Thursday, February 23, 2017

Medical Cannabis And Presumptive Eligibility

The New Mexico Medical Cannabis Program is available to any New Mexico resident with certain medical conditions. A Primary Caregiver may be designated by the Qualified Patient to take responsibility for managing the well-being of the qualified patient in the use of medical cannabis. A qualified patient may also obtain a Personal Production License (PPL) to grow medical cannabis for personal use.
If you believe your debilitating medical condition(s) qualify for the medical cannabis program, discuss your symptoms with your licensed physician.  A doctor has to recommend you to receive medical cannabis as treatment, so the doctor is not prescribing medical cannabis. And this should allow for any licensed physician or nurse practitioner, in New Mexico, to sign for your enrollment.  You must submit an application to New Mexico Department of Health’s Medical Cannabis Program administrator’s office along with all required forms.

Patient Certification And Presumptive Eligibility

Due to the qualifying conditions requirement into the medical cannabis program, the types of debilitating medical conditions that are part of the MCP, the nature of these debilitating medical conditions that qualify(and many others); it only makes sense from a medical standpoint to  immediately certify patients under presumptive eligibility.
It is inhumane to have to tell patients they will need to wait 30 days or potential more to receive their patient cards. Patients are anxious and frequently call their physician’s office to ask “where’s my card?” All these patient who qualify are seriously ill patients who need their certification cards in a timely manner. Most states solve this problem with temporary cards issued by the physician. Polled physicians, conducted by the state of Hawai’i,  unanimously agree that care would be greatly improved if a physician could issue some sort of temporary document at the time of the office visit.

Recommendation – Establish Presumptive Eligibility For All Program Applicants.
The Department of Health could provide an immediate temporary document for all applications submitted in person with a completed application check-list, and another solution would be to have presumptive eligibility in form of a letter from the physician saying that an application into the MCP has been practitioner certified and submitted. This process would be the same as a person who see’s a practitioner and is then prescribed medicine to get a Walgreens.  
The current certification process especially takes too long for terminally ill patients and medical cannabis should be available for end-of-life care for patients who have been diagnosed with terminal illnesses. New Mexico’s program, for example, allows medical cannabis for hospice patients. Since there is a clear certification process and criteria for a patient to qualify for hospice care and since hospice care is usually limited to six months; it is suggested that hospice certification be used to allow a patient presumptive eligibility for medical cannabis. It would be inappropriate for hospice patients to have to wait to receive their certification cards for the current processing time.

The Medical Cannabis Program (MCP) was created in 2007,  under the Lynn and Erin Compassionate Use Act, chapter 210 Senate Bill 523. The purpose of this Act is to allow the beneficial use of medical cannabis in a regulated system for alleviating symptoms caused by debilitating medical conditions and their medical treatments. Under New Mexico law cardholders in the MCP are legally permitted to be in possession of 230 units (grams) and may grow up to 16 medical cannabis plants with a Personal Production License. The New Mexico Department of Health administers the MCP in accordance with the Act.

The Medical Cannabis Program has experienced tremendous growth with new program participants, an increase of 75% during 2016, and currently has almost 45,000 patients benefiting from medical cannabis. The medical cannabis program office is currently processing applications in a 12-14 day range and recommends submitting renewal and new patient applications a minimum of 60 days prior to expiration to allow ample time for processing. The Lynn and Erin Compassionate Use Act requires your application to be completely processed and provided to a person within 30 days. The Department of Health shall issue a registry identification card within five business days of approving an application.  Unless renewed at an earlier date, suspended, or revoked, a registry identification card shall be valid for a period of one year from the date of issuance and shall expire at midnight on the day indicated on the registry identification card as the expiration date.  

