Monday, March 27, 2017
As readers know from recent posts, my Marijuana Law, Policy & Reform seminar students deep into their class presentations. And a student this coming week is "analyzing and comparing the risks, restrictions, and barriers providers face for providing recommendations." Here are the materials this student has prepared for background on this topic:
March 27, 2017 in Business laws and regulatory issues, Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)
Thursday, March 16, 2017
The folks at the Congressional Research Service do a terrific job summarizing complicated law and policy issues for members of Congress, and their latest marijuana publication is no exception. This latest CRS report is titled "The Marijuana Policy Gap and the Path Forward," and it covers an amazing amount of marijuana law and policy in under 50 pages. Here are excerpts from its summary:
Most states have deviated from an across-the-board prohibition of marijuana, and it is now more so the rule than the exception that states have laws and policies allowing for some cultivation, sale, distribution, and possession of marijuana — all of which are contrary to the federal Controlled Substances Act (CSA). As of March 2017, nearly 90% of the states, as well as Puerto Rico and the District of Columbia, allow for the medical use of marijuana in some capacity. Also, eight states and the District of Columbia now allow for some recreational use of marijuana. These developments have spurred a number of questions regarding their potential implications for federal law enforcement activities and for the nation’s drug policies as a whole.
Thus far, the federal response to state actions to decriminalize or legalize marijuana largely has been to allow states to implement their own laws on marijuana. The Department of Justice (DOJ) has nonetheless reaffirmed that marijuana growth, possession, and trafficking remain crimes under federal law irrespective of states’ positions on marijuana. Rather than targeting individuals for drug use and possession, federal law enforcement has generally focused its counterdrug efforts on criminal networks involved in the drug trade.
While the majority of the American public supports marijuana legalization, some have voiced apprehension over possible negative implications. Opponents’ concerns include, but are not limited to, the potential impact of legalization on (1) marijuana use, particularly among youth; (2) road incidents involving marijuana-impaired drivers; (3) marijuana trafficking from states that have legalized it into neighboring states that have not; and (4) U.S. compliance with international treaties. Proponents of legalization have been encouraged by potential outcomes that could result from marijuana legalization, including a new source of tax revenue for states and a decrease in marijuana-related arrests. Many of these potential implications are yet to be fully measured.
Given the current marijuana policy gap between the federal government and many of the states, there are a number of issues that Congress may address. These include, but are not limited to, issues surrounding availability of financial services for marijuana businesses, federal tax treatment, oversight of federal law enforcement, allowance of states to implement medical marijuana laws and involvement of federal health care workers, and consideration of marijuana as a Schedule I drug under the CSA. The marijuana policy gap has widened each year for some time.
March 16, 2017 in Federal Marijuana Laws, Policies and Practices, History of Marijuana Laws in the United States, Medical Marijuana State Laws and Reforms, Recreational Marijuana State Laws and Reforms, Who decides | Permalink | Comments (2)
Wednesday, March 15, 2017
The title of this post is the title of a notable new report issued by National Families in Action. The report can be downloaded at this link, and this press release about the report provides a summary of its themes and core contents:
A new report by National Families in Action (NFIA) uncovers and documents how three billionaires, who favor legal recreational marijuana, manipulated the ballot initiative process in 16 U.S. states for more than a decade, convincing voters to legalize medical marijuana. NFIA is an Atlanta-based nonprofit organization, founded in 1977, that has been helping parents prevent children from using alcohol, tobacco, and other drugs. NFIA researched and issued the paper to mark its 40th anniversary.
The NFIA study, Tracking the Money That’s Legalizing Marijuana and Why It Matters, exposes, for the first time, the money trail behind the marijuana legalization effort during a 13-year period. The report lays bare the strategy to use medical marijuana as a runway to legalized recreational pot, describing how financier George Soros, insurance magnate Peter Lewis, and for-profit education baron John Sperling (and groups they and their families fund) systematically chipped away at resistance to marijuana while denying that full legalization was their goal. The report documents state-by-state financial data, identifying the groups and the amount of money used either to fund or oppose ballot initiatives legalizing medical or recreational marijuana in 16 states. The paper unearths how legalizers fleeced voters and outspent — sometimes by hundreds of times — the people who opposed marijuana.
Tracking the Money That’s Legalizing Marijuana and Why It Matters illustrates that legalizers lied about the health benefits of marijuana, preyed on the hopes of sick people, flouted scientific evidence and advice from the medical community and gutted consumer protections against unsafe, ineffective drugs. And, it proves that once the billionaires achieved their goal of legalizing recreational marijuana (in Colorado and Washington in 2012), they virtually stopped financing medical pot ballot initiatives and switched to financing recreational pot. In 2014 and 2016, they donated $44 million to legalize recreational pot in Alaska, Oregon, California, Arizona, Nevada, Massachusetts and Maine. Only Arizona defeated the onslaught (for recreational marijuana).
March 15, 2017 in Campaigns, elections and public officials concerning reforms, History of Marijuana Laws in the United States, Initiative reforms in states, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms, Recreational Marijuana Commentary and Debate, Recreational Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)
Sunday, March 12, 2017
The title of this post is the headline of this lengthy new local article from Buffalo. Here are excerpts:
The state health commissioner last year declared New York’s medical marijuana program a success. But the five companies that the state selected in 2015 to get marijuana into the hands of people suffering from debilitating and sometimes terminal diseases such as cancer, AIDS and multiple sclerosis tell a different story.
“Our company is not close to break-even yet," said Ari Hoffnung, president of Vireo Health of New York, which has a marijuana-growing facility in Fulton County and dispenses its products in two downstate and two upstate locations. “And based on my understanding, no one has made a dime here in New York."
If other states were a guide, New York should be preparing for at least 200,000 patients enrolled in the program, the industry estimates. But since medical marijuana went on the market in New York State a little over a year ago, just over 14,000 patients have enrolled to buy the drug at one of the 20 dispensaries scattered around the state. Only half of those are regular customers. Many stopped taking the drug because of high costs, distances they must travel to get it or because they died, industry executives say. Fewer than 900 doctors signed on to certify patients to use the drug.
“There are two things the program is lacking: physicians and patients," said Sen. Diane Savino, author of the bill that opened up medical marijuana treatment in New York State. Now, while the five companies producing medical marijuana struggle to stay alive for lack of customers, the Cuomo administration wants to add five more grow-and-distribution licenses.
