Title: Advisory Opinion to The Attorney General Re: Use of Marijuana for Debilitating Medical Conditions & Advisory Opinion to The Attorney General Re: Use of Marijuana for Debilitating Medical Conditions (FIS)

State: florida

Issuer: Florida Supreme Court

Document:

Supreme Court of Florida 
 
 
_______________ 
 
No. SC15-1796 
_______________ 
 
 
ADVISORY OPINION TO THE ATTORNEY GENERAL RE USE OF 
MARIJUANA FOR DEBILITATING MEDICAL CONDITIONS. 
 
_______________ 
 
No. SC15-2002 
_______________ 
 
 
ADVISORY OPINION TO THE ATTORNEY GENERAL RE USE OF 
MARIJUANA FOR DEBILITATING MEDICAL CONDITIONS 
(FINANCIAL IMPACT STATEMENT). 
 
[December 17, 2015] 
PER CURIAM. 
 
The Attorney General of Florida has requested this Court’s opinion as to the 
validity of an initiative petition submitted by an organization called People United 
for Medical Marijuana circulated pursuant to article XI, section 3, of the Florida 
Constitution, and the corresponding Financial Impact Statement.  We have 
jurisdiction.  See art. IV, § 10, art. V, § 3(b)(10), Fla. Const.  For the reasons that 
follow, we conclude that the proposed amendment embraces a single subject and 
therefore complies with article XI, section 3.  We also conclude that the ballot title 
 
 
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and summary comply with section 101.161(1), Florida Statutes (2015).  Finally, we 
conclude that the accompanying Financial Impact Statement is in compliance with 
section 100.371(5), Florida Statutes (2015).  We therefore approve the proposed 
amendment and Financial Impact Statement for placement on the ballot. 
BACKGROUND 
 
On October 20, 2015, the Attorney General of Florida petitioned this Court 
for an opinion as to the validity of an initiative petition sponsored by People 
United for Medical Marijuana and circulated pursuant to article XI, section 3 of the 
Florida Constitution.  The sponsor submitted a brief supporting the validity of the 
initiative petition.   
The proposed amendment would create a new section 29 to article X of the 
Florida Constitution, and states:  
 
ARTICLE X, SECTION 29.  Medical marijuana production, 
possession and use. —  
(a)  PUBLIC POLICY.  
(1)  The medical use of marijuana by a qualifying patient or 
caregiver in compliance with this section is not subject to criminal or 
civil liability or sanctions under Florida law.  
(2)  A physician shall not be subject to criminal or civil liability 
or sanctions under Florida law solely for issuing a physician 
certification with reasonable care to a person diagnosed with a 
debilitating medical condition in compliance with this section.  
(3)  Actions and conduct by a Medical Marijuana Treatment 
Center registered with the Department, or its agents or employees, and 
in compliance with this section and Department regulations, shall not 
be subject to criminal or civil liability or sanctions under Florida law.  
 
