Missouri Amendment 2, Medical Marijuana and Veteran Healthcare Services Initiative (2018)

Elections in Missouri, 2018

* General election: Nov. 6
* Voter registration deadline: Oct. 10
* Early voting: N/A
* Absentee voting deadline: Nov. 6

* Online registration: Yes
* Same-day registration: No
* Voter ID: Non-photo ID required
* Poll times: 6:00 a.m. to 7:00 p.m.

* * *

On the ballot: U.S. Senate • U.S. House • State executive offices • State Senate • State House • Special state legislative • Supreme court • Appellate courts • Local judges • State ballot measures • Local ballot measures • School boards • Municipal • Recalls • Democratic primaries • Republican primaries

Missouri Amendment 2

Election date
November 6, 2018
Topic
Marijuana
Status
a Approved
Type
Constitutional amendment| Origin
Citizens

* * *

List of Missouri measuresMissouri Proposition A - AugustMissouri Amendment 1Missouri Amendment 2Missouri Amendment 3Missouri Amendment 4Missouri Proposition BMissouri Proposition CMissouri Proposition DSubmit

* * *

Missouri Amendment 2, the Medical Marijuana and Veteran Healthcare Services Initiative, was on the ballot in Missouri as an initiated constitutional amendment on November 6, 2018.[1] The measure was approved.

|  A "yes" vote supported this constitutional amendment to:

* legalize marijuana for medical purposes;
* tax marijuana sales at 4 percent; and
* spend tax revenue on healthcare services for veterans.

|

|  A "no" vote opposed this constitutional amendment to:

* legalize marijuana for medical purposes;
* tax marijuana sales at 4 percent; and
* spend tax revenue on healthcare services for veterans.

|

* Timeline for allowing patients to purchase medical marijuana in Missouri: Amendment 2 required the state Department of Health and Senior Services (DHSS) to begin accepting applications for qualifying patients within 180 days after December 6, 2018 (no later than June 4, 2019). Amendment 2 required the department to begin accepting applications for dispensaries no later than 240 days after December 6, 2018 (no later than August 3, 2019). The department is required to accept or reject applications for dispensaries within 150 days of receiving them. Read the DHSS June 4 press release for more information.

## Contents

* 1 Three marijuana measures on the 2018 ballot
* 2 Election results
* 3 Aftermath
* 3.1 Residency requirement lawsuit
* 4 Overview
* 5 Comparison of three ballot measures
* 5.1 Statements from the campaigns
* 5.2 Comparison of 2018 ballot initiatives
* 6 Text of measure
* 6.1 Ballot title
* 6.2 Ballot summary
* 6.3 Constitutional changes
* 6.4 Full text
* 6.5 Readability score
* 7 Support
* 7.1 Supporters
* 7.1.1 Officials
* 7.1.2 Organizations
* 7.2 Arguments
* 8 Opposition
* 8.1 Opponents
* 8.2 Arguments
* 9 Campaign finance
* 9.1 Support
* 9.1.1 Donors
* 9.2 Opposition
* 9.2.1 Donors
* 9.3 Methodology
* 10 Media editorials
* 10.1 Support
* 10.2 Opposition
* 11 Background
* 11.1 State medical marijuana policies
* 11.2 Federal medical marijuana policies
* 12 Path to the ballot
* 12.1 Process
* 12.2 Initiative 2018-51
* 12.2.1 Bradshaw v. New Approach Missouri
* 13 How to cast a vote
* 13.1 Poll times
* 13.2 Registration requirements
* 13.3 Automatic registration
* 13.4 Online registration
* 13.5 Same-day registration
* 13.6 Residency requirements
* 13.7 Verification of citizenship
* 13.8 Verifying your registration
* 13.9 Voter ID requirements
* 13.9.1 Background
* 14 See also
* 15 External links
* 15.1 Information
* 15.2 Support
* 16 Footnotes

## Three marijuana measures on the 2018 ballot[edit]

In November 2018, voters had three medical marijuana initiatives on their ballots—Amendment 2, Amendment 3, and Proposition C. Voters were permitted to vote "yes" or "no" on each of the ballot measures.

As Amendment 2 was approved and Amendment 3 and Proposition C were defeated, a conflicting measures scenario did not occur.

If two conflicting constitutional amendments, such as Amendment 2 and Amendment 3, were approved, the one receiving the most affirmative votes prevails.[2] State law did not provide a protocol for when voters approve statutes, such as Proposition C, and amendments, such as Amendment 2 and Amendment 3, that are in conflict. Speaking to a similar issue regarding tobacco tax initiatives in 2016, the attorney general's office said the issue would need to be decided in court.[3]

To learn more about how these three ballot initiatives compares, see the following subsections of the page:

* Statements: Campaigns answered the question, "Why is your ballot measure the best option for medical marijuana legalization?"
* Comparison: Comparison of the ballot initiatives' provisions.

## Election results[edit]

Missouri Amendment 2

Result | Votes | Percentage

Yes

| 1,583,227 | 65.59%
No | 830,631 | 34.41%

Results are officially certified.
Source

## Aftermath[edit]

### Residency requirement lawsuit[edit]

Lawsuit overview

Issue: Whether the one-year residency requirement for owners of dispensaries violates nonresidents' rights secured under the dormant commerce clause of the United States Constitution
Court: United States District Court for the Western District of Missouri
Plaintiff(s): Mark Toigo, a marijuana investor from Pennsylvania| Defendant(s): Randall Williams, director of the Missouri Department of Health and Senior Services
Plaintiff argument:
The amendment violates nonresidents' rights to operate in the state under the dormant commerce clause of the U.S. Constitution. | Defendant argument:
Unknown
Source: St. Louis Public Raido

In December 2020, Mark Toigo, a marijuana investor from Pennsylvania, filed a lawsuit in the United States District Court for the Western District of Missouri arguing that the amendment's one-year residency requirement violated nonresidents' rights to do business in the state under the commerce clause. The lawsuit says, "The real effect of the residency requirement has been and will continue to be to stifle Missouri’s medical marijuana program by severely restricting the flow of investment into the state. This will mean that Missouri’s medical marijuana businesses will not be able to access the capital necessary to build a vibrant, viable, and successful industry.” The lawsuit was filed against Randall Williams, the director of the Missouri Department of Health and Senior Services.[4]

On June 28, 2021, U.S. District Judge Nanette Laughrey ruled that the residency requirement violates the U.S. Constitution's commerce clause blocking the state from enforcing the requirement. Judge Laughrey said, "The protection of Toigo’s constitutional right to fully participate in the medical marijuana business in Missouri on the same footing as a Missouri resident" serves the public interest.[5]

In October 2021, Judge Laughrey issued a permanent injunction against the residency requirement.[6]

## Overview[edit]

What did Amendment 2 change about marijuana policies in Missouri?

As of 2018, Missouri had not legalized the use or possession or medical marijuana. Amendment 2 legalized marijuana for medical purposes. The ballot initiative allowed state-licensed physicians to recommend marijuana use to patients with nine qualifying conditions and additional conditions with a doctor's approval. Patients were allowed to grow six flowering plants in their homes; purchase 4 ounces of dried marijuana or equivalent; and possess not less than a 60-day supply of dried marijuana or equivalent (more permitted with written certification from two independent physicians). Amendment 2 levied a tax on the sale of medical marijuana at 4 percent and allocated revenue from the tax toward providing healthcare services, job training, housing assistance, and other services for veterans. Amendment 2 tasked the Missouri Department of Health and Senior Services with overseeing and regulating the state's medical marijuana program. The ballot initiative authorized not less than 24 dispensaries in each of the state's eight congressional districts, based on 2018 boundaries.[1]

What was the legal status of medical marijuana in the U.S. in 2018?

As of October 2018, 31 states and Washington, D.C., had passed laws legalizing or decriminalizing medical marijuana. An additional 16 states, including Missouri, had legalized the medical use of cannabidiol (CBD), also known as cannabis oil—one of the non-psychoactive ingredients found in marijuana. Both medical and recreational marijuana are illegal under federal law.[7] However, the U.S. Congress had included an amendment, known as the Rohrabacher–Farr amendment, in each omnibus spending bill since 2014. The Rohrabacher–Farr amendment prohibited federal agents from raiding medical marijuana growers in states where medical marijuana is legal. In 2017, Attorney General Jeff Sessions (R) asked Congress to not renew the Rohrabacher–Farr amendment for the upcoming fiscal year. Congress, however, approved the Rohrabacher–Farr amendment for the fiscal year ending on September 30, 2018.[8] Voters in Utah also decided a medical marijuana initiative in November 2018.

Who was behind the campaigns surrounding the ballot initiative?

New Approach Missouri (NAM), a political action committee, led the campaign in support of Amendment 2. NAM raised $1.78 million, including $258,000 from Drug Policy Action and $125,000 from Belleau Farms. NAM received the endorsement of the National Organization for the Reform of Marijuana Laws (NORML) and the Marijuana Policy Project. Citizens For SAFE Medicine organized to oppose Amendment 2, along with Amendment 3 and Proposition C, and reported $9,700 in contributions—$3,000 from Smart Approaches to Marijuana and $3,000 from Council for Drug Free Youth.[9]

Looking for more information about marijuana on the ballot in 2018? Explore other Ballotpedia articles on the subject below. Marijuana laws in the U.S. Drug Policy Alliance • Marijuana Policy Project • NORML • SAM Action Recreational marijuana on the ballot: Michigan Proposal 1 • North Dakota Measure 3 Medical marijuana on the ballot: Missouri Amendment 2 • Missouri Amendment 3 • Missouri Proposition C • Oklahoma State Question 788 • Utah Proposition 2

## Comparison of three ballot measures[edit]

### Statements from the campaigns[edit]

Ballotpedia asked the campaigns behind Amendment 2, Amendment 3, and Proposition C the following question: "There are three medical marijuana initiatives on the ballot in November. Why do you think that your ballot measure is the best option for medical marijuana legalization on the ballot in 2018?" Ballotpedia received the following responses from each campaign.

Click on the arrows (▼) below for statements from the campaigns behind the medical marijuana ballot initiatives in Missouri.

Missouri Amendment 2: New Approach Missouri is leading the campaign in support of Amendment 2.

“  |

Amendment 2 provides for a safe, responsible and veteran-centered way forward to make Missouri the 31st state to allow medical marijuana. It puts healthcare decisions back into the hands of doctors and their patients, and, of the three ballot options, is the only one backed by a true coalition of patients, veterans and doctors. As a constitutional amendment, it becomes a permanent part of Missouri law, providing certainty to Missouri patients.

