State of the States Scoring Rubric

How States Are Evaluated For Our State of the States Report

Each state was scored based on how well its current law and regulations accommodate patient needs, as broken down into five general categories:

  1. Patient Rights and Civil Protections
  2. Access to Medicine
  3. Program Functionality
  4. Affordability
  5. Health and Social Equity
  6. Consumer Protection and Product Safety
  7. Score Penalties

ASA developed these criteria based on a series of over 100 public meetings across the U.S. as well as surveys of our 100,000+ members. With laws and regulations changing daily, this document is a snapshot of ever-changing programs. ASA has amended this report several times since we began its writing, and we expect that some of this information will be out of date soon after publication. The criteria we selected reflect the current realities of state medical cannabis laws. Definitions for each item can be found below. States that partially met the definition for certain criteria, either directly or indirectly, were eligible for partial points when appropriate.

 

1. Patient Rights and Civil Protections

 

Arrest Protection — 25 points

Arrest protection refers to explicit legislative language that instructs law enforcement to refrain from arresting individuals who are in compliance with state law. For a maximum score, a state must have explicit legal language that protects patients from criminal prosecution.

Affirmative Defense — 20 points

An affirmative defense refers to a criminal defendant’s right to argue medical necessity or compliance with state law as a defense in court. With an affirmative defense, the burden is on the defendant to prove that they were not in violation of the law. Ideally, a state will afford a necessity defense for medical cannabis conduct that does not conform to the strict limits of the state law. For example, possessing amounts above the statutory limit in order to have a consistent supply of medicine on hand for treatment purposes. Some states have an implied affirmative defense within their arrest protection. To earn points in this category, a state must give patients a strong legal defense if they are ever brought to court for a cannabis related incident.

Parental Rights Protections — 20 points

Most states list cannabis possession and cultivation as an indication of child abuse and/or neglect. Explicit protections against such assumptions must instruct state agencies and family courts to recognize that a parent’s status as a medical cannabis patient is not a determining factor in any CPS or court intervention, or other family court proceedings like divorce that could alter parental rights. States that set an “unreasonable danger” standard or have similar provisions should include clear guidance that a patient acting in accordance with state law is not creating an unreasonable danger. To earn all points in this category, a state must have explicit legal language that protects parental rights. If protections place the legal burden on the patient, states will only receive half points.

DUI Protections — 10 points

Many states allow their Driving Under the Influence (DUI) or Driving Under the Influence of Drugs (DUID) statutes to be used as a means of penalizing drivers who are medical cannabis patients, even without evidence of impairment while driving. An individual’s participation in a state medical cannabis program should not constitute probable cause for a sobriety test, nor should the presence of cannabis metabolites in the body - which can be detected days or weeks after last use - indicate actual impairment. By treating cannabis like any other medication under a state’s DUI or DUID laws, patients will still be prohibited from driving while impaired or using cannabis while driving, but patients will not be unnecessarily subjected to arrest and prosecution solely for being a medical cannabis patient or having metabolites in their bodies. To earn full points in this category, a state must have explicit laws that prevent the police from using status as a medical cannabis patient or the smell of cannabis in the vehicle as probable cause to search or conduct a DUID test and provide an affirmative defense for patients if they are charged with a DUI. Partial points can be earned by states that have no legal limits set for THC content while driving which makes enforcement of cannabis related DUIs difficult.

Employment Protections — 20 points

An individual’s status as a medical cannabis patient, or a positive test for cannabis metabolites, should not be an employer’s sole basis for either refusal to hire or dismissal of that person. Because of their regular cannabis use, most patients will test positive without being impaired. Medical cannabis use should be treated like any other prescription medication under state law. While some states have explicit protections, many laws are inadequate in providing necessary safeguards against employment discrimination. Despite concerns to the contrary, it is possible to provide workplace protections for patients while adhering to the federal drug-free workplace requirements that certain employers must meet, as many states have successfully done so. To earn points in this category, a state should have laws that prevent discriminatory hiring practices, and shield employees from punishment for cannabis use off of the job. Ten points are awarded for anti-discrimination policies and 10 points for drug testing protections.

Explicit Privacy Protections — 5 points

Medical cannabis patients deserve the same healthcare privacy rights as all other patients in the U.S., but these rights are often abridged. Information about patients, caregivers, or healthcare providers contained in a registry should be kept confidential in perpetuity and unneeded data should be destroyed. Some states explicitly protect patient information and some have even criminalized privacy violations. The unsanctioned release of registry information should carry substantial administrative penalties. For a maximum score, a state must guarantee that all data related to patients will remain private and have laws punishing those who violate this privacy.

 

2. Access to Medicine

  

Authorizes Retail Access - 10 points

While most states regulate the production and sale of medical cannabis, some states have failed to do so, leaving patients with no legal access option. A majority of patients rely on licensed dispensaries for legal access; access to medical cannabis in states without licensed dispensaries forces patients to patronize illegal market providers who may compromise patient health and safety. While home cultivation can be an alternative in states who authorize this activity, many patients do not have the time, skills, resources or capability to cultivate their own medicine. Cultivation is also not a solution for a patient who needs medicine sooner rather than later. It is imperative that states provide for regulated medical dispensary facilities if they wish to have a functional, effective medical cannabis program. States that have taken measures for the implementation of dispensary programs were awarded partial points. To earn the points in this category, a state must simply have retailers accessible to patients.

Alternative Accessibility Methods - 20 points

Authorizes Delivery - 10 points

Many legal medical cannabis patients cannot travel to purchase medical cannabis due to physical, economic, or time constraints. This is especially problematic for legal patients who are in the hospital, have mobility issues, or live far from a licensed dispensary facility. Allowing for delivery of medicine is a compassionate and common-sense solution for these patients, and is necessary to achieve parity with existing delivery services for patients utilizing prescription or over the counter medicine from local pharmacies. Just as with pharmacy delivery models, common-sense regulations and protocols can be organized to ensure safety and discretion. There is no evidence to show that delivering medicine leads to crime or diversion of medical cannabis for non-medical use. States should be clear that provisions allowing for “delivery” refer to home delivery rather than the criminal law context of delivery of a controlled substance. To earn full credit, delivery must be available to all patients in a given state. Partial points can be earned if regions or jurisdictions have some delivery available.

