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FSMB Model Guidance for Recommendation of Medical Marijuana

FSMB Model Guidance for Recommendation of Medical Marijuana

The use of marijuana in affected person care has undergone widespread progress and acceptance nationwide. Thirty-three states and the District of Columbia have legal guidelines authorizing the use of marijuana in some type. Two of these states – Utah and Missouri – joined that record this previous mid-term cycle, as voters handed initiatives authorizing the use of medical marijuana. Others, akin to Kentucky and Virginia, have pending laws looking for to authorize the use of medical marijuana. Provided that states characterised as Republican-leaning or Democratic-leaning have legalized marijuana in some type, this inexperienced wave is unlikely to reverse or decelerate.

This week in Ohio, the primary gross sales of medical marijuana to sufferers have formally taken place. Moreover, the Ohio affected person registry, which requires the knowledge of sufferers receiving a marijuana suggestion to be entered right into a database, has already amassed over 12,700 registrants since being activated on December 5, 2018. Additionally, over 370 Ohio physicians have acquired Certificates to Advocate from the State Medical Board of Ohio, which authorizes these suppliers to advocate medical marijuana to their sufferers.

Because the use of medical marijuana continues to develop into legally permissible and extensively accepted, necessary questions must be addressed, together with whether or not physicians ought to advocate medical marijuana as half of their commonplace apply and what procedures must be in place to make sure compliance with regulatory expectations. The Federation of State Medical Boards (FSMB), an entity compromising over 70 medical boards throughout the nation, has produced a set of tips to assist physicians in search of to include medical marijuana into their practices. These tips have been developed after an in-depth nationwide evaluation of the prevailing legal guidelines, laws, insurance policies, and disciplinary actions associated to recommending medical marijuana. Whereas physicians ought to all the time look first to state regulation for steerage on correct follow, the place state regulation doesn’t present sufficient perception, FSMB steerage is especially helpful.[i]


The FSMB has adopted the next tips for the advice of marijuana:

1. Doctor-Affected person Relationship: As with all situation, establishing an present and bona fide physician-patient relationship is prime to offering medical care. Thus, physicians ought to have documentation displaying that a correct physician-patient relationship has been established previous to offering a suggestion for medical marijuana. As with different varieties of drugs, physicians shouldn’t advocate for themselves or relations.

2. Affected person Analysis: A documented in-person medical analysis and assortment of related medical historical past ought to be obtained earlier than recommending medical marijuana. At a minimal, the analysis ought to embrace the affected person’s historical past of current sickness, social historical past, previous medical and surgical historical past, alcohol and substance abuse historical past, household historical past with an emphasis on habit or psychological sickness/psychotic issues, bodily examination, documentation of therapies with insufficient response, and analysis requiring the marijuana suggestion.

three. Knowledgeable and Shared Determination Making: Physicians ought to talk about the dangers and advantages of the use of medical marijuana with the affected person. Sufferers must be suggested of the variability and lack of standardization of marijuana preparations and the impact of marijuana. Sufferers must be reminded to not function automobiles and different heavy equipment whereas underneath the affect of marijuana.

four. Remedy Settlement: A well being care skilled ought to doc a written remedy plan that features the next info.

  • Evaluation of different measures tried to deal with the situation at problem.

  • Recommendation about different choices for treating the situation.

  • Willpower that the affected person might profit from the remedy of marijuana.

  • Recommendation concerning the potential dangers of medical marijuana use, together with:

    • Variability of high quality and focus of marijuana;

    • Danger of hashish use dysfunction;

    • Exacerbation of psychotic issues and hostile cognitive results for youngsters and younger adults;

    • Antagonistic occasions, together with falls or fractures;

    • Use of marijuana throughout being pregnant or breast feeding;

    • Have to safeguard all marijuana from youngsters and pets; and

    • Marijuana is simply for the affected person’s use and shouldn’t be shared with some other provider or particular person.

  • Further diagnostic evaluations or different deliberate remedies.

  • A selected period for the marijuana authorization for a interval not than 12 months.

  • A selected ongoing medical remedy plan as medically applicable.

5. Qualifying Circumstances: Recommending marijuana for sure medical circumstances is on the skilled discretion of the doctor. The indication, appropriateness, and security of the advice must be evaluated in accordance with the present requirements of apply and in compliance with state legal guidelines, which specify the qualifying circumstances for which a affected person might obtain medical marijuana.

