With medical marijuana now legal in 20 states and Washington, D.C., and legislation pending in 13 other states*, medicinal use of cannabis has very much become a national issue – and of course it’s an issue with numerous implications for medical practices and the people who manage them.
Richard F. Comenzo is a Massachusetts attorney specializing in medical marijuana laws. His practice assists physicians, dispensary owners, and patients navigate the new landscape. Medical Office Manager asked him for information and insight.
MOM: What is the biggest misconception with regard to medical marijuana?
RFC: The biggest misconception in Massachusetts currently is both that it is a “public safety” issue, as propounded by law enforcement, courts, and probation officers, and also that doctors are certifying patients with “mental health” problems without involving their mental heath providers. I consider these misconceptions because the “public safety” issue is mere opinion not supported by any facts and not enough studies concerning the effect of THC or CBD on the “mental health” of patients have been documented.
MOM: Why is the use of medical marijuana becoming more widespread?
RFC: Foremost, due to the ground-breaking research and the discovery of the cannabinoid system which regulates pain thresholds. Also, due to the prohibitive cost that the enforcement of marijuana laws have generated.
MOM: Laws vary greatly from state to state, so if you’ve worked for a physician’s practice in one state where medical marijuana is legal, and then move to another state where it is also legal, the requirements may be different. Can you give an example of how the law varies, and how the difference has implications for medical office managers?
RFC: The most obvious one is the difference between the laws in California and in Massachusetts concerning probationers and parolees. In CA, a patient who is on probation must provide his/her probation officer with information concerning the use of medical marijuana. In MA, any citizen may qualify for medical marijuana. No exceptions exist for probationers, parolees, felons, etc.
MOM: People seem to have strong feelings about medical marijuana. If you are against marijuana use and a medical office manager, why is it important to separate your personal opinion from your professional responsibilities?
RFC: For the same reason that doctors separate their life-giving skills from let us say the Boston Marathon perpetrator, Mr. Tsarnaev. A manager of a medical office must provide services to the patients no matter what their personal opinion may be.
MOM: When all is said and done, in the states where it is legal, medical marijuana is a prescribed drug. As such, should it be viewed the same as other prescription drugs or is it more complicated than that?
RFC: In Massachusetts it is not a prescribed drug. The Department of Public Health (DPH) specifically designates it as a qualifying certificate to use medical marijuana. I believe that it should be considered a prescription drug. For example, at the present time, a union member or probationer will not be violated if they produce a prescription for Percocet or Vicodin but may be fired if they test positive for THC. A way around this is to provide a patient with Marinol (an ineffective THC-based prescription) so that if THC is detected he has a “prescription.” Of course the obvious drawback is that the doctor is not providing any relief for the patient’s symptoms.
MOM: Do you have any additional advice for medical office managers who are confused about medical marijuana and concerned about how it will impact their job?
RFC: The most important tool to possess is a good follow-up system that allows constant review of these patients. Right now there is no dosage requirement for medical marijuana patients. All patients must “experiment” with the dosage level. The medical profession does not know the proper dosage for the amount of pain or nausea or cramps a patient experiences. Unlike a prescribe drug such as prednisone where dosage is well known and monitored, at the present time it is impossible to determine the exact dosage for medical marijuana. So, as a medical manager I would ensure that these patients get the highest level of scrutiny and follow-up until their dosage is determined. In Massachusetts we have one caregiver designated per patient. The office manager can insure the highest quality of medical care by ensuring that the caregiver is competent and knowledgeable.
*As of April 2014
Related Tools
Model Tool: Where is medical marijuana legal, and where is legislation pending?
