In January 2021, Senator Anna Wishart (D) introduced LB 474, a medical cannabis legalization bill similar to legislation the senator previously proposed in 2019. The bill was also amended in the Judiciary Committee.
Qualifying for medical cannabis
Patients must have a qualifying medical condition and a written certification issued by a physician, nurse practitioner, or physician’s assistant with whom they have a bona-fide relationship.
Qualifying conditions are: ALS, autism with frequent or severe self-injurious or aggressive behavior, cancer, Crohn’s, ulcerative colitis, epilepsy, glaucoma, Hepatitis C (with nausea or cachexia), HIV/AIDS, Huntington’s, Parkinson’s, PTSD, spinal cord injury, terminal illness, serious conditions causing severe nausea or cachexia, and long-lasting severe or chronic pain that hasn’t responded to other, non-opioid treatments.
Patients may voluntarily register with the Cannabis Enforcement Department.
A certified patient requires a renewed written certification every 90 days.
Patients under 18 years of age require written consent from a parent or guardian.
Patients who are not Nebraska residents — but who are certified to use medical cannabis in another state — qualify for legal protections while visiting the state.
Patients may qualify for a hardship waiver by applying to the Cannabis Enforcement Department, which entitles them to at least a 10% discount on medical cannabis purchased from licensed dispensaries.
Allowed and prohibited activities
A certified patient may:
Possess up to 2.5 ounces of cannabis in any form other than a cannabis product; 2,000 mg of THC in the form of cannabis products (edible products are not allowed); or a greater amount specified by a waiver granted by the Cannabis Enforcement Department; and
Designate a caregiver to assist in the use and purchase of medical cannabis.
A certified patient may not:
Smoke cannabis (and is subject to an infraction and penalty for doing so);
Cultivate their own cannabis;
Operate a vehicle while under the influence of cannabis; or
Consume cannabis when in a vehicle, whether they are the driver or a passenger; or
Undertake any task that would be negligent to do under the influence.
Practitioners who certify patients for medical cannabis are required to:
Perform physical exams of patients they certify for medical cannabis;
Assess the patient for alcohol and substance abuse and for a personal or family history of schizophrenia or psychotic disorders, unless the patient is terminally ill;
Complete at least eight hours of continuing medical education courses (CMEs) approved by the Medicinal Cannabis Board; additional CMEs are required for those issuing more than 25 certifications; and
Issue fewer than 1100 certifications in a calendar year and no more than 275 certifications in a 90-day period.
Medical cannabis establishments
There are four types of medical cannabis businesses: producers to grow cannabis; processors to make products such as oils, lotions, and tinctures; dispensaries, to provide cannabis to patients; and laboratories, to test for potency and contaminants.
Dispensaries must contract with a licensed pharmacist and make pharmacists available to patients, in person or by telemedicine to advise patients and consult about dosing.
Dispensaries’ pharmacists must have completed 15 hours of CMEs about drug interactions, dosages, counter-indications, and risks and benefits. Other staff who interact with patients must take four hours of CMEs.
The Cannabis Enforcement Department will license and regulate up to 10 producers and 10 dispensaries in each of the state’s three congressional districts. All qualified processor applicants would be licensed.
There will be at least three tiers of cannabis producers — based on the size or number of plants — with fees and security regulations tiered based on size.
Employers would not have to change any policies to accommodate medical cannabis use.
Private and government insurers are not required cover medical cannabis.
State employees are prohibited from sharing information about registered patients with federal authorities.
State agencies could not deny patients or caregivers their right to possess a firearm.
Patients are granted protections from discrimination in child custody, eligibility for organ transplants, housing, and education.
Safeguards and enforcement
The Cannabis Enforcement Department will create and enforce rules, including for oversight, record keeping, security, child-resistant packaging, and labeling. It will restrict advertising, marketing, and signage.
Medical cannabis businesses’ security measures must include facility access controls, perimeter intrusion detection systems, alarms, and a personnel identification system.
The Department will establish requirements for law enforcement and health professionals to report adverse events involving cannabis.
Medical cannabis businesses may not locate within 1,000 feet of a school, unless a locality reduces the limit to 500 feet and a narrower buffer is needed for patients’ access.
Municipalities may adopt zoning restrictions on the locations of medical cannabis businesses. They may also ban medical cannabis establishments.
Localities could not ban home delivery from licensed dispensaries.
Medicinal Cannabis Board
A seven-member board of experts and stakeholders, appointed by the governor and subject to legislative approval, would meet at least quarterly to advise regulators on rules and:
approve continuing medical education courses for practitioners, recommended by the department;
approve a department-created, scientifically accurate handout for patients that includes information about drug interactions, dosage guidance, and risks of cannabis, including impairment; and
recommend legislative changes to the Medical Cannabis Act.
Taxation and fees
Application fees for larger producers, processors using most solvents, and dispensaries would be set at up to $25,000. Annual fees are up to $40,000 for larger producers and solvent-based processors and $25,000 for dispensaries.
Both application and annual licensing fees would be no more than $5,000 for smaller producers and processors that do not use certain solvents. Applications for laboratories would be up to $10,000, with their annual fee up to $15,000.
Medical cannabis would be subject to standard 5.5% state sales taxes, which would be deposited in the Medicinal Cannabis Regulation Fund.
All fees and taxes collected would be deposited into the Medicinal Cannabis Regulation Fund for the purposes of supporting and administering the medical cannabis program.
Upon passage, patients with certifications could possess and use medical cannabis.
The Department must license producers, processors, and dispensaries by November 1, 2022, unless the Medical Cannabis Board extends the deadline by up to six months.
Producers and dispensaries must begin supplying cannabis by May 1, 2023, unless the Medical Cannabis Board extends the deadline by up to six months.