Amendment 2 is a stark contrast to Amendment 3, the other medical marijuana constitutional amendment on the ballot. Amendment 3 is funded and supported by a coalition of one, a wealthy backer and the petition’s author, personal-injury attorney, Brad Bradshaw. Brad Bradshaw unsuccessfully sued the other two initiatives to try and get them thrown off the ballot.

Amendment 2 requires the Missouri Department of Health to act swiftly and enable implementation by drafting rules and regulations to administer the law. Under Amendment 3 Brad Bradshaw writes himself into the Missouri Constitution as the chairman of a new quasi-state agency and research institute and grants him the authority to appoint its board members. This institute would not only direct how taxpayer money is spent but also write and implement the rules and regulations on licensing and dispensing. No other state has adopted this type of new, unaccountable bureaucracy as their regulatory framework.

Amendment 2 levies a reasonable tax rate of 4% on medical marijuana sales and the revenue generated funds veterans’ services in the state. This funding mechanism is supported by patients, veterans and the healthcare community. Amendment 3 has an exploitive 15% sales tax, the highest medical marijuana tax in the nation, directed to the new research institute. It’s simply wrong to put a tax that high on medicine at the expense of patients with cancer and other debilitating illnesses.

New Approach Missouri is a coalition of medical professionals, patients, former public safety officials, and advocates working to pass Amendment 2 because we believe it is the best way forward to legalize medical marijuana for patients with serious and debilitating illnesses.[10]

|  ”

|
|

Missouri Amendment 3: Find The Cures is leading the campaign in support of Amendment 3.

“  |

Access for Legitimate Patients

Long list of qualifying conditions, which may be expanded by the Research Board when reliable scientific data shows additional conditions will benefit from MMJ treatment.

MMJ is a medicine.

As a real medicine, Amendment 3 requires MMJ to be sold in dispensaries with pharmacist consultations available.

Amendment 3 is for Missourians Only

For an individual to grow or sell MMJ they must be a Missouri resident. Entities must by 70% or more owned by Missouri residents.

Everyone in MO can participate.

With over three times the licenses of the other proposals combined, Amendment 3 has far and away the most licenses to cultivate. 3 also encourages co-ops for farmers, and LLCs-joint ventures for businesses.

Monopolies are prohibited.

No person or entity can own more than 1% of the licenses to cultivate. Everyone gets a chance to be involved.

World Class Cancer Research Center

$66 million annually for Cancer and Disease Research. Each direct dollar will generate up to 4 additional matching dollars annually, bringing the annual total to upwards of $330 million to cure cancer and other diseases. Missouri will become a world leader in medical research. An estimated 10,000+ new high paying jobs will be created. State ballot language, and Tripp Umbach economic impact analysis.

Research Center Location, Satellite Centers

After the board recommends five optimum locations, Missouri voters will decide where the main research center will be located. Missouri Universities will have affiliated satellite research centers.

Economic Impact for Missouri – Proven Track Record

Mayo Clinic generates over $9.6 billion annually for Minnesota, that’s more than all MN hotel and lodging, motor vehicle manufacturing and professional sports combined.

Scripps Research in Florida, 9 years old, is estimated to soon reach $1.5 billion annually. Scripps had almost 3/4 of a billon in reserves last year, and recently Scripps was awarded over 600 Million additional dollars by the NIH.

Income Tax Refund

Income tax refund check to you annually! 50% of the money generated from the research institute must be given back to Missouri residents in the form of an annual income tax refund.

Law Enforcement

Amendment 3 provides almost $2 million in annual funding for local law enforcement. Amendment 3 also requires MMJ to be cultivated in locked secure and safe environments, and only with a proper license to cultivate.

Missouri Schools and Education

Cancer and disease research will generate millions of dollars annually for Missouri’s schools and Missouri students, plus additional millions of dollars specifically set aside for Missouri Universities.

Problems with Amendment 2

Amendment 2 allows home grow, up to 24 plants per household, selling it in neighborhoods. Polling confirms Missouri does not want home grow, and it is a loser on the ballot.

Amendment 2 allows violent convicted felons to grow transport and sell marijuana in Missouri. Need more be said.

Amendment 2 is recreational. 2 allows MMJ to be sold for any medical condition. It also allows “doc in the boxes” where a doctor can sit in a room all day write recommendations for marijuana. 2 is silent on limits.[10]

|  ”

|
|

Missouri Proposition C: Missourians for Patient Care is leading the campaign in support of Proposition C.

“  |

Missourians for Patient Care (MPC) was formed in 2017 by a group of passionate Missouri leaders with a mission to bring medical cannabis to Missouri patients in November 2018. Operated in the shortest time frame, MPC collected signatures from voters in January 2018 and submitted the constitutionally-required number of signatures to the Secretary of State on May 6, 2018. Proposition C has taken best practices from other effective ballot measures across the country and applied them to this statutory initiative.

The sole purpose for Proposition C is to allow Missouri patients quick and efficient access to cannabis by physician certification only. Missouri patients must have a certain qualifying medical condition to access medical cannabis under Proposition C. The newly-created industry in Missouri would be regulated by a state agency that has an 80-year history regulating liquor business: The Division of Alcohol and Tobacco. The Department of Health and Senior Services would also be tasked with confidentially overseeing application and distribution of patient and caregiver identification cards.

Proposition C imposes the lowest tax rate of all three initiatives at 2%. This low retail tax rate lowers the burden of cost on patients accessing medical cannabis. It is the only measure that funds all drug treatment facilities in the state, regardless of drug addiction. Funds would also support veterans’ services, public safety, and early childhood education and development.

Proposition C is the only measure that requires local community approval prior to any licensing. The governing body of the municipality must adopt an ordinance, or the governing body of the county must adopt a resolution containing specific standards for license issuance. This requirement provides local control for communities to have a say in how medical cannabis can be accessed by their constituencies.

Unlike Amendment 3, Proposition C is not looking to threaten private property owners by abusing eminent domain laws or egregiously tax patients at 15% to create a fabricated ‘research institute’ paying them six-figure salaries to hope and find cures for terminal illnesses. Patients with chronic pain deserve serious and effective treatments. Prop C and its supporters stand ready to help deliver medical cannabis treatment options for patients in Missouri as an alternative to heavily-prescribed opioids.[10]

|  ”

|
|

### Comparison of 2018 ballot initiatives[edit]

The following table compares the different provisions of the medical marijuana ballot measures and additional information:

Issue  |  Amendment 2  |  Amendment 3  |  Proposition C

|
|
|

Sponsor  |  New Approach Missouri |  Find the Cures |  Missourians for Patient Care
Type of law  |  Constitutional |  Constitutional |  Statute
Amending or repealing by legislature  |  legislature needs to pass changes by simple majority and refer to the ballot for a public vote  |  legislature needs to pass changes by simple majority and refer to the ballot for a public vote  |  legislature needs to pass changes by simple majority and changes need governor's signature
Comparison of patients and patient use provisions
Number of qualifying conditions  |  9 plus others with doctor's approval  |  10 plus others designed by the research board  |  9 plus others with doctor's approval
Purchase amount  |  department to set a limit of not less than 4 ounces of dried marijuana or equivalent in 30-day period (more permitted with written certification from two independent physicians)  |  department to set limit of not less than 3 ounces of dried marijuana or equivalent in 30-day period (more permitted with written certification from two independent physicians)  |  2.5 ounces of cannabis flower or equivalent in 14-day period (more permitted with written certification from a physician)
Possession amount  |  department to set a limit of not less than a 60-day supply of dried marijuana or equivalent (more permitted with written certification from two independent physicians)  |  not specified in the amendment's text  |  no more than a 60-day supply of cannabis flower or equivalent
Home grow  |  6 flowering plants  |  not specified in the amendment's text  |  home cultivation prohibited
Comparison of sales taxes and tax revenue
Sales tax  |  4 percent  |  15 percent  |  2 percent
Tax revenue distribution  |  healthcare services, job training, housing assistance, and other services for veterans  |  Biomedical Research and Drug Development Institute tasked with developing cures for cancer and other diseases  |  veterans' services, drug treatment, education, and law enforcement
Estimated annual government revenue  |  $24 million  |  $66 million  |  $10 million
Estimated annual government costs  |  $7 million  |  $500,000  |  $10 million
Provisions regarding regulation of marijuana
Regulatory agency  |  Tasks the existing Missouri Department of Health and Senior Services  |  Creates a new Board of Biomedical Research and Drug Development Institute  |  Tasks the existing Missouri Department of Health and Senior Services and Division of Alcohol and Tobacco Control
Local prohibitions  |  local bans not allowed, but local governments can regulate the location of facilities and dispensaries and the time and manner of their operation  |  local governments can prohibit facilities and dispensaries through a simple majority vote of voters  |  local governments can prohibit facilities and dispensaries through a two-thirds vote of voters
Number of dispensaries  |  not less than 24 in each congressional district, based on 2018 boundaries  |  not less than 2 per 20,000 residents in counties and cities  |  not less than 1 per 100,000 state residents (plus extras based on demographics and demand to ensure access)

## Text of measure[edit]

### Ballot title[edit]

The ballot title was as follows:[11]

“  | Shall the Missouri Constitution be amended to:

* allow the use of marijuana for medical purposes, and create regulations and licensing/certification procedures for marijuana and marijuana facilities;
* impose a 4 percent tax on the retail sale of marijuana; and
* use funds from these taxes for health and care services for military veterans by the Missouri Veterans Commission and to administer the program to license/certify and regulate marijuana and marijuana facilities?

This proposal is estimated to generate annual taxes and fees of $18 million for state operating costs and veterans programs, and $6 million for local governments. Annual state operating costs are estimated to be $7 million.[10]

|  ”

|
|

### Ballot summary[edit]

The ballot summary was as follows:[12]

“  |

A “yes” vote will amend the Missouri Constitution to allow the use of marijuana for medical purposes under state laws. This amendment does not change federal law, which makes marijuana possession, sale and cultivation a federal offense. This amendment creates regulations and licensing procedures for medical marijuana and medical marijuana facilities — dispensary, cultivation, testing and marijuana-infused product manufacturing facilities. This amendment creates licensing fees for such facilities. This amendment will impose a 4 percent tax on the retail sale of marijuana for medical purposes by dispensary facilities. The funds from the license fees and tax will be used by the Missouri Veterans Commission for health and care services for military veterans, and by the Department of Health and Senior Services to administer the program to license/certify and regulate marijuana and marijuana facilities.

