Wednesday, May 10, 2017

Recommending Medical Cannabis In New Mexico:

A Resource For Medical Professionals
Understanding-Medical-Cannabis-2.jpg


Medical practitioners in New Mexico are not prescribing medical cannabis; they can only make the recommendation for medical cannabis. Therefore it is best to check with your primary care physician first, as that is your most cost effective route. The New Mexico Medical Cannabis Program, thru the Department of Health, accepts recommendations from both mental health specialists and physicians who are licensed to diagnose any of the qualified medical conditions. A doctor or provider you’ve chosen, has to recommend you to receive medical cannabis as treatment, so the doctor or provider is not prescribing medical cannabis. And this should allow for any licensed physician, in New Mexico, to sign for your enrollment. All practitioners are protected under New Mexico state law under the program.


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. The New Mexico Department of Health administers the MCP in accordance with the Act.



New Mexico’s medical cannabis history started in 1978.  Lynn Pierson, a 26 year old cancer patient,  brought the value of medical cannabis to the New Mexico legislature. After public hearings the legislature enacted H.B. 329, the nation’s first law recognizing the medical value of cannabis. Later renamed The Lynn Pierson Marijuana & Research Act set forth a program that had over 250 New Mexicans receiving medical cannabis through the University of New Mexico until 1986. Federal opposition and state bureaucratic opposition developed  thus ending the program in 1986.
Then in the early 2000’s, Erin Armstrong, a medical cannabis advocate who suffered from thyroid cancer, began to lobby the state legislature to pass a medical cannabis law.  Armstrong, a Santa Fe High and UNM grad, spent three years tirelessly advocating for the medical cannabis program we have today. The Lynn and Erin Compassionate Use Act, 2007, passed under Governor Bill Richardson.
The New Mexico Medical Cannabis Program is available to New Mexico residents with certain medical conditions. The production and distribution of medical cannabis is provided by Licensed Non-Profit Producers (LNPP) throughout the state. 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, 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.
If your debilitating medical condition is not on the list of qualifying conditions, you are strongly encouraged to petition the Medical Advisory Board with a request to add a new condition not currently on the list of qualifying conditions. The Medical Cannabis Advisory Board convenes at least twice each calendar year to conduct public meetings and is made up of eight board certified practitioners.  The board is responsible for reviewing and recommending to the department additional conditions that would benefit from the medical use of cannabis, accepting and reviewing petitions to add medical conditions, medical treatments or diseases to the list of debilitating medical conditions that qualify for the use of medical cannabis; recommending quantities of cannabis necessary to constitute an adequate supply, and issuing recommendations concerning rules to be promulgated for the issuance of registry identification cards.
Where to find a Medical Cannabis Doctor in New Mexico? Medical practitioners in New Mexico cannot prescribe cannabis; they can only make recommendations. Therefore it is best to check with your primary care physician first, as that is your most cost effective route. The New Mexico Medical Cannabis Program accepts recommendations from both mental health specialists and physicians who are licensed to diagnose any of the qualified medical conditions.
Resources For Your Medical Provider On Recommending Medical Cannabis:


Medical Provider Question and Answer Fact Sheet (From NM DoH MCP)

Q: What are the eligible conditions for the New Mexico Medical Cannabis Program?
A: Senate Bill 523-The Lynn and Erin Compassionate Use Act defines debilitating medical conditions eligible for enrollment in the program. These conditions are the following; cancer, glaucoma, multiple sclerosis, epilepsy, positive HIV or AIDS status, damage to the nervous
tissue of the spinal cord with intractable spasticity, admission into hospice care, and any other
medical condition, medical treatment or disease as approved by the department. By the process
of petition brought to the Medical Cannabis Advisory board additional conditions can be
recommended to be added to the program. The final decision is at the discretion of the Secretary
of the Department of Health.

