Tag: the Oregon Medical Marijuana Program (OMMP)

Pharmacist ponders opening medical marijuana dispensary


This might be a bad idea–for the pharmacist

In recent years, a number of states, including Oregon, have “legalized” marijuana for medical purposes (and in fewer states, for recreational use).  As reported in the Okeecheobee News, Florida voters recently approved legalization of medical marijuana and now Florida cities must decide whether to opt out.  If the Okeechobee City Council decides to allow medical marijuana dispensaries within city limits, one local pharmacist urges that he be considered to run the dispensary, but that might be a bad idea–for the pharmacist.

Florida pharmacist Steve Nelson acknowledges that “medicinal marijuana is not an easy issue,” but he is sympathetic, and he has seen the benefits of medical marijuana in treating seizures, terminal cancer, and chronic arthritis.  I don’t doubt him. Mr. Nelson is also quite experienced (40 years as a pharmacist) and appears cautious, urging the city council to be careful, to ensure adequate controls are in place.  One difficulty, according to the Okeecheobee News, is that the city would have “little power” to regulate medical marijuana because “regulation falls to [the] new state law.” It is not that simple, however.

Marijuana: a Schedule I banned substance under federal law

Despite Florida’s new state law, marijuana is still a Schedule I banned substance under the Controlled Substances Act (CSA), meaning that without a research permit or exception, marijuana cannot be possessed, prescribed, or dispensed for any purpose under federal law, and therein lies the rub.  Over the course of his 40 years experience, Mr. Nelson has practiced pharmacy with a state license as authorized in great part by a federal Registration administered by the DEA.  Now he wants to dispense marijuana contrary to the CSA’s drug schedules and DEA oversight?

Admittedly, for a number of reasons, federal law banning marijuana has been lightly enforced and, in those states where marijuana is “legal,” a lax attitude also prevails among the general public.  However, for those of us that possess a professional license, and especially healthcare providers also possessing a DEA Registration, we are held to higher standards.  In my experience, when there is a Board investigation, marijuana, medical or otherwise, is a complicating factor.  I know this to be true for Oregon physicians, whether recommending marijuana for medical use, or consuming marijuana for recreational use, and I fear my experience will prove true for Mr. Nelson should he choose to run a dispensary.  Yes, I know, Mr. Nelson’s state license and federal DEA Registration are not necessary to run a dispensary under Florida’s new law.  Still, Mr. Nelson is a state-licensed pharmacist, with two pharmacies dispensing controlled drugs as authorized by the CSA pursuant to separate DEA Registrations – does Mr. Nelson really want to run a third operation dispensing a Schedule I substance banned under the CSA?  As a lawyer, I recognize the legal distinctions and I can make the arguments to support Mr. Nelson’s goal of running a dispensary but, as a practical matter, I see the risks of unwanted scrutiny, and more.  Much more.  I earlier commented on physicians, marijuana, the new DEA, and the Oregon Medical Board and marijuana, the practice of medicine, and the Oregon Medical Board, cautioning Oregon physicians physicians not to become complacent when involved with marijuana.  I have also defended pharmacists and physicians for dispensing lawful drugs.  Given my experience, I cannot imagine recommending that a state-licensed, DEA-registered practitioner dispense a Schedule I banned substance, even if its “only” marijuana.

Physicians, marijuana, the new DEA, and the Oregon Medical Board

Physicians beware: marijuana may complicate your professional life

I earlier wrote about marijuana, the practice of medicine, and the Oregon Medical Board, cautioning physicians that regardless of state law, marijuana is still a Schedule I banned substance under federal law, meaning that without a research permit or exception, it cannot be used or prescribed for any purpose under federal law.  Consequently, I cautioned physicians not to become complacent when recommending marijuana for medical use and not to confuse compliance with the Oregon Medical Marijuana Program (OMMP) with meeting the applicable standard of care.

Admittedly, under former Justice Department policy, federal law has been lightly enforced and in those states where marijuana is “legal,” a lax attitude prevails among the general public.  For those of us that possess professional licenses, however, we are often held to higher standards and this seems to be particularly true for Oregon physicians, whether they are recommending marijuana for medical use, or consuming marijuana in their off time.  This point was hammered home earlier this month when I represented two physicians during their Investigative Committee (IC) interviews at the Oregon Medical Board.  One physician had recommended marijuana for medical use.  Although he had strictly complied with the Oregon Medical Marijuana Program (OMMP), the Medical Board’s concern was the standard of care.  The other physician had never recommended marijuana for medical use, but he had admitted to personal use, and not always in a state where it was legal under state law.  Both physicians were honest and forthcoming, but marijuana had complicated their professional lives, something we all want to avoid.

Physicians, the times they are a changing: the new DEA

The times are not getting any easier for physicians recommending or using marijuana.  New Attorney General Jeff Sessions, who heads the Drug Enforcement Administration (DEA), has long opposed the legalization of recreational marijuana and yesterday, Sean Spicer, the President’s press secretary, explained during his daily press briefing that under the new administration we can expect “greater enforcement” of federal law banning the recreational use of marijuana even in those states where recreational use is “lawful” under state law.  I suspect the Oregon Medical Board was not surprised. During a side conversation earlier this month, a Medical Board investigator commented this might happen under the new administration and, a few weeks later, it did.  I think it is safe to assume that in this new era, the Oregon Medical Board will have still greater concerns about the recreational use of marijuana by physicians in any state, including Oregon, where it is “legal” under State law but still a Schedule I banned substance under Federal law.

Marijuana, the practice of medicine, and the Oregon Medical Board

Under federal law, marijuana is a Schedule I banned substance, meaning that without a research permit or exception, it cannot be used or prescribed for any purpose. In recent years, however, a number of states, including Oregon, have “legalized” marijuana for medical purposes (and in fewer states, for recreational use). For a number of reasons, the Drug Enforcement Administration (DEA) has abandoned the enforcement of the federal drug laws as they pertain to the medical and recreational use of marijuana in those states that have declared it legal. Based upon my experience, however, I urge you not to become complacent when recommending or approving marijuana for medical use. Here’s why.

The Oregon Health Authority versus the Oregon Medical Board or: “it’s still the practice of medicine, dude.”

The Oregon Health Authority (OHA) sets out the statutes and rules applicable to the Oregon Medical Marijuana Program (OMMP) and further offers a wealth of relevant information and advice. See, e.g., http://public.health.oregon.gov/DiseasesConditions/ChronicDisease/MedicalMarijuanaProgram/Pages/legal.aspx. Be forewarned, however, that compliance with the OMMP will not necessarily satisfy the Oregon Medical Board when there is a complaint or discrepancy involving professional protocols or the standard of care. As one investigator recently put it, “it’s still the practice of medicine, dude.” In other words, it may be legal, but more may be required of you.

Do not confuse “legality” with the standard of care

The State of Oregon may have legalized marijuana, but the Oregon Medical Board regulates the practice of medicine and is particularly concerned with how you meet the applicable standard of care and/or other professional protocols or commitments that may apply in any given situation. Stated differently, in Oregon, the OMMP establishes the circumstances under which medical marijuana is legal, but the medical profession adds another layer – the standard of care – and it is the Oregon Medical Board that will ensure that the standard of care is met. The fact that you may be recommending medical marijuana consistent with the OMMP will not much satisfy the Oregon Medical Board if the standard of care requires more.