IMG_2487(Photo credit: Emily Gray Brosious/Extract)

A recent national assessment by Americans for Safe Access (ASA) of all 44 states with medical cannabis programs gave Illinois the highest overall marks of any state in the country.

ASA, a D.C.-based nonprofit medical cannabis advocacy and lobbying group, rated Illinois as the state with the best medical cannabis program in the country in its annual report, “Medical Marijuana Access in the United States: A Patient-Focused Analysis of the Patchwork of State Laws.”

Illinois’ medical cannabis program received 449 out of 500 possible points, including 25 bonus points for implementing new medical cannabis legislation in 2016, giving it an 89.8 percent score and a B+ grade. If not for the 25 bonus points, Illinois would have received a percentage score of 84.8, putting it firmly in the B range.

Michigan came in a close second place on ASA’s 2017 report, with a B+ grade and a percentage score of 88.75. California’s medical marijuana program claimed third place, with a B+ grade and a percentage score of 87.

This is the second year in a row that Illinois’ medical cannabis program received the top score on ASA’s report, after placing third in 2015 with a percentage score of 87.6.

ASA’s stated mission is “to ensure safe and legal access to cannabis for therapeutic use and research.” The organization’s report based its ratings on five criteria sections: Patient rights, access to medicine, ease of navigation, program functionality and consumer safety. Each category was broken down into key components and scored.

The remaining states with comprehensive medical cannabis programs received grades ranging from B through D-. All 14 states with CBD-only laws – which only permit medical use of low-THC, high-CBD medical cannabis oil – received F- grades.

“Looking at the report, it doesn’t seem like ASA is using the same criteria to judge the program as patients in Illinois are,” Abraham Villegas, medical cannabis industry analyst, consultant and founder of the Illinois Medical Cannabis Community Facebook group, told Extract. “The scores make it seem like Illinois has a better medical cannabis program than California, but I know plenty of people who wouldn’t agree with that. Many patients feel Illinois has the most restrictive program in the country.”

Villegas praised the comprehensive report for giving Illinois credit for positive aspects of its medical cannabis program, such as its superior product safety scores. But he disagreed with the assessment of Illinois’ patient rights and ease of program navigation.

Villegas said many patients in Illinois run into employment and housing problems due to their use of medical cannabis, two areas where ASA’s report gave the state perfect scores of 5/5. Many housing contracts prohibit the use of federally illegal drugs like cannabis. And while employers can’t legally discriminate based on a person’s status as a medical cannabis patient, they can drug test employees and prospective employees, and they’re allowed to fire medical cannabis patients for testing positive for THC.

He thinks the ASA report’s evaluation of Illinois’ program gives the impression that it’s working better than it is. For his part, Villegas thinks a C or C- grade would be more reflective of Illinois’ medical cannabis program.

Kirsten Velasco, a patient advocate and public speaker working with the group Illinois Women in Cannabis, says it’s important to remember that while Illinois’ system isn’t perfect, it has a lot more going for it than many other states.

For example, Illinois allows patients to utilize dry flowers, a smokable form of medical cannabis, which a number of other states with medical cannabis laws do not permit.

“I’m so grateful legislators in Illinois didn’t restrict the law to CBD only,” she told Extract.

Jared Taylor, community relations director for Midwest Compassion Center, a Romeoville medical cannabis dispensary, thinks certain aspects of Illinois’ program like fingerprint requirements and the current size of the qualifying conditions list are problematic. But he agrees that the ability to access dry flower stands out as a relatively significant benefit for Illinois patients.

“We are able to sell cannabis in flower form. This is less restrictive than other states, such as Minnesota, whereby pills, oils, or tinctures are the only permitted forms,” Taylor told Extract in an email.

The Compassionate Use of Medical Cannabis Pilot Program Act (HB 1) was enacted in 2013, and dispensaries became operational in 2015. Under the measure, patients diagnosed with one or more “debilitating conditions”, as defined by law and certified by a physician with whom the patient has a “bone fide” relationship, are eligible to apply for a medical cannabis card. Forty-one conditions currently qualify for medical cannabis under state law.

Ali Nagib, assistant director of the Illinois chapter of the National Organization for the Reform of Marijuana Laws (NORML), thinks ASA’s report did a solid job of coming up with a system for scoring medical cannabis programs across the country. He admits that’s not an easy task, especially with such rapidly changing state medical cannabis laws.

“It’s one assessment, and it comes from a place that’s valid,” Nagib told Extract. “But it’s coming at this with a very particular vision and very particular set of values.”

Nagib notes that ASA’s report heavily weighs certain program elements and patient protections that many patients in Illinois might not even be aware of. For instance, many Illinois medical cannabis patients may not realize they actually have much stronger arrest protections than patients in other states do. Illinois received a perfect 40 out of 40 score for its arrest protections.

“There’s also a certain level of subjectivity to any report like this, and their viewpoint isn’t necessarily that of all patients,” Nagib said.

