Dear Members of the Mississippi Board of Health:

We are writing to express our support for the medical marijuana initiative. The resolution
adopted by the Board on January 8 and the press release issued on January 9 in opposition to the
initiative are filled with misinformation and outdated arguments. The people of Mississippi
deserve better.

Physicians in 34 states are helping more than 3 million Americans with debilitating medical
conditions by certifying the use of medical marijuana. The experience in those states has been
very positive, there is nothing in the Board’s resolution that refutes the benefits obtained by
patients in those states.

As you know, the initiative does not require physicians to treat patients with medical marijuana.
The initiative, that was signed by more than 105,000 Mississippians, simply gives doctors in our
state the opportunity to certify its use from regulated treatment centers. Your resolution offers no
compelling reason why the ten members of the Board should try to stop the more than 5,700
physicians in our state from using our experiences, training, and research to consider treating our
patients with medical marijuana.

While medical marijuana is certainly not a cure-all, Mississippians with debilitating medical
conditions deserve to have this option available to them. The experiences in 34 other states show
that it can be effective, and we believe the benefits of medical marijuana make it a viable
treatment option for many in our state who are suffering.

The resolution adopted by the Board contained a number of allegations. We offer the following
responses and urge the Board to reconsider its position and engage with us and others in a more
thorough discussion of this issue. Each provision of your resolution is bolded below, following
by our response.

“Don’t be fooled, this proposal is not about medicine, and it’s not about parents with
cancer or kids with epilepsy,” and “the proposed amendment to the Mississippi State
Constitution amendment would allow the use of marijuana for a very broad number of
medical indications including such vague reasons as pain management.”

The medical marijuana initiative is absolutely about medicine and is for Mississippians who have
seen a family member suffer from cancer, epilepsy, or one of the other conditions. The
campaign’s signature gatherers heard countless stories from families across Mississippi who are
looking for another treatment option for their loved ones because traditional medication often
does not handle their symptoms and/or has adverse and unwanted side effects. There are too
many testimonials to count from families in other states with medical marijuana programs who
say that medical marijuana positively changed their lives because it alleviated the symptoms of a
condition that traditional medicine couldn’t help. And while there are four FDA approved
medications that are marijuana-based available for epilepsy and nausea related to cancer
treatment, those are the only conditions approved and come in limited delivery methods.
Additionally, three of the four medications are made from synthetic marijuana cannabinoids and
patients have reported the medications were too strong and did not produce the help they needed
or even made them feel sicker; and, the fourth medication, Epidiolex, is made from real
marijuana but only contains one of over 100 compounds found in the plant. These current four
FDA approved medications do not meet the needs of many patients in Mississippi who suffer
from the debilitating medical conditions listed in the initiative, such as cancer, epilepsy,
Parkinson’s disease, ALS, sickle cell anemia, and multiple sclerosis. While the four medications
may be helpful to some, there are patients who are suffering that need more options. This
campaign’s ballot initiative for medical marijuana, if passed in November 2020, would provide
those options that so many other patients are finding relief from in 34 other states.

Furthermore, there are no “vague reasons” included in the initiative. There are 22 chronic and
debilitating medical conditions listed, many of which are incurable, including cancer, epilepsy,
Crohn’s disease, ALS, Parkinson’s disease and Huntington’s disease, among others. These
conditions are consistent with those listed in other state programs and require a diagnosis by a
physician. Additionally, this is only a list that would allow a patient potential access to medical
marijuana; the patient’s physician still has to approve the patient for it, just as with any other
medication.

While FDA approval of these marijuana-based drugs is certainly positive, it is not enough.
Patients in 34 other states are finding relief from their symptoms of debilitating medical
conditions through medical marijuana programs, and this is why it is so important to give
patients here in Mississippi access to medical marijuana through a safe and regulated program.

“Marijuana is a Schedule I drug and illegal under federal law.”

It is true that “marijuana” is classified as a Schedule 1 drug under federal law, though 34 states
have made it legally available to qualified patients. Additionally, since 2014 Congress has
passed laws that prevent any federal money from being spent to interfere with state medical
marijuana programs. Congress is considering legislation this year that would go further and
remove federal restrictions on financial institutions in processing transactions from medical
marijuana treatment centers. Clearly, the federal government sees value in what these programs
are doing for patients despite the federal classification of marijuana. Unfortunately, this
Schedule 1 classification has hindered scientific research in the United States, though there are
many studies that support medical marijuana as a treatment option. Overwhelmingly, patients
have reported that medical marijuana is beneficial for the symptoms of their debilitating medical
conditions. While medical marijuana may not be the right fit for every patient with one of the 22
listed medical conditions, it should certainly be an option for the patient and his or her physician
to discuss.
“Many [states] do not allow smoking of raw product or have other restrictions on
mechanisms of consumption” and “There would be no ability to restrict the mechanisms of
consumption (i.e., edibles, combustible smoking).”

