The Iowa House has passed a bill that would change how much THC patients can receive through the state's medical marijuana program, add more qualifying conditions and allow more health care practitioners to recommend Iowans be added to the program.

The bill, which passed on a vote of 52-46, follows the recommendation of a state advisory board and is in line with what Republican Gov. Kim Reynolds said she is comfortable with signing, but Democrats called it a step backward for the program.

The bill would replace Iowa's current percentage-based limit, which allows medical marijuana products to contain up to 3% THC, with a per-patient limit of 4.5 grams of THC in a 90-day period.

There are two exceptions to the THC limit: The bill would allow patients to exceed 4.5 grams of THC if a doctor determines that amount is insufficient to treat their condition, or if they are terminally ill.

Iowa's program allows capsules, extracts, concentrates, lotions, ointments and tinctures. Smoking medical or recreational marijuana remains prohibited in Iowa.

Rep. John Forbes, D-Urbandale, said a 4.5-gram limit would be "a big step backwards" from how the current law operates. Forbes, a pharmacist, said he has patients who currently receive more THC than would be allowed under the bill's proposed gram limit.

"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.

Last year, Reynolds vetoed a bipartisan bill that would have put the THC limit at 25 grams over 90 days. At the time, she said the state must move cautiously in expanding the program.

Since Reynolds' veto, lawmakers have been looking for a compromise that she would be willing to sign. With Tuesday's vote, the House bill becomes eligible for consideration in the Iowa Senate, where a committee has advanced a separate bill that would put the limit at 25 grams.

Democrats tried unsuccessfully on Tuesday to amend the bill to raise the THC limit to 25 grams over 90 days. The House also voted down Democratic amendments that attempted to compromise on the gram limit and raise it to 15 grams.

"This bill still has work that needs done to it. I would like to see us vote this bill down (and) continue to have conversations with the Senate," said Rep. Wes Breckenridge, D-Newton, shortly before the bill's final passage.

In February, Reynolds said she agreed with the state Medical Cannabidiol Board's recommendation of 4.5 grams of THC per patient over a 90-day period. The board is made up of physicians and law enforcement personnel and makes recommendations about the program's scope.

That public statement from Reynolds gave lawmakers a signal about what she would be willing to sign, said Rep. Jarad Klein, R-Keota, the floor manager for the House bill.

Klein said House Republicans, on the whole, have not been interested in going beyond the recommendations of the Medical Cannabidiol Board.

"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."

Sen. Brad Zaun, R-Urbandale, the floor manager for the Senate bill, said Tuesday that he expects the Senate to take up the House's bill as the vehicle for making any changes to the state's program this year.

Zaun said he recognizes that the 25-gram limit in his bill "was shooting for the stars," but he said he still intends to negotiate with the Senate and Reynolds' office for a higher THC amount.

"I recognize that mine’s probably too high, but I’m willing to negotiate. What we don’t want to do is we don’t want to send a bill that the governor disagrees with like last time," Zaun said.

Klein said he's not interested in negotiating a higher THC limit in the bill and pointed to Reynolds' comments on the subject.

"They may want a compromise that’s higher, but I think the governor’s given us a pretty clear indication of what she wants," Klein said. "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 also makes other changes to the program, including adding post-traumatic stress disorder and "severe, intractable autism with self-injurious or aggressive behaviors" to the list of medical conditions that are treatable through the program. It also replaces "untreatable" pain with "chronic" pain on that list. And it adds physician assistants, podiatrists, advanced registered nurse practitioners and advanced practice registered nurses to the list of health care practitioners allowed to certify patients to receive registration cards to participate in the program.

Stephen Gruber-Miller covers the Iowa Statehouse and politics for the Register. He can be reached by email at sgrubermil@registermedia.com or by phone at 515-284-8169. Follow him on Twitter at @sgrubermiller.

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