Premier Health Medical Marijuana Survey Coming in September

By Jennifer Hauler, DO, system chief medical officer, Premier Health

Emperor Shen Neng of China prescribed marijuana tea for the treatment of gout, rheumatism, malaria, and poor memory as early as 2737 B.C., according to Time magazine. Despite historical accounts of the use of marijuana as a medical treatment for thousands of years, the federal government has classified marijuana as a Schedule I drug with no therapeutic benefit since 1970. Over the last two decades, several states have decreased restrictions on the use of medical marijuana. In September 2016, Gov. John Kasich signed House Bill 523 into law, making Ohio the 25th state to approve medical marijuana. Ohio’s Medical Marijuana Control Program is mandated by law to be operational Sept. 8, 2018, but the program’s launch has been delayed. That means patients will not immediately have access to medical marijuana.

The program is administered by the Ohio Department of Commerce, which regulates and licenses the cultivators, processors, and laboratories; the Pharmacy Board, which regulates the dispensaries, patient and caregiver licenses, and evaluates new forms and methods of medical marijuana use; and the Medical Board, which certifies physicians to recommend marijuana and evaluates new qualifying conditions. House Bill 523 approves five forms of medical marijuana: oils, tinctures, plant materials, edibles, and patches. Formulations and methods of administration that require smoking, are combustible, or are considered attractive to children are prohibited. There are also restrictions on the THC content and what constitutes a 90-day supply.

Federal law prohibits doctors from prescribing marijuana. Interested physicians must apply for a certificate to recommend (CTR) from the State Medical Board. This requires the completion of a two-hour CME course. There are 21 qualifying conditions for which medical marijuana can be recommended: AIDS, amyotrophic lateral sclerosis, Alzheimer’s disease, cancer, chronic traumatic encephalopathy, Crohn’s disease, epilepsy/seizure disorder, fibromyalgia, glaucoma, hepatitis C, inflammatory bowel disease, multiple sclerosis, pain (chronic/severe or intractable), Parkinson’s disease, positive status for HIV, post-traumatic stress disorder, sickle cell anemia, spinal cord disease or injury, Tourette’s syndrome, traumatic brain injury, and ulcerative colitis.

All patients and caregivers must register with the Board of Pharmacy. The registration is electronic and can be submitted by the patient’s recommending physician or the physician’s delegate. The annual registration fee is $50 for patients and $25 for caregivers. Patients under 18 years of age must have a parent or legal representative as a caregiver. A person must be 21 years of age to serve as a caregiver unless that person serves as the caregiver for his/her minor child, in which case, the person must be 18. A patient can have up to two caregivers, and each caregiver can have up to two patients.

House Bill 523 does not require an employer to permit or accommodate an employee’s use, possession, or distribution of medical marijuana. It also does not prohibit an employer from establishing and enforcing a drug testing policy, a drug-free workplace policy, or a zero-tolerance drug policy.

A recent article in the Cincinnati Enquirer stated that fewer than 200 of Ohio’s 46,000 doctors have completed the training course and submitted the necessary paperwork to obtain a certificate to recommend medical marijuana. The article cited a recent Medical Board survey that showed slightly more than 40 percent of Ohio’s doctors were not likely to recommend medical marijuana, while more than 30 percent of doctors said they would consider it.

Hospital systems across the state are developing policies and procedures addressing medical marijuana. Since most hospitals receive taxpayer dollars for research and patient care from Medicaid and Medicare, there is concern that allowing a federally banned drug into hospitals receiving such funding could place these dollars at risk. Many systems hope state officials or other large leading health care agencies will clarify the regulations or provide guidance statements. Nationally, there is great variation in the reaction of health care organizations in states where medical marijuana is approved. Many systems are adhering strictly to federal law, despite state approval, to ban both recreational and medicinal marijuana from facilities. Other systems have embraced medical marijuana and have provided on-site physician and provider education, offered patients portable hotel-style safes to store medical marijuana brought in from home, and operationalized policies and procedures to fully incorporate medical marijuana into office and hospital settings.

Due to current uncertain risks involving CMS reimbursement and the evolving nature of the rules and regulations around the legalization of medical marijuana in Ohio, Premier Health for now is adopting a conservative approach, as have other health care providers across the state. This approach prohibits the use of medical marijuana in inpatient settings.

Physicians practicing in an outpatient setting who have obtained a certificate to recommend in accordance with Ohio law will be able to recommend the use of medical marijuana. Premier Health’s stance will remain in place while we solicit input from key stakeholders and continue to explore how the many issues associated with medical marijuana will be addressed across our system.

In early September, you will receive a short survey via email. I sincerely hope that you will take the time to respond and provide your feedback. The subject is controversial, and it is critical that we understand the opinions and wishes of our physicians and providers in determining the right course for Premier Health. 

Back to the August 2018 issue of Premier Pulse