Introduction 

The National Institute on Drug Abuse website defines marijuana as a “greenish-gray mixture of the dried, shredded leaves and flowers of Cannabis sativa, the hemp plant”(NIDA, 2017). It is known in the public space as weed, herb, grass and pot etc. There are different ways of ingesting marijuana like smoking, as an additive in tea or in solid form like cookies. The main use of marijuana is its mind – altering ability due to the chemical delta-9-tetrahydrocannabinol (THC). Marijuana is used both for recreational and medical purposes. It provides relaxation though there are evidence of negative effects. However, research shows that there could be other compounding factors like simultaneous intake of alcohol which results in the negative effects.

There are many marijuana-based medications available for pain and spasms which are being clinically tested. Certain states in the US have legalized use of marijuana for medical conditions.

The above map is as on 28^th Dec 2016. (28 Legal Medical Marijuana States and DC, 2016)

The below chart has been curated from the ProCon.org official website.

Every state has clear provisions and limit to the amount of marijuana that a patient or caregiver can legally possess. The objective of using marijuana for medical reasons is to alleviate or support challenges for which no other treatment is possible. It is to ease the patient’s condition and provide mental peace.

Today, in the US, 26 states and the District of Columbia have legalized the use of marijuana either for recreational purpose, for medicinal or for both. The following states allow medicinal use of marijuana – Alaska, Arizona, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Ohio, Oregon, Pennsylvania, Rhode Island, Vermont, Washington and Washington DC.

Source: http://www.governing.com/gov-data/state-marijuana-laws-map-medical-recreational.html State Marijuana Laws in 2016 Map

California, Massachusetts, Maine, Nevada, Colorado, Alaska, Oregon, and Washington have legalized the recreational use of marijuana. The legalization of marijuana for recreational purpose has gained prominence as more states have eased the norms for medical use of marijuana. There are however specific norms for growing, selling, carrying in personal possession and consumption in public places like restaurants, shops, malls, concerts or even college and school campuses. The places of usage, quantity of usage and possession are still contentious issues.

What is Amendment 2 in Florida?

The Florida Medical Marijuana Legalization Initiative is commonly known as Amendment 2(Ballotpedia, 2016). This was approved by voters in the state of Florida through general elections on 8^th Nov, 2016 with a clear majority of 71% (the minimum required was 60%). The amendment requires the state health department to regulate the production and distribution of marijuana to patients. It is effective since 3^rd Jan 2017.

Cancer, epilepsy, glaucoma, HIV, AIDS, post-traumatic stress disorder (PTSD), amyotrophic lateral sclerosis (ALS), Crohn’s disease, Parkinson’s disease and multiple sclerosis (MS) are the 11 health conditions specified in Amendment 2 for eligibility to use marijuana for medical purposes.

The proposed rules for regulating the marijuana usage in Florida has been declared and the health department is seeking public representation to draft the regulations in an inclusive manner as the amendment has been brought about by resounding majority stating the public’s sentiment towards the subject. It also indicates the growing acceptability of marijuana by the masses for both medicinal and recreational purpose.

Factors and Regulations

The decriminalization of usage of specified amount of marijuana for recreational purpose in different states have raised the need for specific regulations and guidelines which affects multiple stakeholders and interest parties.

There are broadly six elements revolving around the event.