The overwhelming majority of states do not restrict the mechanisms of consumption available to
patients. Patients and their physicians find that different delivery methods are appropriate for
certain conditions, like lotions for muscle spasticity and vaporizing for nausea. In Mississippi,
delivery methods could include all types to give patients the most choice. The Board of Health,
through regulations, could require labeling and packaging standards, testing requirements, and
prohibitions on certain other ingredients in each form of consumption. It is true that patients get
relief in many forms, and the initiative allows patients to get treatment in ways that they prefer.
This is consistent with the overwhelming majority of states where physicians know that the
benefit of patients accessing medical marijuana in multiple forms outweighs any potential health
risks.

“There are numerous known harms from the use of cannabis products including addiction,
mental illness, increased accidents, and smoking related harms.”

This statement is contradictory to published research that shows medical marijuana is a viable
treatment option for many conditions. Physicians across America see medical marijuana as a
way to help their patients alleviate the symptoms of their illnesses and believe any potential risks
are outweighed by the benefits. If a physician believes that medical marijuana is not the right fit
for his or her patient, that physician is under no obligation to certify a patient for it. Medical
marijuana is not a cure-all, but Mississippians deserve it as an option just like so many other
patients across the country.

“There is not a clearly defined nor FDA approved “Medical Marijuana.””

“Medical marijuana” is clearly defined in the ballot initiative as all parts of the cannabis plant,
including extracts and preparations, that is used to treat the symptoms and/or effects of a
debilitating medical condition as listed in the initiative. This is consistent with the definitions of
other states. This amendment language was particularly chosen as the most conservative
approach to providing a state-regulated medical marijuana program to a subset of Mississippi
patients. In short, “medical marijuana” is regulated marijuana for medicinal purposes for
qualified patients who are suffering.

“There would be no ability to control for the concentration of THC, or the proportion of
THC to CBD” and “unlike FDA approved medicines, marijuana is not consistent; one
ounce may be stronger or weaker than the next.”

This is not true. The Board of Health, as the primary regulator, would have the ability to set
standards or ratios of the compounds within the products, if necessary. However, only two states
limit the amount of THC in products, as the overwhelming majority of states recognize that some
patients need access to products with higher concentrations to alleviate their symptoms. The
Board can certainly require labeling and testing standards for all products sold, as is consistent
with other states. This will give patients and physicians the knowledge as to exactly how much
active ingredients are in each product. While one product may contain more THC than another, a
patient will have that knowledge up front to ensure proper dosing.

“Any subsequent changes to the components of this amendment would have to occur
through ballot measure rather than changes to state statute.”

This ballot measure would be a citizen-elected change to Mississippi’s constitution and merely
sets out a basic framework for a medical marijuana program. The Board of Health, through
regulations, can make many changes without requiring citizens to re-elect a change to the
constitution. The full text of the initiative establishes a medical marijuana program and provides
basic protections to patients and physicians who choose to participate in the program. Every
major detail, including how the program will actually be administered, would be established by
regulations adopted by the Board of Health, which are much easier to amend if necessary.

“A “no” vote on this amendment would keep Mississippians safer at work and on our
roads.”

Nothing in the initiative requires employers to allow the on-site use of medical marijuana by a
qualified patient. Similarly, nothing in the initiative changes existing law or rights applicable to
employers to ensure workplace safety.

The initiative does not allow qualified patients to operate any motor vehicle, aircraft, train, or
boat while consuming or being impaired by medical marijuana. Contrary to your assertions, the
data does not support the contention that Mississippi’s roads will be less safe after a medical
marijuana program is operational. Research published in the American Journal of Public Health,
that covered the period 1985 to 2014, demonstrated that those states that legalized medical
marijuana saw a significant reduction in traffic fatalities both after a state approved medical
marijuana and after dispensaries became operational in a state.

This finding is supported by additional evidence published in the Journal of Law and Economics
which showed that states with medical marijuana programs saw a decrease in traffic fatalities
following the enactment of a medical marijuana law. That study found that traffic fatalities fell
by between 8% and 11% in the first year after the adoption of the medical marijuana law, with
the largest reductions among those aged 20-39.

It is “not supported by rigorous scientific evidence to support the claimed health benefits.”

The use of medical marijuana to treat severe medical conditions is supported by medical
research, countless patient reports, testimonials, and family stories. While it is true that the
federal government has hamstrung clinical trials of medical marijuana, the evidence available
shows that it is certainly a viable option for a physician and his or her patient to consider.
“The proposed amendment would assign responsibilities to the Mississippi State
Department of Health far beyond the scope and mission of the Agency, including oversight
of agricultural production of marijuana, oversight of marijuana product processing and
tax collection.”

To say that helping sick patients of Mississippi is beyond the scope and mission of the
Mississippi State Department of Health sounds heartless to us. The Board of Health is perfectly
situated to bring this treatment option to Mississippians in a safe and regulated manner, just as a
majority of other states already do. Multiple mechanisms were built into the amendment, per
earlier discussions with Department of Health staff, to ensure the MSDH could adequately fund
and staff a medical marijuana program through implementation and create a sustainable program
including:

• The ability to borrow up to $2.5 million to cover the initial expenses of creating a
program. This money is required to be paid back to the State out of revenue generated
from the program.
• Charge fees for issuing patient ID cards (capped at $50) and permits/licenses for
cultivators, processors and retailers.
• Collect a “sales tax” on the retail purchase of medical marijuana up to the state’s sales tax
rate.
• An exclusion from ITS procurement rules up to $250,000 for 2 years.
• An exemption from Personnel Board regulations on hiring new staff.

The Board of Health has the responsibility to ensure that the intent of the constitutional
amendment is carried out, but the Board does not have to execute each facet of a medical
marijuana program. Most departments of health in other states work in conjunction with other
state agencies or private companies to run a successful program. There is no reason your
department of health cannot contract with private companies or organizations to carry out any
facet of the program.

“The consumption of any combustible inhaled product is harmful to individual health.”

Combustible product would only be one of the multiple methods available to patients as no
person is required to smoke anything. There are certain patients who sometimes find the quickest
and most effective relief through smoking, such as cancer patients who cannot keep anything
down and need instant relief. However, medical marijuana will be available to patients in all
forms, including edibles, oils, lotions, aerosols, tinctures, liquids, etc., and most patients in other
states do find relief through other delivery methods. Patients are given the freedom to find
which delivery method provides them the most relief.

Again, this is just another option and physicians don’t have to certify if they don’t want their
patients having access to a combustible form. Rather, physicians and patients must converse
about which methods would be most beneficial and try to find a method that provides the most
relief. A physician has no obligation to certify his or her patients for medical marijuana.
“Routine marijuana consumption has numerous known harms and is contrary to the
mission of public health.”

The routine consumption of medical marijuana by a patient with a debilitating medical condition
as approved by his or her physician is a completely acceptable treatment option. Over 3 million
Americans are finding relief through their states’ medical marijuana programs and there is no
reason why Mississippians shouldn’t have the same opportunity. This is directly in line with the
mission of public health as it will bring a new treatment option to Mississippians who may have
tried pharmaceuticals, surgery, and other treatments, yet have found no relief. Patients do not
have to try medical marijuana and physicians are not required to certify for it. This is simply an
option that may help thousands of Mississippians just as it is helping more than 3 million patients
in 34 other states.

“The Mississippi State Board of Health does not believe it should be able to set tax rates
and spend money without legislative authorization or oversight.”

This is not true. The initiative gives full authority to the Board of Health to set rates on the retail
sale of medical marijuana. These funds will help the Health Department to operate a self-funded
program and ensure that components of the program, including licensure, inspection,
enforcement, and education, are adequately funded. The initiative gives the Board of Health full
authority to raise and spend money to regulate and enforce the program and allows the Board to
operate the medical marijuana program without having to rely on annual appropriations from the
Legislature. This is a positive feature that the MSDH should recognize as a key component to
administrating a sustainable program.

“The proposed ballot measure is a constitutional amendment, and as such is not subject to
the oversight and management of the legislature and the Governor's office; and any
required changes to the proposed amendment would require additional ballot measures,
rendering needed changes essentially impossible to achieve” and “This is not appropriate
under our system of government.”

This constitutional amendment is the purest form of democracy, allowing the citizens of
Mississippi to directly amend the constitution. As stated, this amendment is merely a framework
and lays out the basic components of a medical marijuana program. Any regulations that the
Board of Health adopted to implement and operate this program would have extensive
governmental oversight. Any needed changes that don’t alter this basic framework could be
adopted through the regulatory process. This is the most comprehensive method, using the
clearest language, to establish a medical marijuana program and bring this option to
Mississippians.

The Medical Marijuana 2020 team spoke with program leaders across the country and surveyed
states with medical marijuana programs to ensure that our amendment language was more than
adequate. We know that this amendment will firmly establish a world-class medical marijuana
program for Mississippi’s sickest patients.

As to this being “not being appropriate under our system of government,” what isn’t appropriate
is a state agency refusing to do what the citizens of Mississippi ask them to do. This amendment
would give constitutional authority for the Board of Health to operate this program, as elected by
the people of Mississippi.

The Medical Marijuana 2020 website is full of information, research studies, and patient
testimonials that support the need for this program. The experiences of patients in 34 other states
refute the allegations in the Board’s resolution. We hope you will reconsider your position and
support this initiative that gives Mississippi physicians the opportunity to help their patients
through the use of medical marijuana.

Signed,

Dr. James Griffin, M.D.

Dr. Claude Harbarger, M.D.

Dr. Sharon T. LaRose, M.D.

Dr. Philip Levin, M.D., FACEP

Dr. Jule P. Miller III, M.D.

Dr. Michael L. Sanders, M.D, CPE

Dr. Matthew B. Wesson, M.D.