A “no” vote will not amend the Missouri Constitution as to the use of marijuana.

If passed, this measure will impose a 4 percent retail sales tax on marijuana for medical purposes.[10]

|  ”

|
|

### Constitutional changes[edit]

See also: Missouri Constitution

The measure added an Article XVI to the Missouri Constitution. The following text was added:[1]

Note: Use your mouse to scroll over the below text to see the full text.

Section 1. Right to Access Medical Marijuana

1\. Purposes

This section is intended to permit state-licensed physicians to recommend marijuana for medical purposes to patients with serious illnesses and medical conditions. The section allows patients with qualifying medical conditions the right to discuss freely with their physicians the possible benefits of medical marijuana use, the right of their physicians to provide professional advice concerning the same, and the right to use medical marijuana for treatment under the supervision of a physician.

This section is intended to make only those changes to Missouri laws that are necessary to protect patients, their primary caregivers, and their physicians from civil and criminal penalties, and to allow for the limited legal production, distribution, sale and purchase of marijuana for medical use. This section is not intended to change current civil and criminal laws governing the use of marijuana for nonmedical purposes. The section does not allow for the public use of marijuana and driving under the influence of marijuana.

2\. Definitions

(1) “Administer” means the direct application of marijuana to a Qualifying Patient by way of any of the following methods:

(a) Ingestion of capsules, teas, oils, and other marijuana-infused products;
(b) Vaporization or smoking of dried flowers, buds, plant material, extracts, or oils;
(c) Application of ointments or balms;
(d) Transdermal patches and suppositories;
(e) Consuming marijuana-infused food products; or
(f) Any other method recommended by a Qualifying Patient’s physician.

(2) “Department” means the Department of Health and Senior Services, or its successor agency.

(3) “Entity” means a natural person, corporation, professional corporation, nonprofit corporation, cooperative corporation, unincorporated association, business trust, limited liability company, general or limited partnership, limited liability partnership, joint venture, or any other legal entity.

(4) “Flowering plant” means a marijuana plant from the time it exhibits the first signs of sexual maturity through harvest.

(5) “Marijuana” or “Marihuana” means Cannabis indica, Cannabis sativa, and Cannabis ruderalis, hybrids of such species, and any other strains commonly understood within the scientific community to constitute marijuana, as well as resin extracted from the plant and marijuana-infused products. “Marijuana” or “Marihuana” do not include industrial hemp containing a crop-wide average tetrahydrocannabinol concentration that does not exceed three-tenths of one percent on a dg weight basis, or commodities or products manufactured from industrial hemp.

(6) “Marijuana-Infused Products” means products that are infused with marijuana or an extract thereof and are intended for use or consumption other than by smoking, including, but not limited to, edible products, ointments, tinctures and concentrates.

(7) “Medical Marijuana Cultivation Facility” means a facility licensed by the Department, to acquire, cultivate, process, store, transport, and sell marijuana to a Medical Marijuana Dispensary Facility, Medical Marijuana Testing Facility, or to a Medical Marijuana-Infused Products Manufacturing Facility.

(8) “Medical Marijuana Dispensary Facility” means a facility licensed by the Department, to acquire, store, sell, transport, and deliver marijuana, marijuana-infused products, and drug paraphernalia used to administer marijuana as provided for in this section to a Qualifying Patient, a Primary caregiver, another Medical Marijuana Dispensary Facility, a Medical Marijuana Testing Facility, or a Medical Marijuana-Infused Products Manufacturing Facility.

(9) “Medical Marijuana-Infused Products Manufacturing Facility” means a facility licensed by the Department, to acquire, store, manufacture, transport, and sell marijuana-infused products to a Medical Marijuana Dispensary Facility, a Medical Marijuana Testing Facility, or to another Medical Marijuana-Infused Products Manufacturing Facility.

(10) “Medical Marijuana Testing Facility” means a facility certified by the Department, to acquire, test, certify, and transport marijuana.

(11) “Medical use” means the production, possession, delivery, distribution, transportation, or administration of marijuana or a marijuana-infused product, or drug paraphernalia used to administer marijuana or a marijuana-infused product, for the benefit of a Qualifying Patient to mitigate the symptoms or effects of the patient’s qualifying medical condition.

(12) “Physician” means an individual who is licensed and in good standing to practice medicine or osteopathy under Missouri law.

(13) “Physician certification” means a document, whether handwritten, electronic or in another commonly used format, signed by a physician and stating that, in the physician’s professional opinion, the patient suffers from a qualifying medical condition.

(14) “Primary caregiver” means an individual twenty-one years of age or older who has significant responsibility for managing the well-being of a Qualifying Patient and who is designated as such on the primary caregiver’s application for an identification card under this section or in other written notification to the Department.

(15) “Qualifying medical condition” means the condition of, symptoms related to, or side-effects from the treatment of:

(a) Cancer;

(b) Epilepsy,

(c) Glaucoma;

(d) Intractable migraines unresponsive to other treatment;

(e) A chronic medical condition that causes severe, persistent pain or persistent muscle spasms, including but not limited to those associated with multiple sclerosis, seizures, Parkinson’s disease, and Tourette’s syndrome;

(f) Debilitating psychiatric disorders including but not limited to post-traumatic stress disorder if diagnosed b a state licensed psychiatrist;

(g) Human immunodeficiency virus or acquired immune deficiency syndrome;

(h) A chronic medical condition that is normally treated with a prescription medication that could lead to physical or psychological dependence, when a physician determines that medical use of marijuana could be effective in treating that condition and would serve as a safer alternative to the prescription medication;

(i) Any terminal illness;

(j) In the professional judgment of a physician, any other chronic, debilitating or other medical condition, including, but not limited to, hepatitis C, amyotrophic lateral sclerosis, inflammatory bowel disease, Crohn’s disease, Huntington’s disease, autism, neuropathies, sickle cell anemia, agitation of Alzheimer's disease, cachexia, and wasting syndrome.

(16) “Qualifying Patient” means a Missouri resident diagnosed with at least one qualifying medical condition.

3\. Creating Patient Access to Medical Marijuana

(1) In carrying out the implementation of this section, the Department shall have the authority to:

(a) Grant or refuse state licenses and certifications for the cultivation, manufacture, dispensing, sale, testing, tracking, and transportation of marijuana for medical use as provided by law; suspend, fine, restrict, or revoke such licenses and certifications upon a violation of this section or a rule promulgated pursuant to this section; and impose any administrative penalty authorized by this section or any rule promulgated pursuant to this section.

(b) Promulgate rules and emergency rules necessary for the proper regulation and control of the cultivation, manufacture, dispensing, and sale of marijuana for medical use and for the enforcement of this section so long as patient access is not restricted unreasonably and such rules are reasonably necessary for patient safety or to restrict access to only licensees and Qualifying Patients.

(c) Develop such forms, certificates, licenses, identification cards, and applications as are necessary for, or reasonably related to, the administration of this section or any of the rules promulgated under this section.

(d) Require a seed-to-sale tracking system that tracks medical marijuana from either the seed or immature plant stage until the medical marijuana or medical marijuana-infused product is sold to a Qualifying Patient or Primary Caregiver to ensure that no medical marijuana grown by a Medical Marijuana Cultivation Facility or manufactured by a Medical Marijuana-Infused Products Manufacturing Facility is sold or otherwise transferred except by a Medical Marijuana Dispensary Facility. The Department shall certify, if possible, at least two commercially available systems to licensees as compliant with its tracking standards and issue standards for the creation or use of other systems by licensees.

(e) Issue standards for the secure transportation of Marijuana and Marijuana-Infused Products. The Department shall certify entities which demonstrate compliance with its transportation standards to transport Marijuana and Marijuana-Infused Products to a Medical Marijuana Cultivation Facility, a Medical Marijuana-Infused Products Manufacturing Facility, a Medical Marijuana Dispensary Facility, a Medical Marijuana Testing Facility, or another entity with a transportation certification. The Department shall develop or adopt from any other governmental agency such safety and security standards as are reasonably necessary for the transportation of marijuana. Any entity licensed or certified pursuant to this section shall be allowed to transport cannabis.

(f) The Department may charge a fee not to exceed $5,000 for any certification issued pursuant to this section.

(g) Prepare and transmit annually a publicly available report accounting to the Governor for the efficient discharge of all responsibilities assigned to the Department under this section.

(h) Establish a system to numerically score competing medical marijuana licensee and certificate applicants, only in cases where more applicants apply than the minimum number of licenses or certificates as calculated by this section, which scoring shall be limited to an analysis of the following: (i) the character, veracity, background, qualifications, and relevant experience of principal officers or managers; (ii) the business plan proposed by the applicant, which in the case of cultivation facilities and dispensaries shall include the ability to maintain an adequate supply of marijuana, plans to ensure safety and security of g Qualifying Patients and the community, procedures to be used to prevent diversion, and any plan for making Marijuana available to low-income Qualifying Patients; (iii) site security; (iv) experience in a legal cannabis market; (v) in the case of Medical Marijuana Testing Facilities, the experience of their personnel with testing marijuana, food or drugs for toxins and/or potency and health care industry experience; (vi) the potential for positive economic impact in the site community; (vii) in the case of Medical Marijuana Cultivation Facilities, capacity or experience with agriculture, horticulture, and health care; (viii) in the case of Medical Marijuana Dispensary Facilities, capacity or experience with health care, the suitability of the proposed location, and its accessibility for patients; (ix) in the case of Medical Marijuana-Infused Products Manufacturing Facilities, capacity or experience with food and beverage manufacturing; and (x) maintaining competitiveness in the marijuana for medical use marketplace. In ranking applicants and awarding licenses and certificates, the Department may consult or contract with other public agencies with relevant expertise regarding these factors. The Department shall lift or ease any limit on the number of licensees or certificate holders in order to meet the demand for marijuana for medical use by Qualifying Patients.

