To be delivered to the Department of Public Health on April 19, 2013
The following comments follow the regulations on an issue by issue basis and are a supplement to the testimony of MMS president, Richard Aghababian, M.D.
Page 3 Certifying Physician: The MMS supports the requirement that certifying physicians must have a full medical license from the Board of Registration in Medicine with full prescribing privileges and registrations under state and federal law.
Life limiting illness: The MMS supports this and other requirements for eligibility for certification of patients under the age of 18. Research is well established on the negative impact of marijuana use on developing brains. Therefore the MMS strongly supports this provision and other specific protections for patients under the age of 18.
Registration Card: Language in this definition identifies patients to law enforcement as having medical certificate allowing possession of marijuana. However later language establishes registrations as having a five year duration but certification may be for no more than one year. The MMS is concerned that a five year period, while administratively simple for the Department, is inconsistent with certification requirements, and creates a presumption that all patients will be users of marijuana for extended periods. Additionally, police and perhaps treatment centers are likely to accept possession of a registration rather than logging in to the PMP for verification that a certificate is still active.
Written Certification: This is consistent with the law but there is an issue of patient privacy in setting out particular symptoms and conditions. The MMS is concerned that the Department must treat specific diagnostic information with the utmost confidentiality. It should be used simply for a determination of whether the patient is eligible for registration and then inaccessible except for formal reviews by the Board of Registration of specific physicians in investigation of complaints that the physicians are certifying patients without establishing bona fide physician patient relationships.
Ban on Ownership and self and family certification by physicians: This is a self referral and dispensing ban that is consistent with existing laws for other medications and is supported by the MMS. The MMS also supports a ban on self-certification. In the issue of family member certification, the MMS recommends the Department adopt the same standards as the Board of Registration in Medicine’s prohibition on family prescribing of schedule II drugs except in an emergency. These are all issues which could be directly regulated by the Board of Registration in Medicine.
Caregiver: The MMS supports provisions that one may only be a caregiver for one patient. This would limit professional growers from growing ten ounces for multiple patients and creating significant opportunities for diversion
Vaporizers The MMS has reviewed the limited research available on the use of vaporizers. We have significant concerns about the health effects of smoking and therefore support vaporizers as an apparently less harmful means of administration of marijuana. However, research into the impact of various methods of administration must continue and the Department should carefully monitor educational materials used by dispensaries to ensure that patients are given accurate information on the risks that may be associated with vaporizers and other issues.
Proper ID required: The MMS supports the requirement of proper identification for patients and for shortened registration periods.
Confidentiality: The MMS is concerned that the broad confidentiality language in the regulations is inconsistent with inclusion of specific recommendations in our prior testimony concerning integration of patient specific information into the prescription monitoring program database. Modification of this language is essential for the program to work effectively. We also note that physician participation in the certifying process does not appear to be confidential. The MMS supports access information by the Board of Registration in Medicine but access to the general public on specific information regarding certifications, underlying diagnoses and activity by specific physicians may lead to patient doctor shopping or other undesirable results. Certifying physicians should be exempt from the public record as are all other participants.
Revocation of a Certifying Physician Registration
The MMS is concerned about the process and grounds outlined in the proposed regulations for revocation of a physician’s registration as a certifying physician by the Department. Any action by the state restricting a physician’s ability to fully practice medicine is generally viewed as a disciplinary action by the Board of Registration in Medicine and is reportable to the National Practitioner Data Bank. The MMS is concerned that the Department has no experience in this area and no staff to responsibly implement the due process procedures required in any state action impacting a professional medical license. The MMS recommends that separate provisions should be created in the regulations referring concerns about individual physicians to the Board of Registration in Medicine for appropriate action. The Department should modify its regulations to allow for delayed or suspended actions on pending requests for patient certification by physicians under review until the BRM acts.
Conclusion
The MMS strongly supports the work of the Department in its efforts to establish a responsible regulatory framework for the implementation of last year’s referendum. We look forward to working with the Patrick administration in establishing the Massachusetts system as a true model for clinical integrity and compassionate care of patients.