At the same time, the administration is not opening up a new bidding process. Instead, the Cuomo administration is turning to five companies – from the original 43 bidders – that lost in the application process two years ago. All of this is worrying the companies still trying to stay afloat. “Every single one of them is financially struggling," Savino said....
Instead of adding new grow facilities, the existing licensees say, New York should more aggressively attract physicians to participate and put dispensaries in more locations. Savino, the Staten Island senator who sponsored the legislation, said she is pushing the Cuomo administration to award new “retail license” dispensaries, but to bar the five existing grower/dispensary firms from owning them. She said the administration does not understand how the medical marijuana marketplace works and that adding new growers while supplies exceed demand is “a big mistake.”
Marijuana companies say they are not arguing more licenses should never be issued to grow and sell marijuana. “No one is making any money here. Twenty percent of us have already failed," said Hoffnung, president of Vireo Health, referring to one of the original licensees that sold out to a California company because of financial problems.
March 12, 2017 in Business laws and regulatory issues, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)
Friday, March 3, 2017
The question in the title of this post is the question being raised by a student presentation in in my Marijuana Law, Policy & Reform seminar next week. The student addressing this issue has assembled the following background reading:
1. Press article: "11 key findings from one of the most comprehensive reports ever on the health effects of marijuana"
2. Information from the FDA: "What is the approval process for a new prescription drug?"
3. More from the FDA: "FDA and Marijuana"
4. Press article: "Most uses of medical marijuana wouldn't pass FDA review, study finds"
5. Press article: "When Your State Says Yes To Medical Marijuana, But Your Insurer Says No"
Tuesday, February 21, 2017
The question in the title of this post is the headline of this new Stateline piece. Regular readers may be tired of my repeated emphasis on the possible connections between the nation's opioid problems and marijuana reform, but I continue to consider the story very important and I am especially troubled to see so little attention seemingly given to these matters by those on the front-lines of the opioid epidemic. Here are excerpts from the Stateline piece (which discusses medical marijuana more generally):
In the midst of an opioid crisis, some medical practitioners and researchers believe that greater use of marijuana for pain relief could result in fewer people using the highly addictive prescription painkillers that led to the epidemic.
A 2016 study by researchers at Johns Hopkins Bloomberg School of Public Health found that states with medical marijuana laws had 25 percent fewer opioid overdose deaths than states that do not have medical marijuana laws. And another study published in Health Affairs last year found that prescriptions for opioid painkillers such as OxyContin, Vicodin and Percocet paid for by Medicare dropped substantially in states that adopted medical marijuana laws.
In December, the New York Health Department said it would start allowing some patients with certain types of chronic pain to use marijuana as long as they have tried other therapies. The state’s original medical marijuana law, along with those in Connecticut, Illinois, New Hampshire and New Jersey, did not include chronic pain as an allowable condition for marijuana use, in part over concerns that such a broad category of symptoms could result in widespread and potentially inappropriate use of the controversial medicine.
Advocates for greater use of medical marijuana argue that including chronic pain as an allowable condition could result in even further reductions in dangerous opioid use. But some physicians remain cautious about recommending the botanical medicine as a pain management tool.
Dr. Jane Ballantyne, a pain specialist at the University of Washington and president of Physicians for Responsible Opioid Prescribing, which promotes the use of alternatives to opioids for chronic pain, said she does not recommend that her patients try marijuana. “There is no doubt marijuana is much safer than opiates. So we don’t discourage its use.” But in general, she said, “non-drug treatments are far more helpful than any drug treatment, and marijuana is a drug.”
At Mount Sinai Hospital here in the city, Dr. Houman Danesh, director of integrative pain management, suggests patients try physical therapy, yoga, acupuncture, stem cell therapy, nutrition counseling, hypnosis and behavioral health counseling before resorting to opioids or any other medications. He said lack of sufficient research to back up marijuana’s safety and efficacy has kept him from adding it to his pain management toolkit, but he doesn’t rule it out in the near future....
Dr. Howard Shapiro, started certifying patients for marijuana about a year ago and quickly became a believer. He’s one of only 371 doctors out of nearly 33,000 in [New York] City’s five boroughs registered to certify patients for medical marijuana. Statewide, only 863 out of roughly 96,000 physicians have signed up for the program....
As a primary care doctor who takes a holistic approach to medicine, Shapiro said trying medical marijuana was a natural for him. But he said he worried that “a bunch of druggies would start showing up.” Instead, he said the patients he began seeing were all very sick and none of them appeared to be seeking drugs for fun. The improvement he saw in those first patients was remarkable, he said. “I really think medical marijuana is the drug of the future,” Shapiro said. “We’re going to find out that it does a lot of things we already think it can do, but don’t have scientific studies to prove it.”
Out of 109 patients he’s seen over the past year, all but a handful reported substantial improvement in their pain and other symptoms within a month or two of using medical marijuana, he said. For Shapiro’s patients, the cost of marijuana treatment ranges from $300 to $400 a month, depending on their level of use.
Saturday, February 18, 2017
This Florida newspaper commentary by John Romano, headlined "Doesn't medical marijuana deserve a free market too?," effectively shines a light on the notable fact that the affinity of some Republican leaders for less government regulation and more marketplace freedom often wanes when the commodity at issue is marijuana. Here is a portion of the commentary:
Around here, free market is the answer. And it doesn't even require an actual question.
Education gap? Let the business community fix it. Health insurance? Keep the government out of it. Minimum wage? Leave it up to the job creators. Yes, free market competition will always be the solution in Tallahassee.
Except when it comes to medical marijuana. Apparently, that's an industry in serious need of a government-sponsored cartel.
When first venturing into the marijuana business a couple of years ago, the state handpicked a small group of well-connected nurseries in a highly suspect procurement process. Now that a constitutional amendment has marijuana on the precipice of becoming a billion-dollar industry, the state is considering a plan to reward that same group of nurseries with a huge head start in the marketplace. And that contradicts everything our state leaders normally preach.
Think I'm exaggerating? State Sen. Rob Bradley, R-Fleming Island, recently introduced legislation to repeal the state's "certificate of need" programs for hospitals. The program allows the state to regulate where hospitals open, ostensibly to make sure private facilities do not cater to an affluent population and ignore the poor. Bradley calls it a "cumbersome process" used to "block expansion" and "restrict competition." He says eliminating the program will create jobs and drive down prices.