(2) The Department shall issue any rules or emergency rules necessary for the implementation and enforcement of this section and to ensure the right to, availability, and safe use of marijuana for medical use by Qualifying Patients. In developing such rules or emergency rules, the Department may consult with other public agencies. In addition to any other rules or emergency rules necessary to carry out the mandates of this section, the Department may issue rules or emergency rules relating to the following subjects:

(a) Compliance with, enforcement of, or violation of any provision of this section or any rule issued pursuant to this section, including procedures and grounds for denying, suspending, fining, restricting, or revoking a state license or certification issued pursuant to this section;

(b) Specifications of duties of officers and employees of the Department;

(c) Instructions or guidance for local authorities and law enforcement officers;

(d) Requirements for inspections, investigations, searches, seizures, and such additional enforcement activities as may become necessary from time to time;

(e) Creation of a range of administrative penalties for use by the Department;

(f) Prohibition of misrepresentation and unfair practices;

(g) Control of informational and product displays on licensed premises provided that the rules may not prevent or unreasonably restrict appropriate signs on the property of the Medical Marijuana Dispensary Facility, product display and examination by the Qualifying Patient and/or Primary caregiver, listings in business directories including phone books, listings in marijuana-related or medical publications, or the sponsorship of health or not for profit charity or advocacy events;

(h) Development of individual identification cards for owners, officers, managers, contractors, employees, and other support staff of entities licensed or certified pursuant to this section, including a fingerprint-based federal and state criminal record check in accordance with U.S. Public Law 92-544, or its successor provisions, as may be required by the Department prior to issuing a card and procedures to ensure that cards for new applicants are issued within fourteen days. Applicants licensed pursuant to this section shall submit fingerprints to the Missouri state highway patrol for the purpose of conducting a state and federal fingerprint-based criminal background check. The Missouri state highway patrol, if necessary, shall forward the fingerprints to the Federal Bureau of Investigation (FBI) for the purpose of conducting a fingerprint-based criminal background check. Fingerprints shall be submitted pursuant to 43.543 and fees shall be paid pursuant to 43.530;

(i) Securing requirements for any premises licensed or certified pursuant to this section, including, at a minimum, lighting, physical security, video, alarm requirements, and other minimum procedures for internal control as deemed necessary by the Department to properly administer and enforce the provisions of this section, including reporting requirements for changes, alterations, or modifications to the premises;

(j) Regulation of the storage of, warehouses for, and transportation of marijuana for medical use;

(k) Sanitary requirements for, including, but not limited to, the preparation of medical Marijuana-Infused Products;

(l) The specification of acceptable forms of picture identification that a Medical Marijuana Dispensary Facility may accept when verifying a sale;

(m) Labeling and packaging standards;

(n) Records to be kept by licensees and the required availability of the records;

(o) State licensing procedures, including procedures for renewals, reinstatements, initial licenses, and the payment of licensing fees;

(p) The reporting and transmittal of tax payments;

(q) Authorization for the Department of Revenue to have access to licensing information to ensure tax payment and the effective administration of this section; and

(r) Such other matters as are necessary for the fair, impartial, stringent, and comprehensive administration of this section.

(3) The Department shall issue rules or emergency rules for a medical marijuana and medical marijuana-infused products independent testing and certification program for medical marijuana licensees and requiring licensees to test medical marijuana using one or more impartial, independent laboratories to ensure, at a minimum, that products sold for human consumption do not contain contaminants that are injurious to health, to ensure correct labeling and measure potency. The Department shall not require any medical marijuana or medical marijuana-infused products to be tested more than once prior to sale.

(4) The Department shall issue rules or emergency rules to provide for the certification of and standards for Medical Marijuana Testing Facilities, including the requirements for equipment and qualifications for personnel, but shall not require certificate holders to have any federal agency licensing or have any relationship with a federally licensed testing facility. The Department shall certify, if possible, at least two entities as Medical Marijuana Testing Facilities. No Medical Marijuana Testing Facility shall be owned by an entity under substantially common control, ownership, or management as a Medical Marijuana Cultivation Facility, Medical Marijuana-Infused Product Manufacturing Facility, or Medical Marijuana Dispensary Facility.

(5) The Department shall maintain the confidentiality of reports or other information obtained from an applicant or licensee containing any individualized data, information, or records related to the licensee or its operation, including sales information, financial records, tax returns, credit reports, cultivation information, testing results, and security information and plans, or revealing any patient information, or any other records that are exempt from public inspection pursuant to state or federal law. Such reports or other information may be used only for a purpose authorized by this section. Any information released related to patients may be used only for a purpose authorized by federal law and this section, including verifying that a person who presented a patient identification card to a state or local law enforcement official is lawfully in possession of such card.

(6) Within one hundred eighty days of the effective date of this section, the Department shall make available to the public license application forms and application instructions for Medical Marijuana Cultivation Facilities, Medical Marijuana Testing Facilities, Medical Marijuana Dispensary Facilities, and Medical Marijuana-Infused Products Manufacturing Facilities.

(7) Within one hundred eighty days of the effective date of this section, the Department shall make available to the public application forms and application instructions for Qualifying Patient, Qualifying Patient cultivation, and Primary caregiver identification cards. Within two hundred ten days of the effective date of this section, the Department shall begin accepting applications for such identification cards.

(8) An entity may apply to the Department for and obtain one or more licenses to grow marijuana as a Medical Marijuana Cultivation Facility. Each facility in operation shall require a separate license, but multiple licenses may be utilized in a single facility. Each indoor facility utilizing artificial lighting may be limited by the Department to thirty thousand square feet of flowering plant canopy space. Each outdoor facility utilizing natural lighting may be limited by the Department to two thousand eight hundred flowering plants. Each greenhouse facility using a combination of natural and artificial lighting may be limited by the Department, at the election of the licensee, to two thousand eight hundred flowering plants or thirty thousand square feet of flowering plant canopy. The license shall be valid for three years from its date of issuance and shall be renewable, except for good cause. The Department shall charge each applicant a non-refundable fee of ten thousand dollars per license application or renewal for all applicants filing an application within three years of the effective date of this section and shall charge each applicant a non-refundable fee of five thousand dollars per license application or renewal thereafter. Once granted, the Department shall charge each licensee an annual fee of twenty-five thousand dollars per facility license. Application and license fees shall be increased or decreased each year by the percentage of increase or decrease from the end of the previous calendar year of the Consumer Price Index, or successor index as published by the U.S. Department of Labor, or its successor agency. No more than three Medical Marijuana Cultivation Facility licenses shall be issued to any entity under substantially common control, ownership, or management.

(9) An entity may apply to the Department for and obtain one or more licenses to operate a Medical Marijuana Dispensary Facility. Each facility in operation shall require a separate license. A license shall be valid for three years from its date of issuance and shall be renewable, except for good cause. The Department shall charge each applicant a non-refundable fee of six thousand dollars per license application or renewal for each applicant filing an application within three years of the effective date of this section and shall charge each applicant a non-refundable fee of three thousand dollars per license application or renewal thereafter. Once granted, the Department shall charge each licensee an annual fee of ten thousand dollars per facility license. Application and license fees shall be increased or decreased each year by the percentage of increase or decrease from the end of the previous calendar year of the Consumer Price Index, or successor index as published by the U.S. Department of Labor, or its successor agency. No more than five Medical Marijuana Dispensary Facility licenses shall be issued to any entity under substantially common control, ownership, or management.

(10) An entity may apply to the Department for and obtain one or more licenses to operate a Medical Marijuana-Infused Products Manufacturing Facility. Each facility in operation shall require a separate license. A license shall be valid for three years from its date of issuance and shall be renewable, except for good cause. The Department shall charge each applicant a non-refundable fee of six thousand dollars per license application or renewal for each applicant filing an application within three years of the effective date of this section and shall charge each applicant a non-refundable fee of three thousand dollars per license application or renewal thereafter. Once granted, the Department shall charge each licensee an annual fee of ten thousand dollars per facility license. Application and license fees shall be increased or decreased each year by the percentage of increase or decrease from the end of the previous calendar year of the Consumer Price Index, or successor index as published by the U.S. Department of Labor, or its successor agency. No more than three Medical Marijuana-Infused Products Manufacturing Facility licenses shall be issued to any entity under substantially common control, ownership, or management.

(11) Any applicant for a license authorized by this section may pre-file their application fee with the Department beginning 30 days after the effective date of this section.

(12) Except for good cause, a Qualifying Patient or his or her Primary caregiver may obtain an identification card from the Department to cultivate up to six flowering marijuana plants for the exclusive use of that Qualifying Patient. The card shall be valid for twelve months from its date of issuance and shall be renewable with the annual submittal of a new or updated physician’s certification. The Department shall charge an annual fee for the card of one hundred dollars, with such rate to be increased or decreased each year by the percentage of increase or decrease from the end of the previous calendar year of the Consumer Price Index, or successor index as published by the U.S. Department of Labor, or its successor agency.

(13) The Department may set a limit on the amount of marijuana that may be purchased by or on behalf of a single Qualifying Patient in a thirty day period, provided that limit is not less than four ounces of dried, unprocessed marijuana, or its equivalent. Any such limit shall not apply to a Qualifying Patient with written certification from two independent physicians that there are compelling reasons why the Qualifying Patient needs a greater amount than the limit established by the Department.

(14) The Department may set a limit on the amount of marijuana that may be possessed by or on behalf of each qualifying patient, provided that limit is not less than a sixty day supply of dried, unprocessed marijuana, or its equivalent. A Primary caregiver may possess a separate legal limit for each Qualifying Patient under their care and a separate legal limit for themselves if they are a Qualifying Patient. Qualifying Patients cultivating marijuana for medical use may possess up to a ninety day supply, so long as the supply remains on property under their control. Any such limit shall not apply to a Qualifying Patient with written certification from two independent physicians that there are compelling reasons for additional amounts. Possession of between the legal limit and up to twice the legal limit shall subject the possessor to Department sanctions, including an administrative penalty and loss of their patient identification card for up to a year. Purposefully possessing amounts in excess of twice the legal limit shall be punishable by imprisonment of up to one year and a fine of up to two thousand dollars.

(15) The Department may restrict the aggregate number of licenses granted for Medical Marijuana Cultivation Facilities, provided, however, that the number may not be limited to fewer than one license per every one hundred thousand inhabitants, or any portion thereof, of the state of Missouri, according to the most recent census of the United States. A decrease in the number of inhabitants in the state of Missouri shall have no impact.

(16) The Department may restrict the aggregate number of licenses granted for Marijuana-Infused Products Manufacturing Facilities, provided, however, that the number may not be limited to fewer than one license per every seventy thousand inhabitants, or any portion thereof, of the state of Missouri, according to the most recent census of the United States. A decrease in the number of inhabitants in the state of Missouri shall have no impact.

(17) The Department may restrict the aggregate number of licenses granted for Medical Marijuana Dispensary Facilities, provided, however, that the number may not be limited to fewer than twenty-four licenses in each United States Congressional district in the state of Missouri pursuant to the map of each of the eight congressional districts as drawn and effective on the effective date of this section. Future changes to the boundaries of or the number of congressional districts shall have no impact.

