Information for Physicians about the RI Medical Marijuana Program

Frequently Asked Questions

1. I am a Rhode Island physician. Can I legally recommend medical marijuana to my patients?

Yes. Under the 2006 Rhode Island Medical Marijuana Act, “A practitioner shall not be subject to arrest, prosecution, or penalty in any manner for providing written certifications or for otherwise stating that, in the practitioner’s professional opinion, the potential benefits of the medical marijuana would likely outweigh the health risks for a patient.”

2. For what medical conditions may I recommend medical marijuana?

A patient must have a “debilitating medical condition” to qualify for the medical marijuana program. The Rhode Island Medical Marijuana Act defines “debilitating medical condition” as:

• Cancer or the treatment of this condition
• Glaucoma or the treatment of this condition
• Positive status for Human Immunodeficiency Virus (HIV) or the treatment of this condition
• Acquired immune deficiency syndrome (AIDS) or the treatment of this condition
• Hepatitis C or the treatment of this condition
• A chronic or debilitating disease or medical condition or its treatment that produces one or more of the following:
• Cachexia or wasting syndrome
• Severe, debilitating, chronic pain
• Severe nausea
• Seizures, including but not limited to those characteristic of epilepsy
• Severe and persistent muscle spasms, including but not limited to those characteristic of multiple sclerosis or Crohn’s disease
• Agitation related to Alzheimer’s Disease

or
any other condition or its treatment approved by the Health Department.

Please note that the Health Department has not yet approved additional health conditions or treatments.

3. Will this endanger my license to practice medicine?

The Medical Marijuana Act states, “A practitioner shall not be subject to civil penalty or disciplinary action by the Rhode Island Board of Medical Licensure and Discipline or by any another business or occupational or professional licensing board or bureau.”

4. Do physicians in other states recommend medical cannabis?

Yes. RI was the 11th state to adopt a medical marijuana program. There are, at this writing, physicians in 18 states and the District of Columbia signing applications for medical marijuana patients.

5. Do RI’s medical organizations support recommending medical marijuana?

Yes, including the RI Medical Society, RI State Nurses Association, and RI Academy for Family Physicians.

6. Do I have to be licensed in RI to sign a medical marijuana application for a RI patient?

Physicians licensed with the authority to prescribe drugs in Massachusetts and Connecticut may sign applications for RI patients. Physicians must have a bona fide physician – patient relationship with applicants. Click here to read Minimum Guidelines for Physicians: http://www.health.ri.gov/publications/guides/MinimumStandardsForAuthorizingMedicalMarijuana.pdf

7. Is it illegal under federal law to recommend medical marijuana for a patient?

In 2003, the Supreme Court of the United States allowed a lower court’s decision in Conant v. Walters to stand. According to this 9th Circuit ruling, Dr. Conant and other physicians are protected under the First Amendment to the U.S. Constitution for discussing medical marijuana with patients and for recommending its use verbally or in writing.

In Rhode Island, physicians can complete and sign the practitioner form portion of their patients’ applications to the RI Medical Marijuana program. The practitioner form includes the following statement: Marijuana used medically may mitigate the symptoms or effects of this patient’s condition. Further, it is my professional opinion that the potential benefits of the medical use of marijuana would likely outweigh the health risks for this patient.

8. If I sign a patient’s application, will it become a public?

No. The practitioner form, part of the patient’s application, is signed by the physician or other practitioner and mailed to the Department of Health where it is held in strict confidence. The Medical Marijuana Act was revised in 2010 as follows to insure that the Department of Health will not release the names of physicians: “Applications and supporting information submitted by qualifying patients, including information regarding their primary caregivers and practitioners, are confidential and protected under the federal Health Insurance Portability and Accountability Act of 1996, and shall be exempt from the provisions of the RIGL chapter 38-2 et seq. the Rhode Island access to public records act and not subject to disclosure, except to authorized employees of the department as necessary to perform official duties of the department.”

9. Didn’t the Department of Health release the names of doctors to the Providence Journal a couple of years ago?

That controversial action occurred prior to the amendment enacted in 2010. The amendment prohibits such a release.

10. Do I have to fill out a lot of paperwork to recommend medical marijuana?

No. The application form for the RI Medical Marijuana Program is just three pages, and physicians only need to complete one, the Practitioner Form. This Form requires the physician to: provide their contact info, license number, check a box indicating the patient’s qualifying medical condition, and sign the statement at bottom of the form (as stated in the answer to question 6 above). The other two pages are the Patient Form (for the patient’s contact info) and the Minor Form (only applies if the patient’s age is under 18).