 
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(b)  DEFINITIONS.  For purposes of this section, the following words 
and terms shall have the following meanings:  
(1)  “Debilitating Medical Condition” means cancer, epilepsy, 
glaucoma, positive status for human immunodeficiency virus (HIV), 
acquired immune deficiency syndrome (AIDS), post-traumatic stress 
disorder (PTSD), amyotrophic lateral sclerosis (ALS), Crohn’s 
disease, Parkinson’s disease, multiple sclerosis, or other debilitating 
conditions of the same kind or class as or comparable to those 
enumerated, and for which a physician believes that the medical use 
of marijuana would likely outweigh the potential health risks for a 
patient.  
(2)  “Department” means the Department of Health or its 
successor agency.  
(3)  “Identification card” means a document issued by the 
Department that identifies a qualifying patient or a caregiver.    
(4)  “Marijuana” has the meaning given cannabis in Section 
893.02(3), Florida Statutes (2014), and, in addition, “Low-THC 
cannabis” as defined in Section 381.986(1)(b), Florida Statutes 
(2014), shall also be included in the meaning of the term “marijuana.”  
(5)  “Medical Marijuana Treatment Center” (MMTC) means an 
entity that acquires, cultivates, possesses, processes (including 
development of related products such as food, tinctures, aerosols, oils, 
or ointments), transfers, transports, sells, distributes, dispenses, or 
administers marijuana, products containing marijuana, related 
supplies, or educational materials to qualifying patients or their 
caregivers and is registered by the Department.  
(6)  “Medical use” means the acquisition, possession, use, 
delivery, transfer, or administration of an amount of marijuana not in 
conflict with Department rules, or of related supplies by a qualifying 
patient or caregiver for use by the caregiver’s qualifying patient for 
the treatment of a debilitating medical condition.  
(7)  “Caregiver” means a person who is at least twenty-one (21) 
years old who has agreed to assist with a qualifying patient’s medical 
use of marijuana and has qualified for and obtained a caregiver 
identification card issued by the Department.  The Department may 
limit the number of qualifying patients a caregiver may assist at one 
time and the number of caregivers that a qualifying patient may have 
at one time.  Caregivers are prohibited from consuming marijuana 
obtained for medical use by the qualifying patient. 
 
 
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(8)  “Physician” means a person who is licensed to practice 
medicine in Florida.  
(9)  “Physician certification” means a written document signed 
by a physician, stating that in the physician’s professional opinion, the 
patient suffers from a debilitating medical condition, that the medical 
use of marijuana would likely outweigh the potential health risks for 
the patient, and for how long the physician recommends the medical 
use of marijuana for the patient.  A physician certification may only 
be provided after the physician has conducted a physical examination 
and a full assessment of the medical history of the patient.  In order 
for a physician certification to be issued to a minor, a parent or legal 
guardian of the minor must consent in writing. 
(10)  “Qualifying patient” means a person who has been 
diagnosed to have a debilitating medical condition, who has a 
physician certification and a valid qualifying patient identification 
card.  If the Department does not begin issuing identification cards 
within nine (9) months after the effective date of this section, then a 
valid physician certification will serve as a patient identification card 
in order to allow a person to become a “qualifying patient” until the 
Department begins issuing identification cards.  
(c)  LIMITATIONS.  
(1)   Nothing in this section allows for a violation of any law 
other than for conduct in compliance with the provisions of this 
section.  
(2)  Nothing in this section shall affect or repeal laws relating to 
non-medical use, possession, production, or sale or marijuana. 
 
(3)  Nothing in this section authorizes the use of medical 
marijuana by anyone other than a qualifying patient. 
(4)  Nothing in this section shall permit the operation of any 
vehicle, aircraft, train or boat while under the influence of marijuana.  
(5)  Nothing in this section requires the violation of federal law 
or purports to give immunity under federal law.  
(6)  Nothing in this section shall require any accommodation of 
any on-site medical use of marijuana in any correctional institution or 
detention facility or place of education or employment, or of smoking 
medical marijuana in any public place.  
(7)  Nothing in this section shall require any health insurance 
provider or any government agency or authority to reimburse any 
person for expenses related to the medical use of marijuana. 
 
