Vital Signs: December 2012/ January 2013
The MMS House of Delegates approved an extensive new resolution on medical marijuana in early December, outlining considerations and criteria for regulations governing the implementation of the law, following voter approval of the ballot initiative in November that allows the use of medical marijuana in the state.
The resolution, which now becomes official policy of the Society, was adopted at the 2012 Interim Meeting.
The new policy covers such issues as the nature of the physician-patient relationship under the law, patient certification under the law, implications on occupational health and safety, and the relationship of medical marijuana to the state's Prescription Monitoring Program.
It also addresses physician peer reporting requirements under regulations of the Board of Registration in Medicine (BRM).
"We recognize that the law is binding as a result of the vote," said MMS President Richard V. Aghababian, M.D., "but as written, the law poses many unanswered questions. Of particular concern are issues that bear directly on a physician's practice of medicine under the regulations of the BRM and those that could affect the physician-patient relationship.
"As the law requires physician participation to certify patients, it is imperative that we provide perspective and input on these issues as regulations are developed to govern the full implementation of the medical marijuana law," said Dr. Aghababian.
Specifically, the new policy targets seven areas with respect to the new law and states that the MMS will:
- Work with the BRM to define the nature of the physician-patient relationship required under the law, including required parent or guardian permission for those under 18 years of age
- Advocate for the development of appropriate standards for certification by physicians, including that physicians must have an active license from the BRM, a Massachusetts Department of Public Health (DPH) Controlled Substances Registration, and a federal Drug Enforcement Agency (DEA) Registration - elements not specified in the law
- Advocate that the certifications for registration cards be based on a patient's diagnosis and the physician's assessment that the patient's pain or symptoms cannot be controlled with conventional medical therapy
- Advocate that the regulations consider the implications of marijuana use on occupational health and safety
- Advocate to the BRM and the Department of Public Health that regulations include a number of recommendations from the American Society on Addiction Medicine relevant to patient care
- Advocate with the DPH and the Legislature that marijuana dispensing be integrated with and become part of the state's Prescription Monitoring Program
- Work with the BRM to clarify the mandated peer reporting requirements that do not apply to physicians who choose to provide certifications under the law
The MMS continues to oppose the legalization of medicinal marijuana until such time that scientific studies demonstrate its safety and efficacy, and it has asked the DEA to reclassify marijuana so that its potential medicinal use by human may be further studied and potentially regulated by the U.S. Food and Drug Administration. The Massachusetts law, scheduled to go into effect Jan. 1, does not require any health care professional to authorize the use of medical marijuana for a patient.
The MMS has published interim guidance for physicians on the issue. Visit www.massmed.org/marijuana-considerations for the latest guidance.
- Richard P. Gulla
