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Medical marijuana and the challenges for healthcare

Contradictory laws surrounding medical cannabis pose a number of risks for healthcare providers. What are the challenges they face, and what do they have to know?

Healthcare providers across the U.S. are continually confronted with new challenges as they work to supply consistent, high-quality patient care. One of the foremost confounding emerging risks is medical marijuana, a topic that Zurich North America included in our 2019 Benchmark Study of Healthcare Professional Liability Claims.

Consider this scenario: John suffers from chronic, debilitating pain that traditional medicine has did not address. He has found relief using medical marijuana. When he’s admitted to a medical building, John brings his medical marijuana to self-administer. How should power respond? Should they permit him to self-administer his medical marijuana off-premises? Send him home with a caregiver? Store the cannabis until discharge? Or prohibit its use and confiscate it as contraband?

This example is way from unique. With approximately 3 million medical marijuana users currently enrolled in state registries, consistent with the Marijuana Policy Project, healthcare facilities across the U.S. are being challenged to navigate this complicated, emerging risk.

Marijuana, derived from the cannabis plant, contains tetrahydrocannabinol (THC), a psychoactive compound that delivers the feeling of euphoria. Medical marijuana, or medical cannabis, use the plant and/or chemicals within it to treat patients.

As of September 2019, 33 states and therefore the District of Columbia have legalized medical marijuana. (Eleven states and therefore the District of Columbia have legalized recreational marijuana.) The drive behind the legalization of medical marijuana appears to possess been popular opinion through state ballot initiatives and referenda, with laws that change widely from state to state. All states that have legalized marijuana for recreational use even have whole-plant medical marijuana laws. Some states have more stringent laws, which enable only the utilization of low-THC cannabidiol (CBD) oil and aren’t considered to possess adopted broad medical marijuana laws.

However, the U.S. Drug Enforcement Administration (DEA) classifies marijuana as a Schedule 1 drug under the Controlled Substances Act, complicating things for healthcare providers. A Schedule 1 drug (the list also includes heroin and LSD) is deemed to possess a high potential for abuse and no currently accepted medical use. Despite organized efforts to vary federal law to legalize marijuana, reschedule its classification and decriminalize it for medical purposes, as a Schedule 1 drug medical cannabis remains illegal for doctors to prescribe, dispense or possess for any purpose.

Physicians and, counting on the state, physician assistants and certain nurse practitioners can only write a recommendation, which is different from a prescription. The physician may “recommend” or“certify” patients to get medical marijuana if they meet certain qualifying medical conditions, counting on applicable state law.

Furthermore, some states require physicians to be registered with the regulatory authority, while other states allow physicians to recommend medical marijuana.

Meanwhile, consumer demand for medical cannabis continues to grow, primarily to alleviate chronic pain and other symptoms related to chronic conditions like cancer and epilepsy. Chronic pain accounts for over 67% of qualifying medical conditions reported by patients who use medical marijuana, notes a 2019 government report. Legalized marijuana products have also become hugely profitable. Marijuana Business Daily recently reported estimated sales revenues of $3.8 billion in 2018 alone.

Marijuana legislation continues to stir emotional debates among the general public, politicians, researchers, scientists and therefore the medical profession. Healthcare-related concerns include: Is it safe? Why can’t a physician prescribe it? Who qualifies for a registry card and for what conditions? Is it addictive? Has its effectiveness been proven? Why is it illegal at the federal level but legal in numerous states? Should healthcare facilities allow patients to possess it on the premises? Should facilities allow their physicians to recommend it? Does recommending it violate the quality of care?

An alternative path to approval

An even larger question looms for the healthcare industry: Is marijuana good medicine? Its medicinal approval appears to possess been supported testimonials, legislative initiatives, public reports and/or low-quality scientific evidence, which departs from the normal approach required for Food and Drug Administration (FDA) approval. The shortage of evidence for its medicinal use and questions on its overall effectiveness underscore the necessity for the research, safety studies and well-controlled clinical trials that typically support an FDA-approved medication. However, its Schedule 1 classification strictly limits the sort, amount, availability and funding of such research.

Subsequently, concerns remain about its toxicity, pharmacology, form, delivery method, dosage and, especially, its potency, which has slowly climbed over the past 20 years and is introducing new challenges, consistent with a recent report from CBS News. Fortunately, the DEA recently announced an initiative to facilitate and expand scientific and medical research for marijuana within the U.S.

There is also considerable variability within the profile of various sorts of medical marijuana (i.e., smoking versus consuming edibles), which can affect the body differently. This, too, is obscured by a scarcity of research and a subsequent lack of standards for labeling and testing.

For example, a product might not be regulated or inspected for its chemical contents and purity, and therefore the labeling might not tell the patient much about the merchandise or the way to use it. This presents a possible threat to patient safety by putting them in danger for adverse drug reactions, dose stacking, mixing with other intoxicants and even potential overdose. Medical complications may include gastrointestinal symptoms, psychosis, cardiovascular symptoms, and cannabinoid hyperemesis syndrome, which is very dangerous because it’s difficult to diagnose and treat.

Healthcare organization leaders and physicians are concerned by the shortage of medical standards and whether medical marijuana is that the best treatment modality; The shortage of dosage control; And the way to guard patients against interactions with other medications. They’re also challenged with the way to balance the patient’s experience while managing a physician’s right to refuse to recommend thanks to the stigma related to being labeled a “pot doctor” or a resource for people seeking recreational marijuana.

Proceed with caution

Despite increased public demand for legalization and decriminalization of medical cannabis, many healthcare facilities ban it on their premises in states that have legalized it. Other facilities employ “don’t ask, don’t tell” policies, allowing patients to send it home with a caregiver or use it off hospital premises, which could create the potential risk of losing a hospital license and/or Centers for Medicare and Medicaid Services (CMS) funding.

Recommending patients for medical marijuana use poses a singular challenge for the medical profession. Healthcare facilities face decisions about whether to permit their physicians to recommend it. There’s fear of potential liability, notwithstanding the Conant v. Walters decision, during which the U.S. Court of Appeals for the Ninth Circuit addressed the proper of physicians to recommend medical marijuana, also as First Amendment protections for professional-client speech.

Because laws vary widely from state to state, it’s critical for healthcare facilities to know the laws governing each state, determine their position on this issue and develop appropriate policies and procedures. The Federation of State Medical Boards has developed guidelines to assist state medical boards regarding the advice of marijuana for patient care. These guidelines note that a longtime patient relationship, an honest faith checkup, consent, and an evaluation of addiction potential are at the crux of safe, quality recommendations for patients seeking medical marijuana.

The exposure to significant malpractice liability when recommending medical marijuana is unknown and untested. However, as long as quite half the states leave some medical use, which will likely change. To raised manage their risks, physicians and organizational leaders should understand their role and responsibilities under each state’s laws and any rules or guidelines stipulated by their state medical board. Risk managers might need to encourage their organizations to develop policies and procedures regarding marijuana for medical use, where applicable. This is often an excellent opportunity for risk managers to supply thought leadership and support their organizations in developing an edge on this issue.

Healthcare facilities must still balance patient comfort, popular opinion, and stigma with federal prohibition. The challenge is to teach and have interaction with all stakeholders while supporting safe and effective patient care.

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