Authorizes Curbside Pickup - 10 points

Many states have had very strict rules on where transactions of medical cannabis can take place, generally limiting them to inside of the dispensary itself due to security concerns. In 2020 when the country's COVID-19 lockdowns first began, ASA recommended that states modify their rules to allow dispensaries to deliver medical cannabis to qualifying patients and caregivers in a vehicle parked in the dispensary’s parking lot. The option to pre order and pickup your medicine without having to go inside the dispensary is important to minimize contact with staff and other patients in a time when contact could be deadly. Now that the rules are in place, it has become increasingly clear that allowing dispensary staff to hand off medicine in the dispensary parking lot does not increase security risks. With a proven track record of curbside pickup safety, the option should be open to all patients who need a speedy or convenient method of getting their medicine, especially for patients with mobility issues for whom getting out of the car and into a dispensary is difficult. States with curbside pickup available at any dispensing facility can earn full points in this category. If curbside pickup is only available regionally or on a case-by-case basis, partial points can be earned.

Personal Cultivation - 15 points

Unfortunately, states have been moving to limit personal cultivation by patients and their caregivers, restricting and, in some cases, completely obstructing access to medical cannabis home cultivation. In states that have relied exclusively on regulated production and distribution programs, patients have frequently been left without any options if those programs fail to meet the basic needs of proximity, affordability, safety, privacy, or product availability. While authorizing personal cultivation is not an immediate fix for these issues, it does enable patients with adequate means to produce medicine at a reduced cost over time. To earn all points in this category, a state must allow patients and caregivers to grow cannabis at home without registering with the state or paying fees. If fees or a registration are necessary, partial points are earned.

Collective Gardening - 5 points

Allowing experienced caregivers to cultivate for a limited number of patients can ensure adequate access to a reliable supply of safe, affordable medicine. Collective gardens intended strictly for private consumption among a small group of patients should not be subject to regulatory authority, provided the activity remains non-commercial. Collective gardening is not associated with dispensaries or other commercial businesses that engage in sales, advertising, or trade. States without explicit collective gardening rights that do allow individual caregivers to grow for more than one patient were eligible for partial points in this category.

Sufficient Number of Licensed Retailers - 30 points

Most states have strict licensing requirements or hard caps on the number of licensed operators that can be active at any given time. These can exist for different reasons, from a fear that allowing too many cannabis businesses would fuel the illicit market to state legislators wanting to create a market closed to all but a few wealthy investors.. When an insufficient number of licensed medical retail facilities are licensed, or legal medical retail facilities are located in an arbitrary geographic manner without equal distribution, functional patient access is not achieved. Policy models including such components fail to meet patient needs as they can force patients to navigate long distances to secure safe access, or risk patronizing illegal market providers whose products have not gone through government-mandated consumer product safety testing. Limitations or arbitrary caps on the number of dispensaries should be avoided, and states should work to ensure even geographic distribution of cannabis retail facilities to ensure sufficient patient access is available. When limits are imposed, they must account for patients who live outside urban areas and those with mobility issues or who are confined to their homes. Scoring in this category is based on the ratio of patients to retailers, the survey responses from patients, and the geographic area of the state vs. the number of retailers.

Reciprocity - 20 points

Reciprocity refers to laws providing some measure of legal protection for non-resident medical cannabis patients. These laws generally require that patients carry documentation of their status in their home state’s program. Reciprocity is important for traveling patients, patients who are seeking specialty treatments, and those who need to stay in the care of friends or family out of state, as many state medical cannabis programs require residency for participation or legal protections. To earn all points in this category a state must extend full legal protections and retail access to visiting patients. Partial points can be earned for one or the other. A state cannot earn all points possible if visiting patients are required to register with the state or pay a fee to access these privileges. A maximum of five points can be earned in this category if a state does not have reciprocity, but does allow for recreational adult-use, enabling some patients to still access cannabis.

 

3. Program Functionality

 
Legal Protections Within Reasonable Time Frame - 20 points

Ideally protection from arrest and prosecution should begin the moment a patient leaves the doctor’s office with a recommendation; in this case full points will be earned. In cases where patients must register with the state to obtain arrest protection, partial points may be earned when an affirmative defense is granted to defendants with a valid authorization so as not to leave patients vulnerable while their documentation is processed.

Reasonable Possession Limits - 10 points

While it might make sense to have possession thresholds that give law enforcement guidance on personal medical use, it does not make sense for the state to determine the quantity any patient might need for his or her particular illness. The type and severity of symptoms, the cultivation business producing cannabis, factors specific to each patient (e.g. age, body composition, metabolism), and the route of administration each greatly impact the amount that a specific patient may need at any point in time. The decision as to how much cannabis is sufficient to treat a patient’s illness should ultimately be a decision made by a patient and their health care team, and not the state, and state limits should correspond to the amount that allows the patient an uninterrupted supply necessary for a patient’s treatment protocol. In order to receive full credit in this category, possession limits may not be less than one month’s supply, or 5 ounces, whichever amount is larger.

Reasonable Purchase Limits - 10 points

When a state is considering imposing purchase limits on patients that will restrict the amount they can obtain from a dispensary, it should take into account the distance a patient must travel, the severity of an individual’s medical condition, and any patient mobility issues. Certain cultivators or products may have limited availability, and patients who need those products should not be denied access in favor of concerns with regulatory expediency. The best policy does not restrict patients’ ability to purchase medicine to certain windows of time, as such limits may disrupt patients’ ability to maintain a consistent supply of medical cannabis. To earn full points, a state must allow patients to purchase at least 5 ounces per month.

Telemedicine for Physician Certification - 15 points

Using telecommunications technology to augment the ability for doctors to connect with patients for treatment began in the 1920’s when doctors were communicating with and diagnosing patients over the radio. Telemedicine has allowed remote care to become ubiquitous in the past 100 years. The option to conduct doctors visits remotely is appealing for many patients, especially for those with mobility related issues, or those in rural areas. In the wake of the COVID-19 pandemic, the number of telemedicine visits to doctors sharply increased as individuals and families needed care and isolation simultaneously. Cannabis patients and physicians who recommend it have been typically more strictly regulated than parallel pharmaceutical prescriptions; most states did not allow for cannabis related visits to be conducted remotely. One upside to the pandemic is that many states were forced to recognize the bottleneck to access that requiring in person certifications strict rules would create during the crisis. Upon ASA’s recommendation, states put into place rules allowing physicians to use telemedicine as a means to recommend cannabis. Some states only allowed physicians to renew existing patient certifications; these states will receive partial credit. States that allow both the recommendation, and the renewal, and who have extended or made permanent these emergency rules can receive full credit.