Q: Which additional diagnoses are included in the New Mexico list of indications for cannabis
use?
A: The debilitating medical conditions added by the process of advisory board are the following;
Amyotrophic Lateral Sclerosis (ALS), Crohn’s Disease, hepatitis C currently receiving antiviral
treatment, Huntington’s Disease, inclusion body myositis, inflammatory autoimmune-mediated
arthritis, intractable nausea/vomiting, painful peripheral neuropathy, Parkinson’s disease, posttraumatic stress disorder, severe chronic pain, severe anorexia/cachexia, cervical dystonia, and
ulcerative colitis.

Q: If a medical practitioner would like to certify a patient for the program what are the
requirements for enrollment?
A: A written certification means that, in the practitioner's professional opinion, the patient has a
debilitating medical condition and the practitioner believes that the potential health benefits of
the medical use of cannabis would likely outweigh the health risks for the patient. Certifications
must take place within an established patient‐provider relationship that includes a current
assessment of the applicant’s debilitating medical. Certifications completed in the absence of a
clinical visit, conducted via mail or electronic means are unacceptable.
Certifying providers must meet the following requirements:
1. Have a current and active New Mexico license from their respective medical licensing board
(psychology, nursing, osteopathy, or medical board)
2. Be licensed in New Mexico to prescribe and administer drugs that are subject to the
Controlled Substances Act
A. Hold an active New Mexico Controlled Substance license from the New Mexico
Board of Pharmacy
B. Hold an active DEA license to prescribe controlled substances
3. Have a primary place of practice that is located in the state of New Mexico
4. A patient may not be certified by a practitioner who is related to the patient within the second
degree of consanguinity or the first degree of affinity, including a spouse, child, stepchild,
parent, step‐parent, sibling, grandparent, mother‐in‐law, father‐in‐law, son‐in law, or daughter‐
in‐law of the patient.
5. A practitioner may be prohibited from certifying a patient’s application for: a. failure to
comply with any provision of the rules and regulations of the program NMAC 7.34.2 to 7.34.4;

Q: Is my information confidential if I certify patients for the program?
Pursuant to NMAC 7.3.4.3.16 “Names and contact information regarding a primary caregiver or
certifying provider shall be confidential and shall not be subject to disclosure, except: 1. to
applicable licensing bodies, for the purpose of verifying the practitioner’s licensure status, or in
the event that the medical cannabis program manager or designee has reason to believe that a
practitioner may have violated licensing requirements or an applicable law; 2. to employees of
New Mexico state or local law enforcement agencies, in the event that the medical cannabis
program manager or designee has reason to believe that a primary caregiver or certifying
provider may have violated an applicable law; 3. as provided in the federal Health Insurance
Portability and Accountability Act (HIPAA) of 1996 and applicable state and federal
regulations.” [7.34.3.16 NMAC ‐ Rp, 7.34.3.14 NMAC, 12/30/2010]

Q: What will I be asked to provide on the certification?
1. Your name, address, phone number, clinical licensure, clinical area of medical practice or
medical specialty, length of time you have cared for the patient, NM medical license
number, NM Controlled Substance license number and DEA number.
2. Written certification that the patient has one of the debilitating medical conditions
currently considered as a qualifying condition and that they have symptoms due this
condition or treatment of the condition. Any specific details you can provide will greatly
aid in the review of your patient’s application.
3. Written certification that the potential health benefits of the medical use of cannabis in
this patient would likely outweigh health risks for the patient.
4. Any additional information that you feel would support your patient’s application, such
as therapies tried which were either not efficacious or not tolerated or recent clinic notes.

Q: Will I be penalized for certifying patients for the program?
A: According to SB 523, “A practitioner shall not be subject to arrest or prosecution, penalized in
any manner or denied any right or privilege for recommending the medical use of cannabis or
providing written certification for the medical use of cannabis pursuant to the Lynn and Erin
Compassionate Use Act.”

