Iowa, Medical Cannabis, and Federalism

“The med­i­c­i­nal prop­er­ties of the cannabis plant have been known for mil­len­nia.”  Lam­bert Ini­tia­tive for Cannabi­noid Ther­a­peu­tics, His­to­ry of cannabis, The Uni­ver­si­ty of Syd­ney.

Iowa clas­si­fied cannabis as a habit-form­ing drug with accept­ed med­ical use in 1921.  1921 Acts ch. 282.

In 1967, the Unit­ed States entered into an inter­na­tion­al agree­ment clas­si­fy­ing cannabis as hav­ing no med­ical use.  Sin­gle Con­ven­tion on Nar­cot­ic Drugs, May 25, 1967, 18 U.S.T. 1407, 520 U.N.T.S. 151.  The Sin­gle Con­ven­tion allows excep­tions.  Arti­cle 36(2):

Sub­ject to the con­sti­tu­tion­al lim­i­ta­tions of a Par­ty, its legal sys­tem and domes­tic law, …

Con­gress clas­si­fied cannabis as hav­ing no med­ical use in 1970.  Con­trolled Sub­stances Act, Pub. L. 91–513, 84 Stat. 1242 (Fed­er­al CSA).  The Fed­er­al CSA allows excep­tions.  21 U.S.C. § 822(d):

The Attor­ney Gen­er­al may, by reg­u­la­tion, waive the require­ment for reg­is­tra­tion of cer­tain man­u­fac­tur­ers, dis­trib­u­tors, or dis­pensers if he finds it con­sis­tent with the pub­lic health and safe­ty.

Iowa clas­si­fied cannabis as hav­ing no med­ical use in 1971.  Uni­form Con­trolled Sub­stances Act, 1971 Acts ch. 148 (Iowa CSA).  The Iowa CSA allows excep­tions but only by enact­ing fur­ther leg­is­la­tion.  Iowa enact­ed fur­ther leg­is­la­tion in 2014 autho­riz­ing med­ical use of cannabis extacts.  2014 Acts ch. 1125.  Iowa enact­ed fur­ther leg­is­la­tion in 2017 autho­riz­ing man­u­fac­ture and dis­tri­b­u­tion of cannabis extracts.  2017 Acts ch. 162.

Iowa has not request­ed a waiv­er from the Attor­ney Gen­er­al

Over the past thir­ty (30) years, forty-eight (48) states and sev­er­al fed­er­al ter­ri­to­ries have reversed course, accept­ing what they had pre­vi­ous­ly for­bid­den, med­ical use of cannabis.  The Nation­al Con­fer­ence of State Leg­is­la­tures (NCSL) has a map (click here or click on the map):

The first states to change their laws allowed patients to pos­sess cannabis on the advice of a physi­cian, but with­out any state autho­rized source.  Cal­i­for­nia was the first state to enact such a law in 1996.  Patients had to fig­ure out on their own how to get cannabis and coops began grow­ing it for them.

In 2001, the U.S. Supreme Court held that med­ical neces­si­ty was not a valid defense for a coop grow­ing cannabis for patients in Cal­i­for­nia.  Unit­ed States v. Oak­land Cannabis Buy­ers’ Coop­er­a­tive, 532 U.S. 483 (2001).

In 2002, the U.S. Court of Appeals for the Ninth Cir­cuit held that physi­cians in Cal­i­for­nia rec­om­mend­ing med­ical use of cannabis to their patients were exer­cis­ing free speech pro­tect­ed by the First Amend­ment.  Conant v. Wal­ters, 309 F.3d 629 (9th Cir. 2002), cert. denied, Wal­ters v. Conant, 540 U.S. 946 (2003).

In 2005, the U.S. Supreme Court held that patients in Cal­i­for­nia could not grow their own med­ical cannabis.  Gon­za­les v. Raich, 545 U.S. 1 (2005).

States began licens­ing cannabis grow­ers and dis­pen­saries.  The U.S. Depart­ment of Jus­tice gave these com­mer­cial enter­pris­es a green light, “the exis­tence of a strong and effec­tive state reg­u­la­to­ry sys­tem, and an operation’s com­pli­ance with such a sys­tem, may allay the threat that an operation’s size pos­es to fed­er­al enforce­ment inter­ests.”  James M. Cole Deputy Attor­ney Gen­er­al, Mem­o­ran­dum for All Unit­ed States Attor­neys August 29, 2013, at p. 3.

The Con­gres­sion­al Research Ser­vice reports, “In each fis­cal year since FY2015, Con­gress has includ­ed pro­vi­sions in appro­pri­a­tions acts that pro­hib­it DOJ from using appro­pri­at­ed funds to pre­vent cer­tain states, ter­ri­to­ries, and DC from ‘imple­ment­ing their own laws that autho­rize the use, dis­tri­b­u­tion, pos­ses­sion, or cul­ti­va­tion of med­ical mar­i­jua­na’ (for the most recent pro­vi­sion, see the Con­sol­i­dat­ed Appro­pri­a­tions Act, 2024, P.L. 118–42).” Con­gres­sion­al Research Ser­vice, The Fed­er­al Sta­tus of Mar­i­jua­na and the Pol­i­cy Gap with States (2025).

