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Navigating the Complex Issues Surrounding Medicinal Marijuana

Published on 22 July 2019

With more and more states taking steps to legalize medical marijuana, increasing numbers of individuals are utilizing the substance to treat a variety of health issues. Medical marijuana is quickly becoming a go-to treatment option, yet health care providers and patients still have much to learn regarding its health benefits and risks, as well as the issues surrounding its legality.

“Having worked in oncology for more than a decade, I heard many of my patients openly discuss their use of marijuana while undergoing chemotherapy,” said Christine Roussel, Pharm.D., BCOP, director of pharmacy at Doylestown Hospital in Doylestown, Penn. “When Pennsylvania legalized medical marijuana in early 2016, I found that there was a lack of good medical information for health care providers. With medical marijuana, there are side effects, there are drug interactions, and there are a lot of things legally that doctors and pharmacists need to know.”

As a board-certified oncology pharmacist, Roussel has devoted much of her career to helping health care professionals learn about the safety and clinical use of chemotherapy and cannabis, with a focus on adverse effects. In her home state of Pennsylvania, she developed a medical cannabis training program for the Philadelphia College of Pharmacy through which more than 1,200 licensed health care providers have become able to certify patients or work in Pennsylvania dispensaries. She also educates providers across the country as a member of the board of directors of the American Society of Cannabis Pharmacists (ASCPh), an organization founded to provide quality medical cannabis education and unify pharmacy professionals in support of safe management of medical cannabis.

This education is important because the traditional idea of prescribing does not apply to medical marijuana. Instead, health care professionals can recommend cannabis as a possible therapy using their freedom of speech, and those in states with medical marijuana programs can certify patients to access cannabis.

“In recent years, the number of physicians who certify patients to use medical marijuana has increased dramatically,” Roussel said. “Whether you agree with the medical use of medical marijuana or not, every physician and pharmacist should know about it because so many patients are using it.”

Roussel says, based on state demographic data, pain management is the most common reason individuals seek medical marijuana, and in cancer patients, it also can help with other symptoms like insomnia, depression and loss of appetite. While the use of medical marijuana can be highly beneficial for some patients, she explains that it is not appropriate for all patients, and it’s critical for patients to go through the appropriate channels when obtaining it.

“Based on what state they are in, certified patients who enter a dispensary may meet with a pharmacist, a physician or a completely unlicensed provider. It all depends on the state’s requirements for certification,” Roussel said. “In some cases, providers with no medical background are giving patients medical advice, and that is dangerous.”

As with all medications, patients need clear instructions on using medical cannabis. And with the wide variety of products available in varying strengths, safety is critical. To help improve patient safety, Roussel is working in collaboration with the Institute of Safe Medication Practice, medical cannabis growers and processors, and other stakeholders to create standards for the labeling of medical cannabis.

Licensed health care providers can help ensure that patients are taking medical marijuana in the appropriate doses in order to prevent negative interactions and side effects, and pharmacists have the potential to play a critical role in keeping patients safe.

“Pharmacists need to advocate on behalf of our profession to be the gatekeepers of medical marijuana,” Roussel said. “In states like Connecticut, Minnesota, New York and Pennsylvania, the pharmacist is the one in the dispensary who facilitates which products patients get and guides them toward safe choices, safe dosing and safe titration.”

Locally, Missouri became the 31st state to adopt medicinal marijuana last fall when voters approved Constitutional Amendment 2 and legalized the growing, manufacturing, selling and consumption of medicinal marijuana products in the state.

Under the amendment, doctors may provide patients with a certification allowing marijuana use if the patient has been diagnosed with one or more chronic diseases outlined in the amendment. Amendment 2 also requires patients and providers to apply for state licenses for medical marijuana. The state is accepting license applications this summer, with licensing to begin in the latter part of the year.

Rep. Travis Fitzwater, who represents District 49 in the Missouri House of Representatives, supported the amendment, which he saw as the most thoughtful path forward on legalizing medical marijuana in the state.

“The discussion about medicinal marijuana has been happening in the Missouri legislature for the last five years or so, and it’s reflective of a larger conversation that’s been going on across the nation about how to propose reasonable legislation on the medicinal side,” Rep. Fitzwater said. “What’s important about Amendment 2 is that it’s a policy that’s controlled. Dispensaries have to be approved by the state, and doctors and other health care providers have to follow a protocol to give certifications to patients. There is a process with oversight to ensure that we’re not giving marijuana to everyone in the state who asks for it.”

As the state continues to build its medicinal marijuana distribution infrastructure, Rep. Fitzwater encourages pharmacists to make their opinions heard.

“Pharmacists are the patient care experts in the prescription drug environment, and that makes it important for them to be involved locally with this issue,” Rep. Fitzwater said. “As the state navigates this new avenue for treating patients, it will be critical for pharmacists to stay up to speed on what’s happening and how it will impact their communities and those they serve.”


This story was featured in the Spring 2019 issue of Script magazine. To read past issues of the magazine, visit the Script magazine archive.

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