 
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(8)  Nothing in this section shall affect or repeal laws relating to 
negligence or professional malpractice on the part of a qualified 
patient, caregiver, physician, MMTC, or its agents or employees.   
(d)  DUTIES OF THE DEPARTMENT.  The Department shall issue 
reasonable regulations necessary for the implementation and 
enforcement of this section.  The purpose of the regulations is to 
ensure the availability and safe use of medical marijuana by 
qualifying patients.  It is the duty of the Department to promulgate 
regulations in a timely fashion.  
(1)  Implementing Regulations.  In order to allow the 
Department sufficient time after passage of this section, the following 
regulations shall be promulgated no later than six (6) months after the 
effective date of this section:   
a.  Procedures for the issuance and annual renewal of qualifying 
patient identification cards to people with physician certifications and 
standards for renewal of such identification cards.  Before issuing an 
identification card to a minor, the Department must receive written 
consent from the minor’s parent or legal guardian, in addition to the 
physician certification. 
b.  Procedures establishing qualifications and standards for 
caregivers, including conducting appropriate background checks, and 
procedures for the issuance and annual renewal of caregiver 
identification cards. 
c.  Procedures for the registration of MMTCs that include 
procedures for the issuance, renewal, suspension and revocation of 
registration, and standards to ensure proper security, record keeping, 
testing, labeling, inspection, and safety.  
d.  A regulation that defines the amount of marijuana that could 
reasonably be presumed to be an adequate supply for qualifying 
patients’ medical use, based on the best available evidence.  This 
presumption as to quantity may be overcome with evidence of a 
particular qualifying patient’s appropriate medical use.  
(2)  Identification cards and registrations. The Department shall 
begin issuing qualifying patient and caregiver identification cards, and 
registering MMTCs no later than nine (9) months after the effective 
date of this section.  
(3)  If the Department does not issue regulations, or if the 
Department does not begin issuing identification cards and registering 
MMTCs within the time limits set in this section, any Florida citizen 
 
 
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shall have standing to seek judicial relief to compel compliance with 
the Department’s constitutional duties.  
(4)  The Department shall protect the confidentiality of all 
qualifying patients.  All records containing the identity of qualifying 
patients shall be confidential and kept from public disclosure other 
than for valid medical or law enforcement purposes.  
(e)  LEGISLATION.  Nothing in this section shall limit the legislature 
from enacting laws consistent with this section.  
(f)  SEVERABILITY.  The provisions of this section are severable 
and if any clause, sentence, paragraph or section of this measure, or an 
application thereof, is adjudged invalid by a court of competent 
jurisdiction other provisions shall continue to be in effect to the fullest 
extent possible.  
  
The ballot title for the amendment is: “Use of Marijuana for Debilitating 
Medical Conditions.” The ballot summary states: 
Allows medical use of marijuana for individuals with debilitating 
medical conditions as determined by a licensed Florida physician.  
Allows caregivers to assist patients’ medical use of marijuana.  The 
Department of Health shall register and regulate centers that produce 
and distribute marijuana for medical purposes and shall issue 
identification cards to patients and caregivers.  Applies only to Florida 
law.  Does not immunize violations of federal law or any non-medical 
use, possession or production of marijuana. 
On October 21, 2015, the Financial Impact Estimating Conference 
forwarded to the Attorney General the following financial impact statement 
regarding the initiative petition: 
Increased costs from this amendment to state and local governments 
cannot be determined.  There will be additional regulatory costs and 
enforcement activities associated with the production, sale, use and 
possession of medical marijuana.  Fees may offset some of the 
regulatory costs.  Sales tax will likely apply to most purchases, 
resulting in a substantial increase in state and local government 
 
 
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revenues that cannot be determined precisely.  The impact on property 
tax revenues cannot be determined. 
 
No briefs or comments were submitted to this Court in support of or in 
opposition to the financial impact statement. 
STANDARD OF REVIEW 
 