The Practitioner Form can be found at: http://www.health.ri.gov/forms/registration/MedicalMarijuanaPractitionerForm.pdf

11. Do RI’s medical organizations support recommending medical marijuana?

Yes, including the RI Medical Society, RI State Nurses Association, and RI Academy for Family Physicians.

12. How will my patient acquire medical marijuana for his or her condition? How do I know they won’t get hurt trying to get it? How do I know if it will be quality medicine?

Licensed patients have legal options for obtaining medical cannabis. They may grow their own if they are able and their circumstances are appropriate. They may also appoint one or two caregivers who can acquire or grow their medicine for them. When the state regulated Compassion Centers open, they will be able to use them.
Licensed patients have access to classes and meetings at RIPAC where they can learn more about their medicine and the best means of administration.

13. I don’t want my patients to smoke. Do they have to smoke their medical marijuana?

Absolutely not. We are encouraging patients to vaporize their medicine, a process whereby the cannabis is not heated to the point of combustion and produces only vapor, so no smoke should get in the lungs. There is a range of other options including edibles, oils, tinctures, teas and more. Once a patient is licensed, they have access to meetings, classes, mentors, other patients and caregivers who can educate and guide them.

The Compassion Centers should be opening in the first half of 2013. They will be licensed under Rhode Island law to dispense medical marijuana to licensed patients. They will also serve as resources for patient information.

14. Do I need special certification to be able to sign medical marijuana applications?

No. Physicians licensed to prescribe drugs in Rhode Island, Massachusetts, and/or Connecticut may sign.

15. How long do I have to know a patient before I sign their application?

The RI Medical Marijuana Act requires the physician to have a bona fide physician-patient relationship but does provide a definition. The Board of Medical Licensure and Discipline has issued the following minimum standards:

The authorization of a medical marijuana card requires that the authorizing practitioner conduct the type of physical examination that meets the following criteria:

The authorizing practitioner must establish and maintain a medical record for the qualifying patient as required. In the case of patients who are treating with another practitioner, the authorizing practitioner must review the last 12 months of the patient’s medical record. The practitioner must retain these records for a minimum of 5 years;

The authorizing practitioner must have conducted and documented an acceptable physical examination that meets minimal standards for all new patient examinations;

The authorizing practitioner must have diagnosed or confirmed the diagnosis that meets the acceptable disease categories;

The authorizing practitioner must examine the patient’s response to conventional medical therapies and explain the risks and benefits of the use of marijuana to the qualifying patient;

The authorizing practitioner must be committed to the continual assessment of the patient and the patient’s response to the use of marijuana. This must be demonstrated through follow-up appointments, semi-annually at minimum, before the card is renewed.

15. Can a physician assistant or nurse practitioner sign an application for a patient?

Not at the present time. RIPAC has joined with the ACLU, RI Medical Society, and the RI Academy of Physician Assistants in a law suit which, if successful, will reinstate the right of Nurse Practitioners and Physician Assistants to sign applications.

16. My patient needs help in obtaining and understanding how to use medical cannabis. Is help available?

Yes. RIPAC hosts patient orientations where we explain the Program, the laws, situations to avoid, options for obtaining legal cannabis and more. We do our best to educate patients about their rights, ways to avoid unscrupulous caregivers, and the options for administering medical cannabis. RIPAC also offers classes and meetings where patients can find support and information.

RIPAC activities are posted on the calendar at RIpatients.org. Patients may call RIPAC at 401.861.1601.

17. Where can I obtain an application for my patient?

You can download and print an application by clicking on the following link:

Click to access MedicalMarijuanaNewApplication.pdf

18. Where do I get a copy of the laws and regulations that govern the Program?

The Medical Marijuana Act can be found at:

http://www.rilin.state.ri.us/Statutes/TITLE21/21-28.6/INDEX.HTM

Regulations for the Program can be found at:

http://sos.ri.gov/documents/archives/regdocs/released/pdf/DOH/5923.pdf

More information can be found on the Department of Health’s web site:
http://www.health.ri.gov/healthcare/medicalmarijuana/for/providers/index.php

19. How can I learn more about the science of and studies on medical marijuana?

The following websites should be helpful to you: