On November 8, North Dakota voters approved a compassionate medical marijuana initiative, which will go into effect on December 8, 2016.

Measure 5 creates a state-regulated medical marijuana program for patients with specified debilitating conditions and written certifications from their doctors. Registered patients can obtain medical cannabis from a licensed nonprofit compassion center, or, if they live more than 40 miles from one, they can securely cultivate a limited amount of cannabis for their medical use.

Qualifying patients: To participate in the program, patients would apply to the Department of Health for a registry identification card. They would submit an application, a fee, and a written certification from a doctor that confirms the patient has a qualifying condition and that they are likely to receive therapeutic or palliative benefit from the medical use of marijuana. The patient and doctor must have a bona fide relationship.

Qualifying conditions: To qualify, a patient must have one or more of the following medical conditions: cancer, HIV/AIDS, hepatitis C, ALS, PTSD under certain circumstances, agitation of Alzheimer’s disease, dementia, Crohn’s disease, fibromyalgia, spinal stenosis, chronic back pain (including neuropathy or damage to the nervous tissues of the spinal cord with objective neurological indication of intractable spasticity), glaucoma, epilepsy, a medical condition that produces cachexia or wasting, severe and debilitating pain that has not responded to previously prescribed medication or surgical measures for more than three months or for which other treatment options produced serious side effects, intractable nausea, seizures, or severe and persistent muscle spasms. North Dakota residents may submit a petition to the department to add qualifying conditions. The department will consider the evidence and approve or deny the petition.

Access to medical cannabis via compassion centers: The department will license nonprofit compassionate care centers, which will cultivate a limited amount of medical cannabis and dispense it to registered patients. Compassion centers are required to maintain appropriate security, including well-lit entrances, an alarm system that contacts law enforcement, and video surveillance. They may not be located within 1,000 feet of a school, and they will be subject to inspections and other rules.

Applicants will pay a $5,000 non-refundable application fee and, if they are approved, a $25,000 licensing fee. Compassion center licenses will be granted based on a merit-based application process, which will consider the suitability of the proposed location; the applicants’ character and expertise in related fields; the proposed centers’ plans, including for record keeping, safety, and security, staffing and training, preventing diversion, and for pesticide-free cultivation; whether the applicant has sufficient capital; and its ability to make medication affordable for all patients.

Each staffer of a compassion center must apply for and be granted a registry photo identification card. They must be 21 years of age or older and must not have been convicted of an excluded felony offense or a recent drug misdemeanor.

Packaging and labeling: Marijuana may only be dispensed in sealed, tamper-proof containers clearly identified as medical marijuana having been issued by a specific compassion center. The label would also include the strain, batch, quantity, and active ingredients. Patients and caregivers must keep marijuana in its original packaging.

Limited home cultivation: If a qualified patient lives more than 40 miles from the nearest compassionate care center, the patient or caregiver can cultivate up to eight marijuana plants in an enclosed, locked facility, as long as it is not within 1,000 feet of a public school. The individual must notify local law enforcement that he or she is cultivating marijuana plants. The department can perform on-site evaluations of home cultivation during business hours, but must provide advance notice of 24 hours.

Caregivers: Patients may designate a caregiver to assist with their medical use of marijuana, such as by picking it up from a dispensary for them. To serve as a caregiver, an individual must be 21 years of age or older, have no felony convictions, and must register with the state. They may assist no more than five patients.

Limitations: Patients and caregivers are allowed to possess no more than three ounces of useable marijuana per 14-day period. The initiative does not allow marijuana to be used in a public place or a workplace.