And yet Bradley is also the sponsor of a bill that restricts the number of nurseries allowed to produce medical marijuana, which critics say will create price gouging and limit available product. In effect, it would create the same problems Bradley says hamper the hospital industry....
Personally, I'm waiting for House Speaker Richard Corcoran to get involved. This is a man who does not believe in compromising his principles. He's so committed to free market ideals in education that he called teachers "evil" for pushing back against the privatization of public schools. He once said he would go to war to fight Obamacare's Medicaid expansion.
Not long ago, Corcoran laid out his political principles in a forceful speech: "No economic system has done more to benefit mankind than the free enterprise system … but when judges or legislatures or local governments continually rewrite the rules or attempt to pick winners and losers, that is when markets fail. We need to reverse the damage that has been done, untangle the red tape and tear down all these barriers to entry."
Glad to hear it, Mr. Speaker. Looking forward to you joining the fight.
Wednesday, February 15, 2017
The title of this post is the title of this notable new article posted to SSRN authored by Yu-Wei Luke Chu and Wilbur Townsend. Here is the abstract:
Most of the U.S. states have passed medical marijuana laws. In this paper, we study the effects of these laws on violent and property crime. We first estimate models that control for city fixed effects and flexible city-specific time trends. To supplement this regression analysis we use the synthetic control method which can relax the parallel trend assumption and better account for heterogeneous policy effects.
Both the regression analysis and the synthetic control method suggest no causal effects of medical marijuana laws on violent or property crime at the national level. We also find no strong effects within individual states, except for in California where the medical marijuana law reduced both violent and property crime by 20%.
February 15, 2017 in Criminal justice developments and reforms, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms | Permalink | Comments (0)
Monday, February 13, 2017
The local article, headlined "Data: Only half of state's medical marijuana patients are repeat buyers," reports on some interesting patient data concerning New York's medical marijuana program. Here are excerpts:
More than three-quarters of the state's 13,000 or so medical marijuana-eligible patients have purchased the drug, but only half of the 13,000 are repeat buyers under the tightly regulated state program, according to Department of Health data provided to the Times Union.
Through late January, 12,933 patients had been certified by their doctors to participate in the state's medical marijuana program and 10,250 patients had been dispensed a medical marijuana product. But the number of patients who had been dispensed a product more than once was 6,403. That data backs up anecdotal evidence about patients' purchasing habits over the first year of the program. While the five companies authorized to sell medical marijuana products have had products to offer, demand has been on a slower growth curve than the businesses would like.
These less-than-robust sales have caused issues for patients, including prohibitive prices they must cover out of pocket because insurance does not cover medical marijuana.
Diagnosing why about half of all patients aren't returning to pick up a second round of medicine isn't an exact science. "If the implication is that only certain people are continuing on medical marijuana because they can afford it, there are probably lots of reasons for that besides just price," said Josh Vinciguerra, the Department of Health's Narcotic Enforcement Bureau director. He pointed to the fact that medical marijuana remains a new area of treatment for a number of doctors and patients who might be willing to become certified for the program but are wary of actually taking advantage....
But Vinciguerra said cost does remain a focus for DOH moving forward, adding that the department believes opening the program up to more companies (only five are currently authorized to operate) could also assist with price issues by adding competition to the market. The state has taken other actions to try to grow the program, including steps to allow nurse practitioners and physician assistants, not just doctors, to certify patients; the addition of chronic pain to the list of qualifying conditions; and a decision to allow companies to make home deliveries of their products.
Pricing reforms are happening on the company level, and some have turned to discounts in an effort build up their customer bases. Etain, which grows and produces products in Warren County and has an Albany dispensary, recently instituted a repeat buyer discount program. Politico New York reported Wednesday that PharmaCann will drop prices on all of its products by 25 percent.
Still, one medical marijuana company executive said even if all 13,000 patients (as of Feb. 7, the number stood at 13,389) were purchasing products on a regular basis, they would constitute a market small enough for just one of the five current companies to handle. "But as you now see clearly from the data, we have never had 13,000 patients," Vireo Health of New York CEO Ari Hoffnung said. "We do not even have 6,400 patients, because 6,400 patients is essentially a data point of — over the past 12 or 13 months — how many people purchased twice. You can purchase twice and never purchase again. You may have purchased in January or February of 2016 and never came back. ... There's a lot of reasons patients don't come back."
Friday, February 3, 2017
A busy week prevented me from finding time earlier to blog about this notable Stateline piece headlined "As More Voters Legalize Marijuana, States Left With Regulatory Hurdles." Here are some highlights:
The battle to legally grow, sell, buy and smoke pot in California has been a long one. Voters in the state ushered in medical marijuana 20 years ago, but took until last fall to approve a plan to legalize and regulate recreational marijuana.
Now, California officials are faced with setting rules for a product that has been outlawed by the federal government since the 1930s — a challenge that lawmakers and regulators in the other states that chose some form of marijuana legalization in the November election also are confronting.
Like California, Maine, Massachusetts and Nevada voted to legalize recreational marijuana. They also will need rules about where pot shops can be located and whether dispensaries can sell food and candy infused with marijuana. They will also have to dovetail their recreational regulations with an existing medical marijuana industry, while Arkansas, Florida and North Dakota will be building medical systems from the ground up.
It could take several years. Colorado and Washington paved the way for recreational marijuana by legalizing it in 2012, but they are still sorting out policy details.
There is often a gap between the language of ballot measures like California’s and the detailed regulations needed to get marijuana markets off the ground. And the referendums that voters approve often call for quick implementation, giving legislators and regulators little or no time to enact policies before the drug becomes legal. “There’s no perfect implementation, there’s no perfect legalization effort,” said Michael Correia, a federal lobbyist for the National Cannabis Industry Association. “There’s going to be hiccups.”...
Arkansas and Massachusetts already are discovering the difficulty of setting up a regulatory system. Arkansas has delayed the launch of its medical marijuana program to give public agencies more time to prepare and lawmakers have introduced bills to restrict how the drug is used. Massachusetts lawmakers delayed the opening of marijuana shops by six months and proposed bills that would limit how much can be grown and possessed.
