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Medical Marijuana Prescribing

The Process and compensation for prescribing medical marijuana cards

I never got into marijuana, seems like I missed that boat back in high school when my peers were all about it. Living in Portland, it’s almost part of the culture, for some. I see a few people who meet the criteria for addiction in the urgent care but otherwise, its use seems to be similar to that of alcohol. Recreational.

I finally tried marijuana on 2 occasions and besides making my eyes red and making me sleepy, it really wasn’t for me. Yes, I didn’t do it right and yes, I didn’t inhale deep enough, and yes, I didn’t smoke the right strain. It’s just not for me – just like pitch black dark-roast coffee isn’t for everyone.

I first considered prescribing it back in San Diego when a patient with glaucoma asked me about it. I was quite quickly shut down by my medical group who had a policy against it.

This post stems from an ad I replied to a few months back. The clinic was looking for MD’s who would sign off on medical marijuana cards. I’ll talk about some of the legal changes that have taken place in the Pacific Northwest and the scene of prescribing medical marijuana.

 

Prescribing vs Recommending

I’m not sure if the joke is on us or the government, but doctors cannot prescribe medical marijuana but can recommend it.

Each State has their own process which the clinician must follow in order for the patient to obtain a medical marijuana card from the State.

Marijuana’s smokey prescription laws make it sufficiently complicated for prescribers to figure out. Most doctors don’t want to be bothered and so remain on the sidelines.

 

But isn’t marijuana legal in Oregon?

Yes, recreational marijuana is available over the counter in Oregon. You walk into a dispensary, as they are called, select the strain you want and buy your pot.

You are restricted to a small amount and there is a 25% tax on the sale of the marijuana.

Also, you cannot buy oils and edibles, as I understand it, without a card. Apparently, some of these stronger cannabis formulations are what work best for pain and other medical conditions. They can be synthesized to decrease the high that some of the inhaled formulations possess.

With a card, the patient gets access to the more potent stuff, can buy larger quantities and they don’t have to pay the 25% sales tax.

 

The data behind marijuana’s efficacy

I was going to write a nice little piece on this and then I thought about some of the other crap which is FDA approved for us to prescribe and decided that it’s a waste of time to try to get evidence-based on this particular topic.

Cannabis has been shown to help with appetite, eye pressure, and muscle issues. It can relieve anxiety and pain.

Should doctors be allowed to prescribe it? Of course! A physician should have the ability to make use of any substance in order to treat their patients. We ARE the final decision makers, not the board, not the government and not religious groups.

Should doctors prescribe/recommend it? I have no fucking clue. From the limited data and research that I have come across in my practice and for the writing of this post, I would lean towards a yes.

The reason I decided to not get into a scientific discussion is because we are legally allowed to prescribe opioids for chronic pain which I am absolutely against. Terminal illness aside, controlling a patient’s pain with ever-escalating doses of opioids has never worked in my patient population.

Uptodate didn’t have any recommendations on what to recommend to patients, how to utilize it in a medical practice and no information on which strains are best for what conditions – that was a bit disappointing.

 

MM card process in Oregon

In Oregon, the patient has to meet specific criteria of medical conditions as spelled out by the OMMP in order to receive a medical card.

The patient sends their medical records to the clinic where I review the chart and determine whether they meet these quite specific criteria.

If they do, then the clinic schedules them for a physical exam. During that visit, I will determine whether the information they provided is valid and perform any relevant exams needed. Simple.

If it all looks good, I sign this form (pdf) and they mail it off to the OMMP. This card must be renewed every year, which means the patient has to see a clinician for the renewal.

My signature on that form is only a recommendation, the OMMP is the entity that gets to decide whether the particular patient will receive a card.

 

Medical Marijuana Doctor ad

I came across an ad on Craigslist in July of 2016, asking for MD/DO’s who were willing to fill out medical marijuana card applications for patients. The person who was in contact with me was a bit vague and I couldn’t do any pre-interview research on the company – I nixed the idea.

A week ago, I met a colleague who is thinking of starting her own practice. A really bright doctor, family medicine trained, who has practiced in all sorts of settings. Just like myself, she is trying out various practice settings.

She was telling me about a medical marijuana clinic in Portland which she worked a couple of shifts at. From our conversations, she wasn’t fully comfortable with the idea of signing off on these cards and if I recall, she ended up denying the majority of them.

I asked her about this place, shot them an email and today I got a chance to tour the clinic and meet the owner.

I biked there with my pink folding bike and 18 minutes later I was sitting in S.’s office talking about his unique and interesting clinic.

 

Meeting the owner

Interestingly, the owner is not an MD but has a separate health-related practice in that medical office. He started renting the space 4 years ago for his own clinical service business.

His buddy, an MD, asked him to help start this medical marijuana card location to help those who are legitimately using and needing medical marijuana.

His doc buddy had toured a few other facilities in Portland who offer a similar service and he was disgusted by the way they were doing business, giving out cards to anyone who asked and just practicing shady medicine, apparently.

I really enjoyed meeting this dude. He seemed genuine about the work he does and told me the headaches he had to go through to prevent drug seekers from using his clinic’s services.

He is a smart entrepreneur, using his medical practice in various ways. He is offering other medical services which I will get into in the future. I know I am being a bit vague, but until I sign on a dotted line I don’t like to give away the names of the organizations which I am affiliated with.

 

Compensation for the doctor

Let’s get down to the details. The process is straightforward. The patient has to bring all their relevant medical records to the clinic which will be reviewed by me from the comfort of my home. I can approve or deny them for the next step, an in-person visit.

The patients are charged somewhere in the $200 range for the physical exam part where they have to come into the clinic to see me.

The owner was open to discussing the compensation model, we agreed on $50/patient instead of an hourly rate. As a fast clinician, I get to take advantage of my speed.

The income I will make will be marijuana related. There are all sorts of banking issues with that since medical marijuana is federally illegal. I will need to figure out what to do with the money and how to prevent my accounts from getting closed by banks who don’t want their customers participating in such endeavors.

 

My final verdict

I am going to go ahead with this and should be seeing patients in the next few days.

I am not worried about any repercussions from the federal government or having my license revoked etc. Sure, there are a few horror stories out there on the www, but I don’t think it’s a prevalent recourse for the gov’t.

Worst case scenario, my license gets revoked, I can’t practice medicine any longer and I have to resort to living off of my investments – fine by me. It would give me a good excuse to start another auto mechanic shop in Portland or start a contracting business.

My motivation to do this

I am not sure what my motivation is. It’s an opportunity that’s singing to me, I don’t think I want to pass on it.

I will provide a better impression once I get started with this gig. I don’t think it’s going to be a large source of revenue. Nor am I looking for it to be a substantial source of revenue.

By going and meeting the clinic owner, I have established a new connection in Portland, met someone wonderful and deepened my social network.

 

One reply on “Medical Marijuana Prescribing”

Despite mirijuana’s ‘medical’ purpose which is anecdotal at best or subjective there haven’t been any randomized control trials conforming the superiority over alternatives. RCTs are a clinician’s reliable method of recommending a certain treatment. As a mom who had to watch a bunch of kids be subjected to second hand nasty mirijuana smell which has been shown to kill neuronal brain cell junctioning at a park I don’t recommend it . I have also noticed the vapors do permeate quite more than cigarette smoke. Maybe one day an extract can be used orally just like Lyrica is a specific isomer of Gabapentin for pain, reducing the unwanted side effects .

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