(18) The Department shall begin accepting license and certification applications for Medical Marijuana Dispensary Facilities, Medical Marijuana Testing Facilities, Medical Marijuana Cultivation Facilities. Medical Marijuana-Infused Products Manufacturing Facilities, seed-to-sale tracking systems, and for transportation of marijuana no later than two hundred forty days after the effective date of this section. Applications for licenses and certifications under this section shall be approved or denied by the Department no later than one hundred fifty days after their submission. If the Department fails to carry out its non-discretionary duty to approve or deny an application within one hundred fifty days of submission, an applicant may immediately seek a court order compelling the Department to approve or deny the application.

(19) Qualifying Patients under this section shall obtain and annually renew an identification card or cards from the Department. The Department shall charge a fee of twenty-five dollars per year per card with such fee to be increased or decreased each year by the percentage of increase or decrease from the end of the previous calendar year of the Consumer Price Index, or successor index as published by the U.S. Department of Labor or its successor agency. Upon receiving an application for a Qualifying Patient identification card or Qualifying Patient cultivation identification card, the Department shall, within thirty days, either issue the card or provide a written explanation for its denial. If the Department fails to deny and fails to issue a card to an eligible Qualifying Patient within thirty days, then their physician certification shall serve as their Qualifying Patient identification card or Qualifying Patient cultivation identification card for up to one year from the date of physician certification. All initial applications for or renewals of a Qualifying Patient identification card or Qualifying Patient cultivation identification card shall be accompanied by a physician certification that is less than thirty days old.

(20) Primary caregivers under this section shall obtain and annually renew an identification card from the Department. The Department shall charge a fee of twenty-five dollars per year, with such fee to be increased or decreased each year by the percentage of increase or decrease from the end of the previous calendar year of the Consumer Price Index, or successor index as published by the U.S. Department of Labor, or its successor agency. Upon receiving an application for a Primary caregiver identification card, the Department shall, within thirty days, either issue the card or provide a written explanation for its denial.

(21) All marijuana for medical use sold in Missouri shall be cultivated in a licensed Medical Marijuana Cultivation Facility located in Missouri.

(22) All marijuana-infused products for medical use sold in the state of Missouri shall be manufactured in a Medical Marijuana-Infused Products Manufacturing Facility.

(23) The denial of a license, license renewal, or identification card by the Department shall be appealable to the Administrative Hearing Commission, or its successor entity. Following the exhaustion of administrative review, denial of a license, license renewal, or identification card by the Department shall be subject to judicial review as provided by law.

(24) No elected official shall interfere directly or indirectly with the Department’s obligations and activities under this section.

(25) The Department shall not have the authority to apply or enforce any rule or regulation that would impose an undue burden on any one or more licensees or certificate holders, any Qualifying Patients, or act to undermine the purposes of this section.

4\. Taxation and Reporting

(1) A tax is levied upon the retail sale of marijuana for medical use sold at Medical Marijuana Dispensary Facilities within the state. The tax shall be at a rate of four percent of the retail price. The tax shall be collected by each licensed Medical Marijuana Dispensary Facility and paid to the Department of Revenue. After retaining no more than five percent for its actual collection costs, amounts generated by the tax levied in this section shall be deposited by the Department of Revenue into the Missouri Veterans’ Health and Care Fund. Licensed entities making retail sales within the state shall be allowed approved credit for returns provided the tax was paid on the returned item and the purchaser was given the refund or credit.

(2) There is hereby created in the state treasury the “Missouri Veterans’ Health and Care Fund,” which shall consist of taxes and fees collected under this section. The State Treasurer shall be custodian of the fund, and he or she shall invest monies in the fund in the same manner as other funds are invested. Any interest and monies earned on such investments shall be credited to the fund. Notwithstanding any other provision of law, any monies remaining in the fund at the end of a biennium shall not revert to the credit of the general revenue fund. The Commissioner of Administration is authorized to make cash operating transfers to the fund for purposes of meeting the cash requirements of the Department in advance of it receiving annual application, licensing, and tax revenue, with any such transfers to be repaid as provided by law. The fund shall be a dedicated fund and shall stand appropriated without further legislative action as follows:

(a) First, to the Department, an amount necessary for the Department to carry out this section, including repayment of any cash operating transfers, payments made through contract or agreement with other state and public agencies necessary to carry out this section, and a reserve fund to maintain a reasonable working cash balance for the purpose of carrying out this section;

(b) Next, the remainder of such funds shall be transferred to the Missouri Veterans Commission for health and care services for military veterans, including the following purposes: operations, maintenance and capital improvements of the Missouri Veterans Homes, the Missouri Service Officer’s Program, and other services for veterans approved by the Commission, including, but not limited to, health care services, mental health services, drug rehabilitation services, housing assistance, job training, tuition assistance, and housing assistance to prevent homelessness. The Missouri Veterans Commission shall contract with other public agencies for the delivery of services beyond its expertise.

(c) All monies from the taxes authorized under this subsection shall provide additional dedicated funding for the purposes enumerated above and shall not replace existing dedicated funding.

(3) For all retail sales of marijuana for medical use, a record shall be kept by the seller which identifies, by secure and encrypted patient number issued by the seller to the qualifying patient involved in the sale, all amounts and types of marijuana involved in the sale and the total amount of money involved in the sale, including itemizations, taxes collected and grand total sale amounts. All such records shall be kept on the premises in a readily available format and be made available for review by the Department and the Department of Revenue upon request. Such records shall be retained for five years from the date of the sale.

(4) The tax levied pursuant to this subsection is separate from, and in addition to, any general state and local sales and use taxes that apply to retail sales, which shall continue to be collected and distributed as provided by general law.

(5) Except as authorized in this subsection, no additional taxes shall be imposed on the sale of marijuana for medical use.

(6) The fees and taxes provided for in this Article XVI, Section 1 shall be fully enforceable notwithstanding any other provision in this Constitution purportedly prohibiting or restricting the taxes and fees provided for herein.

(7) The unexpended balance existing in the fund shall be exempt from the provisions of section 33.080 relating to the transfer of unexpended balances to the general revenue

5\. Additional Patient, Physician, Caregiver and Provider Protections

(1) Except as provided in this section, the possession of marijuana in quantities less than the limits of this section, or established by the Department, and transportation of marijuana from a Medical Marijuana Dispensary Facility to the Qualifying Patient’s residence shall not subject the possessor to arrest, criminal or civil liability, or sanctions under Missouri law, provided that the possessor produces on demand to the appropriate authority a valid Qualifying Patient identification card; a valid Qualifying Patient cultivation identification card; a valid physician certification while making application for an identification card; or a valid Primary caregiver identification card. Production of the respective equivalent identification card or authorization issued by another state or political subdivision of another state shall also meet the requirements of this subdivision.

(2) No patient shall be denied access to or priority for an organ transplant because they hold a Qualifying Patient identification card or use marijuana for medical use.

(3) A physician shall not be subject to criminal or civil liability or sanctions under Missouri law or discipline by the Missouri State Board of Registration for the Healing Arts, or its successor agency, for owning, operating, investing in, being employed by, or contracting with any entity licensed or certified pursuant to this section or issuing a physician certification to a patient diagnosed with a qualifying medical condition in a manner consistent with this section and legal standards of professional conduct.

(4) A health care provider shall not be subject to civil or criminal prosecution under Missouri law, denial of any right or privilege, civil or administrative penalty or sanction, or disciplining action by any accreditation or licensing board or commission for owning, Operating, investing in, being employed by, or contracting with any entity licensed or certified pursuant to this section or providing health care services that involve the medical use of marijuana consistent with this section and legal standards of professional conduct.

(5) A Medical Marijuana Testing Facility shall not be subject to civil or criminal prosecution under Missouri law, denial of any right or privilege, civil or administrative penalty or sanction, or disciplinary action by any accreditation or licensing board or commission for providing laboratory testing services that relate to the medical use of marijuana consistent with this section and otherwise meeting legal standards of professional conduct.

(6) A health care provider shall not be subject to mandatory reporting requirements for the medical use of marijuana by non-emancipated Qualifying Patients under eighteen years of age in a manner consistent with this section and with consent of a parent or guardian.

(7) A Primary caregiver shall not be subject to criminal or civil liability or sanctions under Missouri law for purchasing, transporting, or administering marijuana for medical use to a qualifying patient or participating in the patient cultivation of up to six flowering marijuana plants per patient in a manner consistent with this section and generally established legal standards of personal or professional conduct.

(8) An attorney shall not be subject to disciplinary action by the state bar association or other professional licensing body for owning, operating, investing in, being employed by, contracting with, or providing legal assistance to prospective or licensed Medical Marijuana Testing Facilities, Medical Marijuana Cultivation Facilities, Medical Marijuana Dispensary Facilities, Medical Marijuana-Infused Products Manufacturing Facilities, Qualifying Patients, Primary caregivers, physicians, health care providers or others related to activity that is no longer subject to criminal penalties under state law pursuant to this section.

(9) Actions and conduct by Qualifying Patients, Primary Caregivers, Medical Marijuana Testing Facilities, Medical Marijuana Cultivation Facilities, Medical Marijuana-Infused Products Manufacturing Facilities, or Medical Marijuana Dispensary Facilities licensed or registered with the Department, or their employees or agents, as permitted by this section and in compliance with Department regulations and other standards of legal conduct, shall not be subject to criminal or civil liability or sanctions under Missouri law, except as provided for by this section.

(10) Nothing in this section shall provide immunity for negligence, either common law or statutorily created, nor criminal immunities for operating a vehicle, aircraft, dangerous device, or navigating a boat under the influence of marijuana.

(11) It is the public policy of the state of Missouri that contracts related to marijuana for medical use that are entered into by Qualifying Patients, Primary Caregivers, Medical Marijuana Testing Facilities, Medical Marijuana Cultivation Facilities, Medical Marijuana-Infused Products Manufacturing Facilities, or Medical Marijuana Dispensary Facilities and those who allow property to be used by those entities, should be enforceable. It is the public policy of the state of Missouri that no contract entered into by Qualifying Patients, Primary Caregivers, Medical Marijuana Testing Facilities, Medical Marijuana Cultivation Facilities, Medical Marijuana-Infused Products Manufacturing Facilities, or Medical Marijuana Dispensary Facilities, or by a person who allows property to be used for activities that are exempt from state criminal penalties by this section, shall be unenforceable on the basis that activities related to medical marijuana may be prohibited by federal law.