Patient and Physician Representation in Program Decision Making - 20 points

Regulatory agencies for medical cannabis programs vary by state. ASA has found that keeping the medical cannabis program within the Department of Public Health, or its equivalent, provides the most effective assistance to patients and their providers. States that have developed a regulated program should create task forces or advisory boards to help guide the administration of the medical cannabis program and provide assistance in developing regulations. These task forces and advisory boards can be very beneficial to the improvement of state and territory access programs by providing a voice for those most knowledgeable about its effectiveness: patients and healthcare professionals. The makeup of such task forces or boards should only include a minimal presence from law enforcement, if any, as the priorities of police and prosecutors may be at odds with the needs of patients. ASA supports the development of these programs and encourages the inclusion of patients and healthcare providers in them. To earn all points possible in this category, a state must have a proven track record of patient and physician decision making in it’s regulatory affairs. Partial points can be earned if a doctor-patient advisory board exists at all.

Reasonable Caregiver Standards - 5 points

Background Checks - 2 points

A caregiver is a person who assists the patient with procuring and administering their medication. Some states prohibit patients from having caregivers with criminal histories related to drugs. It is ASA’s position that this type of restriction serves no purpose, as they do not protect patients from criminals, but instead punish the patient for having a family member or trusted confidant who may have had a criminal past. These provisions disproportionately impact people of color and should be edited to remove this requirement. Full points are earned if there are no required background checks. A state may earn partial points if a background check is required, but only if the cost of the background check is covered by the state.

Number of Caregivers - 3 points

The number of caregivers allowed for a qualified patient varies from state to state, as does the number of patients a caregiver may serve. Some states are very restrictive and allow only one caregiver per patient, thus putting patients who have mobility problems in a situation where they must rely on a single person to assist with their access to and use of cannabis. Patients must be able to designate caregivers as determined by their unique situations so that they always have access to cannabis when needed. For example, an elderly patient may need to have multiple family members serve as caregivers because no individual in a family has the availability to consistently assist the patient. If a patient can have more than two active caregivers, full points are earned in this category.

Reasonable Physician Standards - 5 points

Some states require patients to have an ongoing relationship with their doctor, often referred to as a “bona fide” relationship. Generally, states define the relationship to include a complete examination and medical history, along with an ongoing expectation of care provided by the physician. Some require that physicians register with the state, or impose education requirements on physicians, which may be beneficial to patients but could be onerous to physicians and are not a requirement for writing prescriptions for more dangerous pharmaceutical medications. ASA’s position is that physicians should only treat ailments and recommend treatments that they are familiar with and feel comfortable discussing with patients. Within the medical field there are many specialties, and prohibiting patients from choosing a doctor who specializes in medical cannabis is antithetical to the practice of medicine. Any physician in good standing with the state should be allowed to recommend the use of medical cannabis to their patients. Physicians who use medical cannabis themselves should not be restricted from recommending it. Because patients with chronic illnesses often seek health care services from a variety of sources, ASA prefers that nurse practitioners, physician assistants, dentists, naturopathic doctors, chiropractors and other healthcare professionals be allowed to recommend medical cannabis, if it is not prohibited by legislation. Health care professionals who are allowed to recommend medical cannabis should not be allowed to have direct or indirect financial interest in a dispensary, manufacturer, laboratory or cultivation operations, or financially benefit from any business that might benefit from a patient’s or caregiver’s use, acquisition, or purchase of medical cannabis. Full points can only be earned if all of the above is true.

Access to Administration Methods - 10 points

Allows Dried Flower - 5 points

A majority of medical cannabis states have allowed patients access to the dried flowers of whole-plant cannabis either for direct inhalation or to process their own medicated edibles or concentrates. However, a few states have limited access to dried flowers in favor of non inhaled cannabis preparations. This is the most obvious flaw in some states, but it is also part of many of the “CBD-only” laws that restrict patients to a manufactured product only. ASA’s experience shows that restricting patients from whole-plant cannabis use can prevent patients from accessing the most effective medicine for their particular condition and can make proper dosing more difficult to achieve. Full points are earned in this category if you can buy dried flower in a given state.

Allows Edibles, Concentrates, and Other Forms - 5 points

Some states explicitly provide for the manufacture and use of edible products or concentrated forms of medical cannabis. Some states do not explicitly allow these forms of medicine, but may tolerate the sale and production of such items. Edibles are important, as this form of administration is ideal or preferred for certain ailments and can offer ease of use for certain patients. States without this explicit right, but that allow for availability of these products in practice, were eligible for partial points. While tolerance is better than denying access to alternative forms of cannabis therapy, clear guidance is optimal to protect patient health by establishing standards for production and testing, as well as ensuring public safety by prohibiting the use of volatile and uncontrolled home manufacturing operations. For these reasons ASA encourages states to protect and regulate the manufacturing, use, and distribution of edible and concentrated medical cannabis products. Full points are earned in this category if a state has edibles, concentrates, and other forms available and regulates their production. Partial points are earned if these products are available but production is not regulated by the state.

Provides Access to Minors on School Grounds - 5 points

Children spend a great deal of time at school, those with medical conditions which require the treatment of medical cannabis should not have to significantly adjust their schedules to comfortably and safely receive an education. Even though the majority of states allow for minors to use cannabis, federal laws regarding drug free school zones keep many states from allowing cannabis on school grounds for fear of losing federal funding. In this case a parent or legal guardian would have to pick a child up and take them off school grounds to administer the dose before returning them to school. This would deeply disrupt not only the child’s education, but also deeply harms a parent’s ability to work because of constant trips to administer doses. While ASA recognizes the federal conflicts with school access policies, a number of states have extended protections within their ability to do so. States which have strong language protecting dosing on school grounds by a faculty member will earn full points in this category. Partial points can be earned by states where dosing can take place on school grounds but must be administered by a parent or legal guardian. Partial points can also be earned in states where there are no specific protections written into the law but the state has not stopped individual jurisdictions or school boards from allowing on campus treatment.

4. Affordability

 

Sales Tax Break for Patients and Caregivers - 20 points

Medical cannabis is real medicine that millions of Americans use to treat serious medical conditions such as epilepsy, cancer, HIV/AIDS, chronic pain, and more. Unfortunately medical cannabis is generally more expensive than other medication and not currently covered by any public or private insurance policies. To combat this obstacle, ASA recommends that states exempt cannabis as a medicine from state and local sales taxes to ease the financial burden on registered patients. Taxation of medicine should be avoided, but when necessary, it should be imposed at an affordable rate for patients that does not prevent safe, legal access. ASA recommends that if taxation of medical cannabis can not be avoided or overcome, that the tax rate applied is comparable to similar products – herbal medicine, over-the-counter remedies, etc. Excessive sales tax is a financial hardship and could compel some patients to buy medical cannabis from the illicit market, where laboratory testing and legal purchasing facilities that aid health and patient safety are absent. Full points are earned when there are no taxes on medical cannabis products. A majority of points can be earned if the total tax rate for patients is less than or equal to 6% and municipalities cannot levy taxes on patients. Partial points are earned if the total tax rate paid by patients is greater than 6% but less than 10%.

