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Three initiatives on the Nov. 6 ballot will give Missouri voters the chance to decide if the use of marijuana for medical issues should be legalized.

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Proposition C

One of the initiatives — Proposition C — would remove state prohibitions on personal use and the possession of medical marijuana with a written certification by a physician who treats a patient diagnosed with a qualifying medical condition.

The conditions specified in the petition — which organizers call the Missouri Patient Care Act — are cancer; epilepsy; glaucoma; intractable migraines (those persistent migraines that don't respond to other treatments); chronic medical conditions that cause 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; debilitating psychiatric disorders (when diagnosed by a state licensed psychiatrist), including but not limited to post-traumatic stress disorder; human immunodeficiency virus or acquired immune deficiency syndrome; chronic medical conditions whose treatment could lead to physical or psychological dependence (if a physician determines cannabis would be effective and safer); any terminal illness; or (in the professional judgment of a physician) any other chronic, debilitating medical condition.

The proposition would legalize growth, possession, production and sale of marijuana for medical purposes by licensed and regulated facilities, their owners and their employees.

Proposition C would impose a 2 percent tax on the retail sale of medical marijuana and would use the funds generated by the tax for veterans' services, drug treatment, early childhood education and for public safety in cities containing medical marijuana facilities.

It is estimated the proposition would require a one-time cost of $2.6 million, with annual costs of $10 million. It would generate about $10 million annually.

"Local government entities estimate no annual costs and are expected to have at least $152,000 in annual revenues," according to the Missouri Secretary of State's Office.

The Missouri Department of Health and Senior Services would oversee regulation of medical marijuana, according to the proposition.

Amendment 2

New Approach Missouri would allow use of marijuana for treatment of similar conditions to the Missouri Patient Care Act.

However, Amendment 2 would impose a 4 percent tax on the retail sale of marijuana for medical use. The revenue would be used to regulate and license procedures for marijuana and marijuana facilities. The provision requires a "seed-to-sale" tracking system to assure no medical marijuana grown by a "cultivation facility" or manufactured by a medical marijuana-infused product facility is sold or transferred outside a dispensary.

Marijuana would be available at dispensary facilities within the state. Dispensaries would collect the taxes and deposit them with the Department of Revenue (in the Missouri Veterans' Health and Care Fund, which would be created). The Missouri Veterans Commission would use the funds for health and care services.

Amendment 2 would allow patients to grow their own marijuana, so long as they possess no more than a 90-day supply and it remains on their property and within their control.

DHSS would monitor medical marijuana and issue an annual report to the governor.

Annual operating costs are expected to be approximately $7 million. The 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.

Amendment 3

Amendment 3 also would allow for the use of marijuana to treat medical conditions and symptoms. Qualifying patients would be required to annually obtain an identification card, for which they will pay $100.

The proposal uses revenue derived from taxes on marijuana to fund a medical research facility (the Biomedical Research and Drug Development Institute, operating independently from state agencies) aimed at creating treatments and cures for cancer and other currently incurable diseases.

Amendment 3 would impose a 15 percent tax on the retail sale of marijuana and other taxes on the wholesale sale of marijuana flowers and leaves per dry-weight ounce to a licensed facility.

The proposal is estimated to generate annual taxes and fees of $66 million. State officials estimate initial implementation cost of $186,000 and increased annual operating costs of $500,000.

What if voters approve more than one proposal?

Having three initiatives that address a similar topic on the ballot brings up the question of which would be implemented if more than one were to be approved by voters.

The Missouri Constitution states, "When conflicting measures are approved at the same election the one receiving the largest affirmative vote shall prevail."

However, a statute that conflicts with the Constitution would always yield to the Constitution, said Charles Hatfield, a Jefferson City attorney with Stinson Leonard Street who has handled more than a dozen cases that went before the Missouri Supreme Court.

"That's why you need the language to explain what happens when two constitutional provisions conflict but there isn't any language about statutes that conflict with constitutional provisions — the law will always take care of that," Hatfield said.

However, determining whether the two actually conflict is tricky, he said.

"Courts will go to the greatest of lengths to read two laws (whether two constitutional provisions or a statute and a constitutional provision) as not conflicting if possible," he said. "So while the rule is simple to say, it is extremely difficult to apply."

Even if one or all pass, marijuana remains an illegal drug under federal law. As a Schedule 1 narcotic, it is considered to have no medicinal value and a high potential for dependence or abuse.

Whether any of the initiatives pass may depend on public willingness to ask patients to pay taxes on medical marijuana.

Proposition C would assess a 2 percent tax on the sale of medical marijuana.

Amendment 2 would impose a 4 percent tax, said Jack Cardetti, spokesman for the amendment.

According to the Marijuana Policy Project, which supports non-punitive, non-coercive marijuana policies, a 15 percent tax, as proposed in Amendment 3, would be the highest tax on marijuana in the country by far.

"We think that it is cruel, and we thing that it is unfair to patients who are suffering," Cardetti said. "We don't think you ought to gouge cancer patients and epilepsy patients."

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