PART X-E. THERAPEUTIC USE OF MARIJUANA

§1046. Recommendation and sale of marijuana for therapeutic use; production facility licensing; regulations and permitting by the Louisiana Department of Health

            A.(1) Notwithstanding any other provision of this Part, any clinician authorized by the provisions of Subsection B of this Section to recommend medical marijuana, referred to in this Section as an "authorized clinician", may recommend, in any form authorized by the rules and regulations of the Louisiana Department of Health, hereafter referred to as the "department", raw or crude marijuana, tetrahydrocannabinols, or a chemical derivative of tetrahydrocannabinols for therapeutic use by any patient clinically diagnosed as suffering from a debilitating medical condition.

            (2)(a) For purposes of this Subsection, "debilitating medical condition" means any of the following:

            (i) Cancer.

            (ii) Glaucoma.

            (iii) Any of the following neurodegenerative diseases and conditions:

            (aa) Alzheimer's disease.

            (bb) Amyotrophic lateral sclerosis.

            (cc) Huntington's disease.

            (dd) Lewy body dementia.

            (ee) Motor neuron disease.

            (ff) Parkinson's disease.

            (gg) Spinal muscular atrophy.

            (iv) Positive status for human immunodeficiency virus.

            (v) Acquired immune deficiency syndrome.

            (vi) Cachexia or wasting syndrome.

            (vii) Seizure disorders.

            (viii) Epilepsy.

            (ix) Spasticity.

            (x) Severe muscle spasms.

            (xi) Intractable pain.

            (xii) Crohn's disease.

            (xiii) Muscular dystrophy.

            (xiv) Multiple sclerosis.

            (xv) Posttraumatic stress disorder.

            (xvi) Any of the following conditions associated with autism spectrum disorder:

            (aa) Repetitive or self-stimulatory behavior of such severity that the physical health of the person with autism is jeopardized.

            (bb) Avoidance of others or inability to communicate of such severity that the physical health of the person with autism is jeopardized.

            (cc) Self-injuring behavior.

            (dd) Physically aggressive or destructive behavior.

            (xvii) Traumatic brain injury.

            (xviii) A concussion diagnosed by an authorized clinician.

            (xix) Chronic pain associated with fibromyalgia.

            (xx) Chronic pain associated with sickle cell disease.

            (xxi) Any condition for which a patient is receiving hospice care or palliative care.

            (xxii) Any condition not otherwise specified in this Subparagraph that an authorized clinician, in his clinical opinion, considers debilitating to an individual patient and is qualified through his clinical education and training to treat.

            (b) No authorized clinician shall recommend medical marijuana for treatment of any condition associated with autism spectrum disorder for a patient who is under the age of eighteen unless the clinician complies with the provisions of this Section and consults with a pediatric subspecialist. For purposes of this Subparagraph, a pediatric subspecialist is an individual licensed to practice medicine in any state in the United States who provides care to patients with autism spectrum disorder.

            (c) Intractable pain means a pain state in which the cause of the pain cannot be removed or otherwise treated with the consent of the patient and which, in the generally accepted course of medical practice, no relief or cure of the cause of the pain is possible, or none has been found after reasonable efforts. It is pain so chronic and severe as to otherwise warrant an opiate prescription.

            (d) Repealed by Acts 2019, No. 284, §2.

            (e) Repealed by Acts 2019, No. 284, §2.

            (3) For purposes of this Part, "recommend" or "recommended" means an opinion of any authorized clinician, provided within a bona fide clinician-patient relationship, that, in the sincere judgment of the clinician, therapeutic cannabis may be helpful to the patient's condition or symptoms and is communicated by any means allowed by the department.

            (4) Any authorized clinician may recommend medical marijuana to any patient suffering from a debilitating medical condition with whom he shares a bona fide clinician-patient relationship.

            (5)(a) No retailer permitted to sell marijuana for therapeutic use in accordance with the provisions of this Section shall sell more than two and one-half ounces, or seventy-one grams, of raw or crude marijuana every fourteen days to any individual patient.

            (b) No retailer permitted to sell marijuana for therapeutic use in accordance with the provisions of this Section shall sell raw or crude marijuana to any person under twenty-one years of age without a recommendation from an authorized clinician specifically recommending marijuana in raw or crude form for that person.

            (6) Authorized clinicians shall report adverse events and health outcomes associated with a patient's use of medical marijuana to the data system provided for in R.S. 40:1168.1 et seq.