Covered by State Insurance or Health Aid - 20 points

Until federal laws regarding medical cannabis are reformed, patients will not be able to use federal medical benefits and health insurance providers will be reluctant to include coverage for medical cannabis. As a result cannabis patients face high costs to obtain medicine with no product subsidies or reduced pricing arrangements consistent with drug purchase assistance available through most standard insurance plans. However, there is no reason why state law should prevent private insurance carriers from covering medical cannabis. An ideal law would require that insurance carriers and state health programs treat medical cannabis like any other legal medication; in this case full points would be awarded.

Reasonable Registration Fees - 20 points

Fees for patient registration should be set to meet reasonable administrative costs of the registry program. Patient fees should not cover costs of medical marijuana business oversight, nor should they be looked at as a source of revenue for any other purposes. Reasonable fees are particularly important due to the lack of health insurance coverage for medical cannabis expenses, and because these registration fees are often paid alongside a consultation fee for a physician. Because of the financial challenges of many chronically ill patients, ASA recommends a sliding scale fee tied to state or federal benefits for which a patient qualifies. States where patients pay less than $50 dollars for a registration fee receive full marks; where patients pay more than $200, zero points are earned.

Financial Hardship Waivers or Discounts - 20 points

With medical cannabis not currently covered by health insurance, many patients are unable to afford treatment without experiencing undue hardship. To ease the financial burden, ASA encourages the adoption of sliding-scale fees and donation programs that cover all or part of the cost of doctor’s visits, registration fees, and medicine for patients in need. Full credit is earned by having both discounts and waivers, and in states with no fees; half credit if only one exists.

Donation Program - 10 points

For many patients, medical cannabis is considered too expensive of an option. Without the help of insurance, patients are forced to pay for their medicine out of pocket, leaving many patients unable to afford consistent treatment. To help patients maintain access, ASA encourages states to create donation or financial assistance programs. Through donation programs, cannabis retailers can provide free cannabis or cannabis products to qualified medicinal patients or their primary caregivers. Licensed cultivators, manufacturers, distributors, retailers or microbusinesses can designate cannabis or cannabis products that they hold in their inventory for donation. Items designated for donation are provided to a medicinal patient or primary caregiver through a licensed retailer and move through the licensed supply chain in the same way as cannabis and cannabis products for sale; meaning they must meet all applicable requirements for cultivation, manufacturing, distribution, laboratory testing, packaging and labeling, etc. Full points are earned if products are also exempt from excise, sales and use, and cultivation taxes.

Financial assistance programs are another option to help patients with affordability. Financial assistance programs can cover the cost of doctor's referrals, the state mandated medical card or the cost of products. The cannabis or cannabis products sold should be of the same quality as that sold to paying customers.

Allows Multi-Year Registrations - 10 points

It makes little sense to require patients with chronic, long-lasting conditions to navigate an annual renewal process, when the chronic health patient’s condition is extremely likely to persist for many years or be permanent. Full points are earned if registrations last longer than a year by default. Partial points can be earned if multi-year registrations are available based on the condition listed in a patient’s application, or that renewal requirements be waived for patients with chronic health diagnoses.

 

5. Health and Social Equity

 

State Program Protections - 25 points

Many states have begun to demand that welfare recipients submit to a drug screening to receive their benefits. Patients should not lose their state benefits for participating in the medical cannabis program. If a state drug tests welfare applicants and has no exemption for medical cannabis patients, they will receive no points in this category. States that do not have a drug testing requirement and states with medical cannabis patient exemptions will receive full points.

Housing Protections - 25 points

Patients who use medical cannabis should not have to live in fear of losing their housing. Patients have routinely been evicted from public and private housing in legal medical cannabis states that have not created explicit protections against such discrimination. While some states do protect patients from housing discrimination, the federal government has left decisions to the discretion of local housing authorities, and has issued guidance to evict tenats who are found to be medical cannabis patients. Full points in this category can be earned by robust protections that would prevent a landlord from denying housing to an individual based on their status as a patient or from evicting an individual based on cannabis use or home cultivation. Partial credit will be given in states with anti-discrimination laws for housing, but allow landlords to restrict activities covered in the medical cannabis program.

Access for Minors - 10 points

Though some states limit the age of a patient, many of these restrictions may be overcome through parents or guardians consenting to the treatment and agreeing to be in control of the minor patient’s acquisition and administration of medical cannabis. States that require pediatric patients to have a recommendation from multiple doctors fail to realize that the added time and expense is a great challenge to meet, especially for families raising a child with special needs. More research has begun around using medical cannabis to treat youth, and it is important to allow parents, along with their children’s physicians, to determine the best, most effective medication for their children. Full points are earned if a minor can be recommended cannabis by a family physician or a single doctor and there are protections in the law to keep public or private schools from discriminating against students based on their status as a patient. Partial points are earned if access is available but certification requires a second opinion or is classified as a medicine of last resort for minors. 5 points will be deducted from the total if there are age requirements to become a minor patient.

Access in Underserved Areas - 10 points

Numerous factors can cause an area to have less access than its neighboring jurisdictions. Rural locations might not get enough commercial traffic, local ordinances could keep businesses from operating, etc. Ideally, medical cannabis should be accessible to patients regardless of the conditions in their geographic area. States where medical cannabis retailers are concentrated in high income and high commercial traffic areas will not receive points in this category. Full credit will be awarded to states with explicit policies to ensure licenses are awarded in underserved areas. States may receive partial credit where the state agency has policies in place to ensure access to all areas of the state, but where local jurisdictions have sole discretion on whether to allow access in the area.