Illinois received 10 out of 10 points for its system for adding new qualifying conditions. ASA’s report also gave the state 47 out of 50 points for its list of qualifying conditions – a near perfect score. That came as a surprise to Nagib, since this is one particular area of Illinois’ program that comes under criticism from patients and advocates.

“We got credit for having a comprehensive list of qualifying conditions, but that list doesn’t include many symptoms that other states do include,” Nagib said.

Chronic pain, chronic nausea, and most symptom-based conditions that can’t be tied directly to a specific diagnosis don’t count as qualifying conditions in Illinois. Neither do most mental health conditions, including depression and anxiety. Post-traumatic stress disorder does qualify in Illinois, however.

Illinois amended its medical cannabis law to add PTSD and terminal illness to its qualifying conditions list and extended the pilot program an additional two years on June 30, 2016. The program is now set to expire on July 1, 2020. The move came shortly after a Cook County judge ordered the state to authorize PTSD for medical cannabis.

In his opinion, Cook County Circuit Court Judge Neil Cohen criticized the Illinois Department of Public Health (IDPH) director Nirav Shah for not following recommendations of the state’s Medical Cannabis Advisory Board to add PTSD.

Beth Collins, ASA’s senior director of government relations and external affairs, acknowledges Illinois’ medical cannabis program has room for improvement but says the state received bonus points on this year’s report because it passed legislation and improved regulatory measures in 2016.

“We hope lawmakers and regulatory agencies will continue to improve their laws,” Collins told Extract in an email.

As far as ASA’s scoring of Illinois’ qualifying conditions list, Collins agrees that “47 [points] may be a bit high.” But she noted that the state did add two new conditions in 2016 and said Illinois’ qualifying conditions list is “much more extensive” than many other state lists.

ASA came up with its scoring system after hosting “scores of community forums across the U.S. to gather input from patients” and creating a point-based matrix to deconstruct various components of state cannabis laws based on patient needs.

Nagib says ASA gave Illinois credit for laws that exist on the books, but not necessarily in practice. The score Illinois received for its system of adding new qualifying conditions to the medical cannabis program – a perfect 10/10 – is one example of this, he says.

While Illinois does have a law on the books outlining the process for adding new conditions, the Health Department has rejected every recommendation and petition.

“So, yeah, the law for adding new qualifying conditions exists on the books, but it doesn’t exist in practice because the Executive branch has subverted it,” Nagib said.

Despite Illinois’ relatively high rating from ASA, the report does identify a few key areas of the medical cannabis program that need improvement, including a recommendation that chronic pain be added to the state’s qualifying conditions list.

Extract reached out to Health Director Shah’s office for comment on ASA’s recommendation regarding chronic pain. IDPH communications manager Melaney Arnold responded via email:

“The State of Illinois was deliberate in developing the Medical Cannabis Pilot Program to ensure qualifying patients would have access to a quality product produced and distributed in a safe manner. As the pilot program evolves, the State will continue to make the health and safety of registered patients a priority.”

Despite Illinois’ safe access and high-quality cannabis products, Velasco thinks the ASA report largely overlooked the impact of Illinois’ medical cannabis program costs, which she calls “prohibitive.”

The report did dock Illinois 20 points for not allowing patients to grow their own cannabis at home, but Velasco says the program’s high costs go beyond the ban on home cultivation.

“Many patients don’t have the money to get the medicine they need, and so many others simply can’t afford to get into the program,” she said. “Being sick makes people poor, and they have to choose between keeping a job to pay for insurance or applying for disability.”

Villegas agrees that Illinois’ medical cannabis program application process can be expensive for low-income individuals. The cost of mandatory doctor’s appointments, application fees and fingerprinting can sometimes add up to nearly $1,000, he said.

Increasing the state’s patient numbers, or even passing legislation to legalize marijuana for adult use, could help bring the cost of medical cannabis down.

“We were forecasted to have 100,000 patients by now, and the state is still shy of 20,000 registered patients,” Villegas told Extract.

As of April 5, 2017, Illinois’ Health Department had approved applications for approximately 18,300 qualifying patients, according to state data.

Illinois dispensary owners attribute low patient numbers to the state’s restrictive qualifying conditions list, reluctance of some doctors to certify patients and state politics.

Another likely factor contributing to low patient numbers is the state ban on anyone convicted of a drug felony. Illinois also bars public safety officials, school bus and commercial drivers, police officers, correctional officers and firefighters from becoming medical cannabis patients.

ASA’s report recommends that Illinois remove the fingerprinting requirements for background checks, “which provide no purpose when it comes to improving the lives of patients.”

Collins would also like to see Illinois and other states eliminate qualifying conditions lists altogether, leaving that choice up to doctors.

“If the states would leave the medical determination to doctors, then patients would not have to lobby condition by condition,” she said.

ASA’s goal going forward is to get state medical cannabis programs into the A-grade range on its annual report, Collins said. That’s something “which no state – after 20 years – has achieved.”

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See also:

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