1. Medical Marijuana Presented by: Debbie Riggle, PT
Vice President Ancillary Services Community Hospital
Bob Clarke, MA
Occupational Health
Community Hospital

2. Colorado Constitution
Amendment 20

3. Medical Marijuana Registry Program
Amendment 20 was adopted in the November 2000 general election.
Colorado Department of Public Health and Environment (CDPHE) was tasked with implementing and administering the medical Marijuana Registry program.
State of Colorado Board of Health approved the Rules and Regulations pertaining to the administration of the program, June 1, 2001.

4. Registry Activity
Between 2002 and 2008, there were about 2,000 registrants.
As of July there were 11,094 registrants in this program.
The Daily Sentinel reported in January ,800 registrants.
72% of the applicants have been male.
Average age is 41.
51% of the applicants reside in Denver-Metro and Boulder.
Severe pain is reported for 89% of the applicants.
65% of the applicants have a designated care-giver.

5. Registry Activity
Prior to a court ruling in late 2007, each caregiver was limited to a maximum of 5 patients.
Once that limit was lifted, running a dispensary became commercially viable.
The current federal administration has said that they will not actively seek prosecution for marijuana possession.

6. Legal Activity 3 marijuana-related convictions of applicants.
No physicians have experienced federal reprisals.
No general funds have been designated.
Statutory language places a burden on law enforcement officers.

7. Federal Law
The use, possession, distribution and manufacture of marijuana remains a federal crime in Colorado, and possession of a registration card provides no protection against federal criminal prosecution.
Marijuana is illegal and the primary chemical in marijuana, THC, is a Schedule 1 controlled substance.
Schedule 1 substances have a high potential for abuse, lack currently accepted medical use in treatment in the US and lack acceptance for safe use under medical supervision.

8. The Registry
The registrant can not engage in the use of medical marijuana in plain view of or in a place open to the general public.
The registrant cannot engage in the medical use of marijuana in any way that endangers the health or well-being of another.
Medically the registrant must have a physicians statement indicating that they have debilitating condition and that marijuana might prove beneficial.

9. The Registry
Registrant may possess up to 2 ounces of marijuana and up to 6 plants with 3 being mature.
A primary care giver must be at least 18 and has significant responsibility for managing the well being of the registrant.
The primary care giver may possess up to 2 ounces of marijuana per registrant and up to 6 plants, 3 being mature, per registrant.
There is no limit to the number of registrants a care giver can have
Dispensaries act as care givers to multiple registrants.

10. Medical Considerations
Institute of Medicine (IOM) released a report in March 1999 which recommended the short-term use of smoked marijuana in certain appropriate and specific circumstances for patients with debilitating symptoms (such as intractable pain or vomiting).
Drug Enforcement Agency reports that there is no medical consensus to support the medical use of marijuana.
AMA Council on Scientific Affairs supports the use of medical marijuana but only under close medical supervision (Report 6 – 2001 CSA).
The active ingredient (THC) in marijuana currently exists in the form of a prescription medication---Marinol.

11. Problems
Medically there is no way to monitor the purity or assess the potency of smoked marijuana.
Dosage is not controlled at all since potency (dose) of smoked marijuana is not standardized.
There is no regulation of the dispensaries.
There are medical concerns associated with smoking anything.
Physicians can not determine when someone is registered leading to potential problems associated with prescription medication use.

12. Safety Considerations
The effect of cannabis compared with alcohol on dr... [Am J Addict May-Jun] - PubMed result

13. Safety Considerations
Driving under the influence of cannabis: links wit... [Accid Anal Prev. 2009] - PubMed result

14. Local Regulation
City of Fruita is proposing a 5% “Fruita Medical Marijuana Tax” on the April ballot.
As of 1/10/10, no dispensaries had applied for business license.
City of Grand Junction passed a temporary moratorium in November and stated they would wait to see what the state passes this next legislative session. There are numerous dispensaries operating in the city.

15. Future Regulation From The Daily Sentinel 1/4/10:
820 licensed doctors had authorized medical marijuana to about 15,800 patients.
Fifteen of those physicians accounted for 73 percent of the patients, and five had done nearly half of them.
Many of those doctors have disciplinary restrictions and aren’t allowed to prescribe medication.

16. Future Legislation HB10-1284 Massey & Romer Introduced 2/5/2010
Currently assigned to Judiciary Committee
Dispensary regulations
SB Massey & Romer
Introduced 1/20/2010
Passed the Senate and second reading pending
Addresses the doctor patient relationship

17. DOT Required Drug Testing
The DOT is very clear – Medical Marijuana is prohibited.
DOT guidelines for drug screening do not allow for the use of medical marijuana but DOT does allow for the use of Marinol.
All positive tests for THC (the ingredient in marijuana) will be verified as positive unless the donor has a valid prescription from a physician for Marinol.
Safety issues must be addressed separately.
Employees with a verified positive drug test must not continue in a safety sensitive position which is DOT regulated.

18. Occupational Health Policy Non-Regulated Drug Testing
The test will be verified negative if the donor presents a valid prescription for Marinol.
The test will be verified positive in all other circumstances including when the donor possesses a valid MMC. The MRO will, however, inform the company that the donor does possess a valid MMC. Safety issues should be addressed on an individual basis and may involve the physician that recommended the MMC. This does not exclude the possibility for the compassionate and appropriate use of marijuana for a medical condition.

19. So what should an employer do?
HAVE A POLICY BEFORE YOU ENCOUNTER THIS SITUATION! 
Community Hospital Occupational Health reminds companies that conduct unregulated drug testing to have a clearly established written policy and to include in their policies procedures that apply when they receive a verified positive drug test for THC and when the donor possesses a valid MMC. The Colorado medical marijuana law indicates that the person who holds a valid card may not engage in the medical use of marijuana in any way that endangers the health or well being of another person.

20. For a copy of this presentation or if you have questions
Thank You
For a copy of this presentation or if you have questions
Contact Bob Clarke