States also face banking challenges, licensing skirmishes and drugged driving debates. But despite all the difficulties, more states are expected to jump into the legalization fray. Already this year, at least 12 states are considering legislation to legalize and regulate marijuana. Another seven are looking at measures to decriminalize simple possession of marijuana and nearly 30 ballot measures related to marijuana are being considered for elections in 2017 and 2018....
Three years after marijuana could first be bought and sold in Colorado, officials are still working through regulatory changes. This year already, bills have been introduced that would create a licensing system for marijuana smoking clubs, prohibit advertising marijuana without a sales license, and allow the use of medical marijuana for stress disorders.
Similarly in Washington, which legalized marijuana on the ballot in 2012, lawmakers are considering legislation that would allow retailers to sell marijuana merchandise like clothing that bears a store’s logo, regulate in-home marijuana production, and standardize the packaging and labeling of edible marijuana products....
One test of how well legalized marijuana is working will be when California, with about 39 million people and the sixth largest economy in the world, opens its recreational marijuana shops. Market researchers estimate that the California cannabis market will grow by 18.5 percent annually over the next five years, reaching $6.5 billion by 2020. By comparison, revenue in Massachusetts and Nevada, which also legalized recreational marijuana in November, is expected to be about $1.07 billion and $629.5 million, respectively.
But regulating the California market won’t be easy. Already there are rumblings of pushing implementation back a year from 2018 to 2019. And it won’t be entirely up to the state. Local governments will have a lot of say in determining when and where marijuana is bought and consumed.
I’m happy to announce that my first-of-its-kind textbook on Marijuana Law, Policy, and Authority will soon be published by Aspen. It will be out in April (in e form) and May (in print). The teacher’s manual and a companion website will be available soon thereafter. Many thanks to Doug and others who have provided helpful feedback on this book over the last 2.5 years!
The book covers a lot of ground, befitting a field that implicates so many different areas of law. The first chapter of the book is now available on SSRN. That chapter provides more details about the book’s coverage and approach, and it also explains why this is such an interesting and worthwhile area of law to study – and not just for those who are interested in practicing in this burgeoning field.
Not coincidentally, I will be posting more this month (both here and at Prawfsblawg) on topics drawn from the book. My first post at Prawfsblawg briefly laid out the case for teaching and writing about marijuana law. Even though most people who read this blog are already sold on the subject, I’ll copy the relevant passage here:
“For one thing, state marijuana reforms and the federal response to them have sparked some of the most challenging and interesting legal controversies of our day. May the states legalize a drug while Congress forbids it? Even so, are state regulations governing marijuana preempted by federal law? Does anyone (besides the DOJ) have a cause of action to challenge them as such? Can the President suspend enforcement of the federal ban? Do state restrictions on marijuana industry advertising violate the First Amendment? These are just a handful of the intriguing questions that are now being confronted in this field.
Just as importantly, there is a large and growing number of people who care about the answers to such questions. Forty-three (43) states and the District of Columbia have legalized possession and use of some form of marijuana by at least some people. These reforms – not to mention the prohibitions that remain in place at the federal level – affect a staggering number of people. Roughly 40% of adults in the U.S. have tried marijuana, and more than 22 million people use the drug regularly. To supply this demand, thousands of people are growing and selling marijuana. In Colorado alone, for example, there are more than 600 state licensed marijuana suppliers. There are also countless third parties who regularly deal with these users and suppliers, including physicians who recommend marijuana to patients, banks that provide payment services to the marijuana industry, firms that employ marijuana users, and lawyers who advise all of the above.
All of these people need help navigating a thicket of complicated and oftentimes conflicting laws governing marijuana. Colorado, for example, has promulgated more than 200 pages of regulations to govern its $1 billion a year licensed marijuana industry. Among many other things, Colorado’s regulations require suppliers to carefully track their inventories, test and label their products, and limit where and how they advertise. These regulations are complicated enough but doubts about their enforceability (highlighted in the questions above) only add to the confusion and the need for informed legal advice.”
In the coming weeks, I will blog about some of the questions noted above. In the meantime, if you are interested in teaching a course or a unit on any aspect of marijuana law, contact me – robert<dot>mikos<at>vanderbilt<dot>edu -- I would be happy to chat.
February 3, 2017 in Assembled readings on specific topics, Books, Business laws and regulatory issues, Current Affairs, Federal Marijuana Laws, Policies and Practices, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Political perspective on reforms, Recreational Marijuana Commentary and Debate, Recreational Marijuana Data and Research, Recreational Marijuana State Laws and Reforms, State court rulings, Who decides | Permalink | Comments (2)
Monday, January 30, 2017
This new AP article, headlined "Minnesota's Medical Marijuana Program Needs More Money," provides an interesting report on the state of the medical marijuana program in the Gopher State. Here are the particulars:
Minnesota's medical marijuana program needs extra state funding to cover the costs of its patient database and inspections of drug manufacturers, just a few of the regulations that make it one of the most restrictive such laws in the country. It's the latest reminder of the financial constraints on the program borne from the heavy restrictions on Minnesota's 2014 law.
The plant form of marijuana remains banned under the law, requiring the state's two medical manufacturers to concoct marijuana oils, pills and vapors with routine state inspections and secondary lab testing. Just 10 severe conditions such as cancer and epilepsy qualify for the program, a number that has grown in recent years with a few additions.
The state's manufacturers combined to lose more than $5 million in the first year of legal medical marijuana sales in 2015. And patient count hasn't met projections, exacerbating high prescription costs for patients that the two companies who cultivate and sell medication have only recently begun to address with modest price decreases.
The Office of Medical Cannabis' request for more than $500,000 over the next two years is just a fraction of the $40 billion-plus budget Minnesota's Legislature will assemble this year. But state regulators say that money is critical to cover the higher-than-expected costs for maintenance of their around-the-clock patient registry and the costs of performing 120 inspections or more each year....
The state already provides about $1.4 million a year to help cover operating costs, and regulators can cover their oversight costs by charging manufacturers, LeafLine Labs and Minnesota Medical Solutions, an annual registration fee. But after increasing the manufacturers' annual fee from $94,000 to $146,000 last year, Gov. Mark Dayton's budget proposal says additional state funding is essential to help avoid an "increase the cost of medical cannabis to program participants."