Q: What is the process after the certification paperwork is completed?
A: The completed application consisting of four pages, medical records if necessary and the
patients NM ID is mailed into the department. The Medical Cannabis Program then has up to 30
days to process the request. Once approved, the patient will receive a list of the licensed
producers in New Mexico, a list of general provisions, and a medical cannabis enrollment card
with an expiration date one year from initial approval. With this card the patient can purchase up
medication at any of the 35 producers. Medical Cannabis can come in a variety of ingestion
options, THC concentrations, and other cannabinoid concentrations. The program recommends
patients keep a log of their medication including strain type, effect and any side effects. The
program can neither recommend which producer a patient uses nor regulate pricing of the
product. Registered patients also have the option of applying for a personal production license.
The requirements are listed on the application at nmhelath.org.

Q: Under what conditions would the program deny an application?
A:An application can only be denied in cases where the applicant fails to provide the required
information, if the application is fraudulent, or if the medical provider has been sanctioned by
their licensing agency. The medical cannabis program may request information to verify a
diagnosis. It is recommended if this is a new application or a new diagnosis some records should
be provided from within the last year related to the diagnosis.

Q: Where can I find additional information and application forms?
A: Additional information on the program including patient applications, common questions and
answers, and current data about the program is located on our website at:
https://nmhealth.org/go/mcp

Q: I would like to have the program come present to our hospital/conference/medical facility.
A: The program conducts over 20 presentations annually. To request more information please
contact the program directly at medical.cannabis@state.nm.us.





Rules & Regulations For Medical Cannabis Pertaining To Providers


7.34.3.17  EXEMPTION FROM STATE CRIMINAL AND CIVIL PENALTIES FOR THE MEDICAL USE OF CANNABIS: ( http://164.64.110.239/nmac/parts/title07/07.034.0003.htm )

               A.            Possession of, or application for, a registry identification card shall not constitute probable cause or give rise to reasonable suspicion for any governmental agency to search the person or property of the person possessing or applying for the card.
               B.            A qualified patient shall not be subject to arrest, prosecution, or penalty in any manner by the state of New Mexico or a political subdivision thereof for the possession of or the use of medical cannabis if the quantity of cannabis, concentrates, or cannabis-derived products does not exceed an adequate supply as defined by rule.
               C.            A primary caregiver shall not be subject to arrest, prosecution, or penalty in any manner for the possession of cannabis by the state of New Mexico, or a political subdivision thereof, for the medical use by the qualified patient if the quantity of cannabis, concentrates, or cannabis-derived products does not exceed an adequate supply as defined by rule.
               D.            A qualified patient or a primary caregiver shall be granted the full legal protections provided under the Lynn and Erin Compassionate Use Act, Section 26-2B-1 et seq., NMSA 1978, by the state of New Mexico if the qualified patient or primary caregiver is in possession of a valid registry identification card.  If the qualified patient or primary caregiver is not in possession of a valid registry identification card, the qualified patient or primary caregiver shall be given an opportunity to produce the registry identification card before any arrest, or criminal charges, or other penalties are initiated.
               E.            A practitioner shall not be subject to arrest or prosecution, penalized in any manner, or denied any right or privilege by the state of New Mexico, or political subdivision thereof, for recommending the medical use of cannabis, or providing written certification for the medical use of cannabis pursuant to this rule and the act.
               F.            Any property interest that is possessed, owned, or used in connection with the medical use of cannabis, or acts incidental to such use, shall not be harmed, neglected, injured, or destroyed while in the possession of New Mexico state or local law enforcement officials.  Any such property interest shall not be forfeited under any New Mexico state or local law providing for the forfeiture of property except as provided in the Forfeiture Act.  Cannabis, cannabis-derived products, paraphernalia, or other property seized from a qualified patient or primary caregiver in connection with the claimed medical use of cannabis shall be returned immediately upon the determination by a court or prosecutor that the qualified patient or primary caregiver is entitled to the protections of the provisions of this rule and the act, as may be evidenced by a failure to actively investigate the case, a decision not to prosecute, the dismissal of charges, or acquittal.
               G.            A person shall not be subject to arrest or prosecution by the state of New Mexico, or political subdivision thereof, for a cannabis-related offense for being in the presence of the medical use of cannabis as permitted under the provisions of this rule and the act.
[7.34.3.17 NMAC - Rp, 7.34.3.15 NMAC, 2/27/2015]


7.34.3.8                 QUALIFYING DEBILITATING MEDICAL CONDITIONS:
               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.


