Page 15 - May 2017
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Cover Story: Medical Marijuana in the Hospital Setting: Are You Ready?
Continued from page 1 marijuana; (ii) streamlines care to marijuana use be permitted? Will to minimize liability at the federal level.
Crohn’s disease, Parkinson’s disease, patients certified to use medical marijua- patients have access to medical marijua- Don’t wait for a problem to arise: be
multiple sclerosis, or other debilitating na; and (iii) ensures patients and their na in the emergency department or proactive and keep your workforce,
medical conditions of the same kind or caregivers have realistic expectations for intensive care unit or only in patients’ decision-makers, and patients informed
class as or comparable to those enumer- use of medical marijuana while using the private or semi-private rooms? about the hospital’s position on medical
ated, and for which a physician believes hospital’s services. Alternatively, will the hospital have des- marijuana from the get-go. 10
that the medical use of marijuana ignated rooms for medical marijuana
would likely outweigh the potential Establishing a Workgroup intake (this may be relevant if the hospi- For questions or more information,
3
health risks for a patient. ” A physician Participation from multiple facets of tal permits vapor use)? contact Lee Lasris at
may issue a certification only after the the organization is key to creating work- • Will hospital staff and practitioners lee.lasris@gmlaw.com, Jodi Laurence at
physician conducts a full examination able medical marijuana policies and pro- ask the patient whether he or she is tak- Jodi.laurence@gmlaw.com,
of the patient and a full assessment of cedures. The hospital should consider ing medical marijuana during intake and or Rebecca Greenfield at
the patient’s medical history. 4 establishing a multidisciplinary work- request a copy of the patient’s medical Rebecca.greenfield@gmlaw.com, health
Florida is currently developing its group comprised not only of the board of marijuana ID card or will the hospital care attorneys at GreenspoonMarder P.A.
new state medical marijuana program directors and senior management deci- adopt a don’t ask don’t tell policy?
which expressly protects certifying sion-makers but also representatives • Will the hospital permit practitioners 1
physicians from criminal and civil lia- from the emergency department, special- to register as caregivers to assist patients Note that although this article focuses on
bility and sanctions, so long as the ty departments, research departments, with the administration of medical mari- hospitals, the guidance is applicable to rehabil-
itation centers, skilled nursing facilities, and
physician certifies the use of medical and other medical units. juana or will only self-administration of hospice centers as well.
marijuana within a reasonable standard Physicians and nurses across medical medical marijuana be permitted? 2 Fla. Const. art. X, § 29
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of care. However, it is important to specialties, addiction specialists, pharma- • Where will the medical marijuana be 3 Id.
keep in mind that marijuana remains a cists, and mental health professionals stored during the inpatient’s stay? Will it 4 Id.
Schedule I controlled substance under should also be included in the conversa- be required to remain with the patient at 5 6 Id.
Ellis, RJ, et.al.; Smoked Medicinal
the federal Controlled Substances Act. tion. Additionally, the hospital should all times or will it be stored on the floor Cannabis for Neuropathic Pain in HIV: a ran-
Although there are significant clinical also consider inviting outside parties, with other scheduled drugs or in the hos- domized, crossover clinical trial;
indications 6 that medical marijuana including legal counsel, consultants, and pital’s pharmacy? Will special labelling Neuropsychopharmacology. 2009
can successfully manage and treat representatives from local and state pro- and/or packaging of the medical marijua- Feb;34(3):672-80. doi: 10.1038/npp.2008.120.
numerous medical conditions, the fed- fessional boards to the workgroup. na be required? Epub 2008 Aug 6; Corey-Bloom J, et. al.,
eral government still defines marijuana Strong differing opinions from work- • Will the hospital permit its physi- Smoked Cannabis for Spasticity in Multiple
as a drug that has no accepted medical group members should be expected. cians to certify medical marijuana or re- Sclerosis: a Randomized, Placebo-controlled
use for treating disease. 7 Notwith - Compromise, voting, and outside assis- fill a medical marijuana order for the Trial; CMAJ. 2012 Jul 10;184(10):1143-50.
doi: 10.1503/cmaj.110837. Epub 2012 May 14;
standing medical marijuana’s illegal sta- tance may be necessary to construct poli- patient while he or she is under the hos- Devinsky, O., et.al., Cannabidiol in Patients
tus under federal law, the federal gov- cies and procedures that the hospital’s pital physician’s care? with Treatment-resistant epilepsy: an Open-
ernment has indicated that prosecution board of directors and its practitioners • What is the hospital’s policy on Label Interventional Trial; The Lancet
for medical marijuana use is not a fed- and staff are amenable to and are willing destruction of medical marijuana in the Neurology , Volume 15 , Issue 3 , 270 – 278
eral priority and that it will not use its to comply with. As difficult as it may be, event a patient leaves the medical mari- 2016 March 2016.
