Getting a Recommendation for Medical Marijuana

October 22nd, 2010 by admin Leave a reply »

Some of the most important words in the 13-page Arizona Medical Marijuana Act are: “Physician Patient Relationship” and “A Full Assessment of the Qualifying Patient’s Medical History”.   The real gatekeepers that’ll determine which applicants ultimately would qualify for a medical marijuana card are Arizona MDs, DOs, Naturopaths and Homeopaths, as they evaluate their patient’s medical conditions and determine who could benefit from the medical use of marijuana.

That’s why the key words above are so important when (or if) we define our Administrative Code.  Before a physician signs a recommendation for a patient, they’re supposed to do a “full assessment of the patient’s medical history” and be in a “physician patient relationship”.

If we don’t define these words carefully we could end up like Colorado and California where patients can walk into a medical practice that specializes in medical marijuana recommendations and get a recommendation after a very short exam (which includes a fee).  One of the first things I’ll do if the Initiative passes is to ask our legal team at the AGs Office to determine how much authority we have to define these words.  If we have the authority, I’d like to somehow craft some criteria that would make sure that some real assessment happens including a discussion of the range of medical management strategies that could be taken to help manage the patient’s condition before a physician can hand out a recommendation. I don’t know if we have that authority, but I sure hope so.

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20 comments

  1. Lawyer says:

    You don’t have the authority. You must follow the guidelines of the proposition. The definitions of those phrases are cut and dry and you should not try to use your position to put a spin on whats very clear because of your bias opinion. “Physician patient relationship” means that you regularly see the physician providing the recommendation. You dont have to sign a annual contract or join a club to have a physician patient relationship. “A full assessment of the Qualifying patients medical history” means the Dr. must check all medical records to make the most informed evaluation possible. Cut and dry. Your legal team will advise you of this.

  2. R Camp says:

    I totally understand where you are coming from.
    I imagine there will be some patients that will try to work the system to become a patient. I do think it will need to be separated into 2 categories. Cancer, Glaucoma, HIV, Chrohns and Alzheimer patients should receive medication and relief immediately. The other conditions such as wasting syndrome, chronic pain, and Amyotrophic lateral sclerosis could fall under another category since they are so hard to diagnose. It’s terrible that someone could fake chronic pain or Lou Gehrig’s disease just to get marijuana but I guess it could happen.

  3. Jac Polsgrove says:

    Sadly, the feds continue to threaten physicians that cooperate with Medicinal Marijuana laws and make recommendations. How can the state make physicians feel safe to make a recommendation if the feds are threatening to take action. The average family practitioner isn’t going to want to risk losing his or her practice/job if they are sanctioned by the feds.

    We will probably have to have a few brave doctors who, as in California, specialize in assessing people for their eligibility for a card. I’m sure I can bring my medical records from my family practitioner and they will clearly demonstrate my health issues. Heck, I could bring in my prescription bottles and they’d demonstrate that I have conditions which clearly qualify!

  4. Patient says:

    What happens if I’m a patient that chooses to live 25 miles away from the nearest dispensary and I secure a home in Oracle, AZ or something. What happens if 5 months later a dispensary opens 20 miles away from me? Am I going to be disallowed to supply my own? Please respond as this is a concern to me because I am currently looking for a new home and am taking into consideration the outcome of proposition 203

  5. Jennifer M Velez says:

    To whom it may concern:

    Could you please direct in the right direction on how to be put on the list to obtain a license to open a medical marijuana dispensary.

    Thank you,

    Jennifer Velez

  6. Registered AZ VOTER says:

    Sir, In no way am I better informed, a legal expert or partial to either side of the argument. I did just finished reading
    http://www.azsos.gov/election/2010/general/ballotmeasuretext/I-04-2010.pdf and If passed prop 203 becomes law and makes the department a part of the process managing registrants, databases and relevant reporting.

    You are correct of whom are the “gate keepers” but nowhere did I read that you and/or your department officials will be part of the process where a doctor makes a recommendation to a patient. I could not find where it spells out the need for crafting additional criteria managing medical management strategies by the department.

