-year-old retired teacher in Honolulu, said cannabis is less impairing than the narcotics doctors prescribed to him for an array of neuropathies and paresthesias.

“Please help stop the uneven enforcement of antiquated marijuana laws,” he told lawmakers in March. “Let’s have professionals, skilled in managing health-related programs, be charged with running this medical program.”

Opposition came from the Honolulu prosecutor — along with county police departments — in large part because marijuana is still classified as a controlled substance under federal law.

“Despite the large number of medical marijuana permits in Hawaii, the bulk of marijuana cases handled by the department do not involve permitted persons,” the Honolulu prosecutor’s office said in its testimony. “Illegal marijuana use continues to be a problem among the general public, such that law enforcement agencies must work closely with the Department of Public Safety to maintain tight monitoring of this substance, around the clock.”

Green said there are already 175 primary care physicians dispensing medical marijuana in the state. He expects this number to double when the law takes effect because of the added comfort of having it under the Department of Health.

He said the average primary care provider on average takes care of 2,500 to 3,000 patients. With 12,000 registered medical marijuana patients in Hawaii, Green said he doesn’t foresee a problem.

But if the Department of Health finds out the capacity is inadequate and if patients’ needs aren’t being met, Green said he would respect the department’s recommendations on how to address those issues.

“It’s better to have a mainstream program where public safety doesn’t vilify patients or physicians if they’re participating,” he said.

Eighteen other states and D.C. have implemented similar programs. All of those jurisdictions that have a registry program have it within their Department of Health, Lichty said.

Gut and Replace Key To Final Passage

It was also essential to Green that both bills pass. But it was a struggle to get them to the final conference committee.

At one point in the session, House Bill 667 — the legislation that went on to become SB 642 — appeared dead because the relevant committee chairs wouldn’t hear it.

Belatti agreed to insert HB 667 into SB 642 since it had a broad enough title — “relating to health” — to allow it. (SB 642 originally required businesses to sell tobacco products from behind a counter. That language later made its way into another bill and passed this week.)

Lichty called Belatti a “champion” for believing in the bill enough to find a way to get it passed.

“I had to get angry to pass both bills,” he said, referring to his passionate discourse during the conference committee hearing. “I wasn’t going to have one without the other.”

The conference committee was comprised of Reps. Belatti, Angus McKelvey, Chris Less and Sylvia Luke and Sens. Roz Baker, David Ige, Clayton Hee and Green.

Compromises were made in conference, including dropping the number of allowable ounces down from five to four and limiting primary caregivers to caring for only one patient.

The bill also was amended to clarify that if an inquiry is made by a law enforcement agency at any time, the Department of Health must immediately verify whether the subject of the inquiry has registered and may provide reasonable access to the registry information for law enforcement purposes.

Despite the watering down of the bills in committee, Lichty said she’s pleased to see the both pass.

“To us, it was a no-brainer, but it’s taken all these years to come to fruition,” she said, noting that it was never a good fit to put the program under DPS.

Hawaii was the first state to legalize medical marijuana without a voter initiative. As a result, Lichty said the law didn’t do as much as it should have because the state took a cautious approach.

“We think it’s time to catch-up,” she said.

The Department of Health says with adequate start-up money, the program will be self-sufficient by January 2015. Lawmakers fully funded its request for resources.

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