               A.            Statutorily-approved conditions:  As of the date of promulgation of this rule, specific qualifying debilitating medical conditions, diseases, and treatments (“qualifying conditions”) identified in the Lynn and Erin Compassionate Use Act, Section 26-2B-3(B) NMSA 1978, include:
                               (1)           cancer;
                               (2)           glaucoma;
                               (3)           multiple sclerosis;
                               (4)           damage to the nervous tissue of the spinal cord, with objective neurological indication of intractable spasticity;
                               (5)           epilepsy;
                               (6)           positive status for human immunodeficiency virus or acquired immune deficiency syndrome; and
                               (7)           admission into hospice care in accordance with rules promulgated by the department.
               B.            Department-approved conditions:  The department finds that the following additional qualifying conditions result in pain, suffering, or debility for which there is credible evidence that the medical use of cannabis could be of benefit, through the alleviation of symptoms, and the department accordingly approves these conditions as qualifying debilitating medical conditions for the participation of a qualified patient or primary caregiver in the medical cannabis program.  The department-approved conditions include:
                               (1)           severe chronic pain:
                                               (a)           objective proof of the etiology of the severe chronic pain shall be included in the application; and
                                               (b)           a practitioner familiar with the patient’s chronic pain shall provide written certification that the patient has an unremitting severe chronic pain condition;
                               (2)           painful peripheral neuropathy:  application to the medical cannabis program shall be accompanied by medical records that confirm the objective presence of painful peripheral neuropathy;
                               (3)           intractable nausea/vomiting;
                               (4)           severe anorexia/cachexia;
                               (5)           hepatitis C infection currently receiving antiviral treatment:  the written certification shall attest:
                                               (a)           that the hepatitis C infection is currently being treated with antiviral drugs; and
                                               (b)           to the anticipated duration of the hepatitis C antiviral treatment.
                               (6)           Crohn’s disease;
                               (7)           post-traumatic stress disorder (PTSD):  each individual applying to the program for enrollment shall submit medical records that confirm a diagnosis of PTSD meeting the diagnostic criteria of the current diagnostic and statistical manual of mental disorders;
                               (8)           inflammatory autoimmune-mediated arthritis:  each individual applying to the program for enrollment shall submit medical records that confirm the diagnosis of inflammatory autoimmune-mediated arthritis;
                               (9)           amyotrophic lateral sclerosis (Lou Gehrig’s disease);
                               (10)         inclusion body myositis;
                               (11)         spasmodic torticollis (cervical dystonia);
                               (12)         Parkinson’s disease;
                               (13)         Huntington’s disease;
                               (14)         ulcerative colitis; and
                               (15)         such other conditions as the secretary may approve.
               C.            Additional application requirements:  A patient shall submit written certification from the patient’s practitioner which shall attest:
                               (1)           to the diagnosis of the medical condition;
                               (2)           that the condition is debilitating; and
                               (3)           that potential risks and benefits of the use of medical cannabis for the condition have been discussed with the patient, in accordance with this rule;  a patient who applies on the basis of having a department-approved condition may also be required to satisfy additional eligibility criteria, as specified in this rule.

What is a chronic medical condition?
A chronic disease is one lasting 3 months or more, by the definition of the U.S. National Center for Health Statistics. Chronic diseases generally cannot be prevented by vaccines or cured by medication, nor do they just disappear.
What is the meaning of debilitating?
Something that's debilitating seriously affects someone or something's strength or ability to carry on with regular activities, like a debilitating illness. Debilitating comes from the Latin word debilis, meaning "weak." That's why you'll often see the adjective used to describe illness, despite the negative reference.
The State of New Mexico defines it in program law as:

“Debilitating medical condition” means:   (1)  cancer;   (2)  glaucoma;   (3)  multiple sclerosis;   (4)  damage to the nervous tissue of the spinal cord, with objective neurological indication of intractable spasticity;   (5)  epilepsy;   (6)  positive status for human immunodeficiency virus or acquired immune deficiency syndrome;   (7)  admission into hospice care in accordance with rules promulgated by the department; or   (8) any other medical condition, medical treatment, or disease as approved by the department which results in pain, suffering, or debility for which there is credible evidence that medical use cannabis could be of benefit.