            (7) Nothing in this Subsection shall be construed to prevent the department from authorizing, by rule, medical marijuana in a form to be administered by metered-dose inhaler. For purposes of this Section, "metered-dose inhaler" means a device that delivers a specific amount of medication to the lungs, in the form of a short burst of medicine that is usually self-administered by the patient via inhalation.

            B. All of the following licensed health professionals are hereby authorized to recommend medical marijuana to patients and, for purposes of this Part, shall be deemed "authorized clinicians":

            (1) Any physician licensed by and in good standing with the Louisiana State Board of Medical Examiners to practice medicine in this state.

            (2) Any nurse practitioner licensed by and in good standing with the Louisiana State Board of Nursing to practice advanced practice registered nursing in this state and who has prescriptive authority conferred by the Louisiana State Board of Nursing.

            (3) Any medical psychologist licensed by and in good standing with the Louisiana State Board of Medical Examiners to practice medical psychology in this state.

            C.(1) The department shall adopt rules to provide for therapeutic marijuana retail permits.

            (2) The rules promulgated pursuant to this Subsection shall include but not be limited to:

            (a) Repealed by Acts 2024, No. 693, §2, eff. Jan. 1, 2025.

            (b) Standards, procedures, and protocols for the dispensing and tracking of recommended therapeutic marijuana in Louisiana.

            (c) Procedures and protocols to provide that no recommended therapeutic marijuana may be sold from, produced from, obtained from, sold to, or transferred to a location outside of this state.

            (d), (e) Repealed by Acts 2022, No. 491, §2.

            (f) Repealed by Acts 2024, No. 693, §2, eff. Jan. 1, 2025.

            (g) The establishment of other permit, renewal, and operational standards which are deemed necessary by the department.

            (h) Repealed by Acts 2022, No. 491, §2.

            (i) The establishment of health, safety, and security requirements for therapeutic marijuana retail permit holders.

            (j), (k), (l) Repealed by Acts 2024, No. 693, §2, eff. Jan. 1, 2025.

            D. Nothing in this Section shall be construed to prohibit the department from adopting emergency rules as otherwise provided for in the Administrative Procedure Act.

            E. Marijuana, tetrahydrocannabinols, or a chemical derivative of tetrahydrocannabinols recommended pursuant to this Section shall be sold in person by a marijuana retail permit holder located in Louisiana.

            F.(1)(a) Each permitted retailer shall acquire and maintain all software, hardware, and communications infrastructure necessary to ensure connectivity to and implementation of the Louisiana Medical Marijuana Tracking System, hereafter referred to as the "LMMTS", from seed to delivery to an approved laboratory, to wholesale to permitted retailers, to wholesale to another licensed cultivation facility, to delivery to an authorized researcher, to sale to patients or caregivers by permitted retailers, or to destruction. A person who sells marijuana, tetrahydrocannabinols, or a chemical derivative of tetrahydrocannabinols pursuant to this Section shall review the patient's information in the database of the LMMTS prior to the selling thereof.

            (b) Each retail permit holder shall appoint a minimum of one pharmacist residing in Louisiana who has an active unrestricted license with the Louisiana Board of Pharmacy who is designated by the retail permit holder to be responsible for the operation of the primary retail location and any satellite locations in compliance with all applicable laws and regulations. The pharmacist shall be considered on duty when accessible by the employees and agents of the primary retail location and any satellite locations through telephonic means during open hours and available by telephone or video conference for a patient consultation during open hours.

            (2) Any person who sells marijuana, tetrahydrocannabinols, or a chemical derivative of tetrahydrocannabinols pursuant to this Section shall comply with the reporting requirements of the LMMTS.

            G.(1)(a) The department shall issue an annual retail permit to sell recommended marijuana for therapeutic use and, except as provided in Paragraph (3) of this Subsection, shall limit the number of retail permits granted in the state to no more than ten.

            (b) Upon each annual renewal period, a retail permit in force shall be renewed by the department for the next succeeding period upon proper application for renewal and payment of permit fees as required by law and the rules and regulations of the department.

            (c) Subject to the limitations in this Subsection, the department shall select a new retail permit holder through a competitive bid process in accordance with the applicable provisions of the Louisiana Procurement Code, R.S. 39:1551 et seq., only if any of the following occur:

            (i) After written notice from the department and failure of the retail permit holder to cure within thirty days following receipt of written notice, a retail permit holder fails to comply with the proper application for renewal and payment of permit fees as required by law and the rules and regulations of the department, and the retail permit is revoked.

            (ii) A retail permit is voluntarily returned or remitted to the department prior to the expiration of the permit period.

            (d) The transfer of a membership interest in an entity that holds a marijuana retail permit may be conducted without approval of the department.

            (2) For the purposes of this Subsection, the regions among which the marijuana retail permits are allocated shall correspond to the sets of parishes comprising, respectively, the administrative regions of the Louisiana Department of Health as those regions existed on August 1, 2022. On and after October 1, 2022, at least one marijuana retailer shall be located in each region.

            (3)(a) After three thousand five hundred active, qualified patients are identified in a region, the department shall notify and allow the marijuana retail permit holder in that region to open one additional retail location as a satellite location in that region. For the purposes of this Paragraph, "satellite location" shall mean an additional marijuana retail location operated by a retail permit holder within the same geographic region but physically separate from the location of the original therapeutic marijuana retail location.

            (b) After seven thousand active, qualified patients are identified in a region, the department shall notify and allow the marijuana retail permit holder in that region to open one additional marijuana retail location as a second satellite location in that region.

            (c) The retail permit holder shall submit an application to open a satellite location provided for in this Paragraph no later than ninety days after receipt of the notification sent by the department pursuant to this Paragraph. The satellite location shall be operational within three hundred ten days of the approval of the application by the department. The department may grant additional time for the satellite location to become operational due to a circumstance beyond the control of the retail permit holder. If a marijuana retail permit holder declines to open a satellite location pursuant to Subparagraph (a) or (b) of this Paragraph, then the department may issue, pursuant to the provisions of Paragraph (1) of this Subsection, an additional marijuana retail permit in that region to open one marijuana retail location in lieu of the original retail permit holder's satellite location in that region.

            (d) The department shall consider any unserved parishes within the region when approving a satellite location or additional marijuana retail permits pursuant to this Paragraph.

            (e) For the purposes of this Paragraph, the active, qualified patient count shall be conducted and reviewed on a quarterly basis using the preceding twenty-four-month period.

            (4)(a) The total number of marijuana retail locations, including satellite locations, approved by the department pursuant to Paragraph (3) of this Subsection shall not be greater than thirty locations.

            (b) The provisions of this Paragraph shall not be construed to authorize a marijuana retail permit holder to open more than two satellite locations in a single region.

            (5) The provisions of this Subsection shall not be construed to require the closure of any marijuana retail location, including satellite locations, if the active, qualified patient count drops below three thousand five hundred after the location is approved.

            (6)(a) No marijuana retail permit holder shall locate within a fifteen-mile radius of another retail permit holder's marijuana retail location.

            (b) Notwithstanding the provisions of Subparagraph (a) of this Paragraph, in a region that encompasses any parish with a population of more than three hundred fifty thousand persons according to the most recent federal decennial census, no marijuana retail permit holder shall locate within a ten-mile radius of another retail permit holder's marijuana retail location.

            (c) Notwithstanding the provisions of Subparagraphs (a) and (b) of this Paragraph, in a region that encompasses any municipality with a population of more than three hundred fifty thousand persons according to the most recent federal decennial census, no marijuana retail permit holder shall locate within a five-mile radius of another retail permit holder's marijuana retail location.

            (d) The provisions of this Paragraph shall not apply if all affected retail permit holders submit a written mutual agreement to the department waiving the provisions of this Paragraph.

            (7) Each marijuana retail permit holder shall offer delivery to patients in each zip code within its region at least once per month.

            (8) For purposes of this Subsection, "active, qualified patient" means a patient who has acquired a therapeutic marijuana product at least once.

            H.(1)(a) The Louisiana Department of Health shall issue no more than two licenses to cultivate, extract, process, produce, and transport therapeutic marijuana in this state. Each license shall be issued on July first and shall be effective for a period of one year.

            (b) The licenses issued on July 1, 2024, shall be to the entities who held contracts with the Louisiana State University Agricultural Center and the Southern University Agricultural Center on January 1, 2024, pursuant to Act No. 261 of the 2015 Regular Session of the Legislature.

            (c) Upon each renewal period, a license in force shall be renewed by the department for the next succeeding period upon proper application for renewal and payment of license fees as required by law and the rules and regulations of the department.

            (d) Subject to the limitation of no more than two licenses to cultivate, extract, process, produce, and transport therapeutic marijuana in this state, the department shall select a new licensee through a competitive bid process in accordance with the applicable provisions of the Louisiana Procurement Code, R.S. 39:1551 et seq., if any of the following occur:

            (i) After written notice from the department and failure of the licensee to cure within thirty days following receipt of written notice, a licensee fails to comply with the proper application for renewal and payment of license fees as required by law and the rules and regulations of the department, and the license is revoked.