In Ohio, for instance, these qualifying circumstances are the next:

  • AIDS;

  • Amyotrophic lateral sclerosis;

  • Alzheimer’s illness;

  • Most cancers;

  • Continual traumatic encephalopathy;

  • Crohn’s illness;

  • Epilepsy or one other seizure dysfunction;

  • Fibromyalgia;

  • Glaucoma;

  • Hepatitis C;

  • Inflammatory bowel illness;

  • A number of sclerosis;

  • Persistent and extreme or intractable ache;

  • Parkinson’s illness;

  • Constructive standing for HIV;

  • Submit-traumatic stress dysfunction;

  • Sickle cell anemia;

  • Spinal twine illness or damage;

  • Tourette’s syndrome;

  • Traumatic mind damage; and

  • Ulcerative colitis.

Nevertheless, the quantity of qualifying circumstances might improve because the State Medical Board of Ohio has just lately closed an software interval to think about including further qualifying circumstances.

6. Ongoing Monitoring and Adapting the Remedy Plan: The doctor recommending marijuana ought to register with the suitable oversight company and supply the registry with the knowledge every time a suggestion, attestation, authorization, or reauthorization is issued. The place obtainable, the doctor recommending medical marijuana ought to verify the state Prescription Drug Monitoring Program (PDMP) every time a suggestion is issued.

The doctor ought to commonly assess the affected person’s response to the use of marijuana and general well being and degree of features. This evaluation ought to embrace the efficacy of the remedy to the affected person, objectives of remedy, and the progress of these objectives. That is when the place a doctor ought to actually query and decide whether or not recommending medical marijuana is acceptable for his or her follow. This steerage would point out the reply to that query isn’t sufficiently addressed by the authorized capability to advocate marijuana. For instance, in Ohio, medical marijuana could also be used to deal with Crohn’s illness or epilepsy. Whereas a psychiatrist or anesthesiologist who has acquired a Certificates to Advocate from the State Medical Board of Ohio can be legally approved to advocate medical marijuana sufferers with these circumstances, it’s questionable whether or not such suppliers can appropriately consider the efficacy medical marijuana is having on treating such circumstances. In these conditions, the supplier might need to take further steps to coordinate with different remedy specialists and be aware to doc these efforts and discussions within the affected person’s medical data.

7. Session and Referral: Along with coordinating with specialists for sure underlying circumstances, a affected person with a historical past of substance abuse dysfunction, or a co-occurring psychological well being dysfunction, might require specialised evaluation and remedy earlier than receiving a suggestion for medical marijuana. The doctor ought to search session with, or refer such a affected person to, a ache administration clinic, or psychiatric, habit, or psychological well being specialist, as wanted.

eight. Medical Data: The doctor ought to maintain correct and full medical data.  Info on these data ought to embrace no less than the next:

  • Affected person’s medical historical past;

  • Outcomes of bodily examination, analysis, diagnostic, therapeutic, and laboratory outcomes;

  • Different remedies and prescribed drugs;

  • Authorization for medical marijuana, together with the date of authorization, the date of expiration, and some other further info required by state regulation;

  • Instruction to the affected person, together with advantages, uncomfortable side effects, and dangers;

  • Outcomes of ongoing assessments and affected person’s response to remedy;

  • A replica of the signed affected person settlement referenced above.

9. Doctor Conflicts of Curiosity: A doctor shouldn’t have knowledgeable workplace situated at a dispensary or cultivation middle or obtain monetary compensation from or maintain a monetary curiosity in dispensary or cultivation middle. Nor ought to a doctor be a director, officer, member, incorporator, agent, or retailer of a dispensary or cultivation middle.


Physicians in search of to include medical marijuana into affected person remedy plans ought to first look to state regulation to make sure compliance. The above FSMB tips ought to be seen as a further useful resource in creating and adhering to greatest practices, because the above tips have been rigorously formulated by members of medical boards throughout the nation. Protecting the foregoing in thoughts, the choice to advocate marijuana shouldn’t be taken flippantly.

[i]  It also needs to be famous that the FSMB has said, “These guidelines should in no way be construed as encouraging or endorsing physicians to recommend marijuana as part of their patient care.”

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