This Court has traditionally applied a deferential standard of 
review to the validity of a citizen initiative petition and “has been 
reluctant to interfere” with “the right of self-determination for all 
Florida’s citizens” to formulate “their own organic law.” Advisory 
Op. to Att’y Gen. re Right to Treatment & Rehab. for Non-Violent 
Drug Offenses, 818 So. 2d 491, 494 (Fla. 2002). 
In re Advisory Opinion to Atty. Gen. re Use of Marijuana for Certain Med. 
Conditions, 132 So. 3d 786, 794 (Fla. 2014).  As such, we have explained that we 
are obliged to uphold a proposed amendment unless it is “clearly and conclusively 
defective.”  In re Advisory Op. to Att’y Gen. re Florida’s Amend. to Reduce Class 
Size, 816 So. 2d 580, 582 (Fla. 2002).   
When this Court renders an advisory opinion concerning a 
proposed constitutional amendment arising through the citizen 
initiative process, the Court limits its inquiry to two issues:  (1) 
whether the amendment itself satisfies the single-subject requirement 
of article XI, section 3, Florida Constitution; and (2) whether the 
ballot title and summary satisfy the clarity requirements of section 
101.161, Florida Statutes.   
Advisory Op. to Att’y Gen. re Water & Land Conservation—Dedicates Funds to 
Acquire & Restore Fla. Conservation & Recreation Lands, 123 So. 3d 47, 50 (Fla. 
2013). 
 
 
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SINGLE-SUBJECT REQUIREMENT 
 
Article XI, section 3, of the Florida Constitution provides that any proposed 
citizen initiative amendment “shall embrace but one subject and matter directly 
connected therewith.”  Art. XI, § 3, Fla. Const.  “In evaluating whether a proposed 
amendment violates the single-subject requirement, the Court must determine 
whether it has a ‘logical and natural oneness of purpose.’ ”  Advisory Op. to Att’y 
Gen. re Amend. to Bar Gov’t from Treating People Differently Based on Race in 
Pub. Educ., 778 So. 2d 888, 891-92 (Fla. 2000) (quoting Fine v. Firestone, 448 So. 
2d 984, 990 (Fla. 1984)). 
This single-subject rule prevents a proposal “from engaging in either of two 
practices:  (a) logrolling; or (b) substantially altering or performing the functions of 
multiple branches of state government.”  Advisory Op. to Att’y Gen. re Water & 
Conservation, 123 So. 3d at 50.  This Court has defined logrolling as “a practice 
wherein several separate issues are rolled into a single initiative in order to 
aggregate votes or secure approval of an otherwise unpopular issue.”  In re 
Advisory Op. to Att’y Gen. re Save Our Everglades, 636 So. 2d 1336, 1339 (Fla. 
1994).  And, this Court has explained that “[a] proposal that affects several 
branches of government will not automatically fail; rather it is when a proposal 
substantially alters or performs the functions of multiple branches that it violates 
 
 
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the single-subject test.”  Advisory Op. to Att’y Gen. re Fish and Wildlife 
Conservation Comm’n, 705 So. 2d 1351, 1353-54 (Fla. 1998).   
We conclude that the initiative has a logical and natural oneness of purpose, 
specifically, whether Floridians wish to include a provision in our state constitution 
permitting the medical use of marijuana.  The proposed amendment’s provision 
regarding the specific role for the Department of Health in overseeing and 
licensing the medical use of marijuana is directly connected with this purpose.  See 
Advisory Op. to Att’y Gen. re Fee on Everglades Sugar Prod., 681 So. 2d 1124, 
1128 (Fla. 1996) (concluding that the proposal did not violate the single-subject 
rule and explaining that “the imposition of the fee and the designation of the 
revenue . . . are two components directly connected to the fundamental policy of 
requiring first processors to contribute towards ongoing Everglades restoration”).  
Further, the proposed amendment’s provision removing state-imposed penalties 
and liability from those involved in the authorized use of medical marijuana is also 
directly connected with the amendment’s purpose.  Therefore, the proposed 
amendment does not engage in impermissible logrolling.  See Advisory Op. to 
Att’y Gen. re Fla. Transp. Initiative for Statewide High Speed Monorail, Fixed 
Guideway or Magnetic Levitation Sys., 769 So. 2d 367, 369 (Fla. 2000) (holding 
that “there is no impermissible logrolling” where “[t]he only subject embraced in 
the proposed amendment is whether the people of this State want to include a 
 
 
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provision in their Constitution mandating that the government build a high speed 
ground transportation system”).   
 
