D.

Scott Dibble
Senator

District 61
South, Southwest and Downtown Minneapolis



Minnesota Senate
State Capitol., Room 111
75 Rev. Dr. Martin Luther King J r. Blvd.
St. Paul, Minnesota 55155

651-296-4191
sen.scott.dibble@senate.mn
www.senate.mn/senatordibble

May 11, 2014

Governor Mark Dayton Representative Carly Melin
Office of the Governor MN House of Representatives
110 State Capitol 515 State Office Building
St. Paul, MN 55155 St. Paul, MN 55155

Dear Governor Dayton and Representative Melin,

Let me echo the warm regards with respect to our mutual efforts to find a path forward on
passage of a measure that will provide relief in the form of medical cannabis for suffering
Minnesotans who have exhausted all other treatment options, while at the same time providing
for sound public safety and public health policy.

We share these goals and these important values.

I am very glad to see progress on this important measure in the form of passage of the House bill
and an indication from the Governor that it is important to enact something into law.

The bill as passed by the Senate on a strong bipartisan vote of 48 to 18, cannot be fairly
characterized as expansive or broad. Unlike the House bill, it received extensive review and
underwent substantial revisions and improvements via a thorough committee hearing and public
engagement process. It is significantly more narrowly tailored than any other similar measure in
other states that have successfully enacted medical cannabis programs. It is worth noting that
despite other states' less strict policies, officials have not observed corresponding increases in
negative safety or health outcomes. In fact, the Senate file's provisions that provide for safety and
that guard against diversion of cannabis into the hands of those who should not have it are more
specific and thorough.

I am also anxious for some legislative success this year. In our shared pursuit of a measure to
provide adequate access to those who need it, in the forms of cannabis that will provide for the
best benefit people with the least risk of harm, and giving adequate provisions for public safety.

With that in mind, the House measure falls short in a number of key ways.

Governor Dayton
Representative Melin
May 11, 2014
Page 2



Public safety
Paradoxically, law enforcement is neutral on the House bill, while standing opposed to the
Senate measure, despite the fact that the Senate measure is far superior in addressing their
ostensible concerns. I believe public safety concerns focus on policies put in place in other states
that I do not wish to replicate. Law enforcement testimony in Senate hearings disregarded the
content of my bill and instead focused on other states policies. Public safety officials have
consistently mischaracterized my bill in public statements and have not engaged me in
conversations on the issue. As evidence of the strong measures put in place in the Senate file,
please consider these shortcomings of the House file:
No increased penalties on the part of employees of dispensaries, patients or caregivers for
illegal diversion of cannabis under the auspices of medical use.
Failure to revoke that ability of patients to participate for diverting cannabis.
Controls over location and business practices to allay community impacts are not addressed
(signage, marketing, timely notice of loss or theft).
Manufacturer / dispensary security measures are weak and non-specific.
Commissioners authority to investigate and revoke manufacturers ability to participate is
not addressed. (Even if this were remedied, should the single manufacturer be in violation, its
closure would eliminate the program entirely.)

Forms of cannabis available
Refusing access to the whole plant form and providing only the limited, much more expensive
forms of processed cannabis in the House bill leaves many patients behind, and exposes those
who do participate to lesser efficacy and greater risk. The compounds, allowed to work in
tandem as only found in the whole plant, are proven by research to have important therapeutic
effects not otherwise available. Vaporizing oil and other forms have significant drawbacks and
risks not present in the whole plant form, especially because these forms are more potent.
Because digestive absorption is slow and uneven, oral ingestion in pill or other forms does not
allow patients to receive immediate benefit and to very precisely limit their own dosage to
alleviate symptoms, leading often to unnecessary and unwanted intoxication.

Despite claims to the contrary, law enforcement loses no probable cause considerations that
would limit their ability to conduct searches of those suspected to be in illegal possession of
controlled substances should the odiferous plant material be allowed out of a locked settings.
Other states show this to be the case.

Governor Dayton
Representative Melin
May 11, 2014
Page 3

The House measure requires the Commissioner to first determine what forms and chemical
composition of medical cannabis can be available before any access is granted. This is a curious
requirement in light of the Commissioners publicly stated objection to any access. Further, he
and the HHS Commissioners have stated that the potential harms and unknowns should in large
part rule out its use. I fear that this is another pretext to simply doing nothing. The Commissioner
has the authority to extend this work for an additional 18 months beyond the first deadline next
year.