List of Qualifying Conditions is Exhaustive or All Inclusive - 10 points

Every state that has enacted protections for medical cannabis patients has mentioned conditions that may be effectively treated by cannabis (see Chart 1). Some states recognize the constitutional right of physicians to recommend cannabis to any patients who could benefit from it, while other states limit the ability of physicians to certify patients for participation in their medical cannabis program with restrictive qualifying conditions lists. Many states provide for a rigorous process to expand their “approved ailment” list through the state department of health. ASA’s position is that there should be access to medical cannabis for every patient who needs it, and that the decision to use cannabis as a treatment should be left to the patients and their physicians, not state or territorial governments. Full points can only be earned if a state recognizes any condition for which a doctor recommends medical cannabis as a qualifying condition. High points are earned for exhaustive lists and must include conditions that cover multiple ailments like chronic pain. If a state severely limits conditions and does not include chronic pain, it will receive no more than 3 points in this category.

Allows Patients to Medicate Where They Choose - 10 points

Some states restrict the locations where patients can use medical cannabis. While it may make sense to limit the right to use inhaled cannabis in places where other smoking is allowed, it is abhorrent to otherwise limit locations where a sick person can use his or her medicine, including on school and college campuses, in private housing, or in specially designated use facilities. Cannabis should be treated like any other medication in this regard, and ASA encourages states to include safeguards protecting patient location of use.

Organ Transplants - 5 points

Several hospitals in the U.S. have removed medical cannabis patients from their organ transplant lists after the patients tested positive for cannabis metabolites. This exclusionary practice is based on outdated policies with no scientific basis, that assume cannabis use automatically indicates substance abuse and therefore poses a danger that the transplanted organ will be rejected. Transplant candidates should not be forced off the treatment a doctor has recommended while they wait for life-extending measures. If a patient’s access to organ transplants is explicitly protected by the law, they receive the points in this category.

Ownership or Employment Restrictions - 5 points

Lawmakers often create barriers to entry in the cannabis industry. These can take the form of rules preventing the participation of individuals with criminal charges in their background, or hefty fees to become a licensed operator. Ideally, the financial barriers to entry should be minimal and, for any state that has not already expunged state level cannabis convictions. Full credit will be awarded to states with policies that provide attainable opportunities for all potential owners or employees.

6. Consumer Protection and Product Safety

States were evaluated for consumer protection and product safety requirements in the four main industry areas:

Cultivation Operations - 50 points

Quality Management Systems - 10 points

Good agricultural (collection) practices (GAP) are a type of quality management system for cultivation operations that outlines best practices. Best practices include specifications for raw materials acquisition, nutrient, fertilizer, and pesticide usage and application, pest identification, and harvesting along with a documentation system for recording and reporting cultivation activities.

Staff Training - 10 points

Many state governments have training requirements for cultivation employees. This training should include knowledge of state and federal regulations related to cannabis cultivation along with training on job hazards, personal protective equipment, and good agricultural practices.

Standard Operating Procedures - 8 points

Good agricultural practices and quality management systems require written procedures that employees need to understand and follow. States were scored on whether they specifically require written procedures and whether they required procedures for facility and equipment sanitation, workplace safety, product storage, batch and lot tracking, security, waste disposal, water management, and records management.

Facility and Equipment Sanitation - 1 point

Contamination can occur at many various points in the cultivation process. State laws should require that medical cannabis cultivation be conducted under sanitary conditions that aim at reducing contamination and pests. ASA recommends using existing sanitation standards for farming, food packaging, and herbal medicine processing as models for sensible regulations to protect patients from contaminants.

Workplace Safety - 1 point

Cannabis, like other crops produced for human consumption, requires the use of various types of equipment, mediums, amendments, and plant treatments during the course of its production. The proper use and storage of these items, coupled with the use of appropriate personal protective equipment by employees and training on use of PPE helps to ensure that the workplace is safe and accident-free.

Product Storage (Short and Long-Term) - 1 point

State regulations should require that medical cannabis cultivators store medicine in a manner that is sanitary and appropriate for each state of production. Cannabis, like other plants and perishable products, can degrade when stored improperly; in order to reduce the risk of spoilage and contamination, there should be written procedures for both short and long term storage of cannabis flowers.

Batch and Lot Tracking - 1 point

Many states require seed to sale tracking of cannabis products. This allows a product to be traced back to its origins in the event of a recall. By utilizing unique batch and lot numbers for products a consumer who has experienced an adverse event or a product that has been released but found to fail contaminant testing, can be identified and recalled along with any associated batches or lots.

Security - 1 point

State laws and regulations should require legal medical cannabis businesses to develop and implement a written security plan that should address issues such as security of the physical plant, loss prevention, diversion prevention, theft or robbery prevention, and emergency action preparedness.

Waste Disposal - 1 point

Most state regulations require proper disposal of cannabis waste but often fail to address issues related to disposal of nutrients, fertilizers, pesticides, and other growth and pest products. Cultivation operations should have written procedures for how each of the various types of waste streams are handled and how access to those waste streams is controlled.

Water Management - 1 point

To address environmental concerns surrounding cultivation of cannabis, several state governments have developed regulatory programs to address water use and the agricultural discharges associated with cannabis cultivation. Cultivation facilities should have a written water management plan that addresses water sourcing, water usage, and discharge.

Records Management - 1 point

Part of all GAP and QMS systems is accurate documentation that policies and procedures are being followed correctly. Good recordkeeping practices help businesses to monitor cultivation practices, employee performance, and identify trends and issues. These records also provide regulators with the evidence they need to ensure compliance with state rules and regulations.

Pesticide Usage Limitations - 2 points

The use of pesticides during cannabis cultivation can lead to downstream contamination of final products including flowers, concentrates, and products made from flowers, extracts, and concentrates. The US Environmental Protection Agency has not approved any pesticides for use on Cannabis outside of any products whose label is broad enough to include it. Because of this lack of federal regulation, states must take steps to include requirements in their rules and regulations around pesticides that may be approved for use, pesticides that are banned for use, and pesticides that laboratories must test for.

Environmental Impact Regulations - 2 points

New this year, a state may earn 2 points for addressing not only pesticide usage, but also the environmental impact of cannabis cultivation. States received points for addressing things such as sustainable cultivation and electricity usage.

Required Testing - 8 points

In order to ensure patient safety and accurate labeling of medical cannabis, state governments should require that representative samples of each batch be sampled and analyzed by an independent, third-party laboratory to determine their purity, potency, and quality including freedom from harmful contaminants. Potency testing includes testing for both cannabinoids and terpenes, the chemicals responsible for the entourage effect. Contaminant testing should include testing for various classes of microbials, aflatoxins/mycotoxins, pesticides, heavy metals, foreign matter, moisture content, and water activity.

Packaging and Labeling - 3 points

Accurately labeled products provide patients with information regarding the potency of a product including both its cannabinoid and terpene content, which can help inform medical decision making. Patients should also be aware of any pesticides used in the cultivation process, as misused or improperly applied pesticide products can affect product safety.