            (ii) A license is voluntarily returned or remitted to the department prior to the expiration of the licensure period.

            (2)(a) The Louisiana Department of Health shall collect all of the following information from each retail permit holder:

            (i) The amount of gross marijuana produced by the licensee during each calendar year.

            (ii) The details of all production costs including but not limited to seed, fertilizer, labor, advisory services, construction, and irrigation.

            (iii) The details of any items or services for which the licensee subcontracted and the costs of each subcontractor directly or indirectly working for the licensee.

            (iv) The amount of therapeutic chemicals produced resulting from the marijuana grown pursuant to this Section.

            (v) The amounts paid each year to the licensee related to the licensee's production of therapeutic marijuana pursuant to this Section.

            (vi) The amount of therapeutic marijuana distributed to each retail permit holder during each calendar year.

            (b) The Louisiana Department of Health shall provide the information collected as required by this Paragraph for the previous calendar year in the form of a written report to the legislature no later than February first of each year. The department shall also make a copy of the report required by this Subparagraph available to the public on the internet.

            (3) No company that has made a contribution to a candidate in a Louisiana election governed by the provisions of the Campaign Finance Disclosure Act within the five years prior to bidding for the license, or is controlled wholly or in part by a person who made such a contribution within the five years prior to the company bidding for the license, may be eligible for the license.

            (4) The Louisiana Department of Health shall:

            (a) Establish and collect an annual license fee of one hundred thousand dollars from each licensee permitted to cultivate, extract, process, produce, and transport therapeutic marijuana.

            (b) Collect a nonrefundable application fee of ten thousand dollars.

            (c) Assess a fee of seven percent of the gross sales of therapeutic marijuana. The fee shall be reported and paid by the licensee. The fee shall be collected by the Department of Revenue and shall be subject to the provisions of Chapter 18 of Subtitle II of Title 47 of the Louisiana Revised Statutes of 1950. The Department of Revenue shall transfer monthly to the state treasury for deposit into the Disability Services Fund, as established in R.S. 28:826, the amount of revenues collected in accordance with this Subparagraph.

            (5) The Louisiana Department of Health shall promulgate rules and regulations as necessary to implement the provisions of this Subsection.

            I. The levels of THC in any marijuana produced pursuant to this Section shall be reduced to the lowest acceptable therapeutic levels available through scientifically accepted methods.

            J. Notwithstanding any other provision of law to the contrary, employers and their worker's compensation insurers shall not be obliged or ordered to pay for medical marijuana in claims arising under Title 23 of the Louisiana Revised Statutes of 1950, the Louisiana Workers' Compensation Law.

            K. Nothing in this Part shall be construed or enforced in any manner that prevents a clinician authorized by Subsection A of this Section to recommend therapeutic marijuana from recommending therapeutic marijuana through telehealth as defined in R.S. 40:1223.3 in this state.

            L. The Louisiana State University Agricultural Center, the Southern University Agricultural Center, and the University of Louisiana at Monroe may conduct research on marijuana for therapeutic use.

            M. The provisions of this Section shall terminate on July 1, 2030.

            Acts 1991, No. 874, §1; Acts 2006, No. 676, §3, eff. July 1, 2006; Acts 2015, No. 261, §1, eff. June 29, 2015; Acts 2016, No. 96, §§1, 2, eff. May 19, 2016; Acts 2016, No. 567, §1; Acts 2018, No. 206, §4; Acts 2018, No. 496, §§1, 2, eff. May 23, 2018; Acts 2018, No. 708, §§1, 2; Acts 2018, No. 715, §§1, 2; Acts 2019, No. 207, §§1, 3; Acts 2019, No. 284, §§1, 2; Acts 2019, No. 331, §§2, 3, eff. July 1, 2019; Acts 2020, No. 286, §§1, 2; Acts 2021, No. 424, §1, eff. Jan. 1, 2022; Acts 2022, No. 271, §4; Acts 2022, No. 444, §1; Acts 2022, No. 491, §§1, 2; Acts 2022, No. 492, §1, eff. June 16, 2022; Acts 2023, No. 311, §1, eff. June 13, 2023; Acts 2023, No. 322, §4, eff. Jan. 1, 2024; Acts 2024, No. 150, §1, eff. May 22, 2024; Acts 2024, No. 693, §§1, 2, eff. Jan. 1, 2025.