Massachusetts

Under 935 CMR 501.010 [FIND LINK], a “Certifying Healthcare Provider” in Massachusetts is a Massachusetts-licensed:

• Physician (MD or DO)
• Certified Nurse Practitioner (CNP)
• Physician Assistant (PA)

All must hold an active, full license with no prescribing restrictions and a Massachusetts Controlled Substances Registration (MCSR). All must have at least one established physical practice location in Massachusetts.

A written certification is not a prescription. It reflects your clinical determination that the patient has a debilitating medical condition that may benefit from cannabis treatment.

Certifying physicians recommending medical marijuana must have (1) an active Massachusetts medical license issued by the Massachusetts Department of Public Health, with (2) no prescribing restrictions, (3) a Massachusetts Controlled Substances Registration (MCSR), and (4) at least one established place of practice in Massachusetts.

Physicians are also required to take Continuing Medical Education before issuing written certifications for the medical use of marijuana. Physicians must have completed a minimum of 2.0 Category 1 continuing professional development credits prior to issuing certifications for the medical use of marijuana. The continuing education program must explain the proper use of marijuana, including side effects, dosage, and contraindications, including with psychotropic drugs, as well as on substance abuse recognition, diagnosis, and treatment related to marijuana. DPH will conduct random audits for compliance.

A certification is an electronic document completed and signed by the certifying physician in the MMJ Online System, which states that in the physician's professional opinion, the potential benefits of the medical use of marijuana would likely outweigh the health risks for the qualifying patient.

The certification must specify the qualifying patient's debilitating medical condition and must indicate the time period for which the certification is valid (not less than 15 calendar days, and not longer than one year).

In order to issue a certification to a qualifying patient, a physician must register with the Medical Use of Marijuana Program via the MMJ Online System.

A certification can only be made in the course of a bona fide physician-patient relationship.

A bona fide physician-patient relationship is defined in the Regulations as a relationship between a certifying physician (acting in the usual course of professional practice) and a patient, in which the physician has conducted a clinical visit, completed and documented an assessment of the patient's medical history and current medical condition, has explained potential risks and benefits of the marijuana use, and has a role in the patient's ongoing and treatment.

A certifying physician cannot delegate to any other healthcare professional or other person authority to diagnose the qualifying patient as having a debilitating medical condition.

A physician may not issue a written certification for himself/herself or for his/her immediate family members, but may issue a written certification for his/her employees or coworkers.

Once registered in the MMJ Online System, the physician remains registered and retains the ability to certify a patient indefinitely, unless the:

1. physician's license to practice medicine in Massachusetts is suspended, revoked, or restricted with regard to prescribing;
2. physician has voluntarily agreed not to practice medicine in Massachusetts;
3. physician's MCSR is revoked or suspended;
4. physician has fraudulently issued a written certification;
5. physician surrenders his/her registration; or
6. physician has certified a qualifying patient without completing the required continuing medical education, as described in the regulations

The restrictions apply to the certifying physician, his/her co-workers, employees, and immediate family members. These individuals may not:

1. Directly or indirectly accept from, ask for or offer anything of value to a personal caregiver, RMD, or anyone associated with the RMD in any manner.
2. Offer a discount or anything of value to a qualifying patient based on the patient's agreement or decision to use a particular personal caregiver or RMD;
3. Examine or counsel a patient at a RMD;
4. Issue a certification at a RMD; or
5. Have a direct or indirect financial interest in a RMD

All Certifying Healthcare Providers must register with the Medical Use of Marijuana Program before issuing written certifications. Registration is completed at masscannabiscontrol.com/certifying-healthcare-providers/requirements/.

Required for registration:

• Active, full Massachusetts professional license with no prescribing restrictions
• Massachusetts Controlled Substances Registration (MCSR)
• At least one established physical practice location in Massachusetts
• CNPs: board authorization from the Massachusetts Board of Registration in Nursing to practice as a CNP
• PAs: board authorization from the Massachusetts Board of Registration of Physician Assistants

Once registered, a Certifying Healthcare Provider retains the ability to certify patients indefinitely, unless their Massachusetts license is suspended, revoked, or restricted with regard to prescribing, they no longer hold an MCSR, or they no longer maintain a physical practice in Massachusetts.

Initial Education Requirement:

Before issuing any written certifications, all Certifying Healthcare Providers must complete a training program covering: proper use of cannabis, side effects, dosage, contraindications (including interactions with psychotropic drugs), substance abuse recognition, diagnosis, and treatment. [verify current approved training programs at masscannabiscontrol.com and provide a link]

Continuing Education (CME/CEU):

Certifying Physicians (MDs and DOs) must complete a minimum of 2.0 Category 1 continuing professional development credits as defined in 243 CMR 2.06(6)(a)1 [FIND LINK], specifically addressing medical cannabis.

All Certifying Healthcare Providers must complete continuing professional development credits that correspond to their professional licensure prior to issuing certifications for medical use of marijuana. The continuing education program must explain the proper use of marijuana, including side effects, dosage, and contraindications, including with psychotropic drugs, as well as on substance abuse recognition, diagnosis, and treatment related to marijuana.

A Certifying Physician shall have completed a minimum of 2.0 Category 1 continuing professional development credits as defined under Board of Registration in Medicine regulations for continuing education as defined in 243 CMR 2.06(6)(a)1.

A Certifying Nurse Practitioner shall have completed a minimum of one program meeting the requirements for continuing education of Board of Registration in Nursing as defined under 244 CMR 5.00: and 244 CMR 6.00:

A Certifying Physician Assistant shall have completed a minimum of one program meeting the requirements for Physicians Assistant’s License Renewal as defined under 263 CMR 3.05(3).

