To be delivered before the Department of Public Health on April 19, 2013
Good Morning, I am Richard Aghababian, M.D. and I am the President of the Massachusetts Medical Society. The MMS, through its House of Delegates and committees, has researched and debated the issue of medical use of marijuana. We have complimented the work of the Department in its comprehensive process of developing the proposed regulations and offer the following testimony with the intent of helping the Commonwealth to responsibly implement the requirements of last year’s referendum. Our testimony will be delivered in two sections with the second presented by our staff attorney. On to specific issues:
The MMS supports the definition of bona fide physician patient relationship proposed by the Department. We are pleased that the Board of Registration is involved in developing the proposal and will maintain an active role in enforcing this standard. The MMS supports the expectation that certifying physicians should have an ongoing role in the care and treatment of the patient.
With regard to that care and treatment, if marijuana is truly evolving as a “medicinal” tool, it must undergo the same rigorous clinical trials as any other medicine that we use in our medical practices. We rely on that peer reviewed assessment as part of our clinical decision making in determining the best course of treatment for our patients.
Adopted MMS policies, adapted from the American Society of Addiction Medicine, clarify that key elements of that ongoing physician role include:
- Development of a treatment plan with objectives;
- Provision of informed consent, including discussion of side effects;
- Periodic review of a treatment’s efficacy.
We anticipate that the Board of Registration in Medicine will have an active role in reviewing the standards of care of physicians who certify patients for registration by the Department. The Department has done its part in defining the basic minimum standards for participation by physicians.
The definitions of debilitating and debilitating medical condition are important efforts by the Department to focus the use of marijuana to cases where there is an underlying research basis for use. The MMS supports clarification that a patient must not only have one of the diseases included in the referendum but also must suffer debilitating symptoms. The MMS policy on this issue establishes a threshold that optimal control of pain and spasticity are not met by conventional methods prior to considering marijuana use. The MMS strongly supports adapting the regulations to create a clinical advisory group within the DPH which will review available research and determine appropriate standards for inclusion of diseases, conditions and levels of symptoms which are appropriate for certification. The MMS has concerns that unfettered discretion allowed in the certification process in other states has led to abuses which threaten the integrity of the entire process. We should not follow that model in Massachusetts.
On the issue of a sixty day supply the MMS has significant concerns that a standard determination that a patient has the choice to receive up to ten ounces of marijuana is unsupported by clinical evidence. Organizations such as the American Society of Addiction Medicine have compiled numerous papers on the impact of heavy use of marijuana on brain function.
Concerning continuing medical education requirements, the MMS supports the position that Massachusetts licensed physicians who chose to certify patients for medical marijuana use should participate in accredited continuing medical education (CME) activities on medical marijuana use, with adequate training on issues that mitigate risks to patient safety, to include substance abuse and recognition. The MMS, as a nationally accredited provider of continuing medical education for physicians, will work to increase physicians’ clinical competence in areas relative to their patients’ use of medical marijuana.
Regarding the mandated review of the Prescription Monitoring Program prior to the certification of a patient for marijuana use, the MMS is supportive since there may be significant clinical issues impacting a decision for marijuana use by patients where a history of prescription use for pain and mental health conditions would be relevant. However, the MMS is opposed to the apparent intent of the DPH to create a new and free standing data base for medical marijuana. Integration of marijuana data into the PMP should be straightforward and simple. We are at the onset of designing a system, we should not be designing separate databases which do not communicate and which require separate physician logins to review and enter data. The PMP should be expanded to include whether a patient is certified for marijuana use, the date of certification, the dispensary in use, and the dates and amounts of product distributed to the patient. The DPH should enter this data as provided to them by dispensaries to prevent access to the PMP by dispensary employees. Certification by physicians may be electronic or in writing to the Department.
Finally, I would like to support the provisions in the draft regulations regarding contaminants and patient protections. If we are purporting to create a system for responsible medical use of marijuana then of course we must insure a supply of a medicinal grade product with all the purity and freedom from contaminants both chemical and biological that is implied by the use of medical in describing marijuana Thank you for the opportunity to present our views.
