New legal rules regarding medical cannabis

During this past legislative session, the legal requirements regarding medical cannabis were changed. This article will discuss the new rules as well as the existing legal requirements regarding medical cannabis. Under federal law, even medical cannabis is categorized as a schedule 1 drug and is therefore illegal to prescribe. The original four-year pilot program, “Illinois Medical Cannabis Pilot Program”, was enacted in 2014 but did not start until later that year because the rules needed to be drafted. The program was extended by the legislature and will run through July 1, 2020, unless the legislature extends the program again.

Under the program, patients can receive up to 2.5 ounces per 14-day period which includes usable cannabis: seeds, leaves, buds and flowers. It also includes edibles and other non-refrigerated, non hot-holding items (e.g. tinctures). Minors can only use cannabis-infused products. It is possible for patients to obtain a waiver to get more than 2.5 ounces per 14-day period. No limit is specified for patients qualified for the waiver. The waiver requires a statement by a physician as to why the patient requires more than the 2.5 ounces. Physicians should keep in mind that 2.5 ounces is not a small amount as it is enough for 50-100 joints.

Currently, the only psychiatric condition included in the conditions approved for medical cannabis is post-traumatic stress disorder (PTSD). The Medical Cannabis Advisory Board (Board) has considered petitions to add anxiety and anorexia nervosa as conditions to the list of approved conditions, but the Board declined to add them. The Illinois Psychiatric Society (IPS) has submitted letters opposing the addition of anorexia nervosa and PTSD, and will continue to oppose the addition of psychiatric conditions to the list of conditions approved for medical marijuana, as it is likely that those conditions will be reconsidered in the future by the Board. Here is the list of all conditions approved for medical cannabis:

Cancer, glaucoma, positive status for human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), hepatitis C, amyotrophic lateral sclerosis, Crohn’s disease, agitation of Alzheimer’s disease, cachexia/wasting syndrome, muscular dystrophy, severe fibromyalgia, spinal cord disease, including but not limited to arachnoiditis, Tarlov cysts, hydromyelia, syringomyelia, Rheumatoid arthritis, fibrous dysplasia, spinal cord injury, traumatic brain injury and post-concussion syndrome, Multiple Sclerosis, Arnold-Chiari malformation and Syringomyelia, Spinocerebellar Ataxia (SCA), Parkinson’s, Tourette’s, Myoclonus, Dystonia, Reflex Sympathetic Dystrophy, RSD (Complex Regional Pain Syndromes Type I), Causalgia, CRPS (Complex Regional Pain Syndrome Type II), Neurofibromatosis, Chronic Inflammatory Demyelinating Polyneuropathy, Sjogren’s syndrome, Lupus, Interstitial Cystitis, Myasthenia Gravis, Hydrocephalus, nail-patella syndrome, residual limb pain, seizures (including those characteristic of epilepsy) post-traumatic stress disorder (PTSD), or the treatment of these conditions and terminal illness with a diagnosis of 6 months or less (if the terminal illness is not one of the qualifying debilitating medical conditions, then the physician shall on the certification form identify the cause of the terminal illness.

Until this past summer, in order for patients to obtain medical marijuana, they had to obtain recommendations by physicians that medical marijuana would benefit the patient’s condition. However, as of this summer, physicians no longer need to make a recommendation that medical marijuana would benefit the patient. Instead, the new certification form only requires that the physician check the box for the condition that the patient has and sign the document as the patient’s treating physician. Here is a link to the certification form: <https://www.illinois.gov/gov/mcpp/Documents/Physician%20Certification%20Form%20080814.pdf>.

Under the law, physicians will not be subject to arrest, prosecution, or penalty, or denied any right or privilege solely for providing written certifications. However, a physician may be sanctioned for issuing a written certification for a patient not under his/her care or for failing to properly evaluate a patient’s medical condition.

The law does include a variety of physician restrictions. A physician may not:

1. Seek or accept any payment other than a fee for the examination required prior to certifying a patient.

2. Offer a discount for use of a particular primary caregiver or dispensing organization.

3. Conduct a personal physical examination at a cultivation center or dispensary.

4. Refer patients to a cultivation center, dispensing facility, or registered designated caregiver.

5. Advertise in a cultivating center or dispensing facility.

6. Hold any financial interest in a cultivation center or dispensing facility if the physician certifies patients or is financially connected to a physician who certifies patients.

7. Serve on the board of directors or as an employee of a cultivation center or dispensing facility.* 

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*However, a cultivation center or dispensing facility may hire a physician as an independent contractor provided the physician’s involvement in the cultivation center is limited exclusively to designing or conducting non-proprietary medical research or studies.

Meryl Camin Sosa is the Executive Director of the Illinois Psychiatric Society.