7.34.3.10               QUALIFIED PATIENT AND PRIMARY CAREGIVER REGISTRY IDENTIFICATION CARD APPLICATION REQUIREMENTS:
               A.            The department shall issue a registry identification card to an applicant for the purpose of participating in the medical cannabis program upon the written certification of the applicant’s practitioner and supporting application documents.  Certifications from certifying providers must be obtained within 90 calendar days prior to the expiration of the patient’s registry identification card.
               B.            The department may require the submittal of a recent photograph from a patient applicant and primary caregiver applicant.
               C.            Replacement card fee: A fifty dollar ($50) payment is required for replacement of registry identification card.
               D.            The following information shall be provided in (or as an attachment to) the participant enrollment form submitted to the department in order for a registry identification card to be obtained and processed. An attached original medical provider certification for patient eligibility form shall contain:
                               (1)           the name, address, and telephone number of the practitioner;
                               (2)           the practitioner’s clinical licensure;
                               (3)           the patient applicant’s name and date of birth;
                               (4)           the medical justification for the practitioner’s certification of the patient’s debilitating medical condition, which shall include but not be limited to a statement that, in the practitioner’s professional opinion, the practitioner believes that the potential health benefits of the medical use of cannabis would likely outweigh health risks for the patient;
                               (5)           an attestation that the practitioner’s primary place of practice is located within the state of New Mexico;
                               (6)           the practitioner’s signature and the date;
                               (7)           the name, address, and date of birth of the applicant;
                               (8)           the name, address, and telephone number of the applicant’s practitioner;
                               (9)           a legible photocopy of the applicant’s New Mexico driver’s license or comparable state of New Mexico or federal issued photo identification card verifying New Mexico residence;
                               (10)         documented parental consent, if applicable, to the applicant;
                               (11)         the applicant’s debilitating medical condition;
                               (12)         the length of time the applicant has been under the care of the practitioner providing the medical provider certification for patient eligibility;
                               (13)         the applicant’s signature and date; and
                               (14)         a signed consent for release of medical information related to the patient’s debilitating medical condition, on a form provided by the medical cannabis program.


I.             Certifying practitioner requirements:
                               (1) A patient may not be certified by a practitioner who is related to the patient within the second degree of consanguinity or the first degree of affinity, including a spouse, child, stepchild, parent, step-parent, sibling, grandparent, mother-in-law, father-in-law, son-in law, or daughter-in-law of the patient.
                               (2) A practitioner’s primary place of practice must be located within the state of New Mexico in order for the practitioner to certify a patient’s eligibility.
                               (3) In order to certify a patient’s application, a practitioner must have an actual physician-client relationship with the applicant or qualified patient, and shall conduct an in-person physical or mental evaluation of the applicant or qualified patient prior to issuing a certification.
                               (4) A practitioner may be prohibited from certifying patient applications for:
                                               (a)failure to comply with any provision of this rule;
                                               (b)falsification of any material or information submitted to the department;
                                               (c)threatening or harming an employee of a producer, a medical practitioner, a patient, or an employee of the department; or
                                               (d)any determination by the practitioner’s licensing body that practitioner has engaged in unprofessional or dishonorable conduct.
               J.             Continuing education of certifying practitioners: The department encourages certifying practitioners to obtain at least two continuing medical education credit hours annually related to the medicinal use of cannabis.
[7.34.3.10 NMAC - Rp, 7.34.3.9 NMAC, 2/27/2015]