    If and when medical marijuana becomes the law it will make marijuana medicine to registered patients. Perhaps your statements are expressed concerns about abuse, which is a legitimate concern these days, abuse of regulated prescription medicine appears out of control and the ones affected are legitimate users who deal with restrictions and carry the burden of being biased. Ask yourself; “ How would your department rate if pharmaceutical abuse was a performance yardstick for the department”? Would it excel in managing its affairs, and reduce abuse? Fortunately the law in effect today and the verbiage in prop 203 will provide you on how to deal with abuse and will provide guidance how to structure administrative rules.

    Sir, You are entitled by right to express concern but when you intend to define the law and vow to manage doctor patient relations may give someone the perception that you do not support medical marijuana. I read that there is a 52% for and a 30% against in recent polls. There are various ways one could protest to get appeal and approval from the 30% side. For example; one could decline any salary increases as a result of added responsibility related to prop 203. The day prop 203 becomes law one can demonstrate grief by resigning. At the very least resist new office furniture with money from license fees

    Using the position of director, the departments authority and precious taxpayer resources to define/interpret law based on ones views on the matter may do more harm than good; the law will license people who applied for a card and if the department does not do its duties as required by law, it is opening the door for abuse because applications will not processed properly. But morre importantly one is in conflict with approximately 52% of Arizona voters their fundamental Constitutional rights.

    Sir, to my knowledge no one in the other states has died from having a valid prescription, what is your concern does the proposed law pose a health risk to state residents? please set aside your agenda and embrace the law empowers the department with managing a big part of how medicine is managed. Do it right, illegal drugs are illegal drugs leave that to the cops, judges and lawyers. A medical Marijuana law protects doctors doing their job helping a patient find the best treatment, don’t you think the candidates listed have enough to worry about, at least prosecution will no longer be one of the.. Funding is guaranteed with license fees, if managed efficiently perhaps it can help the department with its liabilities, create some jobs, that is always a positive. By managing the registration process you have a chance to make a difference by doing it right In turn you are guaranteed success and public approval (remember 52%) because that is service. Marijuana aside You are in charge of a department that provide a service to Arizona residents. Can they count on you to lead by example and set the standard for good service?

    If it is your opinion you not agree with prop 203 then it is your right express that on voting day. Remember not everyone voting for prop 203 is a marijuana user and everyone voting on Nov. 2 2010 is a good citizen.

    Signed
    DJJ ©

  7. Mary Jane says:

    Yea it’s kinda crazy how things got here in Colorado. There are places where you can walk in without any medical history and walk out in a few minutes with a legal medical marijuana recommendation. However, these places are not very well respected because that was never the intention of the laws.

    So like you said, it’s really important to define your laws early so things don’t quickly get out of hand.

  8. R Camp says:

    When you put a plan together for this, can you make it all encompassing?
    Patients will frequently go “Doctor Shopping” to receive prescriptions for Xanax, opiate based drugs such as Oxycontin, and amphetamine based drugs such as Adderall. These drugs are extremely addictive and don’t have a negative stigma such as marijuana. But these drugs can kill you unlike a plant like marijuana.
    I strongly urge you to look at the health and welfare of ALL Arizona patients, not just the marijuana patients. It would be hypocritical to stop patients from using a safe drug like Marijuana and continue to allow these dangerous and life-threatening activities. Until now I had no idea you were biased when it came to this proposition, but please try to concern yourself of the patients welfare in all situations, instead of “thinking” of the patients when it suits your negative opinions of medical marijuana.

  9. Pozycjonowanie Szczecin says:

    I like your blog

  10. Care Giver says:

    The only way to regulate how hard it is for patients to get their medical card is to follow the same guidelines our AZ family doctors use to determine if a patient needs a script for narcotics (pain killers) like oxycodone. It is my opinion that these drugs should be harder to obtain a script for than mmj as they are more harmful to the body, more addictive, they cause more side effects… Any more difficulty is merely unwise. We cannot allow the pharmaceutical companies to influence the decisions we make regarding medical marijuana. Why is it that we are ok with a person walking into a Dr.’s office with back pain and getting pain killers and muscle relaxers without any hesitation but yet we want to make it next to impossible to allow them to have mmj license? The mmj industry is truly about helping people feel better without destroying their body the way most prescriptions do.

  11. David Schuff says:

    Mr. Humble,

    I do not want Arizona to be like California, for example people with signs soliciting a physicians instant approval. Prop 203 has more regulation than both California and Colorado; and if you can help keep this new industry as respectable and professional as possible, power to you!

