Medical Marijuana

MMS Outlines Proposed Criteria for New Medical Marijuana Law

Posted in Interim Meeting 2012, Medical Marijuana on December 1st, 2012 by MMS – Comments Off on MMS Outlines Proposed Criteria for New Medical Marijuana Law

The chief policy-making body of the Massachusetts Medical Society today passed a set of recommendations relating to the state’s new medical marijuana law, calling for the MMS to advocate for the development of appropriate certification criteria for certification for medical marijuana use.

The resolution, approved by the MMS House of Delegates at its Interim Meeting, also calls for the Society to work with the Board of Registration in Medicine to define the physician-patient relationship required for such treatment.

MMS also voted to advocate for the development of physician licensing standards for marijuana certification, and specifications for marijuana registration cards for patients.

Saturday’s resolution also calls for MMS to advocate for regulations reflecting the implications of medical use of marijuana on occupational health and safety. New Massachusetts regulations should include comprehensive treatment recommendations developed in 2010 by the American Society on Addiction Medicine.

Marijuana should be included within the existing state Prescription Monitoring Program, and physicians who prescribe it should be exempted from existing state peer-reporting requirements, the resolution stated.

–Erica Noonan

Medical Use of Marijuana: Considerations for Massachusetts Physicians

Posted in Medical Marijuana on November 16th, 2012 by MMS – Comments Off on Medical Use of Marijuana: Considerations for Massachusetts Physicians

Updated 11/16/12 7:30 p.m.

The passage last week of Question 3, “Medical Use of Marijuana,” has raised many questions about the rights and responsibilities of Massachusetts physicians under the new law.

The Mass. Department of Public Health (DPH) has 120 days to develop and issue regulations on the law, so we are unable to answer many questions at this time. However, some issues are relatively clear.

When does the law take effect?

The law takes effect on January 1, 2013. Physicians should not authorize the use of marijuana before that date.

Note that even after January 1, the practice of authorizing the use of marijuana remains illegal under federal law. Marijuana is still classified as a Schedule I drug. However, U.S. Attorney General Holder has said he does not currently plan to prosecute those who operate within state law.

Is a physician required to participate in the program? 

Nothing in the law requires any health care professional to authorize the use of medical marijuana for a patient.

What may a physician do under the new law?

Physicians may provide and sign a “written certification” stating that in the physician’s professional opinion, the potential benefits of the medical use of marijuana would likely outweigh the health risks for the qualifying patient. The physician must conduct a full assessment of the qualifying patient’s medical history and condition, and that the medical use of marijuana may benefit a particular qualifying patient.  It’s important to note that under this law, physicians are not “prescribing” marijuana, per se.

Must the physician have a “physician-patient” relationship with the patient?

Yes. There must be a “bona fide” physician patient relationship.

Does the certification need to specify the qualifying patient’s debilitating medical condition(s)?

Yes. The law defines “debilitating medical condition” as: cancer, glaucoma, positive status for HIV, AIDS, hepatitis C, ALS, Crohn’s disease, MS and other conditions as determined in writing by the qualifying  patient’s physician.

What does a patient do with the written certification?

The patient would use the written certification from a physician to obtain a DPH-issued “registration card” to allow him or her to possess marijuana for personal medical use.

Have any dispensaries been authorized in Massachusetts?  

Not yet. In the first year after the effective date, DPH will issue registrations for up to 35 nonprofit centers, with between one and five centers per county. The law does not provide guidance about the number of authorized dispensaries in later years.

What should physicians know about the time period between the effective date of the law and the promulgation of regulations?

After January 1 but before to the issuance of regulations, certain provisions apply. These include the following exemption from the requirement that the state must approve the designation of patient having hardship cultivation status. “Until the department issues such final regulations, the written recommendation of a qualifying patient’s physician shall constitute a limited cultivation registration,“ the law states.