1. Users
   1. The eligibility of patients is limited to 11 health conditions. The regulation should have a provision to include other illness or health factors based on the recommendations of an empowered committee of medical professionals, practitioners and researchers. Recreational use of marijuana will allow almost anyone to have access. The regulations should be clear for minimum age possession and consumption.
   2. The identification of users through an online registry system will be useful for tracking usage and even to extract statistical data. The benefits or harmful effects of using marijuana in combination of other chemical compounds or in specific health challenges can be ascertained if the demographic profile, usage pattern, etc. are tracked by an online system that can be subjected to certain algorithms. The registry should be enriched with biometric information and latest photographs.
   3. The registration of patients and care-givers including others staying with the patient but not direct care-givers will be important from the law and order angle as possession of marijuana is otherwise a criminal offense. The same applies to recreational users as the federal laws are still against marijuana usage. If a person possesses it and crosses state lines it can become a crime.
   4. User information safety and privacy will be a concern in an online registry system. The legal implications of misuse of the information, subsequent punishment and authority of different government agencies in this regard must be built into the regulation.
2. Permitted Places
   1. The places eligible for authorized usage of recreational marijuana must be notified to the residents of a state. Recreational does not mean it can be used in schools, college campuses or church.
   2. The online database should have the complete details of the users to aid both the users and the law enforcement in case of a search or negligence.
   3. There are additional challenges of drug overuse if the effects do not manifest swiftly on administration of marijuana. Patients are prone to using more than the prescribed limit if the impact and effect is slow. Any cases of overdose or misdemeanor at any of the approved places must be reported including the drug delivery mechanism.
   4. The legal rights and provisions for protecting users while allowing the authorities to legally charge misdemeanors must be pre-determined and defined. This is essential so that users do not have to fear for unfair prosecution and try dangerous methods.
3. Suppliers
   1. The Floridian market is about half a million patients need free market access to cannabis. Florida Market size expected to be $1.6 billion by 2020 at a CAGR of 140%. The state has allowed 5 companies and a 6^th one has been allowed by the courts to grow and dispense marijuana for all legally
      eligible patients or their care-givers. This will lead to cartelization and unfair trade practices. The few permitted growers will decide the demand and supply of the product. This is the case for medical use.
   2. The recreational market of users will be governed by simple economics of demand and supply. If the law specifies the number of plants that individual growers can maintain, it might have alternate effect on the demand for produce of growers and even curtail black market.
   3. The number of users of marijuana will grow now that it can be legally prescribed. This will increase the demand of the product. The growers currently have limited capacity and will be looking out to enhance their production. The state health department should be in control of the production of this product for medicinal use and determine the price by allowing tax exemptions for competitively priced low THC marijuana. The regulation should be altered as commercial use is authorized. The taxation and disclosures of large – scale growers must be enumerated.
   4. The presence of a black market of suppliers can lead to frequent robberies and harm to the life of the transporting personnel. Need good policy for procurement, transportation and delivery.
   5. The suppliers should be given tax exemptions if they research and come up with safer drug delivery mechanism and devices which are patient friendly. There should be sops for producing actionable research on the effects of using marijuana on different age group and gender or even illness type.
   6. The supplier’s production and sales data should be made completely available always for inspection by department of health officials and other law and order agencies. This should also be a part of the online registry. The sales data is specifically important for ensuring proper and legal usage instead of serving the black market.
