By: Jody Lutz
Reading Time: 8 minutes
Oklahoma recently became the 30th state in the US to allow access to medical marijuana. The proposal, which passed by a 57% to 43% margin allows doctors to recommend cannabis for any medical condition they deem medically necessary. This makes Oklahoma's law one of the least restrictive in the country.
In a press release, Oklahoma Gov. Mary Fallin said, “These rules are very basic, and represent the best option in developing a proper regulatory framework for medical marijuana, with the highest priority given to the health and safety of Oklahomans.”
The Oklahoma Medical Marijuana Authority (OMMA) states that it, “was established to oversee the medical marijuana program for the State of Oklahoma. It is responsible for licensing, regulating, and administer the program as authorized by state law. Operating under the Oklahoma State Department of Health, the primary goal is to ensure safe and responsible practices for the people of Oklahoma. This website is the official site for application submission and information for patients, caregivers, dispensaries, growers, processors, and physicians.”
Patient license applications became available online on August 25, 2018. Applications are available at the Oklahoma Medical Marijuana Authority.
The OMMA states, "A medical marijuana patient license allows an individual with an approved application to legally buy, use, and grow medical marijuana and medical marijuana products in Oklahoma. This license will be in the form of an identification card that can be used to prove an individual is a license holder. This card will contain the individual’s name, photo, date of birth, city and county of residence, the type of license, the date the license expires, and the patient’s unique medical marijuana license number." Licenses are good for two years unless revoked.
OMMA stipulates the regulation for physician marijuana prescribing regulations as well. Guidance for physicians can be found here.
It states in part, in order to recommend a patient obtain a medical marijuana license:
- A physician must be in good standing with his or her licensure board.
- The physician must establish a medical record for the patient and must have a bona fide physician-patient relationship.
- The physician must determine the presence of a medical condition(s) for which the patient is likely to receive therapeutic or palliative benefit from the use of medical marijuana.
- The physician must recommend a medical marijuana license according to the accepted standards a reasonable and prudent physician would follow for recommending or approving any medication.
- If applicable, the physician may certify that the patient is homebound or does not have the capability to self-administer or purchase medical marijuana due to a developmental disability or a physical or cognitive impairment; and the physician believes the patient would benefit from having a caregiver with a caregiver’s license designated to manage the patient's medical marijuana on the patient's behalf.
- The physician must verify the patient’s identity as provided in the Oklahoma Medical Marijuana Authority Rules (310:681-1-7).
ADDITIONAL CHANGES & CONCERNS:
In July of 2018, penalties for possession of marijuana changed as well. Those without a patient license found in possession of up to 1½ ounces of marijuana would face only a misdemeanor and $400 fine if they state to law enforcement a medical condition.
Additionally, the Oklahoma State Department of Health (OSDH) Board voted to exclude “smokable” cannabis sold through licensed dispensaries as a method to receive “medical marijuana." The board also voted to require a licensed pharmacist to be in the dispensaries as part of the approval process. However, Oklahoma Attorney General Mike Hunter informed the Department of Health they were not within their legal doctrine to enact those rules and they were subsequently not adopted by Government Fallin.
Other concerns outlined in the letter include:
- Restricting dispensaries to limited locations;
- Prohibiting dispensaries from co-locating with other businesses;
- Requiring medical marijuana be grown, processed and dispensed in enclosed structures;
- Requiring a surety bond for licensing;
- Setting hours of operation;
- Limiting the amount of THC in flower, leaf or concentrate for sale or distribution.
So what do physicians need to know?
The adopted draft legislation offers the following outline of key terms:
"Physician" means a doctor of medicine or a doctor of osteopathic medicine who holds a valid, unrestricted and existing license to practice in the State of Oklahoma and meets the definition of “board certified” under rules established by either the Oklahoma Board of Medical Licensure or the Oklahoma Board of Osteopathic Examiners and has been issued a current and active registration from the United States Drug Enforcement Administration (DEA) and the Oklahoma Bureau of Narcotics and Dangerous Drugs (OBNDD) to prescribe controlled substances.
(a) A physician must file a registration with the Department as a recommending physician on a form prescribed by the Department if the physician holds a valid, unrestricted and existing license to practice in the State of Oklahoma and meets the definition of "board certified" under rule established by either the Oklahoma Board of Medical Licensure or the Oklahoma Board of Osteopathic Examiners and has been issued a current and active registration from the United States Drug Enforcement Administration (DEA) and the Oklahoma Bureau of Narcotics and Dangerous Drugs (OBNDD) to prescribe controlled substances.
(b) A registration must include, at a minimum, all of the following:
- The physician's full name, business address, professional email address, telephone numbers and, if the physician owns or is affiliated with a medical practice, the name of the medical practice.