    You will be able to choose the best candidates for dispensaries, and that position will provide you some control over how these establishments conduct business. Please pick the applicants who demonstrate an honest interest in helping valid and approved patients, and not just promoting recreational marijuana and making a quick buck!

    I don’t believe pharmacies recommend Doctors and I don’t see why our new dispensaries would need to provide that service for genuinely ill patients either! Most people with cancer, MS, etc., even severe and chronic pain should already be under the care of their own Doctor!

    Since pharmaceutical abuse is a very serious growing problem, any efforts to regulate Doctor patient relationships should responsibly address that issue also. Two birds with one stone.

    All best,
    David Schuff

  12. Nurse says:

    Sir,
    With all due respect, why do you care if people smoke marijuana recreationally anyway?

  13. ron says:

    when will patient aplications for reistry id cards be available?

  14. Marc Perlman says:

    Why arent nurse practitioners included with the other professionals that can recommend marijuana?

  15. Citizen says:

    “If we don’t define these words carefully we could end up like Colorado and California where patients can walk into a medical practice that specializes in medical marijuana recommendations and get a recommendation after a very short exam (which includes a fee).”…..Will Humble

    A personal opinion, and very condescending!

  16. A very detailed scientific study of 1-Trans-Delta9-Tetrahydrocannabinol (THC) was conducted from 1988 to 1990 by the federal government, the results published in 1994 (National Toxicology Program, Technical Report Series, N.T.P. #446). It was conducted by the National Institutes of Health, National Toxicology Program.

    Gavage (stomach tube feeding) studies were undertaken on mice and rats, who were given pure THC in corn oil for two years. The N.I.H. initially performed 13-week studies to determine the toxicity and dosing amounts for the 2-year studies.

    Those were followed by the main study to determine both toxicity and carcinogenesis. A link to cancer was not found (NO evidence in rats, and only equivocal evidence in mice, and then only in a dose of 125mg/kg of weigh, a dose 10 times more than the minimal dose and 2-1/2 times the maximum 50mg/kg dose, Page 7 of the Final Report ). Toxicity was ruled out!

    THC is neither toxic nor can a human being consume enough Marujuana to cause a fatal reaction.(It would take a person eating approximately 67 POUNDS of marijuana at a single sitting to kill him or her). It is non-toxic in any realistic dose.

    The study is far too lengthy to repeat here, but the most important portion was the result regarding toxicity. Not only did the THC not kill the rats and mice, ALL THE DOSED RATS AND MICE OUTLIVED ALL OF THE CONTROL ANIMALS! In fact, THC appears to have extended the lifespan of all dosed subjects! Why are we afraid of this plant?

    The report states, regarding the effects on humans, “In humans, acute toxic effects include depression of the brain reticular system and the primary sensory pathways, disorientation, dissociation of personality, euphoria, emotional excitement, uncontrolled laughter, hallucinations, illusions, distortion of the sense of time and space, increased sensitivity to sound, loss of motor control and parasthesia. Acute and subacute doses of cannabis may produce vomiting, diarrahia, and abdominal distress (ARF/WHO, 1981).”

    This the WORST that can be said of the marijuana high, at it’s most potent dose (“acute toxic effects’). Draft Report, at Page 33.

    Non-toxic, does not cause cancer, is there still a cogent argument to be made for it to remain Schedule 1 by the D.E.A.??? ABSOLUTELY NOT!

    SALT will kill you if you eat too much. ASPIRIN will kill you if you take too much (the average over-the-counter bottle contains a potentially lethal dose). Many prescription medicines routinely prescribed by physicians are deadly if abused. Marijuana CANNOT kill you, no matter how much you take. Why are we afraid of this plant???

    When, in your deliberations, you contemplate the results of the occaisional user obtaining a recommendation for medical marijuana by deception, all you risk is that someone will not be arrested and prosecuted for using a substance that by all medical reason should be legal to begin with. Why are we afraid of this plant?

    Let the medical profession deal with the careless practitioner. We don’t need another layer of unnecessary beaurocracy impeding the alleviation of human suffering. God speed.

  17. hcg homeopathic says:

    I’ve always wondered why nurse practitioners aren’t in the same category to recommend marijuana? It just never made sense to me.

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