   7. The complete database of all employees and handlers including transport personnel should be uploaded to a department of health online portal for veracity and control. These people should have periodic clearance from law enforcement authorities to be around a controlled substance like marijuana so that illegal activities can be stemmed from the root.
   8. Usage of marijuana can lead to health challenges which will not be covered through insurance. The state’s policy on marijuana usage related illness and management is an important part of the regulation.
   9. If there are more growers, the market will be balanced. The conditions leading to the creation of the black market due to higher price and lower availability can be nullified. It will also lead to a free market driven pricing which will be beneficial for the users.
   10. The users of marijuana are susceptible to abuse of the drugs. The regulation of the state should create provisions for such cases both for punishment and rehabilitation.
4. FDA
   1. The foremost task for the FDA is to widen the source of legal marijuana by carefully inducting more licensed growers and distributors. Florida is still better than other states like Alabama, Georgia or Kentucky where only specific universities have the right to produce the product.
   2. A transparent selection process should be instituted for more willful investors to enter this upcoming market.
   3. Health department should also devise a public policy for fair procurement practices to serve the market ensuring the well-being of the users.
   4. Every grower and distributor should be closely scrutinized and issued with stringent quality processes as well as templates for presentation of production and sales data to avoid willful or otherwise leakage into the black market. Any cases of hoarding can also be detected through routine scrutiny.
   5. The purview of the FDA must include defining the dosage plan or usage level per use. This will also prevent excessive usage or overdose.
   6. Every case of hospitalization or health emergency of patients having access to marijuana should be reported and analyzed.
   7. The safe access to the drug and safety of patients consuming marijuana should be continuously promoted by the FDA different means of communication to reach out the users.
   8. The legal disclosures required on the packing of each bottle and delivery device should be defined by the department. The labeling should enable tracking of the product from the grower to the end user.
   9. Since the density of growers and distributors are less compared to the number of patients, the department should setup and authorize third-party dispensing organizations in state to enable patients to access the product. This is also critical from safety point of view as the business is mostly cash – driven and there are routine cases of break-in to steal cash and the product.
   10. Every dispensing location and grower locations should have closed circuit cameras to capture movement of personnel and buyers which can be provided to law enforcement personnel on demand.
5. Law Enforcement Authorities
   1. The updated registry information which is accessed by the state department of health, certified physicians, suppliers should be made accessible to law and order authorities to avoid unnecessary harassment of citizens.
   2. A balanced legislation to punish misuse by users must be developed to act as a strong deterrent. It can range from fines, community service, jail term depending on the gravity of the cases.
   3. The cases of assault and robbery of dispensing agencies of marijuana is a constant challenge. The law enforcement personnel should be included in identifying locations within the community where the marijuana is dispensed to users and extra surveillance should be implemented. Finally, if marijuana usage becomes legal for recreational purpose then they are responsible for the well-being of the citizens – patients, users, physicians, growers and distributors.
   4. Drug abuse, black market trade and trafficking are regular concern for the drug enforcement agencies. The legalization of marijuana increases their work load. A framework of interdepartmental access to information like online registry, grower’s data, manpower database of people other than users, list of certified physicians can help streamline the work burden of the law enforcement authorities.

Conclusion

The precedence set in many states allowing legal use of marijuana for recreational purpose through voting and clear majority indicates the growing acceptance of the drug in the community.

While it is useful for many illness and diseases, legalization can also curb the effects of a black market and anti-social elements who can cause law and order problems. If users can grow their own plants and use marijuana, the entire premise of trade, black market will vanish as there will be no incentive left. In the larger context of the society and its well-being legalization seems to be the right move. However, in the US federal laws still do not permit marijuana. The future will decide how the discord between regulations of the state and the federal system will unfold.

References

28 Legal Medical Marijuana States and DC. (2016, Dec 28). Retrieved from Procon.Org: http://medicalmarijuana.procon.org/view.resource.php?resourceID=000881

Ballotpedia. (2016, Nov 8). Florida Medical Marijuana Legalization, Amendment 2 (2016). Retrieved from Ballotpedia – The Encyclopedia of American Politics: https://ballotpedia.org/Florida_Medical_Marijuana_Legalization,_Amendment_2_(2016)

NIDA. (2017, Feb 19). What is marijuana? Retrieved from National Institute of Drug Abuse: https://www.drugabuse.gov/publications/research-reports/marijuana/what-marijuana

APPENDIX

The following table is from National Conference of State Legislatures

(http://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx)

Table 2. Limited Access Marijuana Product Laws (low THC/high CBD- cannabidiol)
State	Program Name and Statutory Language (year)	Patient Registry or ID cards	Dispensaries or Source of Product(s)	Specifies Conditions	Recognizes Patients from other states	Defintion of Products Allowed	Allows for Legal Defense	Allowed for Minors
Alabama	SB 174 “Carly’s Law” (Act 2014-277) Allows University of Alabama Birmingham to conduct effectiveness research using low-THC products for treating seizure disorders for up to 5 years. HB 61 (2015) Leni’s Law		Only the Univ. Alabama Birmingham is allowed to dispense FDA-approved trial products with the proper permissions. Provides legal defense for posession and/or use of CBD oil.	Yes, debilitating epileptic conditions or life-threatening seizures.	No	Extracts that are low THC= below 3% THC	Yes	Yes
Florida	Compassionate Medical Cannabis Act of 2014 CS for SB 1030 (2014) Patient treatment information and outcomes will be collected and used for intractable childhood epilepsy research	Yes	Yes, 5 registered nurseries across the state by region, which have been in business at least 30 years in Florida.	Yes, cancer, medical condition or seizure disorders that chronically produces symptoms that can be alleviated by low-THC products	No	Cannabis with low THC= below .8% THC and above 10% CBD by weight		Yes, with approval from 2 doctors
Georgia	HB 1 (2015) (signed by governor 4/16/15)	Yes	Law allows University System of Georgia to develop a lot THC oil clinical research program that meets FDA trial compliance.	Yes, end stage cancer, ALS, MS, seizure disorders, Crohn’s, mitochondrial disease, Parkinson’s, Sickle Cell disease	No	Cannabis oils with low THC= below 5% THC and at least an equal amount of CDB.	Yes	Yes
Iowa	SF 2360, Medical Cannabidiol Act of 2014 (Effective 7/1/14)	Yes	Doesn’t define or provide in-state methods of access or production.	Yes, intractable epilepsy	No	“Cannabidiol- a non-psychoactive cannabinoid” that contains below 3% THC, no more than 32 oz, and essentially free from plant material.	Yes	Yes
Idaho- VETOED BY GOVERNOR	SB 1146 (VETOED by governor 4/16/15)	No	Doesn’t define.	The possessor has, or is a parent or guardian of a person that has, cancer, amyotrophic lateral sclerosis, seizure disorders, multiple sclerosis, Crohn’s disease, mitochondrial disease, fibroymyalgia, Parkinson’s disease or sickle cell disease;	No	Is composed of no more than three-tenths percent (0.3%)  tetrahydrocannabidiol by weight;  is composed of at least fifteen (15) times more cannabidiol than tetrahydrocannabidiol by weight; and contains no other psychoactive substance.	Yes	Yes
Kentucky	SB 124 (2014) Clara Madeline Gilliam Act Exempt cannabidiol from the definition of marijuana and allows it to be administerd by a public university or school of medicine in Kentucky for clinical trial or expanded access program approved by the FDA.	No	Universities in Kentucky with medical schools that are able to get a research trial. Doesn’t allow for in-state production of CBD product.	Intractable seizure disorders	No	No, only “cannabidiol”.
Louisiana	SB 143 The “Alison Neustrom Act” Please see bolded comment to the right.		Louisiana State Univ. and the Southern Univ. Agricultural Center have the right of first refusal to be the licensed production facility. If they pass, it opens up to a competitive bid process.	Yes	No	NCSL counts this act as a low-THC program based on this statement in the enacted legislation. “THC shall be reduced to the lowest acceptable therapeutic levels available through scientifically acceptable methods.” NCSL also does NOT count this program as “comprehensive” because it does not allow for the combustion or vaporizing of flowered product.  Other organizations or groups may count this as a comprehensive program, but please refer to NCSL’s definitions above. NCSL will reconsider its categorization based on final rules, regulations and practice when they are finalized.	Yes	Yes
Mississippi	HB 1231 “Harper Grace’s Law” 2014		All provided through National Center for Natural Products Research at the Univ. of Mississippi and dispensed by the Dept. of Pharmacy Services at the Univ. of Mississippi Medical Center	Yes, debilitating epileptic condition or related illness	No	“CBD oil” – processed cannabis plant extract, oil or resin that contains more than 15% cannabidiol, or a dilution of the resin that contains at least 50 milligrams of cannabidiol (CBD) per milliliter, but not more than one-half of one percent (0.5%) of tetrahydrocannabinol (THC)	Yes, if an an authorized patient or guardian	Yes
Missouri	HB 2238 (2014)	Yes	Yes, creates cannabidiol oil care centers and cultivation and production facilities/laboratories.	Yes, intractable epilepsy that has not responded to three or more other treatment options.	No	“Hemp extracts” equal or less than .3% THC and at least 5% CBD by weight.	Yes	Yes
North Carolina	HB 1220 (2014) Epileps y Alternative Treatment Act- Pilot Study HB 766 (2015) Removes Pilot Study designation	Yes	University research studies with a hemp extract registration card from the state DHHS or obtained from another jurisdiction that allows removal of the products from the state.	Yes, intractable epilepsy	No	“Hemp extracts” with less than nine-tenths of one percent (0.9%) tetrahydrocannabinol (THC) by weight. Is composed of at least five percent (5%) cannabidiol by weight. Contains no other psychoactive substance.	Yes	Yes
Oklahoma	HB 2154 (2015)	Yes	No in-state production allowed, so products would have to be brought in. Any formal distribution system would require federal approval.	People under 18 (minors) Minors with Lennox-Gastaut Syndrome, Dravet Syndrome, or other severe epilepsy that is not adequately treated by traditional medical therapies	No	A preparation of cannabis with no more than .3% THC in liquid form.	Yes	Yes, only allowed for minors
South Carolina	SB 1035 (2014) Medical Cannabis Therapeutic Treatment Act- Julian’s Law	Yes	Must use CBD product from an approved source; and (2)    approved by the United States Food and Drug Administration to be used for treatment of a condition specified in an investigational new drug application. -The principal investigator and any subinvestigator may receive cannabidiol directly from an approved source or authorized distributor for an approved source for use in the expanded access clinical trials. Some have interpreted the law to allow patients and caregivers to produce their own products.	Lennox-Gastaut Syndrome, Dravet Syndrome, also known as severe myoclonic epilepsy of infancy, or any other form of refractory epilepsy that is not adequately treated by traditional medical therapies.	No	Cannabidiol or derivative of marijuana that contains 0.9% THC and over 15% CBD, or least 98 percent cannabidiol (CBD) and not more than 0.90% tetrahydrocannabinol (THC) by volume that has been extracted from marijuana or synthesized in a laboratory	Yes	Yes
Tennessee	SB 2531 (2014) Creates a four-year study of high CBD/low THC marijuana at TN Tech Univ. ______ HB 197 (2015)	Researchers need to track patient information and outcomes ______ No	Only products produced by Tennessee Tech University. Patients may possess low THC oils only if they are purchased “legally in the United States and outside of Tennessee,” from an assumed medical cannabis state, however most states do not allow products to leave the state. _____ Allows for legal defense for having the product as long as it was obtained legally in the US or other medical marijuana state.	Yes, intractable seizure conditions. ______ Yes, intractable seizure conditions.	No ______ No	“Cannabis oil” with less than .9% THC as part of a clinical research study ______ Same as above.	Yes	Yes
Texas	SB 339 (2015) Texas Compassionate Use Act	Yes	Yes, licensed by the Department of Public Safety.	Yes, intractable epilepsy.	No	“Low-THC Cannabis” with not more than 0.5 percent by weight of tetrahydrocannabinols; and not less than 10 percent by weight of cannabidiol	Yes	Yes
Utah	HB 105 (2014) Hemp Extract Registration Act	Yes	Not completely clear, however it may allows higher education institution to grow or cultivate industrial hemp	Yes, intractable epilepsy that hasn’t responded to three or more treatment options suggested by neurologist	No	“Hemp extracts” with less than .3% THC by weight and at least 15% CBD by weight and contains no other psychoactive substances	Yes	Yes
Virginia	HB 1445	No	No in-state means of acquiring cannabis products.	Intractable epilepsy	No	Cannabis oils with at least 15% CBD or THC-A and no more than 5% THC.	Yes	Yes
Wisconsin	AB 726 (2013 Act 267)	No	Physicians and pharmacies with an investigational drug permit by the FDA could dispense cannabidiol. Qualified patients would also be allowed to access CBD from an out-of-state medical marijuana dispensary that allows for out-of-state patients to use their dispensaries as well as remove the products from the state. No in-state production/manufacturing mechanism provided.	Seizure disorders		Exception to the definition of prohibited THC by state law, allows for possession of “cannabidiol in a form without a psychoactive effect.”  THC or CBD levels are not defined.	No	Yes
Wyoming	HB 32 (2015) Supervised medical use of hemp extracts. Effective 7/1/2015	Yes	No in-state production or purchase method defined.	Intractable epilepsy or seizure disorders	No	“Hemp extracts” with less than 0.3% THC and at least 5% CBD by weight.	Yes	Yes