The Iowa House of Representatives passed a bill on Tuesday that would add more qualifying medical conditions to the state’s medical marijuana program and change the cap on THC for patients. The bill, House File 2589, was passed by a vote of 52 to 46.

Under the bill, post-traumatic stress disorder and “severe, intractable autism with self-injurious or aggressive behaviors” would be added to the state’s list of medical conditions that qualify a patient to use medical marijuana. The measure also changes “untreatable” pain to “chronic” pain on the list.

Additionally, the bill adds physician assistants, podiatrists, advanced registered nurse practitioners, and advanced practice registered nurses to the list of health care practitioners who are permitted to certify patients to use medicinal cannabis. But a change in the cap on the amount of THC a patient can receive that is also included in the bill has some Democrats describing the bill as a step backward for the program.

Under Iowa’s current program, only medical marijuana products with less than 3% THC are allowed. The bill passed on Tuesday changes that to a limit of 4.5 grams of total THC per patient in a 90-day period. The cap would be waived for the terminally ill and if a doctor determines that 4.5 grams is not enough THC to treat a patient’s condition. Capsules, extracts, and topicals are permitted but smoking cannabis is not legal.

A Step Backward for Patients

Democratic Rep. John Forbes, who is also a pharmacist, said that the change represents a “big step backwards” for patients who currently use more THC.

“I’ve had a couple of patients tell me if we pass legislation that limits it to the 50 milligrams per day, which is the 4.5 grams per 90 days, they will probably drop off the program — and they’ll have to have something for pain relief, so they’ll go back on their opioid medications,” Forbes said.

The new THC limit follows the recommendation of the state’s Medical Cannabidiol Board, which is made up of health professionals and members of law enforcement. The cap is also supported by Republican Gov. Kim Reynolds, who last year vetoed a bipartisan measure that would have set the cap at 25 grams of THC every 90 days.

Rep. Jarad Klein said that the 4.5 gram THC limit is supported by most of his fellow Republicans in the House.

“We based a lot of this on the advice of very smart medical professionals because in the state of Iowa we have a medical program, not a recreational program masquerading as a medical program,” Klein said. “And that’s the way we’re going to keep it.”

Before the bill was passed, Democrats in the House tried to amend the bill to 25 grams of THC per 90 days and then a compromise limit of 15 grams, but both attempts failed.

“They may want a compromise that’s higher, but I think the governor’s given us a pretty clear indication of what she wants,” said Klein. “And, based on last year, we know she’s not afraid to veto a bill that she doesn’t think is right, especially in this area.”

The bill now heads to the Iowa Senate, where another bill that would set the THC limit at 25 grams per 90-day period is also under consideration and has been advanced in committee.