Tuesday, June 7, 2011

Many Physicians Eligible to Prescribe Medical Marijuana in Arizona

The Arizona Medical Marijuana Act (AMMA) authorizes medical doctors, osteopaths, naturopaths, and homeopaths who are licensed in the state to provide the medical certification to the Arizona Department of Health Services (ADHS) that equates to a valid medical marijuana prescription.

During the ramp-up to the AMMA’s implementation, one of the most closely watched issues was whether the ADHS regulations would require a long-standing physician-patient relationship before the physician could provide a medical certification as part of the Qualified Patient (QP) application process.  The proposed regulations issued originally by ADHS contained a requirement that the physician-patient relationship either:

(1) had been in existence for at least a year and had included at least four in-person visits during the course of the relationship in which the physician had assessed the debilitating medical condition for which the medical marijuana was being prescribed; or

(2) be one in which the certifying physician has assumed primary responsibility for the management and routine care of the patient’s debililtating medical condition at the time of certification
In essence, the original proposed regulations would not allow a physician to provide a medical certification solely for the purpose of prescribing medical marijuana. 

When the final regulations came out, the requirement that the physician have a yearlong preexisting relationship with the patient or assume primary responsibility for the ongoing treatment of the condition had been eliminated. 

Instead, as the ADHS FAQ on QPs states,

The written certification given to a qualifying patient does not have to come from the physician diagnosing the qualifying patient’s debilitating condition or from the qualifying patient primary care provider.  The written certification can be obtained from a different physician whom the qualifying patient has consulted about the qualifying patient’s medical use of marijuana.”
In other words, a QP can see a physician solely for the purpose of obtaining a prescription for marijuana.  All that is required of the certifying physician is that he or she

  • Make a confirmed diagnosis of a debilitating medical condition.
  • Establish and maintain a medical record for the QP as required by state law.
  • Conduct an in-person medical exam “appropriate” to the debililtating medical condition.
  • Review other medical records from physicians who have treated the QP within the past 12 months, the QP’s responses to conventional medications and medical therapies, and the QP’s profile on the Arizona Board of Pharmacy Controlled Substances Prescription Monitoring Program.
  • Explain the potential risks and benefits of medical marijuana to the QP.
  • Disclose the physician’s relationship with any dispensary to which he refers the QP.
  • Attest that in his or her professional opinion, the QP is likely to receive therapeutic or palliative benefit from medical marijuana to treat or alleviate the QP’s debilitating medical condition.

ADHS Director Will Humble and Chief Medical Officer Laura Nelson, M.D. sent a joint open letter to physicians just after the final regulations were released.  The letter characterizes the Arizona regulatory program as one crafted to “be the first true medical marijuana program in the country” because of the expectations it sets for the clinical assessment required to issue a medical marijuana certification.”  Director Humble and Dr. Nelson say this is their way to try to avoid a program that over time becomes “largely recreational.”

ADHS has warned physicians that it will review the demographics of the QPs.  If ADHS determines that a physician is engaging in unprofessional conduct, it has promised to provide information to the physician’s licensing board.

The warning is not stopping the “pot docs” from advertising their services.  A couple of days ago, my craigslist search for “medical marijuana certification” located 17 offers in the Phoenix area alone.  The weGrow outlet whose grand opening I reported on last week offers medical certification assistance.  Several medical providers have set up dedicated websites.

Thus, despite the sincere efforts of the ADHS regulators, it appears that some Arizona physicians are making a thriving practice out of medical marijuana certifications.  Your employees should not have a difficult time getting a QP ID card if they need one, and maybe if they just want one.  Only time will tell.


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