Additionally, the proposed amendment does not substantially alter or 
perform the functions of multiple branches.  If the proposed amendment passes, the 
Department of Health would perform regulatory oversight, which would not 
substantially alter its function or have a substantial impact on legislative functions 
or powers.  The proposed amendment would require the Department of Health (or 
its successor agency) to register and oversee providers, issue identification cards, 
and determine treatment amounts.  See Advisory Op. to Att’y Gen.—Fee on 
Everglades Sugar Prod., 681 So. 2d at 1128 (“[T]he Fee amendment does not 
substantially affect or alter any government function, but is a levy by an existing 
agency.”); see also Advisory Op. to Att’y Gen. re Term Limits Pledge, 718 So. 2d 
798, 802 (Fla. 1998) (finding that the initiative did not substantially alter the 
functions of multiple branches “even though affecting the constitutional authority 
of the Secretary of State and affecting more than one provision of the 
constitution”).  “[T]he fact that [a] branch of government is required to comply 
with a provision of the Florida Constitution does not necessarily constitute the 
usurpation of the branch’s function within the meaning of the single subject rule.”  
Advisory Op. to Att’y Gen. re Protect People, Especially Youth, From Addiction, 
Disease, & Other Health Hazards of Using Tobacco, 926 So. 2d 1186, 1192 (Fla. 
 
 
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2006).  Moreover, the Department of Health would not be empowered under this 
proposed amendment to make the types of primary policy decisions that are 
prohibited under the doctrine of non-delegation of legislative power.  See Askew v. 
Cross Key Waterways, 372 So. 2d 913 (Fla. 1978).   
 
Accordingly, we conclude that the amendment complies with the single-
subject requirement of article XI, section 3. 
BALLOT TITLE AND SUMMARY 
 
We next address whether the proposed amendment will be “accurately 
represented on the ballot.”  Armstrong v. Harris, 773 So. 2d 7, 12 (Fla. 2000) 
(emphasis omitted).  We conclude that the ballot title and summary meet the 
statutory requirements and accurately represent the proposed amendment on the 
ballot. 
Section 101.161(1), Florida Statutes (2015) provides the following clarity 
requirements for the ballot title and summary: 
The ballot summary of the amendment or other public measure shall 
be an explanatory statement, not exceeding 75 words in length, of the 
chief purpose of the measure. . . .  The ballot title shall consist of a 
caption, not exceeding 15 words in length, by which the measure is 
commonly referred to or spoken of. 
The purpose of these requirements is “to provide fair notice of the content of the 
proposed amendment so that the voter will not be misled as to its purpose, and can 
 
 
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cast an intelligent and informed ballot.”  Advisory Op. to Att’y Gen. re Term 
Limits Pledge, 718 So. 2d 798, 803 (Fla. 1998).   
This Court’s review of the validity of a ballot title and summary under 
section 101.161(1) involves two inquiries:   
First, the Court asks whether “the ballot title and summary . . . fairly 
inform the voter of the chief purpose of the amendment.”  Right to 
Treatment and Rehabilitation for Non-Violent Drug Offenses, 818 So. 
2d [491, 497 (Fla. 2002)].  Second, the Court asks “whether the 
language of the title and summary, as written, misleads the public.”  
Advisory Op. to Att’y Gen. re Right of Citizens to Choose Health 
Care Providers, 705 So. 2d 563, 566 (Fla. 1998). 
Advisory Op. to Att’y Gen. re Fairness Initiative Requiring Leg. Determination 
That Sales Tax Exemptions & Exclusions Serve a Public Purpose, 880 So. 2d 630, 
635-36 (Fla. 2004).   
 
We conclude that the ballot title and summary comply with the statutory 
word limitations.  Additionally, the ballot title and summary fairly inform voters of 
the purpose of the proposed amendment—the state authorization of medical 
marijuana for patients with debilitating medical conditions.  The language is clear 
and does not mislead voters regarding the actual content of the proposed 
amendment.  Accordingly, we conclude that the ballot title and summary comply 
with the clarity requirements of section 101.161. 
 
