Recommending Cannabis in Massachusetts

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.

Written Certification Requirements

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. To learn how to register with the Program, please read the document titled “Physician Step-by-Step Registration Information” located at the following link:

http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/medical-marijuana/info-forphysicians.html

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 a 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.

Definitions

105 CMR 725.005

As described in the Act, a debilitating medical condition includes “cancer, glaucoma, positive status for human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), Hepatitis C, amyotrophic lateral sclerosis (ALS), Crohn’s disease, Parkinson’s disease, and multiple sclerosis (when such diseases are debilitating), and other debilitating conditions as determined in writing by a qualifying patient’s certifying physician.”

“Debilitating” is defined in the Regulations as “causing weakness, cachexia, wasting syndrome, intractable pain, or nausea, or impairing strength or ability, and progressing to such an extent that one or more of a patient’s major life activities is substantially limited.”

If a patient has had a diagnosis of 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 not to be considered to be suffering from a debilitating medical condition.

Renewal

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.

Restrictions and Limitations

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