Physician’s Code Of Ethics And Medical Cannabis

Excerpted from the AMA’s current opinions on the physician’s code of ethics - http://www.ama-assn.org
The Principles of Medical ethics of the AMA article III states “A physician shall respect the law and also recognize a responsibility to seek changes in those requirements which are contrary to the best interests of the patient.”
The following are other portions of the Physician’s code of ethics which relate to medical cannabis:
Section 1.02 – ‘The Relation of Law and Ethics’: “Ethical values and legal principles are usually closely related, but ethical obligations typically exceed legal duties.  In some cases, the law mandates unethical conduct.  In general, when physicians believe a law is unjust, they should work to change the law.  In exceptional circumstances of unjust laws, ethical responsibilities should supersede legal obligations.”
Section 2.17 – ‘Quality of Life’: “In the making of decisions for the treatment of… persons who are severely disabled by injury or illness, the primary consideration should be what is best for the individual patient and not the avoidance of a burden to the family or to society. Quality of life, as defined by the patient’s interests and values, is a factor to be considered in determining what is best for the individual. It is permissible to consider quality of life when deciding about life-sustaining treatment.”
Section 2.24 – ‘Impaired Drivers and Their Physicians’: “A tactful but candid discussion with the patient and family about the risks of driving is of primary importance.”
Section 5.05 – ‘Confidentiality’:The information disclosed to a physician during the course of the relationship between physician and patient is confidential to the greatest possible degree.”
Section 5.06 – ‘Confidentiality: Attorney-Physician Relation’: “The patient’s history, diagnosis, treatment, and prognosis may be discussed with the patient’s lawyer with the consent of the patient or the patient’s lawful representative.”
Section 8.06 – ‘Prescribing and Dispensing Drugs and Devices’: “(1) Physicians should prescribe drugs, devices, and other treatments based solely upon medical considerations and patient need and reasonable expectations of the effectiveness of the drug, device or other treatment for the particular patient… (6) Patients have an ethically and legally recognized right to prompt access to the information contained in their individual medical records. Since a prescription is part of the patient’s medical record, the patient is entitled to a copy of the physician’s prescription for drugs or devices, including eyeglasses and contact lenses. Therefore, physicians should not discourage patients from requesting a written copy of a prescription.”
Section 8.20 – ‘Invalid medical treatment’: “(3) Among the treatments that are scientifically valid, medically indicated, and offer a reasonable chance of benefit for patients, some are regulated or prohibited by law; physicians should comply with these laws.  If physicians disagree with such laws, they should seek to change them.”
Section 9.012 – ‘Physicians’ Political Communications with Patients and Their Families’: “In addition, physicians have a responsibility to work for the reform of, and to press for the proper administration of, laws that are related to health care. Physicians should keep themselves well-informed as to current political questions regarding needed and proposed changes to laws concerning such issues as access to health care, quality of health care services, scope of medical research, and promotion of public health.”


Resources for Medical Professionals and Researchers

(From American For Safe Access : http://www.safeaccessnow.org/medical_professionals)



The medicinal properties of cannabis are varied given the multiplicity of physiological roles of the endocannabinoid system, a ubiquitous molecular signaling system at which compounds in cannabis have robust receptor-based actions. Here is information on medical cannabis practice policies and procedures in your locality, as well as scientific and practice ethics information.

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PFC Brochure

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Scientific History of Medical Cannabis

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The Answer Page

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One stop shopping for quality CME credits on medical marijuana. This content is jointly sponsored by the Massachusetts Medical Society and The Answer Page and approved for AMA PRA Category 1 Credits.™


"The American Medical Association has no objection to any reasonable regulation of the medicinal use of cannabis and its preparations and derivatives. It does pretest, however, against being called upon to pay a special tax, to use special order forms in order to procure the drug, to keep special records concerning its professional use and to make special returns to the Treasury Department officials, as a condition precedent to the use of cannabis in the practice of medicine."                     ~Wm. C. Woodward, Legislative Counsel - 11:37 AM Monday, July 12, 1937

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