State Capitol News
8:41 am
Tue February 1, 2011

State Health Officials Scrap a Key Requirement Before Someone Can Get Medical Marijuana

Phoenix, AZ – The medical marijuana law approved by voters in November allows
people with certain medical conditions to obtain a doctor's
written certification to purchase up to 2 1/2 ounces of the drug
every two weeks. It also says a recommendation can be issued only
after a full assessment of the person's medical history within
the context of a -- quote -- bona fide physician-patient
relationship. But that was not defined in the ballot measure,
leaving it up to state Health Director Will Humble. His first
draft rules in December said someone needed to have seen a doctor
at least four times over the past year. That is now gone, with
Humble saying the state will now rely on doctors to screen out
would-be abusers.

(We're requiring physicians to do a full physical examination
that's relative and appropriate to that person's diagnosis for
their debilitating medical condition. And we're asking for
assurances from the physician that they've looked at medical
records going back a year for that patient, that they have
medical records on file and that they've really been acting in a
true physician-patient relationship.)

But Humble said he doesn't believe the change will result in the
problems that have occurred in other states, where the laws and
regulations make it easy for doctors to write recommendations for
just about anyone. He stressed, though, the revised rules won't
give doctors carte blanche. Humble said officials from his agency
will be looking over doctors' shoulders. He pointed out that
every time a doctor writes a recommendation, a report will go to
the state outlining the patient's age, medical condition and
where each person lives.

(So, by putting those pieces of information together, along with
the number of certifications that they've written, we hope to be
able to identify those physicians who are not really doing full
assessments, that aren't doing those physicals, that aren't
looking at the medical history, and that aren't acting
professionally.)

And at that point Humble said his staffers will report those with
suspicious patterns to the boards that regulate doctors, who have
the ultimate authority to sanction a physician or suspend or
revoke that person's license. Humble said any doctor writing a
lot of recommendations -- a figure he put at more than 100 a year
-- is going to come under scrutiny. But he said that's not a hard
and fast rule. For example, it might not be unreasonable for an
oncologist who treats cancer patients to write that many
certifications.


(On the other hand, if we see a physician who's in general
practice, got 100 recommendations from a small area by a
university amongst people who are all in their 20s and 30s in
chronic pain as the identifying condition, that's the kind of
person that we need to do some additional surveillance on.)

Still there are potential loopholes. Laura Nelson, the health
department's medical director, noted that the list of conditions
for which a doctor may recommend marijuana contains a catch-all
for any chronic or debilitating condition or a treatment that
results in -- quote -- severe and chronic pain.

(The challenge there is how you measure that. We contemplated at
one point, do we require that the physician that's doing the
written certification review X-rays or MRI scans or things like
that. The reality is there is no easy way to quantity or to verify
chronic pain.)

Nelson said the state is relying on the doctors to be
responsible. The latest version of the rules also says there will
be one dispensary in each of the state's 126 community health
analysis areas. Humble said that should guarantee accessibility
for patients in rural communities while preventing dispensaries
from concentrating in the same highly populated areas. For
Arizona Public Radio this is Howard Fischer.