Those costs range from software licensing and fixing bugs on their patient registry — where the state tracks each patient's progress with the new medications — to the travel bills that come from visiting every distribution site, from Rochester in southern Minnesota to Moorhead, near its northwestern corner. "I don't think anyone thought about us having eight cannabis centers statewide," said Michelle Larson, the director of the state program. "Our annual cost is a little bit more than folks thought it would be."
Garofalo also has a different approach: He's proposing legislation that would allow manufacturers to write off business expenses on their Minnesota tax filings. That's impossible at the federal level while it's still considered a Schedule I drug, subjecting marijuana-related businesses to some of the highest effective tax rates.
LeafLine Labs chief executive Andrew Bachman said his company will likely lose money again in 2017, and he wasn't sure whether the tax break would help it break even. But by treating the business just as any other Minnesota company, he said it would help cement medical marijuana as just another type of medicine. "It's about normalization. Cannabis is medicine is thousands for Minnesotans now," Bachman said.
Wednesday, January 25, 2017
The question in the title of this post is one that I wonder about a lot as more and more communities struggle for responses to the opioid epidemic. The question is also the title of this new local article from New Hampshire, which discusses a legislative hearing about addiction and other conditions being added to the state's list of qualifying conditions for medical marijuana. Here are excerpts:
In the midst of a heroin and fentanyl crisis, New Hampshire lawmakers are considering a bill that would add opioid addiction to the list of qualifying conditions for the state’s therapeutic cannabis program.
That bill was one of five that could add chronic pain, opioid addiction, post-traumatic stress disorder, fibromyalgia and myelitis disorder to the list of conditions that qualify someone to use therapeutic cannabis in the state. New Hampshire lawmakers heard testimony on the bills Wednesday morning.
A number of patients testified in favor of the bills, but one doctor told legislators to proceed with caution on the bill that would allow doctors to treat drug addiction with marijuana.
Dr. Molly Rossignol, a family physician and addiction doctor at Concord Hospital, said there is not enough research to suggest cannabis is an effective treatment for addiction. “We’re going down a dark and potentially dangerous road,” Rossignol said. “In the past year, I’ve evaluated over 100 patients in our capital region. It is clear cannabis is not helping them stop or reduce their use of opioids.”
While medical marijuana is widely used in other states to treat chronic pain and other medical conditions, no state so far has approved therapeutic cannabis to treat addiction. However, at least one study showed a correlation between overdose deaths and medical marijuana laws. A 2014 study published in the Journal of the American Medical Association found opioid overdose deaths went down 25 percent in states that had medical marijuana laws.
State health officials in Maine considered the question of whether to add addiction as a qualifying condition last year, but ultimately their Department of Health and Human Services concluded there was not enough research or evidence to show it would be effective.
“Given the lack of rigorous human studies on the use of marijuana for the treatment of opioid addiction (only one clinical trial has been completed) and the lack of any safety or efficacy data, the Committee can not conclude that the use of medical marijuana for treatment of opioid addiction is safe,” wrote Dr. Siiri Bennett, the Maine state epidemiologist, and Dr. Christopher Pezzullo, the state health officer.
Rossignol said the issue of marijuana being used to treat addiction needed more time. “This has to be vetted, it has to be scientifically studied,” she said.
Rossignol said her experience with addicted patients has so far indicated marijuana is not helpful with addiction. She treats her addicted patients with Suboxone, a drug taken daily to keep cravings and withdrawal symptoms at bay. Suboxone, methadone and naltrexone are the three drugs approved by the Food and Drug Administration to treat addiction – Rossignol said when used with evidence-based therapies, many studies show they help with addiction.
She said she believed marijuana could do the opposite. “It is something that I see every day reducing their chances of getting into longterm recovery,” she said. “I think it is a very slippery slope.”
Several patients traveled to the State House to testify in favor of the five cannabis bills, including ones to add chronic pain and PTSD to the list of qualifying conditions. Stephen Boulter of North Conway told lawmakers that therapeutic cannabis had dramatically decreased his pain and increased his quality of life.
Boulter was able to qualify for medical marijuana due to a vertebrae injury. He said pain from that injury became debilitating. “It’s with you 24 hours a day, you always have pain,” he said. “The only thing that mitigated the pain were opiates, which I detested.”
When Boulter qualified for medical marijuana, he found it got rid of his pain and didn’t make him loopy. “It made a tremendous difference, it allows me to go to bed at night and go to sleep,” he said. “I firmly believe that anyone suffering with severe chronic pain working with a qualified provider can restore a normal, high quality standard of living.”
Former state Rep. Joe LaChance of Manchester, a disabled veteran, encouraged lawmakers to add PTSD to the list of qualifying conditions. “This is so important to us,” LaChance said. “This is near and dear to my heart.” LaChance briefly described his struggles with drugs and alcohol, crediting therapeutic cannabis with his recovery. “Cannabis saved my life,” he said. “The VA got me addicted to opioids. Add a bottle of Jack Daniels to that, I’m lucky to be here.”
Some prior related posts:
- Given latest opioid death data, should Ohio officials be fast-tracking access to medical marijuana?
- "The Case for Pot in the Age of Opioids: Legalizing medical marijuana could save lives that may otherwise be lost to opioid addiction."
- "Elizabeth Warren Urges CDC To Consider Cannabis To Solve Opioid Epidemic"
- Yet another study suggests link between medical marijuana availability and decreased opioid use
- "Could medical marijuana solve Ohio's opioid problem?"
- "Legalize marijuana and reduce deaths from drug abuse"
- "Obama’s Opioid Offensive Again Ignores the Cannabis Solution"
January 25, 2017 in Medical community perspectives, Medical Marijuana Commentary and Debate, Medical Marijuana Data and Research, Medical Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)
Thursday, January 19, 2017
Two notable new pieces from two notable marijuana reform states (co-authored by two notable former students who took my OSU College of Law marijuana seminar)
One of many reasons I have been bullish on teaching marijuana reform at The Ohio State University Moritz College of Law is because I view the new marijuana reform universe to be a particularly exciting potential "growth industry" for junior lawyers. For that reason (and others), I was so very pleased to see this week the publication of these two (very different) pieces discussing marijuana reform developments in two (very different) states that were both co-authored by students who took my marijuana reform class. Here are links to the pieces and their starting paragraphs:
From California here, "Reclassifying Marijuana Convictions on Your Criminal Record Under California's New Proposition 64," a piece co-authored by Cat Packer, who is now a policy coordinator at the Drug Policy Alliance based in California.
