For the past five years, Melissa Mentele and New Approach South Dakota have been fine-tuning a ballot measure that would legalize a medical marijuana program in the state.

With less than six months before the general election in which Initiated Measure 26 will appear on South Dakotans' ballots, Mentele, of Emery, previously expected this to be the time to ramp up campaigning at fairs and other summer events across the state. But with events across South Dakota and the world cancelled or on hold due to COVID-19, those plans have shifted.

“It’s hard. We have an office in Sioux Falls. We have it closed to the public right now, and I have my staff all at home working," Mentele told The Daily Republic last week. "We’ve lost that community piece of having our office open. We always had people that stopped by … It took away the cannabis library, cannabis classes, all the stuff that we were doing through that office.”

Instead, Mentele said New Approach has been focusing on digital outreach and promoting absentee voting and has plans to set up virtual town halls in addition to launching digital media campaigns in June.

IM 26 is one of two marijuana-related ballot questions South Dakota's voters will consider on Nov. 3. The 96-section measure proposes details of a medical marijuana program ranging from cultivation and testing regulations to physicians' involvement, legalizing limited amounts of substances that are currently considered felony or misdemeanor criminal offenses to possess.

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Also set to appear on November's ballot is Constitutional Amendment A, which would legalize the recreational use of marijuana for adults 21 or older and would require the state's legislature to pass laws ensuring access to medical marijuana and implementing programs for the cultivation of industrial hemp.

For Mentele, the push to legalize medical marijuana in South Dakota is personal on multiple fronts: she's spent 22 years working in health care and has a medical condition she said responds to products with cannabis in them.

In 2012, Mentele had an accident at work that led to her having major surgery on her left shoulder. She later was diagnosed with reflex sympathetic dystrophy, a condition that affects the sympathetic nervous system and causes a number of other issues, including constant pain and sensitivity.

"Six weeks after surgery, I got up on a Saturday morning and my arm looked like Barney’s leg," said Mentele, who originally thought she had developed a blood clot. "I went into acute care, and the doctor very sadly shook his head and said, ‘I’m so sorry. You need to go back and see your surgeon.’”

Mentele compares the chronic burning feeling she experiences from her collarbone to her fingertips to having frostbite or running hands under warm water after coming in from the cold. After multiple rounds of elimination testing confirmed she did in fact have RSD, she was unable to pursue the most common courses of treatment for the condition due to having severe reactions to opioid pain medications and having a nickel allergy.

At a friend's recommendation, Mentele purchased a lotion containing cannabis from a Colorado company.

“I wasn’t able to wear a shirt at the time. Air blowing across my arm would drop me to my knees," Mentele said. “During the time I tried it, I was having a gigantic flare-up, so my whole arm was purple. But the spot I put the salve on turned back to my normal skin color.”

After about six months of using the lotion regularly, Mentele said, almost all of her symptoms disappeared. When she took it to her doctor, she was told she could be arrested if caught with it, even if it was listed on her medical records.

“Going to prison was really not in my five-year plan," said Mentele, who lives in Emery with her husband and three children. "My doctor basically said, ‘Melissa, if you want this to be legal, you have to change the law.’ And so I started looking for organizations in my state that were doing anything."

Mentele said after attending a protest in Sioux Falls and seeing how marijuana legalization was being framed by South Dakota's advocates, she didn't feel the approach was one that would resonate with many people in the state. She decided to take the issue in a different direction with New Approach.

"We started to change the way people looked at this and started doing education, doing events at the library, and we started looking at writing a bill. I had no political experience at all," Mentele said. "... I got a very big, long crash course over the last five years, and here we are.”

Mentele and New Approach volunteers have met with officials with South Dakota's departments of health and public safety in order to address concerns about medical marijuana from law enforcement and health care professionals. Some of those concerns were addressed by changing language in and making additions to IM 26.

For example, the bill originally included the word "prescriber" when referring to a person who would be permitted to prescribe marijuana for medical use. That's since been changed to "physician," meaning only a doctor would be able to prescribe cannabis, which is more restrictive than language used in other states.

“This bill has been an evolutionary bill. We have continued to adjust and fine-tune things that we saw that didn’t work other places and fix them so when we got to South Dakota, it was good and it was everything that we wanted it to be," Mentele said.

Currently, marijuana for either medical or recreational use remains illegal at the federal level, though it has been legalized for medical use in 33 states and recreational use in 11 of those 33 (Washington, D.C. allows both). If South Dakota voters pass both IM 26 and Amendment A in November, the state would be the first to approve the legalization of both medical and recreational marijuana in the same election cycle.

Mentele said supporters of Amendment A have worked with New Approach to both include language that would protect IM 26 from being altered significantly by the legislature and to help the measure get onto the ballot.

“When they were doing their drafting, they changed language in their bill to protect medical, and that is the most important thing I think people need to understand. Amendment A, it’s not just adult use," Mentele said. "... Amendment A makes sure that next year the legislature cannot repeal the medical bill, hemp gets done, and our farmers don’t have to wait anymore."

South Dakota is one of two states set to vote on adult-use recreational marijuana this year. The other, New Jersey, first legalized medical marijuana 10 years ago.

To date, no state has approved the legalization of recreational marijuana use fewer than four years after first voting to begin a medical marijuana program. Eleven states and D.C. waited an average of 14 years between voting to allow medical marijuana and approving recreational usage.

“This bill has some really neat history. It’s been legislatively sponsored twice in its entirety, and so we’ve had this really amazing opportunity to, instead of taking something on a ballot initiative level and shoving it down people’s throats and doing it in one year and putting it on the ballot where nobody knows what’s going on, this has been an ongoing conversation," Mentele said. "... It’s truly been a life-changing experience for everybody that works in our organization, because you don’t see these conversations happening in other states where they use the ballot initiative process.”