Massachusetts Medical Society: Overview of Physician Sections of Medical Marijuana Regulations

Overview of Physician Sections of Medical Marijuana Regulations

This overview is provided for informational purposes only and is not authoritative. Readers are strongly encouraged to read the full text of the regulations (.pdf, 52 pages).

Patient Eligibility

  • A patient may use marijuana for medical purposes only after receiving written certification from a physician that the patient has a debilitating medical condition, which is defined as cancer, glaucoma, positive status for HIV, AIDS, hepatitis C, ALS, Crohn’s disease, Parkinson’s disease, multiple sclerosis, and other debilitating conditions as determined in writing by a qualifying patient’s certifying physician.”
  • The condition must be debilitating, which is defined as “causing weakness, cachexia, wasting syndrome, intractable pain, nausea, impairing strength or ability, and progressing to such an extent that one or more of patient’s major life activities is substantially limited.”
  • Patients who received a diagnosis of a debilitating medical condition in the past, but do not have an active condition and are not undergoing treatment for such condition, are not eligible for certification. This does not apply to patients whose symptoms are mitigated by using marijuana for medical purposes.
  • A patient under age 18 seeking certification must have written consent of his or her parent or guardian. Other rules for minors:
    • At least two physicians must diagnose that such a minor patient has a debilitating condition that is life-limiting. At least one of these physicians must be board-certified in pediatrics or a pediatric subspecialty.
    • “Life-limiting” is defined as “a debilitating medical condition that does not respond to curative treatments, where reasonable estimates of prognosis suggest death may occur within two years.”
    • The possible effects of marijuana on neurological development must be discussed with the patient’s parent or legal guardian.
    • Documentation of the rationale for certification must be provided in the medical record and the written certification.

Physician Requirements

  • Physicians are not required to issue certifications to any patient.
  • Physicians who certify patients for medical marijuana must:
    • Have a full active Massachusetts license
    • Have at least one established place of practice in Massachusetts
    • Register as a certifying physician with the Department of Public Health. The physician retains the registration indefinitely; unless the registration is revoked for reasons outlined in the regulations (see below)
    • The state has not proposed to assess a fee to physicians for such registrations.
  • Physicians who provide certifications must have a bona fide physician-patient relationship with the patient. This means:
    • While acting in the usual course of his or her professional practice, the physician must conduct a clinical visit before issuing a certification.
    • The physician must complete and document a full assessment of the patient’s medical history and current medical condition.
    • The physician must explain the potential benefits and risks of marijuana use.
    • The physician must have a role in the ongoing care and treatment of the patient.
  • Certification must not be for less than 15 days or longer than one year. It must be issued in a form and manner determined by the Department of Public Health.
  • Physicians may certify for up to a 60-day supply, which is defined as 10 ounces of marijuana. If a physician determines that a patient needs more than 10 ounces during that 60-day period, the physician must document the amount and rationale in the medical record and in the written certification.
  • Physicians must utilize the state Prescription Monitoring Program before issuing a written certification.
  • To issue certifications on or after July 1, 2014, physicians must complete at least 2.0 hours of Category I Continuing Medical Education credits relating to medical marijuana.
  • A physician may not issue a certification for himself or herself, or for his or her immediate family members.
  • A certifying physician, co-worker, employee or family member may not:
    • Have a direct or indirect financial interest in a dispensary
    • Receive directly or indirectly anything of value from a dispensary, or any person related to the dispensary
    • Offer a discount to a qualifying patient for using a particular caregiver or dispensary
  • Grounds for revoking a physician’s right to certify patients:
    • The physician fraudulently issues a written certification to a patient
    • The physician’s license to practice is suspended or revoked
    • The physician voluntarily agrees not to practice medicine in Massachusetts
    • The physician’s license to prescribe controlled substances is suspended, revoked or restricted
    • The physician fails to complete the required CME requirements after July 1, 2014.
    • The physician fails to comply with the medical marijuana law or its regulations
    • Any other grounds that serves the purposes” of these regulations or the medical marijuana law

Patients’ Rights and Responsibilities after Certification

  • After receiving a certification letter from a physician, the patient must apply to the Department of Public Health for a registration card before obtaining marijuana from a dispensary. The registration card is valid for one year. The state is proposing to assess a $50 annual fee for patient registration cards.
  • The patient may designate up to two “personal caregivers” who may assist patients in traveling to dispensaries, or cultivating, preparing or administering marijuana for patient. The regulations have detailed requirements regarding personal caregivers (pages 10-12).
  • Patients may cultivate their own marijuana if they receive a “hardship cultivation registration” from the state due to:
    • Financial hardship
    • Physical incapacity to access “reasonable transportation”
    • Doesn’t have a personal caregiver
    • Doesn’t live within a “reasonable distance” from a dispensary
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