- The physician's credentials, education, area of board certification, training and experience, and supporting documentation when available.
- The physician's medical license number.
- A certification by the physician that states:
- That the physician's Oklahoma license to practice medicine is active and in good standing.
- If the physician has been subject to any type of professional disciplinary action that would prevent the physician from carrying out the responsibilities under the Act and this part, together with, if applicable, an explanation of the professional disciplinary action.
- That the physician does not hold any direct or economic interest in a commercial establishment, grower, commercial grower, manufacturer, or processor.
Recommending Physician Standards:
(a) Any Physician, before making a recommendation for medical marijuana or medical marijuana products under these provisions, shall be in “good standing” with their licensure board and must have completed all required training as required by their licensure board for the recommendation of medical marijuana or medical marijuana products to patients prior to recommending a patient for a patient medical marijuana license. Additionally, the physician must comply with all continuing education requirements generally and specifically required by their board of licensure for the recommendation of medical marijuana under these provisions. Resident physicians do not meet the definition of Physician under this section and any recommendation for a patient medical marijuana license will not be processed by the Department.
(b) Accepted standards a reasonable and prudent physician shall follow when recommending medical marijuana to a patient include the following:
- Establishment of a bona fide physician-patient relationship in which physician has ongoing responsibility for the assessment, care and treatment of a patient’s medical condition or an aspect of the patient’s medical condition;
- Documentation of an in-person (tele-medicine is prohibited) medically reasonable assessment by the recommending physician of the patient’s medical history and current medical condition including physical examination within the past 30 days;
- Diagnosis of a medical condition , in the physician’s opinion, the qualifying patient is likely to receive therapeutic or palliative benefit from the medical use of marijuana to treat or alleviate the medical condition.
(4) Discussion of the risks and benefits of the use of medical marijuana with the patient to include:
- The risk of cannabis use disorder, including in adolescent and young adult users;
- The risk for exacerbation of psychotic disorders and adverse cognitive effects for children and young adults;
- The variability and lack of standardization of marijuana preparations and the effect of marijuana;
- The increased risk of motor vehicle crashes while under the influence of marijuana;
(5) Provision of follow-up care and management of the patient’s medical condition for which use of medical marijuana is recommended, including any follow-up examination necessary to determine the efficacy of marijuana for the patient’s medical condition. All recommendations for medical marijuana shall be governed by the standards for prescription of controlled dangerous substances as codified by the Oklahoma Board of Medical Licensure, the Board of Osteopathic Examiners, including a review by the physician, at least annually, of the necessity of the medical need for the continuing recommendation of medical marijuana.
(6) Maintenance of accurate and complete medical records.
(7) Provision of screening for substance abuse or mental health disorders and determination that issuance of the subsequent medical marijuana recommendation does not present an undue risk of abuse, addiction, or diversion and documents that determination.
(8) Physicians are prohibited from issuing a recommendation for approval of medical marijuana license to females of childbearing years without first performing a pregnancy test on the patient. If the patient is pregnant, the physician may make the recommendation for medical marijuana to the patient if the physician determines that the benefits of the recommendation outweigh the risk of potential harm to the fetus.
(9) Physicians are prohibited from issuing a recommendation for approval of a patient license to themselves, their family members of the first or second degree, their co-workers, or employees; and
(10) A physician who recommends use of medical marijuana shall not:
- Accept, solicit, or offer any form of pecuniary remuneration from or to a caregiver, dispensary, processor, or commercial grower; (B) Offer a discount or any other thing of value to a patient who uses or agrees to use a particular caregiver or dispensary;
- Examine a patient for the purposes of recommending medical marijuana at a location where medical marijuana is dispensed;
- Hold a patient medical marijuana license in his or her personal capacity or as a caregiver if actively marking recommendations under these provisions for other patients;
- Hold any economic interest in an enterprise that grows, transports, processes, or dispenses medical marijuana.
(11) If after a physician completes a follow-up examination and review pursuant to subsection (6) and determine the continued use of medical marijuana by the patient no longer meets the standards set forth in subsection (3) the physician shall so notify the Department.
(12) Check the qualifying patient’s profile on the Oklahoma Prescription Drug Monitoring Program each time a recommendation for approval of the marijuana medical license is made to the Department to:
- Determine whether a patient may be under treatment with a controlled substance by another physician or health care provider;
- Determine the controlled substance history of the patient; or
- Recommend a change of amount or form of medical marijuana.
As this topic continues to evolve, here are some additional resources to utilize:
- Opioid Prescribing Guidelines: A State-by-State Overview
- Oklahoma Medical Marijuana Authority Registration Page for Patients and Physicians
- Oklahoma Medical Marijuana Authority Rules & Regulations
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