No More Easy Red Cards: Colorado's New MMJ Physician Guidelines in Place

The waiting room at Colorado Wellness, a Denver medical marijuana dispensary.EXPAND
The waiting room at Colorado Wellness, a Denver medical marijuana dispensary.
Scott Lentz

The state’s medical marijuana program started a new era last month, after the Colorado Medical Board unanimously approved a set of recommendation guidelines for medical marijuana physicians – and those guidelines took effect immediately. Although the final draft of the policy, written by the Medical Board’s Medical Marijuana Workgroup and designed to set a standard of good practices, had met with little resistance from medical marijuana stakeholders, the new rules definitely put structure in a program that was fairly loose in the past. So far, though, complaints have been few.

The new guidelines are a result of Colorado’s Caregiver Act, which passed the legislature earlier this year. The proposal was pushed as a way to tighten up the state’s medical marijuana caregiver program by limiting the number of plants that caregivers can grow; proponents had claimed that unregulated herb was aiding diversion and reducing tax revenues from recreational pot. The Caregiver Act also required the Colorado Medical Board to craft a policy that physicians should use while evaluating potential medical marijuana patients. Unlike evaluations for other debilitating conditions, such as those prescribing treatment with narcotics, up to that point the state had no specific policy regarding medical marijuana evaluations.

So you can expect such evaluations — or re-evaluations — to be more professional from now on, since any physician who doesn’t follow these examination, assessment and relationship guidelines could be referred to the Medical Board and ultimately lose his or her license to practice medicine. The new policy calls for doctors to take a closer look at people applying for medical marijuana; that means the guy your friend gave $75 to for a wink and the signature needed to get his red card probably won’t be operating like that much longer.

Physicians are now strongly urged to follow up with patients after issuing recommendations for medical marijuana, and the initial evaluation process is more similar to the evaluation for other medical treatments, with more documentation and collaboration with other health-care providers. Patient background information — such as family, medical and mental-health history when relevant — should be part of evaluations; appropriate physician examinations and pertinent imaging and laboratory data are also suggested. Extended plant counts, which allow patients and caregivers to grow more than the standard twelve plants that medical patients are allowed (caregivers may have up to 99 plants), will also require more detail in their justification.

“The Medical Board’s mission on this was to protect the consumer and to also provide guidance to the health professionals that it licenses,” says Colorado Medical Board director Karen McGovern, who presided over the drafting meetings.

Although the rules might sound rigid compared to the old way of doing things, many marijuana physicians think they represent a step toward legitimacy in their practices. Previously, since there were no guidelines pertaining to medical marijuana recommendations, the only road map that physicians had was the Generally Accepted Standards of Medical Practice – a constantly changing set of medical-community standards that are based on peer-reviewed medical literature, controlled clinical trials and observational studies from credible institutions, all of which have little to no data on medical marijuana, thanks to the federal prohibition of cannabis. Marijuana physicians are hopeful that these rules will make their line of work more respectable to their peers in the health-care community while still leaving them room to operate fairly.

“As it is now, it’s mostly asking for decent recordkeeping, and [for] MMJ doctors to adhere to more conventional standards. It will require just a few tweaks to the way we do things,” says one medical marijuana physician. “Hopefully, it will cut down on some of the nonsense – doctors giving out huge plant counts, giving cards to nineteen-year-olds with bullshit problems, etc. – and not become a heavy-handed,  bureaucratic nightmare.”

Medical marijuana physicians must now include more detailed patient information in evaluations.
Medical marijuana physicians must now include more detailed patient information in evaluations.
Thomas Mitchell

Physicians had a much different attitude toward the first guidelines draft released in September. That version strongly recommended incorporating mental-health background checks and background checks for family members, as well as other medical records, along with imaging studying and laboratory testing for prospective patients – all of which had to be paid for by the customer. It also suggested pregnancy tests for any woman of childbearing age, and singled out chronic pain in a way that offended medical marijuana physicians.

“When we were developing the first draft, we knew this was a policy where we’d request stakeholder input,” McGovern says. “The number of comments we received for this was far in excess [of those received] for any other policy that we drafted through the public.”

After receiving more than 400 comments from medical marijuana stakeholders, the Medical Board’s Medical Marijuana Workgroup combed through the first draft line by line to ensure that the proposed guidelines weren’t misconstrued or overly harsh. “Anytime you submit a written document, the tone is subject to inference,” McGovern says. “Since the second policy was sent out October 29, we did not receive any negative comments.”

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Still, some marijuana doctors and members of the medical marijuana community are worried about the consequences of the tighter watch on extended plant counts and the physicians who recommend them. Jason Werf, executive director of the Southern Colorado Cannabis Council, who participated in the stakeholder meetings during the drafting process, is wary of the potential referrals to the Medical Board that a physician could receive for having recommended extended plant counts before the new guidelines were approved – something he sees as retroactive punishment. “A month or two from now, we'll have a much better idea on this,” he says. “We haven't seen a lot of things transpire, but it could change at a drop.”

When recreational marijuana stores first opened, the state anticipated that the number of medical marijuana patients would decrease as pot became more easily available. Higher tax rates and lower quality on the recreational side, however, kept the medical migration at bay – and the number of patients in Colorado actually increased as physicians running what critics have called “card mills” continued to hand out pot recommendations without much restraint.

As of September 2015, there were 114,767 patients on the Colorado Medical Marijuana Registry, up from the 111,030 patients in January 2014, when recreational sales began. Over 90 percent of them report chronic pain as the reason they need medical marijuana. Since the Colorado Medical Marijuana Registry began in 2000, more than 310,000 people have applied for medical marijuana treatment.

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