On November 8, 2016, Californians took a major step towards ending the war on drugs and repairing some of the damage inflicted on people’s lives by marijuana prohibition, by passing Proposition 64, the Adult Use of Marijuana Act. Although, the most serious marijuana-related crimes such as providing marijuana to minors, or attempting to smuggle marijuana across state lines remain felonies, under Prop. 64, most marijuana-related misdemeanors and felonies have been reduced or altogether eliminated. These sweeping reductions in criminal penalties are retroactive, meaning past convictions for marijuana offenses reduced or eliminated under Prop. 64 can be reclassified on a criminal record with the courts for free.
From Pennsylvania here, "Medical Marijuana Comes to Pennsylvania: What to Expect As the Keystone State Rolls Out its New Medical Marijuana Program," a piece co-authored by Kelly M. Flanigan, an Associate at K&L Gates
A lack of consensus regarding both medical and recreational marijuana has sparked intense debate across the country. Combined with federal law prohibitions, the state-by-state mosaic creates a dynamic legal landscape. Marijuana remains illegal federally and retains its classification as a Schedule I drug under the Controlled Substances Act. However, 26 states and the District of Columbia have enacted state laws legalizing marijuana in some form. On April 17, 2016, Pennsylvania joined other states that have recognized some medical use for marijuana when Governor Tom Wolf signed the Medical Marijuana Act (“Act 16”) into law.
The Pennsylvania Department of Health (“DOH”) is charged with implementing Act 16, and it promptly developed the medical marijuana program. The DOH has been rolling out temporary regulations (three sets so far) and it anticipates that medical marijuana will become available in Pennsylvania in early 2018. The first critical date for those interested in becoming a medical marijuana organization is January 17, 2017, when the DOH releases its applications for grower/processors and dispensaries through its website.
January 19, 2017 in Criminal justice developments and reforms, Medical Marijuana Commentary and Debate, Medical Marijuana State Laws and Reforms, Recreational Marijuana Commentary and Debate, Recreational Marijuana State Laws and Reforms | Permalink | Comments (0)
Friday, January 13, 2017
This new press article, headlined "Study Links Medical Marijuana to Fewer Traffic Fatalities: The health and public safety concerns that kept marijuana illegal for generations are proving unfounded where it is now legal," reports on more good news emerging from public health research in medical marijuana states. Here are the details (with links from the original):
A new study from Columbia University found that traffic fatalities have fallen in seven states where medicinal cannabis is legal and that, overall, states where medical marijuana is legal have lower traffic fatality rates than states were medical marijuna remains illegal.
The study found that “medical marijuana laws were associated with immediate reductions in traffic fatalities in those aged 15 to 24 and 25 to 44 years, and with additional yearly gradual reductions in those aged 25 to 44 years.” Medical marijuana is now legal in 28 states.
Seven researchers from Columbia’s Mailman School of Public Health worked on the study, with two more researchers from the University of California at Davis and Boston University. They published the study in the American Journal of Public Health.
The researchers used traffic accident data from 1985 to 2014, about 1.2 million accidents. They focused on the relationship between medical marijuana laws and the number of fatal traffic accidents, examining each state with legalized medical marijuana separately.
They also looked at the relationship between the existence of medical marijuana dispensaries and traffic accidents, finding a reduction in the number of fatal accidents among those ages 25 to 44 in areas where dispensaries were open.
The researchers concluded that both medical marijuana legalization and dispensaries were, on average, associated with a reduction in traffic fatalities, particularly among drivers 25 to 44-years-old.
They suggested a few possibilities for this conclusion.
- Those under the influence of marijuana are more aware of their impaired condition than those under the influence of alcohol and may more often make the choice not to drive.
- More people have replaced going out to drink in bars with partaking of marijuana at home, reducing the number of impaired drivers on the road.
- An increased police presence in areas where medical marijuana is legal could have led to fewer people attempting to drive while under the influence of marijuana.
“Instead of seeing an increase in fatalities, we saw a reduction, which was totally unexpected,” Julian Santaella-Tenorio, the lead researcher on the study, told Reuters.
The title of this post is the headline of this lengthy new article from The Hill. Here are excerpts:
Legislators in more than a dozen states have introduced measures to loosen laws restricting access to or criminalizing marijuana, a rush of legislative activity that supporters hope reflects a newfound willingness by public officials to embrace a trend toward legalization.
The gamut covered by measures introduced in the early days of legislative sessions underscores the patchwork approach to marijuana by states across the country — and the possibility that the different ways states treat marijuana could come to a head at the federal Justice Department, where President-elect Donald Trump's nominee for attorney general is a staunch opponent of legal pot.
Some states are taking early steps toward decriminalizing possession of small amounts of marijuana. In his State of the State address this week, New York Gov. Andrew Cuomo (D) said he will push legislation to remove criminal penalties for non-violent offenders caught with marijuana. “The illegal sale of marijuana cannot and will not be tolerated in New York State, but data consistently show that recreational users of marijuana pose little to no threat to public safety,” Cuomo’s office wrote to legislators. “The unnecessary arrest of these individuals can have devastating economic and social effects on their lives.”
New Hampshire Gov. Chris Sununu (R) said during his campaign he would support decriminalizing marijuana. Legislation has passed the Republican-led state House in recent years, though it died when Sununu’s predecessor, now-Sen. Maggie Hassan (D), said she did not support the move.
Several states are considering allowing marijuana for medical use. Twenty-eight states already have widespread medical marijuana schemes, and this year legislators in Missouri, South Carolina, Tennessee, Texas and Utah have introduced bills to create their own versions. Republicans in control of state legislatures in most of those states are behind the push.
Legislators in Connecticut, Rhode Island, Vermont, Delaware, New Mexico and New Jersey will consider recently introduced measures to legalize marijuana for recreational use.
There is little consensus on just how to approach legalization: Three different bills have been introduced in Connecticut’s legislature. Two have been introduced in New Mexico, and three measures to allow medical pot have been filed in Missouri.
