Issue link: https://viewer.e-digitaledition.com/i/808278
IN THE FACE of Ohio's opioid epidemic that leads the nation in fatal heroin over- doses — an ironic byproduct of addiction to prescription painkillers — does medical marijuana provide a viable alternative for physicians to manage intractable pain and other Qualifying Medical Conditions? The issue remains up in the air. Ohio's Medical Marijuana Act (House Bill 523) became effective September 8, 2016. It sti l l ha s a way to go before becom ing f u l ly implemented by t he September 8, 2018 dead li ne. To get there, cultivator/processor rules, test- ing laboratory rules, dispensary rules, patient/caregiver rules, and physician certificate rules must go through the rule making process by September 8, 2017. On December 15, 2016, t he St at e Medica l Boa rd of Ohio published its proposed draft of physician certificate rules for public comment. 1 At the same time, it published the results of a survey to Ohio physicians, asking whether they would recommend medical marijuana to their patients. PROPOSED PHYSICIAN CERTIFICATE RULES The proposed rules require physicians (MDs/DOs) to obta in from the State Medical Board a Certificate to Recommend medical marijuana, defined as cultivated, processed, dispensed, tested, possessed, and used for a medical purpose 2 , to treat or alleviate 21 enumerated Qualifying Medical Conditions. Qualifying Medical Conditions include (but are not limited to) Alzheimer's, cancer, glaucoma, MS, chronic and severe or intractable pain, Parkinson's, epilepsy, and post-traumatic stress sy ndrome. Doctors a lso must annually complete two hours of Board- approved CME on medical marijuana. A s proposed , doc t or s who hold a certif ication to recommend 3 medica l marijuana, must: (1) establish a bona fide physician-patient relationship; (2) conduct an in-person physical exam; (3) diagnose the patient with a Qualifying Me d ic a l C ond it ion ; (4) r e v ie w t he pat ient 's med ica l /d r u g record s; (5) obtain an OARRS report over the past 12 months; (6) inform the patient of the risks and benefits of medical marijuana; (7) determine that the benefits of medical marijuana outweigh the risks and may be more effective and beneficia l than ma instrea m conventiona l dr ugs a nd therapies; (8) establish a care plan with ongoing monitoring; and (9) obtain an informed consent from the patient or caregiver. All this must be documented in the patient's medical record. Physicians are prohibited from person- a lly furnishing or dispensing medica l marijuana or from issuing a recommenda- tion for a family member or the physician's own use. Physicians also must not have a n ow nersh ip, i nvest ment i nterest , or compensation arrangement with a medical marijuana cultivator/processor, dispenser, or other related entity. Those who violate these prohibitions not only face ca ncellation of their Cer tif icate to Recommend, but are also subject to disciplinary action. Physicia ns must submit a n a nnua l repor t t o t he St at e Med ica l B oa rd , describing their observations regarding the effectiveness of medical marijuana in treating patients (described in the aggregate) during the year covered by that report. PHYSICIAN SURVEY RESULTS In September, 2016, the State Medical Board distributed a survey to the 46,000 physicia ns licensed in Ohio in order to gauge their attitude toward recom- mending medica l marijuana for their patients. Three thousand physicians of those surveyed replied. Only three out of 20 indicated that they would be "highly likely" to recommend medical marijuana. Forty-five percent indicated that they wou ld un likely recommend medica l ma rijua na to t heir patients, stating that they need to see more results from peer-reviewed research on efficacy, side- effects, disorder and diversion, OVI data, and menta l hea lth events before they would consider recommending medi- cal marijuana. The smoke needs to clear before Ohio's medical marijuana law takes effect and physicians are inclined to recommend medical marijuana to their patients. J o e F e l t e s i s a n a t t o r n e y w i t h Buckingham, Doolittle & Burroughs in Canton OH and a member of its Health & Medicine Practice Group. He is also the managing partner of Buckingham Canton. For more information about the law firm, go to www.bdblaw.com or email Mr. Feltes at JFeltes@BDBLAW.com. n References 1. The Medical Board received numerous com- ments and articles supporting and opposing the proposed rules. 2. Medical marijuana is classified as a schedule II controlled substance. 3. In Ohio, doctors technically will only be able to recommend, not prescribe, medical marijuana to patients, because of the Federal Controlled Substances Act. but Are Physicians Willing to Recommend? BY JOSEPH J. FELTES, JD OHIO'S MEDICAL MARIJUANA LAW PROGRESSES, 1 0