MEDICAL MARIJUANA & TELEMEDICINE: A PERFECT PARTNERSHIP?

Medical Marijuana and telemedicine. Those are two things you probably haven’t heard in the same sentence yet. But why not?

They’re both relatively new phenomena that have caught on with doctors and patients in the past few years. Legislators have been pushing bills through to regulate both, due to popular demand and evidence showing the benefits of each to providing better healthcare.

One of our current clients actually runs their medical marijuana practice completely online, with all patient visits done virtually. Many other practices are starting to follow suit in states that allow it.

So, how does this pairing work? With Marijuana classified as a schedule I drug, what rules do doctors need to follow? What does a healthcare provider need to know before recommending medical marijuana via virtual visit?

Because the policy is still shifting around both telemedicine and medical marijuana, pairing the two together comes with certain challenges. Doctors not only need to meet the clinical and legal guidelines for each program, they also need to follow their state medical board’s recommendations on how to mix the two.

Currently, 23 states plus DC have legalized medical marijuana. But many state medical boards are still weighing in on whether telemedicine can be used for medical marijuana consults.
Take Colorado, the first state to legalize marijuana. Colorado’s medical board just recently issued updated guidelines for telemedicine, and specifically excluded medical marijuana consults as an acceptable telemedicine service. Even as their update helped remove some of the restrictions on telemedicine practice, it failed to make medical marijuana an allowed part if virtual care. The state of Washington likewise says physicians can only give medical marijuana recommendations if they do an in-person exam.

California seems to be leading the way in pairing medical marijuana with telemedicine. California’s medical board is more lenient. Their guidelines say that telehealth can be used to establish the qualifying condition for medical marijuana:

"The initial examination for the condition for which marijuana is being recommended must be an appropriate prior examination and meet the standard of care. Telehealth, in compliance with Business and Professions Code section 2290.5, is a tool in the practice of medicine and does not change the standard of care."

The process for actually “prescribing” medical marijuana works a bit differently here, too. While many telemedicine platforms allow physicians to ePrescribe, providers cannot legally prescribe marijuana to patients. That’s because marijuana is a schedule 1 drug. Instead, states with medical marijuana programs generally require providers to fill out an authorization form (sometimes on “tamper-free paper,” in the case of Washington) that patients then take to a medical dispensary. These sorts of additional restrictions can again place limits on whether a medical marijuana consult can happen completely online.

Another important factor here is establishing a provider-patient relationship and documenting a “qualifying condition.” Depending on the state, telemedicine guidelines may require the provider and patient doing the virtual visit to have a pre-existing relationship. Medical marijuana laws sometimes have a similar requirement, especially when the provider needs to document an eligible qualifying condition (like cancer or PTSD) for medical marijuana therapy. To establish that medical condition over a virtual visit, a provider who does not already know that patient may need access to their medical records from another provider which documents that condition and a recent physical exam.

There are still many points for state medical boards to figure out. But as both the medical marijuana and telemedicine industries grow and more systematic guidelines are put into place, we’re likely to see these two phrases get paired together more frequently.

Want to find out more about the guidelines for prescribing medical marijuana virtually in your state?Here are a few helpful sites to check out:

Your state medical board website
NORML State Policy Center
International Cannabinoid Research Society
Society of Cannabis Clinicians