In 2016, voters in four states — Maine, Massachusetts, Nevada and California — joined Washington, Oregon, Alaska and Colorado in passing ballot measures legalizing pot for recreational purposes. Those efforts, marijuana reform advocates say, have lifted the stigma legislators might have felt. “Now that voters in a growing number of states have proven that this is a mainstream issue, many more lawmakers feel emboldened to champion marijuana reform, whereas historically this issue was often looked at as a marginalized or third-rail issue,” said Tom Angell, chairman of the pro-legalization group Marijuana Majority.
Just because measures get introduced does not mean they will advance. In many cases, Angell said, it is governors — Democrats and Republicans alike — who stand in the way. Though Democrats control the Connecticut legislature, Gov. Dan Malloy (D) has made clear he is no supporter of legalized pot. Vermont Gov. Phil Scott (R) has not said he would veto a legalization bill, though he is far less friendly to the idea than his predecessor, Democrat Peter Shumlin.
In New Mexico, Gov. Susana Martinez (R) has called decriminalizing marijuana a “horrible, horrible idea.” Democratic legislators are considering a plan to put legal marijuana to voters, by proposing an amendment to the state constitution. If New Jersey legislators advance a legalization law, they would run into an almost certain veto from Gov. Chris Christie (R).
While 14 state legislatures have legalized marijuana for medical use, no state legislature has passed a measure legalizing pot for recreational use. “Every year, we’ve seen legalizers throw everything at the wall to see what might stick,” said Kevin Sabet, who heads the anti-legalization group Smart Approaches to Marijuana. “I’m not surprised by any means. I don’t think there’s much appetite to legalize through the legislature.”...
In Washington, the incoming Trump administration has sent signals that encourage, and worry, both supporters and opponents of looser pot rules. The Obama Justice Department issued a memorandum to U.S. attorneys downplaying the importance of prosecuting crimes relating to marijuana in states where it is legal.
Trump’s nominee to head the next Justice Department, Sen. Jeff Sessions (R-Ala.), has been sharply critical of states that have legalized marijuana. In his confirmation hearings this week before the Senate Judiciary Committee, Sessions said current guidelines, known as the Cole memo, are “truly valuable.”
Marijuana industry advocates seized on those comments in hopes of locking Sessions into maintaining the status quo. “The current federal policy, as outlined by the Cole memo, has respected carefully designed state regulatory programs while maintaining the Justice Department’s commitment to pursuing criminals and prosecuting bad actors,” said Aaron Smith, executive director of the National Cannabis Industry Association.
Sunday, January 8, 2017
This local article, headlined "Judge: Insurance company must pay for medical marijuana for injured N.J. worker," reports on what would seem to be a significant ruling from an administrative law judge in New Jersey. Here are the details from the press report:
In what could be a precedent-setting decision, a New Jersey administrative law judge has ordered an insurance company to pay for medical marijuana for an injured worker who suffers from lingering neuropathic pain in his left hand after an accident while using a power saw at an 84 Lumber outlet in 2008.
Judge Ingrid L. French took testimony from the worker, a 39-year-old Egg Harbor Township man, and a Cherry Hill psychiatrist/neurologist who said the marijuana treatment was appropriate because it would allow the patient to reduce his prescription opiate use and lower the risk of serious side effects.
Andrew Watson was seeking reimbursement for marijuana he had purchased at a dispensary in his Atlantic County township over three months in 2014 after enrolling in the state's program. He also sought a ruling that would allow him to be covered for the treatment in the future.
French issued her opinion last month, saying "the evidence presented in these proceedings show that the petitioner's 'trial' use of medicinal marijuana has been successful. While the court is sensitive to the controversy surrounding the medicinal use of marijuana, whether or not it should be prescribed for a patient in a state where it is legal to prescribe it is a medical decision that is within the boundaries of the laws in the state."
The opinion did not state the reimbursement owed Watson, although his attorney said the marijuana itself cost less than $1,000 because it was only three ounces.
John Gearney, a Mount Laurel lawyer who writes a weekly blog on workers' compensation cases, says the written ruling may be the first in New Jersey to address whether an insurer should pay for marijuana. "It's not binding, but it's really an important decision. There are about 50 workers' compensation judges in the state, and they will read it and see what the judge thought when a case like it comes before them," he said.
Gearney, of the Capehart Scatchard firm, said the only other court ruling he had heard of involving medical marijuana and workers' compensation came when a New Mexico appeals court decided a few years ago that an injured worker was entitled to marijuana treatment. In that case, the court ruled that marijuana was "reasonable and necessary" for an injured worker who had reported that traditional treatments had not alleviated his pain.
John Carvelli, a Mount Laurel lawyer who represented Gallagher Bassett Services, a third-party administrator for 84 Lumber's insurance company, said in an email Thursday: "With respect to the recent decision, we respect the court's decision. . . . At this juncture there is no plan to appeal."...
Philip Faccenda, a Cherry Hill lawyer who represented Watson, said the decision might benefit insurance companies, too. "We believe this will offer very powerful cost savings with respect to the entire workers' compensation industry in New Jersey. . . . More costly pharmaceuticals can be reduced and medical marijuana would be a less expensive treatment modality," he said.
Faccenda said that his client stopped using marijuana in 2014 because he could not afford to continue paying for it. The insurance carrier continued to pay for his use of opiates to treat his pain. The decision means Watson can resume using marijuana, he said.
French wrote in her eight-page decision that Watson's testimony was credible. "He testified that the effects of the marijuana, in many ways, is not as debilitating as the effects of the Percocet (which is how he refers to his prescriptions for Endocet or Oxycodone). . . . Ultimately, the petitioner was able to reduce his use of oral narcotic medication. . . . The court found the petitioner's approach to his pain management needs has been cautious, mature, and overall, he is exceptionally conscientious in managing his pain."
French also wrote that Watson's expert witness, Cherry Hill psychiatrist Edward H. Tobe, described the benefits Watson can obtain by using marijuana and also described the risks of taking opiates. "Opiates can shut down breathing (whereas) marijuana cannabinoids won't . . . Marijuana does not affect the mid-brain. The mid-brain is critical in controlling respiration, heart rate, many of the life-preserving elements," he said, according to an excerpt of his testimony that was included in the judge's opinion.
Tobe said using marijuana, combined with less opiate use, would likely benefit Watson and help him "achieve better function." French said the evidence convinced her that Watson was entitled to participate in the marijuana program and that doing so was "reasonable and necessary" to relieve his continuing pain.
