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
                5
          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.
                                                                                                                      7
          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).
                                                                                                                      9
                                                                                                                        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).
                                                                                                                      10
                                                                                                                        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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