 
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FINANCIAL IMPACT STATEMENTS 
 
We have an independent obligation to review the financial impact statement 
to ensure that it is clear and unambiguous and in compliance with Florida law.  See 
Adv. Op. to Atty Gen. re Use of Marijuana for Certain Medical Conditions, 132 
So. 3d at 809 (citing Adv. Op. to Atty Gen. re Referenda Required for Adoption & 
Amend. of Local Gov’t Comprehensive Land Use Plans, 963 So. 2d 210, 214 (Fla. 
2007)).  Article XI, section 5(c), of the Florida Constitution provides, “The 
legislature shall provide by general law, prior to the holding of an election pursuant 
to this section, for the provision of a statement to the public regarding the probable 
financial impact of any amendment proposed by initiative pursuant to section 3.”  
Additionally, section 100.371(5)(a), Florida Statutes (2015), provides that the 
financial impact statement must address “the estimated increase or decrease in any 
revenues or costs to state or local governments resulting from the proposed 
initiative.”  Section 100.371(5)(c)2, Florida Statutes (2015), requires the financial 
impact statement to be “clear and unambiguous” and “no more than 75 words in 
length.” 
 
We have explained that our “review of financial impact statements is 
narrow.”  Adv. Op. to Att’y Gen. re Water & Land Conservation, 123 So. 3d at 52.  
We address only “whether the statement is clear, unambiguous, consists of no 
more than seventy-five words, and is limited to address the estimated increase or 
 
 
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decrease in any revenues or costs to the state or local governments.”  Advisory Op. 
to Att’y Gen. re Local Gov’t Comprehensive Land Use Plans, 963 So. 2d at 214. 
 
We determine that the financial impact statement complies with the word 
limit and meets the other statutory requirements.  It clearly and unambiguously 
states that there are likely increased costs associated with the additional regulatory 
and enforcement activities that the proposal would require, but that the amount 
could not be determined and fees may offset a portion of the increased costs.  
Additionally, the financial impact statement clearly and unambiguously explains 
that the Financial Estimating Conference could not determine the change in 
revenue.  Accordingly, we hold that the financial impact statement complies with 
section 100.371(5), Florida Statutes (2015).  See Advisory Op. to Att’y Gen. re 
Fla. Growth Mgmt. Initiative Giving Citizens the Right to Decide Local Growth 
Mgmt. Plan Changes, 2 So. 3d 118, 124 (Fla. 2008) (“Overall, the financial impact 
statement is necessarily indefinite but not unclear or ambiguous.”).   
CONCLUSION 
 
Based on the foregoing, we conclude that the initiative petition and ballot 
title and summary satisfy the legal requirements of article XI, section 3, of the 
Florida Constitution, and section 101.161(1), Florida Statutes.  In addition, the 
Financial Impact Statement is in compliance with section 100.371(5), Florida 
 
 
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Statutes.  We therefore approve the proposed amendment and Financial Impact 
Statement for placement on the ballot. 
 
It is so ordered. 
LABARGA, C.J., and PARIENTE, LEWIS, QUINCE, CANADY, POLSTON, 
and PERRY, JJ., concur. 
 
NOT FINAL UNTIL TIME EXPIRES TO FILE REHEARING MOTION, AND 
IF FILED, DETERMINED. 
 
Two Cases:  
 
Original Proceeding – Advisory Opinion – Attorney General  
 
Pamela Jo Bondi, Attorney General, and Ellen B. Gwynn, Senior Assistant 
Attorney General, Tallahassee, Florida, 
 
for Petitioner 
 
Jon L. Mills of Boies Schiller & Flexner, LLP, Miami, Florida; Timothy Edd 
McLendon, Gainesville, Florida; and Andrew Mifflin Starling, Orlando, Florida, 
 
 
for People United for Medical Marijuana, Sponsor