A debilitating medical condition is one that causes weakness, cachexia, wasting syndrome, intractable pain, or nausea, to the extent that it substantially limits major life activities.

Qualifying medical conditions include:

• Cancer 
• Glaucoma 
• HIV/AIDS 
• Hepatitis C 
• Lou Gehrig’s disease (ALS) 
• Crohn’s disease 
• Parkinson’s disease 
• Multiple Sclerosis
• Other debilitating conditions as determined in writing by a certified physician

If a patient has been diagnosed with a debilitating medical condition in the past, but does not have an active condition (unless the symptoms related to such condition are mitigated by the medical use of marijuana), and is not undergoing treatment for such a condition, the patient is no longer considered to be suffering from a debilitating medical condition.

Massachusetts has no fixed list of qualifying conditions. Certifying Healthcare Providers have broad clinical discretion to certify any condition they determine to be debilitating. Certifications must be issued only after establishing a bona fide physician-patient relationship. For current program guidance, visit masscannabiscontrol.com.

A Massachusetts resident 18 years of age or older who has been diagnosed by a Certifying Healthcare Provider as having a debilitating medical condition may become a Qualifying Patient. 

Massachusetts residents under the age of 18 may qualify under limited circumstances. Two Massachusetts-licensed Certifying Healthcare Providers—one of whom is a board-certified pediatrician or board-certified pediatric subspecialist—must diagnose the underage Qualifying Patient as having a debilitating life-limiting illness. 

A debilitating life-limiting illness is defined as a condition that does not respond to curative treatments, where reasonable estimates of prognosis suggests death may occur within two years. If the debilitating medical condition is not life-limiting, both physicians must determine that the benefits of the medical use of marijuana outweigh the risks.

Certifying Healthcare Providers must discuss the potential negative impacts on neurological development with the parent or legal guardian of the Qualifying Patient—and the parent or legal guardian must provide written consent.

The Certifying Healthcare Provider must document the rationale to prescribe medical marijuana in both the Qualifying Patient’s medical record and certifying document.

Step 1: Establish a bona fide physician-patient relationship.

Review the patient’s medical history and conduct a relevant clinical evaluation.

Step 2: Determine that the patient has a debilitating medical condition.

Discuss the risks and benefits of medical cannabis with the patient.

Step 3: Issue the written certification through the program online system.

Issue the written certification through the Medical Use of Marijuana Program Online System at masscannabiscontrol.com. The system will generate a 4-digit PIN that is sent to the patient by email to complete their registration.

Step 4: Maintain records.

Document your evaluation and certification in the patient’s medical record. Telehealth certifications are permitted in Massachusetts.

A Qualifying Patient certification is an electronic document executed by the Certifying Healthcare Provider in the Medical Use of Marijuana Program Online System.

The certification states—in the physician’s professional opinion—that the potential benefits of the medical use of marijuana likely outweigh the health risks for the Qualifying Patient.

The certification must specify the Qualifying Patient’s debilitating medical condition and must indicate the time period of certification—not less than 15 calendar days, and not longer than one year.

Step-By-Step Instructions

1. Log on to https://provider.massciportal.com. 
2. Select ‘Certify’ (in upper right hand corner).
3. Enter the Qualifying Patient’s first and last name, date of birth, and last four digits of Social Security Number. If the Qualifying Patient already exists in the system, the personal information will appear.
4. Enter the Certifying Duration. Intervals can be 15 days, 60 days, 90 days, 180 days, 210 days, or 365 days.
5. Enter Certification Date. The system will automatically calculate the Certification Start and Expiration dates. The System will auto populate the Maximum Quantity for 60 days  (10.0 ounces/283.5 Grams). The Provider has the option to override Maximum Quantity in a 60 day period.
6. Provider Agrees to Attestation:
   • This is a Qualifying Patient with whom I have a bona fide healthcare provider-patient relationship.
   • I have had a clinical visit with this Qualifying Patient and completed a thorough assessment before submitting this certification.
   • I have reviewed the Massachusetts Prescription Monitoring Program (PMP) to assess the Qualifying Patient’s prescription history and to coordinate the Qualifying Patient’s care at the time of his/her clinic visit.
   • As part of my clinical assessment of the Qualifying Patient, I have reviewed the risks of using marijuana for medical reasons with my Qualifying Patient and provided the Qualifying Patient with educational information.
   • I certify that this Qualifying Patient is currently suffering from the active debilitating medical condition as stated above and in my professional opinion, the potential benefits of the medical use of marijuana would likely outweigh the health risks for the Qualifying Patient.
   • If the debilitating medical condition is not life-limiting, I certify that I have determined that the benefits of the medical use of marijuana outweigh the risks, I have discussed the potential negative impacts on neurological development with the parent or legal guardian of the Qualifying Patient, and I have secured the written consent of the parent or legal guardian and documented the rationale in the Qualifying Patient’s medical record and in this certification.

PATIENT RECERTIFICATION

Process is the same as Certification.  Certifying Duration intervals can be 15 days, 60 days, 90 days, 180 days, 210 days, or 365 days.

Medical professionals have a legal right to recommend cannabis as a treatment in any state, as protected by the Medical Marijuana and Cannabidiol Research Expansion Act (Title III, Section 301), which became law on December 2, 2022, and the First Amendment, as established by a 2004 United States Supreme Court decision upholding earlier federal court rulings that physicians and their patients have a fundamental constitutional right to freely discuss treatment options.

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