Complaints, Adverse Events, and Recall Procedures - 7 points

Businesses must have policies and procedures in place with regard to how they receive complaints and reports of adverse events, both of which could trigger a recall. Operators must have written procedures and should conduct mock recalls to be prepared. Many states have requirements for how an operator should handle a recall but fail to address receiving complaints and adverse event reports.

Manufacturing Operations - 50 points

Quality Management Systems - 10 points

Good manufacturing practices (GMP) are a type of quality management system for manufacturing operations that outlines best practices. Best practices include specifications for raw materials acquisition including cannabis and non-cannabis based ingredients, safe food handling procedures, and the development of product specifications for each type of manufactured product.

Staff Training - 10 points

Many state governments have training requirements for manufacturing employees. This training should include knowledge of state and federal regulations related to cannabis manufacturing along with training on job hazards, personal protective equipment, and good manufacturing practices.

Standard Operating Procedures - 7 points

Good manufacturing practices and quality management systems require written procedures that employees need to understand and follow. States were scored on whether they specifically require written procedures and whether they required procedures for facility and equipment sanitation, workplace safety, product storage, batch and lot tracking, security, waste disposal, and records management.

Facility and Equipment Sanitation - 1 point

Contamination can occur at many various points in the manufacturing process. State laws should require that medical cannabis manufacturing be conducted under sanitary conditions that aim at reducing contamination and pests. ASA recommends using existing sanitation standards for manufacturing, food production, and herbal medicine processing as models for sensible regulations to protect patients from contaminants and adulterants.

Workplace Safety - 1 point

Manufacturing cannabis products requires the use of various types of equipment and utensils, including equipment operated at high temperatures and/or pressures, during the course of its production. The proper use and storage of these items, coupled with the use of appropriate personal protective equipment by employees and training on use of PPE helps to ensure that the workplace is safe and accident-free.

Product Storage (Short and Long-Term) - 1 point

State regulations should require that medical cannabis manufacturers store medicine in a manner that is sanitary and appropriate for each state of production. Cannabis, like other plants and perishable products, can degrade when stored improperly; in order to reduce the risk of spoilage and contamination, there should be written procedures for both short and long term storage of manufactured cannabis products including extracts, concentrates, foods, and topical products.

Batch and Lot Tracking - 1 point

Many states require seed to sale tracking of cannabis products. This allows a product to be traced back to its origins in the event of a recall. By utilizing unique batch and lot numbers for products a consumer who has experienced an adverse event or a product that has been released but found to fail contaminant testing, can be identified and recalled along with any associated batches or lots.

Security - 1 point

State laws and regulations should require legal medical cannabis businesses to develop and implement a written security plan that should address issues such as security of the physical plant, loss prevention, diversion prevention, theft or robbery prevention, and emergency action preparedness.

Waste Disposal - 1 point

Most state regulations require proper disposal of cannabis waste but often fail to address issues related to disposal of chemicals and other products used during manufacturing activities. Manufacturing operations should have written procedures for how each of the various types of waste streams are handled and how access to those waste streams is controlled.

Records Management - 1 point

Part of all GMP and QMS systems is accurate documentation that policies and procedures are being followed correctly. Good recordkeeping practices help businesses to monitor manufacturing activities, employee performance, and identify trends and issues. These records also provide regulators with the evidence they need to ensure compliance with state rules and regulations.

Environmental Impact Regulations - 3 points

New this year, a state may earn 3 points for addressing the environmental impact of cannabis manufacturing activities. States received points for addressing things such as electricity usage, chemical handling and storage, limiting the chemicals that may be used to manufacture concentrates, and ensuring waste disposal for chemicals including flammable substances such as butane and ethanol are disposed of properly and not a source of environmental contamination.

Required Testing - 10 points

In order to ensure patient safety and accurate labeling of medical cannabis, state governments should require that representative samples of each batch be sampled and analyzed by an independent, third-party laboratory to determine their purity, potency, and quality including freedom from harmful contaminants. Potency testing includes testing for both cannabinoids and terpenes, the chemicals responsible for the entourage effect. Contaminant testing should include testing for various classes of microbials, aflatoxins/mycotoxins, pesticides, heavy metals, foreign matter, moisture content, water activity, residual solvents, and homogeneity.

Packaging and Labeling - 5 points

Accurately labeled products provide patients with information regarding the potency of a product including both its cannabinoid and terpene content, which can help inform medical decision making. Patients should also be aware of any ingredients used in manufacturing the cannabis product including the identification of any known allergens and the nutritional content of edible products.

Complaints, Adverse Events, and Recall Procedures - 5 points

Businesses must have policies and procedures in place with regard to how they receive complaints and reports of adverse events, both of which could trigger a recall. Operators must have written procedures and should conduct mock recalls to be prepared. Many states have requirements for how an operator should handle a recall but fail to address receiving complaints and adverse event reports.

Dispensary Operations - 50 points

Staff Training - 10 points

Many state governments have training requirements for dispensary employees. This training should include knowledge of state and federal regulations related to cannabis possession and what the means for patients in their state, resources for patients to learn more about cannabis including how to become a medical cannabis patient in that state, along with what products the dispensary offers including their dosage and estimated time of on-set.

Standard Operating Procedures - 7 points

Quality management systems require written procedures that employees need to understand and follow. States were scored on whether they specifically require written procedures and whether they required procedures for facility and equipment sanitation, workplace safety, product storage, batch and lot tracking, security, waste disposal, and records management.

Facility and Equipment Sanitation - 1 point

Contamination can occur at many various points in the manufacturing process. State laws should require that medical cannabis manufacturing be conducted under sanitary conditions that aim at reducing contamination and pests. ASA recommends using existing sanitation standards for manufacturing, food production, and herbal medicine processing as models for sensible regulations to protect patients from contaminants and adulterants.

Workplace Safety - 1 point

Manufacturing cannabis products requires the use of various types of equipment and utensils, including equipment operated at high temperatures and/or pressures, during the course of its production. The proper use and storage of these items, coupled with the use of appropriate personal protective equipment by employees and training on use of PPE helps to ensure that the workplace is safe and accident-free.

Product Storage (Short and Long-Term) - 1 point

State regulations should require that medical cannabis manufacturers store medicine in a manner that is sanitary and appropriate for each state of production. Cannabis, like other plants and perishable products, can degrade when stored improperly; in order to reduce the risk of spoilage and contamination, there should be written procedures for both short and long term storage of manufactured cannabis products including extracts, concentrates, foods, and topical products.

