Photo by Steph Zimmerman
Update: On Tuesday, November 6, Missouri voters passed Amendment 2. To read more about what happens next with Missouri and medical marijuana, see our story here.
Good news for Missourians who like options: Head to the polls on November 6, and you'll see three proposals—Amendment 2, Amendment 3, and Proposition C—for the legalization of medical marijuana. The bad news: Forbes has called our state's “certainly the most complicated campaign” of four states with marijuana initiatives on the ballot this election cycle.
While Amendment 2, Amendment 3, and Proposition C would all legalize marijuana for medical uses, there are stark differences among them in regard to who would be able to access and grow cannabis, where the generated tax revenue would go, and who is pushing each measure forward. If any of the three measures pass, Missouri will join 31 other states that allow legal access to medical marijuana—and if Missourians vote “yes” on only their favored measure, they could potentially split the vote.
Experts think it’s not a matter of if medical marijuana will be legalized this election, but how.
“A majority of people in opinion polls indicate support at least for medical marijuana,” says Peter Joy, professor of law and director of Washington University’s Criminal Justice Clinic. “I am anticipating that one or more of these measures are going to pass. Then the question will be which one is going to get the most votes.”
Here's what you need to know about Amendment 2, Amendment 3, and Proposition C:
Who is sponsoring Amendment 2, Amendment 3, and Proposition C?
Amendment 2, sponsored by the campaign New Approach Missouri, would place a 4 percent sales tax on the retail sale of medical marijuana. The proceeds, an estimated $24 million in government revenue, would go to veterans’ health care and resources in Missouri. In Amendment 2, the Missouri Department of Health and Senior Services is responsible for overseeing licensing and implementation of medical marijuana programs.
“We hear so many stories, and see so many examples, of loved ones, family members, colleagues, that can’t even discuss medical marijuana with their doctor right now,” New Approach Missouri spokesperson Jack Cardetti said. “And some of them are having to make the hard decision of, do you uproot your family and move to another state that you can legally access that? And that’s not a situation we ought to be putting Missouri patients in.”
Springfield lawyer and physician Brad Bradshaw funded and wrote Amendment 3, which has a 15 percent sales tax.
Amendment 3 would generate an estimated $66 million per year, which Bradshaw plans to put toward the establishment of a biomedical research and drug development institute. He says the institute will conduct cancer research. Bradshaw's 15 percent tax is a fixed flat tax, he says, unlike that of Amendment 2, which may be in addition to state and local taxes.
There are two main differences, Bradshaw says, that set his proposal apart from the others.
“Most importantly, Amendment 3 provides for a world-class medical research center for finding cures for cancer and early detection of cancer and it provides for a tax refund for every tax-paying Missourian,” he says. “And, there’s no home grow.”
Joy, the Wash U professor, says Amendment 3’s main distinction is more fundamental than that. Bradshaw intends to oversee the research institute and appoint its board.
“It’s very unusual to have constitutional amendments or propositions where there’s basically a single person who may benefit in some way by the voters approving that measure,” Joy said. “So that’s an issue here that’s not a normal kind of issue.”
Bradshaw says his position on the board is temporary and unpaid.
“Somebody’s going to be on the board, running it, so to speak,” he said. “And my thought is, let’s have the best scientists in the world responsible for this, not some politician’s appointees.”
Proposition C, or the Missouri Patient Care Act, levies a 2 percent sales tax on medical marijuana sales, which could generate about $10 million in government revenue to be used in veterans’ services, drug treatment, public safety, and education. The Missouri Department of Health and Senior Services and Division of Alcohol and Tobacco Control would oversee operations under Proposition C.
“I just hope that people understand that we put this together for patients, for patient access,” says lobbyist Mark Habbas. “A lot of people really want to see cannabis legalized for medical use, and I just hope that at the end of the day people understand that Prop C was put together by some passionate people who want to take care of loved ones and make sure that they have this option.”
What is the difference between the amendments and the proposition?
Petitions for statutory changes in Missouri, like Proposition C, require signatures from 5 percent of legal voters in six of the state’s eight Congressional districts. Constitutional changes, like Amendments 2 and 3, require 8 percent of legal voters in six districts.
If both Amendments 2 and 3 pass, the one earning the higher number of votes would take effect. If both one of the amendments and Proposition C pass, the result will likely be determined in the courts.
Perhaps the biggest difference to keep in mind is that because Proposition C is a statutory change, the legislature could reverse or change it without those changes being put to another statewide vote.
Habbas says he knows individuals may be skeptical of statutory measures that may be altered by lawmakers. He believes, however, the statutory nature of Proposition C renders it more flexible.