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resources to interfere with state medical it is imperative that at the end of the day, juana behind or the patient becomes 8 21 U.S.C. 812(c).
CONSOLIDATED APPROPRIATIONS
marijuana programs. 8 the hospital adopts a uniform position incapacitated or dies? ACT, 2016, PL 114-113, December 18, 2015
Although there is evidence that the about medical marijuana. This uniformi- • Will the hospital permit practitioners (preventing the Department of Justice, includ-
federal government would not prosecute ty will ensure practitioners and staff to “opt out” and request that the patient ing the DEA, from using funding to interfere
a hospital for permitting the use of med- throughout the hospital are capable of be transferred to another practitioner if with state medical marijuana programs);
ical marijuana 9 on site, a dichotomy successfully handling encounters with the patient demands to use medical mar- Guidance Regarding Marijuana Related
between federal and state law will exist as patients, patient advocates, and the com- ijuana and the practitioner does not Financial Crimes, James M. Cole, U.S.
Department of Justice Office of the Deputy
long as medical marijuana is labelled an munity at large with regard to medical believe in the use of medical marijuana? Attorney General (February 14, 2014). See
illicit drug under federal law. This causes marijuana. If so, what will be the procedure for also VHA Directive 2011-004, Department of
serious challenges for a hospital, which transferring the patient and what should Veterans Affairs (January 31, 2011) (the U.S.
must strike a delicate balance between Topics for Consideration be documented? Department of Veterans Affairs prohibits the
limiting federal liability for itself and its The workgroup should consider, at a denial of VA benefits enrolled in state medical
practitioners and minimizing disruption minimum, the following: Other Considerations marijuana programs).
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See Press Briefing by Press Secretary Sean
to a patient’s successful course of treat- • Will the hospital permit the use of In addition to the above substantive Spicer, 2/23/2017, #15 (although the new
ment. medical marijuana within the hospital, medical marijuana use, storage, and administration appears to be less supportive
Establishing policies and procedures and if so, what type of delivery mecha- delivery issues, the workgroup should than the Obama administration with regard to
that address the hospital’s position on the nisms will be permitted? For example, create policies and procedures that recreational marijuana, the current administra-
use, storage, and delivery of medical mar- will medical marijuana use be permissi- describe how the hospital will ensure its tion has made public comments indicating
ijuana ensures practitioners and staff act ble in vapor form? What about pill or staff and practitioners comply with the their support for state medical marijuana pro-
in accordance with the hospital’s prede- edible form? policies and procedures. grams).
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Legislation implementing Amendment 2
termined acceptable levels of risk and • Who may use medical marijuana in The hospital should also consider has not yet been passed by Florida’s legislature;
refrain from taking actions that could the hospital? Will only certified inpa- implementing training requirements for however, the house and senate are negotiating
increase federal liability for the hospital. tients be permitted to use medical mari- its workforce with regard to these issues the language of the legislation and have until
The adoption and communication of juana or will outpatients be permitted to and support feedback from hospital May 5, 2017 to pass such legislation. Florida’s
uniform policies and procedures also (i) use medical marijuana as well? Will the stakeholders. Like other compliance medical marijuana laws are subject to change;
minimizes confusion amongst the hospi- hospital adopt special policies for inpa- policies, the hospital should regularly therefore, hospitals and health practitioners
must be in constant contact with their health
tal’s practitioners and staff by giving tient mental health and substance abuse assess the policies and procedures to care attorneys to ensure they are compliant
direction as to what to do when confront- patients? ensure it remains compliant with state with state law.
ed with a patient certified to use medical • Where in the hospital will medical law and closely work with legal counsel
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