This language, as much of the initiative, is a little vague. It isn’t clear that a “written recommendation” is the same as a “written certification.” Physicians should be aware that they write a letter certifying a patient as qualifying under the terms of the law to possess marijuana for medical use, the letter will also qualify them to grow marijuana until such time as regulations are promulgated. There may be additional federal issues raised for facilitating cultivation rather than the issues raised in writing a certification letter to the DPH.

The MMS is also working to develop answers the question of what constitutes a bona fide relationship, appropriate medical examination and record. Physicians are advised to look at prescribing guidelines of the Board of Registration in Medicine in this regard. These state:

“Statutory language sets forth the minimum requirements that must be met in order for a prescription to be valid in the Commonwealth. To satisfy the requirement that a prescription be issued by a practitioner in the usual course of his professional practice, there must be a physician-patient relationship that is for the purpose of maintaining the patient’s well-being and the physician must conform to certain minimum norms and standards for the care of patients, such as taking an adequate medical history and conducting an appropriate physical and/or mental status examination and recording the results. Issuance of a prescription, by any means, including the Internet or other electronic process, that does not meet these requirements is therefore unlawful.”

While a physician is not writing a prescription this is the closest guideline to the elements of a physician patient relationship.

Language in the law includes protections from state prosecution and penalties for physicians for advising patients on medical marijuana or providing a patient with a written certificate after full assessments of a patient’s history and condition. However, such protections are probably irrelevant in civil cases based on medical negligence.

Liability coverage for civil cases based on negligence and the standards of care which will inform such claims remain to be determined. Case law will establish the answers to these questions.

Further issues remain as to how a physician is to advise a qualifying patient to obtain marijuana. Which dispensaries are appropriate and provide unadulterated products? What is an effective dose? What are the side effects and contraindications? Does a physician have an obligation to review patients in the prescription monitoring database to assess their history?

The full text of the law is available here.

MMS will continue to monitor the regulatory process, and will provide updates as soon as they are available.

MMS Comments on the Passage of Medical Marijuana Ballot Question

Posted in Medical Marijuana on November 6th, 2012 by MMS – 2 Comments

From Richard V. Aghababian, MD, President of the Massachusetts Medical Society:

“Despite the vote, the Massachusetts Medical Society continues to assert that marijuana has not been proven to be medicine. It has not been subjected to the same rigorous testing and trials as other drugs approved by the Federal Drug Administration and used every day in practice by physicians.

“We have asked the Drug Enforcement Administration to reclassify marijuana so that research and clinical trials can determine whether or not it has medical value. Until its effectiveness is proven clinically and accepted by the FDA, we urge physicians to refrain from recommending it to their patients.

“Above all, the prescribing of drugs by a physician should be based on clinical and medical evidence, not by popular vote. Further, we will closely monitor the impact of this law and will not hesitate to recommend changes if necessary.”

Background: The Massachusetts Medical Society was opposed to Question 3, reflecting its current policy, adopted by the MMS House of Delegates at its 2012 Annual Meeting, when more than 82 percent of delegates voted to oppose legalizing medical marijuana “until such time that scientific studies demonstrate its safety and efficacy.” In a letter dated October 2, 2012, the Medical Society has asked the U. S. Drug Enforcement Administration to reclassify marijuana “so that its potential medicinal use by humans may be further studied and potentially regulated by the U.S. Food and Drug Administration.”

Boston Globe Editorial: No on the Medical Marijuana Ballot Question

Posted in Medical Marijuana on October 30th, 2012 by MMS – Comments Off on Boston Globe Editorial: No on the Medical Marijuana Ballot Question

The Boston Globe editorial board today came out against Massachusetts Ballot Question 3, “Medical Use of Marijuana.”

The editors wrote:

“Because marijuana has been illegal, and isn’t regulated through the Food and Drug Administration, there aren’t consistent guidelines for its use. Without such rules, Massachusetts shouldn’t put itself in the position of dispensing a drug it can’t safely regulate. Despite some persuasive arguments in favor of marijuana’s medicinal properties, voters should check “no” on Question 3.”

If you have access to the Globe’s online version, you can read the complete editorial here.