“It’s easier to be revised than a constitutional measure. So with an industry like this, there’s going to have to be revisions in the future like we’ve seen in other states,” Habbas said. “We’ve consulted with many people who are passionate about cannabis use and people that implement these laws in other states, and they say that the one big mistake they made was doing it constitutionally, where it was much more difficult to revise these.”
Joy says, however, it’s not a safe bet that lawmakers will make changes that Missourians want to see.
“The fact that the legislature still has a role to play in the proposition means that people favoring the proposition also are betting that the state legislature will go along with what the proposition proposes,” Joy said. “That hasn’t always happened in Missouri. So if someone definitely wants medical marijuana to be approved, it would be better to vote for one of the constitutional amendments.”
What exactly is going on with Amendment 3’s research facility?
Well, a lot.
Bradshaw says the team will be comprised of world-class scientists devoted to research on cancer and other incurable diseases. But several groups have raised concerns regarding the research facility.
Republican state Senator Brian Munzlinger has cited concerns of eminent domain, which is the right of the government to seize private land. Cardetti echoes this sentiment. Bradshaw says the voters will determine where the facility goes.
“The research facility is picked by the people. So nobody is coming in and forcing anybody to have a medical institute,” Bradshaw said. “Although quite frankly, people and physicians in Kansas City and St. Louis have both asked if they can have the facility in their cities.”
Bradshaw’s research facility also drew attention when the Missouri Catholic Conference issued a statement October 16 expressing concerns about the use of funds for medical research involving stem cells and aborted fetal remains.
Bradshaw says the church is mistaken.
“We spoke to the Catholic Church about two years ago, and they wanted to make sure we left stem cell research out of this amendment. So you’ll see there is no mention of stem cell research,” Bradshaw says. “But for some reason, I guess the new members, whoever is in charge now, there are always concerns that maybe something will be done involving stem cells. But actually Amendment 3 is silent on stem cells.”
The St. Louis Post-Dispatch called Amendment 3 “an especially bad idea” because the research institution will be controlled by Bradshaw, “the person pushing the ballot measure.”
Who would be permitted to use marijuana?
This is where the measures start looking a little more similar. All three define qualifying medical conditions as including cancer; epilepsy; glaucoma; intractable migraines; severe, persistent pain or muscle spasms; debilitating psychiatric disorders; and any terminal illness.
Amendment 2 and Proposition C also allow state-licensed physicians to recommend cannabis for other chronic, debilitating medical conditions.
Both of these two measures also aim to reduce the opioid epidemic in Missouri by including cannabis substitution for drugs that cause physical or psychological dependency. Opioids are highly addictive painkillers often prescribed after surgery. In 2017, 951 Missourians died from opioid overdoses.
“Our coalition of veterans and patients fundamentally believes that when it comes to medical treatment options, those are decisions that ought to be made between a doctor and a patient,” New Approach Missouri's Cardetti said. “And unlike in 30 other states, Missourians don’t have that option. And so unfortunately when Missourians are dealing with pain and other illnesses, all too often, their only ability relief is opioids.”
Amendment 3 doesn’t afford this decision-making power to physicians. However, it does enable the research board to name additional qualifying conditions in the future.
Joy emphasizes that it is important to distinguish between recreational and medical legalization.
“If some form of medical marijuana passes, then people who end up getting the prescription for medical marijuana and have it for their personal medical use, it’s going to be fine,” Joy says. “Now if they give their medical marijuana to a friend or neighbor, they could be prosecuted, and their neighbor could be prosecuted.”
Which measures allow patients to grow their own marijuana plants at home?
Amendment 2 is unique from the other two initiatives in allowing patients to grow up to six of their own plants at home.
Bradshaw says that home grow is difficult to regulate, making recreational use more likely. Amendment 3 does not allow home grow.
As of now, Proposition C doesn’t allow home grow. However, because the measure is statutory, Habbas says, it could be amended to include home grow in the future.
What does this all mean moving forward?
Katharine Ponzillo, a physician specializing in hospice and palliative medicine, says that if any one of the measures passes, more medical research should examine the long-term effects of marijuana on people with illnesses.
“I think one of the things that is very challenging is we don’t know a lot scientifically about marijuana and its interactions with traditional pharmaceuticals, medications that patients are prescribed everyday,” she says. “In addition to that, a lot of patients that may be considering medical marijuana may be taking herbal supplements and over-the-counter supplements that we also don’t have information with regards to scientific data that speak to good or bad effects on the body and how they interact with medications patients may already be taking.”
