Voters will be challenged on Nov. 8 to vote on a number of ballot measures, including one that would legalize medicinal marijuana. But how would the system work, be funded, and help those in need without unintentionally turning North Dakota into a pro-legalization state despite the will of residents?

Voters will be challenged on Nov. 8 to vote on a number of ballot measures, including one that would legalize medicinal marijuana. But how would the system work, be funded, and help those in need without unintentionally turning North Dakota into a pro-legalization state despite the will of residents?

If passed, the measure would “provide for the medical use of marijuana for defined medical conditions, such as cancer, AIDS, hepatitis C, ALS, glaucoma, and epilepsy,” and patients “could be dispensed up to three ounces of usable marijuana, and could grow marijuana if his or her home is located more than 40 miles from the nearest registered facility.”

The language in the measure indicates that the North Dakota Department of Health would become responsible for managing the identification system, enforcing the new regulations, and referring violations to law enforcement.

In other words, the department would take on a great deal of new responsibility.

In a memo responding to the ballot measure, the Department of Health detailed a number of concerns with the measure as it is currently written.

One of those concerns is funding. According to the department, revenue generated from the measure’s passing would not offset the cost of its implementation. Not only would the initiated measure “require the addition of 32 full time employees,” but the program would cost an estimated $8.7M over the first two years after implementation.

According to a report from the North Dakota Legislative Council, “The fiscal impact to the department would be an estimated $7.4 million in expenditures and $4.8 million in revenue for the 2017-19 biennium.”

Other issues with the measure as written are detailed in the Department of Health’s memo. Though the department states that they are prohibited by state law from supporting or opposing any ballot measure, some of the concerns detailed seem to indicate that the measure could benefit from more specific language:

- All forms of marijuana can be used for medical purposes, including smoking.  
- Individuals of any age, including children, are able to obtain a referral for medical marijuana in any form.
- Additional legislation would be necessary to address whether restrictions on smoking within various establishments will include medical marijuana use.
- Additional legislation would be necessary to address student use of medical marijuana on school property.

However, North Dakotans for Compassionate Care (Measure No. 5 is also known as the Compassionate Care Act) have other concerns. According to their website (, “North Dakota patients are prohibited access to a treatment that could provide a safer alternative to traditional prescription medications.”

The harsh side effects of many prescription drugs compared to the relatively benign side effects of marijuana use are often cited by medical marijuana advocates, and North Dakotans for Compassionate Care mentions cancer treatment as an example:

“Modern treatment of cancer includes high dose steroids, addictive pain meds, anti-nausea medications, and laxatives all to lessen the side effects of surgery, radiation, and chemotherapy,” according to the site.

Though the Department of Health says in their memo that children may be prescribed marijuana if Measure No. 5 passes, ND Compassionate Care sees this as a benefit: “Medical marijuana is helping adults and children of all ages who are undergoing all sorts of disorders. Kids that have tried and exhausted all prescription medications for seizures are using (medical marijuana) to control them.”

However, the site fails to point to research that supports some of their claims.

That may partially be due to federal regulations that classify marijuana as a Schedule I drug, alongside such drugs as heroin and LSD.

The classification limits research on the benefits of medical marijuana, and also subjects states that legalize marijuana for either medicinal or recreational purposes to federal law enforcement efforts.

The Drug Enforcement Agency recently declined to reconsider its approach to marijuana on a federal level, though federal law enforcement has largely left states to their own devices in recent years.

That doesn’t mean that research isn’t being conducted, but many states have concerns that passage of laws that legalize marijuana put them at odds with federal statutes.

The Department of Health states such a concern in their July memo. “Both recreational and medical marijuana remain illegal under the federal Controlled Substances Act. Additional research would be necessary to identify potential legal implications,” according to the department.

Because 25 states allow the use of marijuana for either medicinal or recreational purposes, it seems that any state considering legalization has at least a rough guideline for how to approach the issue.

One such state is Minnesota, which recently approved marijuana for medical use.

In contrast to the language in Measure No. 5 on the ballot in North Dakota, Minnesota’s statute does not allow for the smoking or growing of marijuana.

Instead, patients with the ailments described in Measure No. 5 are prescribed marijuana in pill or liquid form, including oil. According to the Minneapolis Star-Tribune, “Minnesota's medical marijuana program is one of the most tightly regulated in the nation, and also the most clinical...manufacturers will be able to tailor doses, not only to different conditions, but to different patients and their needs.”

The Minnesota approach could benefit both medical marijuana advocates in North Dakota should the measure fail, and the state’s Department of Health should it pass.

Though polling is currently unavailable on Measure No. 5, the fact that half the country has legalized some form of marijuana makes it unlikely that the issue will be settled no matter which way this year’s vote goes.