6\. Legislation

Nothing in this section shall limit the General Assembly from enacting laws consistent with this section, or otherwise effectuating the patient rights of this section. The legislature shall not enact laws that hinder the right of Qualifying Patients to access marijuana for medical use as granted by this section.

7\. Additional Provisions

(1) Nothing in this section permits a person to:

(a) Consume marijuana for medical use in a jail or correctional Facility;

(b) Undertake any task under the influence of marijuana when doing so would constitute negligence or professional malpractice; or

(c) Operate, navigate, or be in actual physical control of any dangerous device or motor vehicle, aircraft or motorboat while under the influence of marijuana; or

(d) Bring a claim against any employer, former employer, or prospective employer for wrongful discharge, discrimination, or any similar cause of action or remedy, based on the employer, former employer, or prospective employer prohibiting the employee, former employee, or prospective employee from being under the influence of marijuana while at work or disciplining the employee or former employee, up to and including termination from employment, for working or attempting to work while under the influence of marijuana.

(2) No Medical Marijuana Cultivation Facility, Medical Marijuana Testing Facility, Medical Marijuana Dispensary Facility, or Medical Marijuana-Infused Products Manufacturing Facility, or entity with a transportation certification shall be owned, in whole or in part, or have as an officer, director, board member, manager, or employee, any individual with a disqualifying felony offense. A “disqualifying felony offense” is a violation of, and conviction or guilty plea to, state or federal law that is, or would have been, a felony under Missouri law, regardless of the sentence imposed, unless the Department determines that:

(a) The person’s conviction was for the medical use of marijuana or assisting in the medical use of marijuana; or

(b) The person’s conviction was for a non-violent crime for which he or she was not incarcerated and that is more than five years old, or

(c) More than five years have passed since the person was released from parole or probation, and he or she has not been convicted of any subsequent criminal offenses.

The Department may consult with and rely on the records, advice and recommendations of the Attorney General and the Department of Public Safety, or their successor entities, in applying this subdivision.

(3) All Medical Marijuana Cultivation Facility, Medical Marijuana Dispensary Facility, and Medical Marijuana-Infused Products Manufacturing Facility licenses, entities with Medical Marijuana Testing Facility certifications, and entities with transportation certifications shall be held by entities that are majority owned by natural persons who have been citizens of the state of Missouri for at least one year prior to the application for such license or certification. Notwithstanding the foregoing, entities outside the state of Missouri may own a minority stake in such entities.

(4) No Medical Marijuana Cultivation Facility, Medical Marijuana Dispensary Facility, or Medical Marijuana-Infused Products Manufacturing Facility shall manufacture, package or label marijuana or marijuana-infused products in a false or misleading manner. No person shall sell any product in a manner designed to cause confusion between a marijuana or marijuana-infused product and any product not containing marijuana. A violation of this subdivision shall be punishable by an appropriate and proportional Department sanction, up to and including loss of license.

(5) All edible marijuana-infused products shall be sold in individual, child-resistant containers that are labeled with dosage amounts, instructions for use, and estimated length of effectiveness. All marijuana and marijuana-infused products shall be sold in containers clearly and conspicuously labeled, in a font size at least as large as the largest other font size used on the package, as containing “Marijuana,” or a “Marijuana-Infused Product.” Violation of this prohibition shall subject the violator to Department sanctions, including an administrative penalty.

(6) No individual shall serve as the Primary caregiver for more than three Qualifying Patients.

(7) No Qualifying Patient shall consume marijuana for medical use in a public place, unless provided by law. Violation of this prohibition shall subject the violator to sanctions as provided by general law.

(8) No person shall extract resins from marijuana using dangerous materials or combustible gases without a Medical Marijuana-Infused Products Manufacturing Facility license. Violation of this prohibition shall subject the violator to Department sanctions, including an administrative penalty and, if applicable, loss of their identification card, certificate, or license for up to one year.

(9) All Qualifying Patient cultivation shall take place in an enclosed, locked facility that is equipped with security devices that permit access only by the Qualifying Patient or by such patient’s Primary caregiver. Two Qualifying Patients, who both hold valid Qualifying Patient cultivation identification cards, may share one enclosed, locked Facility. No more than twelve Qualifying Patient or Primary caregiver cultivated flowering marijuana plants may be cultivated in a single, enclosed locked facility, except when a Primary caregiver also holds a Qualifying Patient cultivation identification card, in which case no more than eighteen flowering marijuana plants may be cultivated in a single, enclosed, locked facility.

(10) No Medical Marijuana Cultivation Facility, Medical Marijuana Dispensary Facility, Medical Marijuana-Infused Products Manufacturing Facility, Medical Marijuana Testing Facility, or entity with a transportation certification shall assign, sell, give, lease, sublicense, or otherwise transfer its license or certificate to any other entity without the express consent of the Department, not to be unreasonably withheld.

(11) Unless allowed by the local government, no new Medical Marijuana Cultivation Facility, Medical Marijuana Testing Facility, Medical Marijuana Dispensary Facility, or Medical Marijuana-Infused Products Manufacturing Facility shall be initially sited within one thousand feet of any then-existing elementary or secondary school, child day-care center, or church. No local government shall prohibit Medical Marijuana Cultivation Facilities, Medical Marijuana Testing Facilities, Medical Marijuana-Infused Products Manufacturing Facilities, or Medical Marijuana Dispensary Facilities, or entities with a transportation certification either expressly or through the enactment of ordinances or regulations that make their operation unduly burdensome in the jurisdiction. However, local governments may enact ordinances or regulations not in conflict with this section, or with regulations enacted pursuant to this section, governing the time, place, and manner of operation of such facilities in the locality. A local government may establish civil penalties for violation of an ordinance or regulations governing the time, place, and manner of operation of a Medical Marijuana Cultivation Facility, Medical Marijuana Testing Facility, Medical Marijuana-Infused Products Manufacturing Facility, Medical Marijuana Dispensary Facility, or entity holding a transportation certification that may operate in such locality.

(12) Unless superseded by federal law or an amendment to this Constitution, a physician shall not certify a qualifying condition for a patient by any means other than providing a physician certification for the patient, whether handwritten, electronic, or in another commonly used format. A Qualifying Patient must obtain a new physician certification at least annually.

(13) A physician shall not issue a certification for the medical use of marijuana for a non-emancipated Qualifying Patient under the age of eighteen without the written consent of the Qualifying Patient’s parent or legal guardian. The Department shall not issue a Qualifying Patient identification card on behalf of a non-emancipated Qualifying Patient under the age of eighteen without the written consent of the Qualifying Patient’s parent or legal guardian. Such card shall be issued to one of the parents or guardians and not directly to the patient. Only a parent or guardian may serve as a Primary caregiver for a non-emancipated Qualifying Patient under the age of eighteen. Only the Qualifying Patient’s parent or guardian shall purchase or possess medical marijuana for a non-emancipated Qualifying Patient under the age of eighteen. A parent or guardian shall supervise the administration of medical marijuana to a non-emancipated Qualifying Patient under the age of eighteen.

(14) Nothing in this section shall be construed as mandating health insurance coverage of medical marijuana for Qualifying Patient use.

(15) Real and personal property used in the cultivation, manufacture, transport, testing, distribution, sale, and administration of marijuana for medical use or for activities otherwise in compliance with this section shall not be subject to asset forfeiture solely because of that use.

8\. Severability

The provisions of this section are severable, and if any clause, sentence, paragraph or section of this measure, or an application thereof, is adjudged invalid by any court of competent jurisdiction, the other provisions shall continue to be in effect to the fullest extent possible.

9\. Effective Date

The provisions of this section shall become effective on December 6, 2018.

[10]

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### Full text[edit]

The full text of the measure is available here.

### Readability score[edit]

See also: Ballot measure readability scores, 2018
Using the Flesch-Kincaid Grade Level (FKGL) and Flesch Reading Ease (FRE) formulas, Ballotpedia scored the readability of the ballot title and summary for this measure. Readability scores are designed to indicate the reading difficulty of text. The Flesch-Kincaid formulas account for the number of words, syllables, and sentences in a text; they do not account for the difficulty of the ideas in the text. The secretary of state wrote the ballot language for this measure.

The FKGL for the ballot title is grade level 16, and the FRE is 11. The word count for the ballot title is 103, and the estimated reading time is 27 seconds. The FKGL for the ballot summary is grade level 16, and the FRE is 14. The word count for the ballot summary is 164, and the estimated reading time is 43 seconds.

In 2018, for the 167 statewide measures on the ballot, the average ballot title or question was written at a level appropriate for those with between 19 and 20 years of U.S. formal education (graduate school-level of education), according to the FKGL formula. Read Ballotpedia's entire 2018 ballot language readability report here.

## Support[edit]

New Approach Missouri led the campaign in support of Amendment 2.[13]

### Supporters[edit]

#### Officials[edit]

* U.S. Sen. McCaskill (D) (also endorsed Proposition C)[14]

#### Organizations[edit]

* Epilepsy Foundation of Missouri and Kansas[15]
* National Organization for the Reform of Marijuana Laws (NORML)[16]
* Our Revolution[17]

### Arguments[edit]

* Justin Strekal, political director of NORML, stated, "This is a patient-centered proposal that puts power in the hands of state-licensed physicians and their patients, not politicians or bureaucrats. Passage of Amendment 2 will create a robust statewide system for production and sale of medical cannabis. Of the three proposals on the ballot this fall, we believe that Amendment 2 is the clear choice for voters.”[16]

* Tom Mundell, chairman of the Missouri Association of Veterans’ Organizations, said, "We can dramatically improve the lives of thousands of Missouri veterans by passing this critical medical marijuana initiative petition. Our proposal will both provide veterans suffering illnesses much-needed relief and provide resources for underfunded veterans health care programs throughout Missouri."[18]

## Opposition[edit]

### Opponents[edit]

* Missouri State Medical Association[19]
* Kansas City Medical Society[20]
* Kansas City Academy of Family Physicians[20]
* Missouri Association of Osteopathic Physicians and Surgeons[20]
* Missouri Society of Eye Physicians and Surgeons[20]
* Missouri Psychiatric Physicians Association[20]
* Missouri College of Emergency and Physicians[20]
* Missouri Pharmacy Association[20]
* St. Louis Metropolitan Medical Society[20]
* Greene County Medical Society[20]