Batch and Lot Tracking - 1 point

Many states require seed to sale tracking of cannabis products. This allows a product to be traced back to its origins in the event of a recall. By utilizing unique batch and lot numbers for products a consumer who has experienced an adverse event or a product that has been released but found to fail contaminant testing, can be identified and recalled along with any associated batches or lots.

Security - 1 point

State laws and regulations should require legal medical cannabis businesses to develop and implement a written security plan that should address issues such as security of the physical plant, loss prevention, diversion prevention, theft or robbery prevention, and emergency action preparedness.

Waste Disposal - 1 point

Most state regulations require proper disposal of cannabis waste but often fail to address issues related to disposal of chemicals and other products used during manufacturing activities. Manufacturing operations should have written procedures for how each of the various types of waste streams are handled and how access to those waste streams is controlled.

Records Management - 1 point

Part of all good recordkeeping systems is accurate documentation that policies and procedures are being followed correctly. Good recordkeeping practices help businesses to monitor sales activities, employee performance, and identify trends and issues. These records also provide regulators with the evidence they need to ensure compliance with state rules and regulations.

Product Testing - 10 points

Product Meets Requirements Before Sale - 5 points

States must institute checks into the system that prevent products that have failed testing from entering the market. This includes requiring dispensaries to verify passing testing results prior to accepting products into their facility.

COA Disclosure - 5 points

Dispensaries should make available the Certificate of Analysis (COA) to patients so that patients may have accurate information on the types of testing that was done on a product and the results of those tests.

Complaints, Adverse Events, and Recall Procedures - 13 points

Dispensary operations are likely the first place a patient will go if they have a complaint or experience and adverse event. Businesses must have policies and procedures in place with regard to how they receive complaints and reports of adverse events, both of which could trigger a recall. Operators must have written procedures and should conduct mock recalls to be prepared. Many states have requirements for how an operator should handle a recall but fail to address receiving complaints and adverse event reports.

Laboratory Operations - 50 points

Independent or Third-Party - 5 points

Being independent or third-party means that a laboratory is not swayed by any financial obligations to a client to alter test results or pass samples that may have failed testing. Laboratories must remain unbiased toward the results they are reporting and therefore must not be connected by ownership or financial ties to cultivation, manufacturing, or dispensary operations.

Laboratory Sampling - 5 points

Sampling should be conducted in a manner consistent with good sampling practices including use of sterile equipment and personal protective equipment. Because of the high value of cannabis products there may be incentive from some producers to do things to their samples prior to submitting them to the laboratory to ensure they pass contaminant testing. By having laboratories collect samples these types of situations can be avoided. Samples should be representative of the entire batch or lot.

Method Validation - 4 points

Method validation is a process whereby laboratories evaluate their test method for accuracy, precision, and robustness. Methods need to be accurate and precise in order to provide accurate quantitative results and robust enough to ensure that it will provide quality results consistently. Method validation is a requirement for ISO 17025, states received partial points for requiring ISO 17025 and full points for specifically requiring method validation.

Quality Management Systems - 5 points

Good laboratory practices (GLP) are a type of quality management system for laboratory operations that outlines best practices. Best practices include specifications for the acquisition of standards and reference materials, laboratory controls, data and results review and reporting, and employee demonstrations of competency.

Staff Training - 20 points

Are laboratory staff required to be trained in state and federal regulations, state cannabis laws, maintaining confidentiality of test records, and how to conduct the testing activities they are approved to perform?

Many state governments have training requirements for laboratory employees. This training should include knowledge of state and federal regulations related to cannabis possession, regulatory inspection preparedness, and training to safely and accurately perform testing. States received partial points for requiring ISO 17025 and full points for specifically mentioning training in their regulations.

Standard Operating Procedures - 7 points

Quality management systems require written procedures that employees need to understand and follow. States were scored on whether they specifically require written procedures and whether they required procedures for facility and equipment sanitation, equipment and instrument calibration, workplace safety, sample tracking, security, waste disposal, and records management.

Facility and Equipment Sanitation - 1 point

Laboratory equipment and utensils should not be a source of contamination during cannabis product testing. The laboratory should have procedures in place to ensure the facility and equipment are maintained in a clean and sanitary manner.

Equipment and Instrument Calibration - 1 point

Laboratories that are reporting quantitative test results must have procedures for instrument and equipment calibration that allows results to be reported accurately and precisely. Calibration should be done at specified intervals and by accredited organizations.

Workplace Safety - 1 point

Testing cannabis products requires the use of various types of equipment and utensils, including equipment operated at high temperatures and/or pressures, and chemicals that may pose significant health hazards. The proper use and storage of these items, coupled with the use of appropriate personal protective equipment by employees and training on use of PPE helps to ensure that the workplace is safe and accident-free.

Sample Tracking - 1 point

Laboratories must utilize a system to track samples from collection through results reporting and disposal. This system should be used to report test results to state regulatory agencies and allow a laboratory to identify a retained sample in the event that a retest is needed.

Security - 1 point

State laws and regulations should require legal medical cannabis businesses to develop and implement a written security plan that should address issues such as security of the physical plant, loss prevention, diversion prevention, theft or robbery prevention, and emergency action preparedness.

Waste Disposal - 1 point

Most state regulations require proper disposal of cannabis waste but often fail to address issues related to disposal of chemicals and other products used during testing activities. Laboratory operations should have written procedures for how each of the various types of waste streams are handled and how access to those waste streams is controlled.

Records Management - 1 point

Part of all good recordkeeping systems is accurate documentation that policies and procedures are being followed correctly. Good recordkeeping practices help businesses to monitor testing activities, employee performance, and identify trends and issues. These records also provide regulators with the evidence they need to ensure compliance with state rules and regulations.

Results Reporting - 4 points

States should have systems in place to track testing results of products to ensure that products which fail testing do not enter the market. States received partial points for requiring reporting of failed tests and full reports for requiring reporting of all test results.