I cannot find the ruling discussed here on line, but more about the ruling can be gleaned from this posting at the NJ Workers' Comp Blog.
Sunday, December 18, 2016
As regular readers know, 2016 was a banner year for marijuana reform. Specifically, in addition to eight states in which voters enacted significant recreational or medical marijuana reforms by ballot initiatives, two important "rust-belt, swing-states," Ohio and Pennsylvania, enacted medical marijuana reforms via the traditional legislative process. Here is a round-up of some recent notable news from a number of these states:
From Alaska here, "Downtown Anchorage retail marijuana store opens up shop"
From California here, "Legalization is opening doors for new marijuana entrepreneurs. Are we about to see a pot gold rush?"
From Florida here, "Medical marijuana questions linger after Amendment 2"
From Maine here, "Recount bid ends, clearing way for legal marijuana in Maine"
From Montana here, "Hundreds of patients apply for medical marijuana after court ruling"
From Nevada here, "How will legalized recreational marijuana affect the gaming industry?"
From Ohio here, "Survey finds Ohio physicians not yet sold on medical marijuana"
From Pennsylvania here, "Pa. senator says he used medical marijuana despite ban"
Thursday, December 15, 2016
This local article, headlined "Ohio medical marijuana dispensary, physician rules released," suggests that medical marijuana advocates might feel a bit warmer on a cold winter day in central Ohio due to the release of proposed details for the implementation of the state's medical marijuana law. Here are the basic details:
Up to 40 medical marijuana dispensaries would be licensed in Ohio under draft rules released Thursday morning. Would-be dispensary owners would have to pay a $5,000 application fee and an $80,000 license fee every other year. Applicants must show they have liquid assets totaling at least $250,000.
Dispensaries would have to hire a pharmacist, nurse, physician or physician's assistant to train employees, develop patient educational materials and be on-call or on the premises during operating hours. Dispensary employees would also have to, by law, report all medical marijuana purchases to the state controlled substances database, OARRS, within 5 minutes of dispensing a product.
A separate set of rules released Thursday requires doctors to take two hours of continuing education classes about medical marijuana as one of several requirements to become certified to recommend marijuana to patients. Certified physicians are barred from owning a dispensary or other medical marijuana business.
The Ohio Medical Marijuana Advisory Committee will review the rules at its meeting Thursday. Public comment will be collected on both physician and dispensary rules until Jan. 13, 2017.
Ohio's medical marijuana law allows patients with 20 medical conditions to buy and use marijuana if recommended by a doctor. The law prohibits smoking and growing marijuana at home. The law left most of the regulatory details, including how to license growers and register patients, to the Ohio Department of Commerce, Ohio State Board of Pharmacy and Ohio State Medical Board to decide over the next year.
The State of Ohio Board of Pharmacy drafted the dispensary rules, and the medical board developed the guidelines for physicians.
The proposed Ohio dispensary rules (which run 66 pages) are available at this link.
The proposed Ohio physician rules (which run 13 pages) are available at this link.
Sunday, December 11, 2016
Are Rhode Island and other New England states now sure to follow Massachusetts on the path the marijuana legalization?
The question in the title of this post is prompted by this local article headlined "R.I., Mass. marijuana markets intertwined: It's one reason legalization in Rhode Island is seen as inevitable." Here are excerpts:
If you want a sense of the connections between the Massachusetts and Rhode Island marijuana markets and the growth that entrepreneurs imagine, look no further than Rhode Island's first approved marijuana cultivator.
Medici Products and Solutions Inc., of Warwick, hopes to have a final license in hand by the end of the year. Its owners, John M. Rogue and Christopher E. Roy, have been selling marijuana to the state's three medical dispensaries as caregivers in a joint grow for two years.
Roy, a retired Woonsocket police officer, has been involved even longer, selling through a separate company, Grow Smart Solutions. With the state shutting down caregiver sales to dispensaries on Jan. 1 and converting to a licensed commercial-grower system, the pair needed a license to keep doing business. State startup fees for a 10,000-square-foot facility, the smallest category: $25,000.
But that's a drop in the bucket compared to their plans in Massachusetts. Rogue and Roy have three medical dispensary and cultivation applications pending in the Bay State under the name Hope Heal Health Inc. They've already received provisional approval for a flagship site on West Street in Fall River. The investment they'll need to make in the building they hope to open next year: $4 million to $7 million, according to Rogue.
Massachusetts documents show the company's projected revenues for the first year at $5.3 million, with $3.1 million in expenses. They expect to sell 952 pounds of medical marijuana at $350 an ounce. "I saw this as an opportunity where we could provide to patients the medicine they need," said Rogue, 65, of Warren. "... My wife passed away from cancer. My partner's mother passed away from cancer. We're just trying to give back."
On Thursday, the pair will be at a North Attleboro selectmen's meeting, seeking town approval for a second cultivation site. They're eyeing Berkley for a third site, said Rogue, whose career before marijuana ranged from technology company management to real estate development. In all matters in Massachusetts, the pair are represented by former Fall River Mayor William Flanagan.
And with Massachusetts voting to legalize marijuana last month, Rogue said the company is interested in moving into the recreational market as well. He acknowledged there are many unknowns, but the ballot question appears to give those who have opened or applied for medical dispensaries preference when recreational sales begin, possibly by 2018.
Massachusetts, which has roughly double Rhode Island's population of marijuana patients, at 33,000, currently has nine medical dispensaries. Another 67 applications for dispensaries, cultivation and processing sites, including Hope Heal Health in Fall River, have received provisional approval....
As for Medici's future in Rhode Island, Rogue — like so many others — says legalization here is inevitable. If not this year, then the next, was his guess. At a Publick Occurrences forum co-hosted by The Journal last Monday, 84 percent of the audience members polled said it was just a matter a time before the state legalizes marijuana.
In an interview last month, House Speaker Nicholas Mattiello noted that, given Massachusetts' legalization, soon Rhode Island will have "a lot of the concerns that marijuana creates" and "none of the revenues to help us address that." Asked if Rogue will be up on Smith Hill pushing for movement this year, he said he'll leave that to the membership. "It's going to happen," he said.
December 11, 2016 in Business laws and regulatory issues, Medical Marijuana State Laws and Reforms, Recreational Marijuana Commentary and Debate, Recreational Marijuana State Laws and Reforms, Who decides | Permalink | Comments (0)