Conditions and symptoms covered
The Senate bill provides a very narrowly construed listing of those qualifying conditions and
symptoms. Chief among those left out in the House bill are those with intractable pain. Despite
the misrepresentations that this expands the availability of medical cannabis to too many people,
intractable pain has a specific statutory definition. In short, it is pain that will not respond to any
other form of treatment. I would again propose as I did in writing prior to the House vote that it
be included, and go a step further, requiring a second diagnosis from a Board certified pain
specialist medical doctor. Use of cannabis for this purpose has shown to allow for reduced use of
expensive and harmful pain medications including highly addictive opioids.

Under the House bill, doctors need only certify a particular ailment, not whether the
corresponding symptoms might respond to cannabis, again leaving many out unnecessarily.
Paradoxically, unlike the Senate bill, this creates a situation in which many would qualify who
should not because of this reliance on a mere disease diagnosis instead of a qualitative analysis.
A patient with non-malignant skin cancer requiring no chemotherapy and involving no pain
would qualify, while a veteran who suffers from residual limb pain whose doctor believes
cannabis would be a safe and effective treatment option would not. Finally, to leave out those
with severe nausea and severe wasting / cachexia from chronic conditions eliminates a wide
swath of those commonly recognized to have potential benefits not otherwise available to them.
Again, as I proposed prior to the House vote, including these individuals is important.

Access based on location
The Senate proposal provides for 55 alternative treatment centers, also known as dispensaries.
This represented an effort to balance the community concerns with adequate access for those
who need it. The House bill only provides for one manufacturer and three satellite distributors in
the entire state where patients can obtain medical cannabis. There are no provisions for people
with disabilities who cannot get their own to obtain assistance from a friend or family member to
do so. I had conveyed a willingness in my written communication prior to the House vote to drop
that number to 24, three per congressional district. I renew that proposal here.

Governor Dayton
Representative Melin
May 11, 2014
Page 4

This extreme limitation on locations and providers is very problematic. First and foremost is the
negative effect that a monopoly business will have on pricing, quality and availability of needed
forms of cannabis. Additionally, should the monopoly provider be put out of business, the entire
program would collapse immediately. Finally, Minnesota is a big state. It takes 7.5 hours to drive
from International Falls to Worthington. Asking an ill person to drive several hours to get what
they need, or go to the expense of having it delivered because there are no provisions for asking
a trusted person to do so for them, will put relief out of reach for many.

The Senate bill also provides specific measure for safety compliance facilities secure
laboratories, with the same safety measures that the centers are subject to, that could provide
control measures for purity and content testing, labeling information, etc. The House measure
states that a laboratory would need to be engaged, but with no parameters on security, business
operations, etc.

People with disabilities who need help have no options other than to receive assistance with the
use of medical cannabis in their home, treating them differently than others.

Cost and complexity
The House bill costs an estimated $5 million, with little or no of that cost being recoverable.
General fund subsidies would have to continue in perpetuity. The agency is asked to establish
forms of cannabis to be available, set up a state run-research and study effort that is unclear and
ill defined, asks doctors to be a part of the study and thus go to significant unreimbursed effort to
facilitate their patients access. The Senate proposal is much more straightforward, pays for
itself, and in fact will generate a surplus of revenues.

Medical and Health care community
Every recent scientific poll has shown a majority of medical doctors in strong favor of allowing
patients access to cannabis for the alleviation of symptoms. Many medical and professional
health associations have strongly stated policy positions in its favor, including the Minnesota and
the American Nurses Association, the American Academy of HIV Medicine, the Epilepsy
Foundation, and the Leukemia & Lymphoma Society and the American Public Health
Association.

The communication of one organized medicine group stating preference for the House
measure contained irreconcilable inconsistencies within it that can, again, only lead one to
conclude that their desire is for no actual forward movement on the matter.

Governor Dayton
Representative Melin
May 11, 2014
Page 5

The goal of this letter is to convey my very serious concerns with the House proposal that may
prove it to be inadequate and unworkable. I affirm and respect that we are all in pursuit of the
same goal and seeking to find a viable way forward. It is my sincere hope that some or all of
these issues can be ironed out so that Minnesotans suffering day in and day out have a shot at a
better life.

I am convinced a middle ground exists between the House and the Senate files that allows for
meaningful study and data gathering on use of medical cannabis that will continue to inform
public policymaking. We can sensibly provide relief to thousands of Minnesotans while ensuring
cannabis only reaches those who need it for medical purposes. I stand ready to discuss these
concerns formally or informally.

Very truly yours,

D. Scott Dibble
State Senator, District 61


cc: Senator Tom Bakk, Majority Leader
Representative Paul Thissen, Speaker of the House
Representative Erin Murphy, Majority Leader
Senator Katie Sieben, Assistant Majority Leader