7. Score Penalties - 100 points

 

Gives Regulatory Preference to Adult Use - 20 points

Oftentimes, legalization for all adults is treated by lawmakers as the terminus of cannabis policy. Many medical cannabis laws include very strict regulations in order to allow as few people into the programs as possible. This leaves the medical programs more time consuming, restrictive and costly for patients, because patients have to pay for doctor visits, apply, pay, and wait for their medical cannabis cards to be approved before they can access their medicine. This causes many patients to leave medical programs altogether and use the adult-use market instead. When states are creating adult use programs, it is critical that they first acknowledge the unnecessary restrictions in the medical programs and make corrections to ensure that people who need cannabis for medical purposes have the same level of access--and priority of access--as those that consume it for recreational purposes. Oftentimes, patients get paved over to make room for consumers who are seen as more profitable and therefore valuable. When legalization is finally implemented, many states will roll regulatory control of medical cannabis into the same body that oversees the adult use market. Broader regulatory bodies won’t approach issues in a patient centric manner, which means patients get left behind. Medical cannabis should be regulated by the state health department or an agency directly affiliated with it. To avoid this penalty, a state where cannabis is legal for all adults must have a proven track record of addressing patient issues and a regulatory agency independent of adult use regulation.

 

Classifies Cannabis as a Medicine of Last Resort - 15 points

Some state laws only allow medical cannabis as a last resort, after all other treatments have failed. This approach is harmful and interferes with the doctor-patient relationship. Doctors should be able to recommend or approve medical cannabis use at any point in a patient’s treatment. Requiring patients to try less desirable and potentially more dangerous treatments, such as opioids, is an unnecessary burden and may cause needless suffering. Emerging science and the experience of healthcare practitioners and patients all over the country indicate that cannabis is a safe, legitimate medicine with real benefits for patients. State law should respect the welfare of the patients, the doctor’s discretion, and the science of cannabis.

Requires Vertical Integration - 10 points

Vertical integration refers to the requirement that one licensing category is permitted to be paired with one or more of the other authorized licensing categories offered by states. For example, some states permit a cultivation license to be paired with a distribution or retail license. While vertical integration can allow larger cannabis businesses to maximize efficiency and cost effectiveness, it can also lead to supply problems and increased costs for consumers if vertically integrated businesses become the primary or only business arrangement authorized by states or territories. ASA recommends that states do not require vertical integration of cannabis businesses, but allow it so long as combined licensing categories do not compromise patient health (e.g. no licensing category should be coupled with a testing laboratory), and models are established to ensure sufficient patient access to and availability of specific cannabis medicines correlating to patient treatment protocols (e.g. collective models that maintain patient access to the individual cannabis products that patients are using to treat their health condition).

Administrative or Supply Problems - 15 points

While ASA supports the creation of a statewide regulatory framework for medical cannabis, administrative oversight has become a hindrance to safe access in some states. Some states have programs that inadvertently caused shortages (and therefore disruptions) in the supply and variety of available medical cannabis, or delays in facility licensing authorization, inspection or failed to include fixed timelines for facility opening following licensing. Restrictions on commercial cultivation plant numbers, the number of cultivation or retail access points (e.g. dispensary and/or delivery), or over-regulation of certain areas of production and distribution can have an adverse effect on the patient population. States should consider third-party certification as a way to ease administrative burdens. ASA discourages the development of policies that unnecessarily restrict or otherwise hamper the supply of medical cannabis, and encourages states to think carefully through supply chain regulations to optimize efficiency of moving legal cannabis from cultivation to retail as quickly and at the lowest possible cost to patients.

Creates New Criminal Penalties for Patients - 10 points

Some states create new criminal penalties when organizing their medical cannabis programs, including penalties for the fraudulent use of the medical cannabis program (i.e. diversion), violation of privacy provisions, and falsely identifying oneself as a participant in the medical cannabis program. As states allow for the non-medical use of cannabis, they should not punish existing patients for failure to comply with the provisions of the new law. If there are any penalties written into the law that were not crimes that existed before the medical cannabis program was put into place, the state is penalized.

Limits Patients to a Single Retailer - 10 points

Some states require that patients designate a single dispensary from which they may acquire their medicine. While such an approach may be easier to regulate, such requirements often result in patients bearing artificially high costs and experiencing reduced medical product diversity, which must be addressed to ensure provision of appropriate patient treatment options. Forcing patients to register to a single dispensary to access their medicine triggers this penalty.

No System for Adding Qualifying Conditions - 10 points

In most states that have a restrictive list of qualifying conditions, a procedure exists for the addition of new conditions to the list of approved ailments that may be effectively treated by cannabis. New studies are being published regularly, and treatments that are not contemplated by the law should be available to physicians, much like “off-label” use is available in the realm of prescription medication. It is ASA’s position that if these restrictions are imposed, then the procedure to add new conditions should be uncomplicated and expedited to deliver access to eligible new patients as quickly as possible. While many states have created such a process, the hurdles to add new conditions are sometimes nearly impossible to clear. States that have no proven track record of new conditions being added will receive this penalty.

Imposes Bans on THC - 5 points

Tetrahydrocannabinol (THC) is a proven therapeutic component of the cannabis plant that the FDA has recognized for medical use, which has been demonstrated to work in synergy with other important therapeutic cannabinoids such as cannabidiol (CBD) to treat specific health conditions, as well as provide for related symptom relief. These cannabinoids, along with an estimated 120 others, engage the human endocannabinoid system to deliver therapeutic benefits. While more research is needed, a 2011 review of studies in the British Journal of Pharmacology revealed that combining THC with other cannabinoids creates a more effective treatment than CBD or other cannabinoids alone. Some states that have passed so-called “CBD-only” legislation, which are sometimes described as “lowTHC” programs, impose arbitrary limits on the amount of THC permitted in authorized medical products or enact outright bans. These laws have the effect of promoting development of only a limited number of cannabis medical products with limited treatment capability for the wide range of health issues which cannabis can effectively treat or mitigate. ASA encourages states to avoid THC caps or prohibitions and instead authorize production of cannabis and cannabis products that are effective in treating health conditions regardless of THC content. States that ban THC entirely will receive the full penalty; states that put a cap on THC will receive a partial penalty.

Imposes Bans on CBD - 5 points

Some states have passed “CBD-enriched” or “CBD-only” legislation. The legislative intent behind this has been to eliminate the psychoactive properties of cannabis compounds, namely THC, however these preparations only benefit a small portion of a state’s patient population because CBD has been shown to work more effectively in tandem with other plant components. Even among the minority of patients who can benefit from low-THC preparations, minimum CBD requirements restrict access to the ratios of CBD to THC that may work best for them. For example, while some pediatric patients with seizure disorders benefit greatly from 30:1 ratios, other children will respond better to 1:1 ratios (and anything in between or beyond). Imposing arbitrary cannabinoid level minimum requirements that are not rooted in science provide no benefit to the public health of a state. States that ban CBD entirely will receive the full penalty; states that put a cap on CBD will receive a partial penalty.