Under the fed­er­al CSA, users do not reg­is­ter.  21 U.S.C. § 822©(3).  See Raich, 545 U.S. at 28 (“The CSA requires man­u­fac­tur­ers, physi­cians, phar­ma­cies, and oth­er han­dlers of con­trolled sub­stances to com­ply with statu­to­ry and reg­u­la­to­ry pro­vi­sions man­dat­ing reg­is­tra­tion with the DEA”).  The excep­tion under the Fed­er­al CSA only applies to reg­is­tra­tion.  21 U.S.C. § 822(d) (waiv­ing reg­is­tra­tion require­ments “con­sis­tent with the pub­lic health and safe­ty”).

Ignor­ing this pro­tec­tion and plac­ing patients in fed­er­al jeop­ardy vio­lates their civ­il rights.  The state has a duty to pro­vide its cit­i­zens with the pro­tec­tion that fed­er­al­ism defines, 21 U.S.C. § 822(d).

Bond v. Unit­ed States, 564 U.S. 211, 220 (2011) (“The indi­vid­ual, in a prop­er case, can assert injury from gov­ern­men­tal action tak­en in excess of the author­i­ty that fed­er­al­ism defines.  Her rights in this regard do not belong to a State.”).  Bond , 564 U.S. at 221 (“fed­er­al­ism secures to cit­i­zens the lib­er­ties that derive from the dif­fu­sion of sov­er­eign pow­er”).  Bond , 564 U.S. at 223 (“If the con­sti­tu­tion­al struc­ture of our Gov­ern­ment that pro­tects indi­vid­ual lib­er­ty is com­pro­mised, indi­vid­u­als who suf­fer oth­er­wise jus­ti­cia­ble injury may object”).

As Supreme Court Jus­tice Clarence Thomas has point­ed out, “This con­tra­dic­to­ry and unsta­ble state of affairs strains basic prin­ci­ples of fed­er­al­ism and con­ceals traps for the unwary.”  Stand­ing Akim­bo v. Unit­ed States, 594 U.S. ___ (June 28, 2021) (State­ment of Jus­tice Thomas), slip op. at 1.

Forc­ing patients to choose between vio­lat­ing fed­er­al drug law or going with­out treat­ment is a betray­al of fun­da­men­tal rights and expos­es the pub­lic to dan­ger with­out jus­ti­fi­ca­tion.  Safe Streets Alliance v. Hick­en­loop­er, 859 F.3d 865, 884 (10th Cir. 2017) (“Mar­i­jua­na is a con­trolled sub­stance under the CSA.  21 U.S.C. § 802(16).  So the man­u­fac­ture, dis­tri­b­u­tion, and sale of that sub­stance is, by def­i­n­i­tion, rack­e­teer­ing activ­i­ty under RICO.  18 U.S.C. § 1961(1)(A), (D)”).

REQUIRED REPORTS: Iowa Code § 124E.5(5) (“On or before Jan­u­ary 1 of each year, begin­ning Jan­u­ary 1, 2018, the med­ical cannabid­i­ol board shall sub­mit a report detail­ing the activ­i­ties of the board”).

2022 Annu­al Report:  “The Board rec­om­mends that a task force of legal experts be autho­rized, sim­i­lar to the cur­rent board of med­ical experts, to assist the depart­ment in nav­i­gat­ing the legal issues involved with request­ing an exemp­tion for Iowa’s pro­gram from nec­es­sary Fed­er­al agen­cies.  This is relat­ed to a rec­om­men­da­tion in the Board’s 2019 Annu­al Report and the pas­sage of HF2589 in June, 2020.”

2023 Annu­al Report:  “The Board rec­om­mends that a task force of legal experts be autho­rized, sim­i­lar to the cur­rent board of med­ical experts, to assist the Depart­ment in nav­i­gat­ing the legal issues involved with request­ing an exemp­tion for Iowa’s pro­gram from nec­es­sary Fed­er­al agen­cies.  This is relat­ed to a rec­om­men­da­tion in the Board’s 2019 Annu­al Report and the pas­sage of HF2589 in June, 2020.”

2024 Annu­al Report:  The Board rec­om­mends that a task force of legal experts be autho­rized, sim­i­lar to the cur­rent board of med­ical experts, to assist the depart­ment in nav­i­gat­ing the legal issues involved with request­ing an exemp­tion for Iowa’s pro­gram from nec­es­sary Fed­er­al agen­cies.  This is relat­ed to a rec­om­men­da­tion in the Board’s 2019 Annu­al Report and the pas­sage of HF2589 in June, 2020.”