### Arguments[edit]

* The Missouri State Medical Association said, "The Missouri State Medical Association opposes the three “medical” marijuana ballot questions that will be offered to Missouri voters in November. MSMA acknowledges there are a limited number of patients who may receive limited relief from minor pain and nausea, but numerous studies have identified negative health effects for a large number of diagnoses. Until the DEA reclassifies marijuana to allow extensive scientific research, MSMA remains concerned Missourians will be gambling with their health using an unregulated drug."[21]
* Brandon Costerison, MO-HOPE project manager at NCADA, stated, "Very few things that get passed … get it right the first time, and there’s always unforeseen circumstances. So we know that a legislative or statutory change to create a system would be the most effective so that we can address unforeseen consequences that come down the road; maybe it’s an expansion of conditions that are eligible or ways to regulate dosing."[22]

## Campaign finance[edit]

See also: Campaign finance requirements for Missouri ballot measures
Total campaign contributions:

Support: |  $1,777,322.18
Opposition: |  $9,700.00

There was one campaign committee, New Approach Missouri (NAM), registered in support of the ballot initiative. The committee raised $1.78 million and spent $1.70 million. NAM was also registered as spending funds to oppose Amendment 3.[9]

The top contributor to New Approach Missouri was Drug Policy Action, which contributed $258,000.[9]

There was one campaign committee, Citizens For SAFE Medicine, registered in opposition to the ballot initiative, along with the other two medical marijuana measures on the ballot in Missouri. The committee raised $9,700, including $3,000 from Smart Approaches to Marijuana and $3,000 from Council for Drug Free Youth.[9]

### Support[edit]

The following were contribution and expenditure totals for the committee supporting the initiative.[9]

| Committees in support of Amendment 2

Supporting committees| Cash contributions| In-kind services| Cash expenditures
New Approach Missouri| $1,569,794.04| $207,528.14| $1,488,633.30
Total| $1,569,794.04| $207,528.14| $1,488,633.30
| Totals in support

Total raised:| $1,777,322.18
Total spent:| $1,696,161.44

#### Donors[edit]

The following were the top five donors who contributed to New Approach Missouri:[9]

Donor  |  Cash  |  In-kind  |  Total

|
|
|

Drug Policy Action |  $258,000.00  |  $0.00  |  $258,000.00
New Approach PAC |  $0.00  |  $188,470.00  |  $188,470.00
Belleau Farms/Adulphus Busch IV  |  $125,000.00  |  $0.00  |  $125,000.00
Seven Points LLC |  $125,000.00  |  $0.00  |  $125,000.00
Larry Malaschock |  $110,000.00  |  $0.00  |  $110,000.00

### Opposition[edit]

The following were contribution and expenditure totals for the committee opposing the initiative.[9]

| Committees in opposition to Amendment 2

Opposing committees| Cash contributions| In-kind services| Cash expenditures
Citizens For SAFE Medicine| $9,700.00| $0.00| $13,896.34
Total| $9,700.00| $0.00| $13,896.34
| Totals in opposition

Total raised:| $9,700.00
Total spent:| $13,896.34

#### Donors[edit]

The following were the top donors who contributed to Citizens For SAFE Medicine:[9]

Donor  |  Cash  |  In-kind  |  Total

|
|
|

Council for Drug Free Youth |  $3,000.00  |  $0.00  |  $3,000.00
Smart Approaches to Marijuana |  $3,000.00  |  $0.00  |  $3,000.00
John Hagan |  $2,000.00  |  $0.00  |  $2,000.00
Tri County Mental Health |  $1,000.00  |  $0.00  |  $1,000.00

### Methodology[edit]

To read Ballotpedia's methodology for covering ballot measure campaign finance information, click here.

## Media editorials[edit]

### Support[edit]

* Joplin Globe: "Having three measures on the ballot at the same time is confusing, but for a number of reasons, Amendment 2 clearly stands out as the best option for our state. ... Voters in Missouri who support legalizing medical marijuana should vote yes on Amendment 2, no on Amendment 3 and no on Proposition C."[23]
* St. Louis Post-Dispatch: "Having dissected the three measures — Constitutional Amendments 2 and 3, and Proposition C — we recommend Amendment 2. ... So why is Amendment 2 superior? The first issue isn’t about marijuana, but our Legislature — which has a history of arrogantly reversing ballot propositions voters pass but that legislators don’t like. If voters legalize medical marijuana via Prop C, lawmakers could reverse it because it’s a mere statutory change. ... Between Amendment 2 and Amendment 3, we prefer the earmarked use of the money in Amendment 2, which will go for veteran health services, a tangible benefit to the state. Amendment 3 would use its proceeds to create and fund a cancer research institute — a goal no one would denigrate, but one that shouldn’t take precedence over Missourians’ more immediate needs."[24]

### Opposition[edit]

Ballotpedia did not find any media editorial boards opposing Amendment 2. If you are aware of an editorial, please email it to editor@ballotpedia.org.

## Background[edit]

### State medical marijuana policies[edit]

As of September 2018, 31 states and Washington, D.C., had passed laws legalizing or decriminalizing medical marijuana. An additional 16 states, including Missouri, had legalized the medical use of cannabidiol (CBD), also known as cannabis oil—one of the non-psychoactive ingredients found in marijuana.[25] The following map illustrates the legal status of medical marijuana in the states:[7]

### Federal medical marijuana policies[edit]

In 2014, the U.S. Congress passed a law, known as the Rohrabacher–Farr amendment, that prohibited federal agents from raiding medical marijuana growers in states where medical marijuana is legal. The Rohrabacher–Farr amendment was a provision of an omnibus spending bill, and thus needed to be renewed each fiscal year to remain in effect. As of 2018, Congress had continued to pass the amendment in each annual spending bill.

On May 1, 2017, Attorney General Jeff Sessions (R) asked Congress to not renew the Rohrabacher–Farr amendment for the upcoming fiscal year, which began on October 1, 2017.[26] Congress, however, approved the Rohrabacher–Farr amendment for the fiscal year ending on September 30, 2018.[8]

## Path to the ballot[edit]

See also: Laws governing the initiative process in Missouri

### Process[edit]

In Missouri, the number of signatures required to qualify an initiated constitutional amendment for the ballot is equal to 8 percent of the votes cast for governor in the previous gubernatorial election in six of the eight state congressional districts. Signatures must be filed with the secretary of state six months prior to the election.

The requirements to get an initiated constitutional amendment certified for the 2018 ballot:

* Signatures: The smallest possible requirement was 160,199 valid signatures. The actual requirement depends on the congressional districts in which signatures were collected.
* Deadline: The deadline to submit signatures was May 6, 2018.

Once the signatures have been filed with the secretary of state, the secretary copies the petition sheets and transmits them to county election authorities for verification. The secretary of state may choose whether the signatures are to be verified by a 5 percent random sample or full verification. If the random sampling projects between 90 percent and 110 percent of required signatures, a full check of all signatures is required. If more than 110 percent, the initiative is certified, and, if less than 90 percent, the initiative fails.

### Initiative 2018-51[edit]

Sheila Dundon, a member of New Approach Missouri, filed five different versions of the initiative with the secretary of state's office between November 18 and November 28, 2016.[11] In December 2016, Dundon said activists had surveyed the state and were confident that voters would approve the measure.[27] New Approach Missouri selected one of the proposals—Initiative 2018-051—to collect signatures for.[28] The initiative was approved for signature gathering on January 5, 2017.[11]

In October 2017, Jack Cardetti, a representative of New Approach Missouri, said that the group had collected about 100,000 signatures.[29] On February 20, 2018, New Approach Missouri reported that more than 200,000 signatures had been collected.[30]

On May 4, 2018, New Approach Missouri reported filing more than 370,000 signatures for the ballot initiative.[31] On August 2, 2018, Ashcroft announced that the ballot initiative qualified to appear on the ballot.

Cost of signature collection:
Sponsors of the measure hired Fieldworks, LLC to collect signatures for the petition to qualify this measure for the ballot. A total of $530,296.96 was spent to collect the 160,199 valid signatures required to put this measure before voters, resulting in a total cost per required signature (CPRS) of $3.31.

#### Bradshaw v. New Approach Missouri[edit]

Lawsuit overview

Issue: Did Amendment 2's petitioners violate the legal requirements of the signature gathering process?
Court: Cole County Circuit Court and Missouri Court of Appeals
Ruling: Courts dismissed the case, saying Bradshaw did not have standing to challenge how signatures were gathered
Plaintiff(s): Brad Bradshaw| Defendant(s): New Approach Missouri
Plaintiff argument:
Petitioners for Amendment 2 violated the legal requirements of the signature gathering process. | Defendant argument:
Plaintiffs' argument is unfounded.
Source: The Joplin Globe

On August 10, 2018, Brad Bradshaw, backer of the medical marijuana measure Amendment 3, filed litigation alleging that New Approach Missouri, which sponsored Amendment 2’s signature drive, “ran an intentional, systematic, pervasive, and ubiquitous pattern of instructing individuals to violate the legal requirements of the petition signature gathering process.” He also filed litigation against Amendment C. He asked the Cole County Court to remove Amendment 2 from the general election ballot.[32]

Jack Cardetti, a spokesperson for New Approach Missouri, said, "These are all desperate claims because Mr. Bradshaw knows he won't have any support at the ballot box. New Approach is a coalition of literally thousands of patients, doctors and veterans that have come together to get this done, while Mr. Bradshaw has tried and failed to get anyone to support his measure besides himself.”[33]

On August 31, 2018, Judge Pat Joyce dismissed Bradshaw’s lawsuit against Amendment 2, saying, “The Missouri Supreme Court has already ruled that once the signatures have been submitted to the Secretary of State and verified by local election authorities the only relevant issue at this point is whether the signatures are those of registered voters, not whether each signature was collected in complete compliance with statutory requirements.”[34]

Bradshaw appealed the case to the Missouri Court of Appeals in Kansas City.[35] On September 18, 2018, the Court of Appeals upheld the lower court's ruling, saying, "[Judge Pat Joyce] did not err in granting the Intervenors' motion to dismiss Bradshaw's petition for failure to state a claim."[36]

## How to cast a vote[edit]

See also: Voting in Missouri

### Poll times[edit]

In Missouri, all polling places are open from 6:00 a.m. to 7:00 p.m. Central Time. An individual who is in line at the time polls close must be allowed to vote.[37]

### Registration requirements[edit]

To vote in Missouri, one must be 18 years old, a United States citizen, and Missouri resident.[38] An applicant may print an application, pick one up from a county clerk's office, or request that an application be mailed. The completed application must be returned by mail. All returned applications must be postmarked at least 27 days prior to Election Day in order to be processed. An applicant may also register to vote online.[38]

### Automatic registration[edit]

Missouri does not practice automatic voter registration.

### Online registration[edit]

See also: Online voter registration

Missouri has implemented an online voter registration system. Residents can register to vote by visiting this website.

### Same-day registration[edit]

Missouri does not allow same-day voter registration.

### Residency requirements[edit]

To register to vote in Missouri, you must be a resident of the state. State law does not specify a length of time for which you must have been a resident to be eligible.

### Verification of citizenship[edit]

See also: Laws permitting noncitizens to vote in the United States

Missouri requires those registering to vote by mail for the first time to provide a form of identification that shows proof of United States citizenship.[39]

### Verifying your registration[edit]

The Missouri Secretary of State's office allows residents to check their voter registration status online.

### Voter ID requirements[edit]

Missouri requires voters to present identification while voting. Identification with or without a photo can be used.[40]

The following were accepted forms of identification as of October 2019. Click here for the Missouri Secretary of State's page on accepted ID to ensure you have the most current information.

Voters can present the following forms of information:

* Nonexpired Missouri driver’s license
* Nonexpired or nonexpiring Missouri non-driver license
* Nonexpired document which contains the voter's name, the voter’s photograph, and is issued by the United States or the state of Missouri
* Nonexpired or nonexpiring military ID card with a photograph
* Identification issued by the state of Missouri, an agency of the state, or a local election authority of the state
* Identification issued by the United States government or agency thereof
* Identification issued by an institution of higher education, including a university, college, vocational and technical school, located within the state of Missouri
* Copy of a current utility bill, bank statement, paycheck, government check or other government document that contains the name and address of the voter

If a voter does not have an ID, he or she can obtain one for free by filling out this form.

#### Background[edit]

On January 14, 2020, the Missouri Supreme Court, in a 5-2 ruling, upheld a lower court's decision striking down a state law that required voters without photo ID to sign affidavits before voting. Consequently, voters in Missouri may present either photo or non-photo identification at the polls and cast regular ballots without signing affidavits.[41]

On October 9, 2018, Richard Callahan, a state court judge, originally enjoined the affidavit provision. Callahan found that the affidavit's language was "contradictory and misleading," requiring signers to "swear that they do not possess a form of personal identification approved for voting while simultaneously presenting to the election authority a form of personal identification that is approved." Callahan ordered officials to desist from executing the affidavit for voters presenting non-photo ID at the polls. Callahan also ordered officials not to distribute any materials indicating that a photo ID is required to vote. State officials appealed to the state supreme court, asking the court to stay Callahan's order. On October 19, 2018, the state supreme court denied the request for a stay, but permitted the appeal to proceed. This allowed Callahan's order to stand in advance of the November 6, 2018, election.[42][43]

The state supreme court heard oral arguments in the appeal in October 2019. Justice Mary Rhodes Russell penned the court's opinion, which was joined by Chief Justice George Draper and Justices Paul C. Wilson, Patricia Breckenridge, and Laura Denvir Stith. Justices Wesley Brent Powell and Zel Fischer dissented. Russell wrote, "Because the affidavit requirement of sections 115.427.2(1) and 115.427.3 is misleading and contradictory, the circuit court’s judgment declaring the affidavit requirement unconstitutional is affirmed. Further, the circuit court did not err in enjoining the State from requiring individuals who vote under the non-photo identification option provided in section 115.427.2(1) to execute the affidavit or in enjoining it from disseminating materials indicating photo identification is required to vote."[41]

Powell, joined by Fischer, wrote the following in his dissent: "If the affidavit requirement set forth in section 155.4271 is ambiguous, contradictory, and unconstitutional as the principal opinion proclaims, the opinion errs in severing the entire affidavit requirement without also severing the non-photo identification option set out in section 115.427.2 in its entirety. Because the legislature would not have enacted the non-photo identification option without an accompanying affidavit requirement, the principal opinion’s remedy is contrary to law."[41] As of April 2021, 35 states enforced (or were scheduled to begin enforcing) voter identification requirements. A total of 21 states required voters to present photo identification at the polls; the remainder accepted other forms of identification. Valid forms of identification differ by state. Commonly accepted forms of ID include driver's licenses, state-issued identification cards, and military identification cards.[44][45]

## See also[edit]

2018 measures

* 2018 ballot measures
* Marijuana on the ballot
* 2018 legislative sessions
* Federal policy on marijuana, 2017-2018

Missouri

* Missouri ballot measures
* Missouri ballot measure laws
* Marijuana laws in the United States

News and analysis

* Ballot measure lawsuits
* Ballot measure readability
* Ballot measure polls
* History of marijuana on the ballot

|
|

## External links[edit]

### Information[edit]

* Missouri Initiative 2018-051

### Support[edit]

* New Approach Missouri
* New Approach Missouri Facebook
* New Approach Missouri Facebook Twitter

## Footnotes[edit]

1. ↑ 1.0 1.1 1.2 Missouri Secretary of State, "Petition 2018-051," November 28, 2016
2. ↑ FindLaw, "Missouri Revised Statutes Title IX. Suffrage and Elections § 116.320. Adoption of measure, vote required--effect of approval of conflicting measures," accessed September 9, 2018
3. ↑ Springfield News-Leader, "Dueling Missouri tobacco tax initiatives causing confusion," October 21, 2016
4. ↑ St. Louis Public Radio, "Lawsuit Targets Residency Requirement For Missouri Medical Marijuana Licenses," December 16, 2020
5. ↑ Missouri Independent, "Judge rejects residency requirement for Missouri medical marijuana licenses," June 28, 2021
6. ↑ St. Louis Today, "Judge rejects Missouri’s residency rule for medical marijuana," October 12, 2021
7. ↑ 7.0 7.1 National Conference of State Legislatures, "State Medical Marijuana Laws," September 6, 2018
8. ↑ 8.0 8.1 Vanderbilt University Law School, "Congress Renews DOJ Spending Rider," March 28, 2018
9. ↑ 9.0 9.1 9.2 9.3 9.4 9.5 9.6 9.7 Missouri Ethics Commission, "Candidate or Committee Name Search," accessed July 26, 2018
10. ↑ 10.0 10.1 10.2 10.3 10.4 10.5 Note: This text is quoted verbatim from the original source. Any inconsistencies are attributable to the original source. Cite error: Invalid `<ref>` tag; name "quotedisclaimer" defined multiple times with different content
11. ↑ 11.0 11.1 11.2 Missouri Secretary of State, "2018 Initiative Petitions Approved for Circulation in Missouri," accessed January 12, 2017
12. ↑ Missouri Secretary of State, "2018 Ballot Measures," accessed October 8, 2018
13. ↑ New Approach Missouri, "Homepage," accessed August 31, 2018
14. ↑ Springfiled News-Leader, "McCaskill celebrates defeat of 'right-to-work' while calling Hawley out of touch," August 24, 2018
15. ↑ The Missouri Times, "Epilepsy Foundation endorses Amendment 2 for patients to access medical marijuana," August 29, 2018
16. ↑ 16.0 16.1 NORML, "NORML Endorses Missouri’s Amendment 2," September 5, 2018
17. ↑ Our Revolution, "Ballot Initiatives," accessed October 8, 2018
18. ↑ The Missouri Times, "New Approach to get head start on medical marijuana ballot measure," February 17, 2017
19. ↑ Buffalo Reflex, "Missouri doctors oppose marijuana ballot questions," August 23, 2018
20. ↑ 20.0 20.1 20.2 20.3 20.4 20.5 20.6 20.7 20.8 ’’Ballotpedia staff’’, “E-mail with Monica Meeks," October 31, 2018
21. ↑ Missouri State Medical Association, "Missouri Physicians Oppose Marijuana Ballot Questions," August 17, 2018
22. ↑ St. Louis Public Radio, "Pro & Con: Will Missourians pass an initiative to legalize medical marijuana?" October 30, 2018
23. ↑ Joplin Globe, "Our view: Vote yes on Amendment 2," October 21, 2018
24. ↑ St. Louis Post-Dispatch, "Editorial: Amendment 2 is the best of three ballot measures to legalize medical marijuana," October 11, 2018
25. ↑ LA Times, "Congress quietly ends federal government's ban on medical marijuana," December 16, 2014
26. ↑ The Daily Chronic, "Federal Medical Marijuana Protections Temporarily Extended (Again)," December 22, 2017
27. ↑ KOMU, "Missouri medical marijuana activists aim for 2018," December 21, 2016
28. ↑ New Approach Missouri, "Initiative 2018-051," November 28, 2016
29. ↑ St. Louis Dispatch, "Missouri groups try again to get medical marijuana on the ballot," October 30, 2017
30. ↑ New Approach Missouri, "200k signatures!" February 20, 2018
31. ↑ Riverfront Times, "New Approach Missouri Turns In Signatures for Medical Marijuana Initiative," May 4, 2018
32. ↑ The Joplin Globe, "Marijuana initiative organizer sues to get other two removed from ballot," August 13, 2018
33. ↑ Cite error: Invalid `<ref>` tag; no text was provided for refs named `lawsuit`
34. ↑ News Tribune, “Judge rejects 1 of 2 medical marijuana lawsuits,” August 31, 2018
35. ↑ News Tribune, “Bradshaw's lawyer appeals Joyce's ruling after she dismissed his lawsuit,” September 4, 2018
36. ↑ News Tribune, "Appeals court rules to keep marijuana amendment on ballot," September 21, 2018
37. ↑ Missouri Secretary of State - Elections and Voting, "Frequently Asked Questions," accessed October 17, 2019
38. ↑ 38.0 38.1 Missouri Secretary of State, "Register to Vote," accessed October 4, 2019
39. ↑ Missouri Secretary of State, “Missouri Voter Registration Application,” accessed October 4, 2019
40. ↑ Missouri Secretary of State, "How To Vote," accessed October 27, 2019
41. ↑ 41.0 41.1 41.2 Supreme Court of Missouri, "Priorities USA v. Missouri: Appeal from the Circuit Court of Cole County," January 14, 2020
42. ↑ Circuit Court of Cole County, Missouri, "Priorities USA, et al. v Missouri: Order and Judgment," October 9, 2018
43. ↑ St. Louis Post-Dispatch, "Missouri’s controversial voter photo ID rules ‘eviscerated’ by state Supreme Court," January 15, 2020
44. ↑ National Conference of State Legislatures, "Voter Identification Requirements|Voter ID Laws," June 5, 2017
45. ↑ The Washington Post, "Do I need an ID to vote? A look at the laws in all 50 states," October 27, 2014

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