1. 1 Maine’s New Medicinal Marijuana Law Maine Association of Psychiatric Physicians April 30, 2010 Gordon H. Smith, Esq. Executive Vice President Maine Medical Association

2. 2 Background 1999 Original law passes via public initiative, use permitted for medicinal purposes, but no legal means to acquire the product Nov. 2009 Maine Medical Marijuana Act approved by voters (I.B.2009, Chapter 1) Dec. 2009 Governor Baldacci establishes a Task Force, by Executive Order

3. 3 Maine Medical Marijuana Task Force Formed to: Review the implementation of similar laws in other states Make recommendations on the implementation of the law in Maine to ensure effective implementation and ongoing monitoring and to protect public health and safety Advise HHS on rules and fees

4. 4 Debilitating Medical Conditions Cancer Glaucoma HIV/AIDS Hepatitis C ALS Crohn’s Disease Agitation of Alzheimer’s disease Nail-patella syndrome OR the treatment of any of these conditions

5. 5 More Conditions A chronic or debilitating disease or medical condition or its treatment that produces intractable pain, which is pain that has not responded to ordinary medical or surgical measurers for more than 6 months

6. 6 More Conditions A chronic or debilitating disease or medical condition or its treatment that produces: 1. Cachexia or wasting syndrome 2. Severe nausea 3. Seizures 4. Severe and persistent muscle spasms (including M.S.)

7. 7 More Conditions Any other medical condition or its treatment approved by HHS to be recommended by Advisory Board consisting of at least 11 health care practitioners, including: neurology addictionology gastroenterology gynecology pain management medical oncology psychiatry infectious disease hospice medicine family medicine pediatrics

8. 8 Advisory Board Members must be board certified in their specialty and knowledgeable about the medical use of marijuana. Board also includes two public members, one of whom is a registered patient. Practitioners must be chosen from list submitted by MMA and MOA.

9. 9 Other functions of Advisory Board Conduct, at least yearly, public hearings adding additional medical conditions, medical treatments or diseases to the list Make recommendations on adding medical conditions Recommend quantities of marijuana necessary to constitute an adequate supply

10. 10 Role of Physician Medical Certification Document signed by a physician and stating that in the physician’s professional opinion a patient is likely to receive therapeutic or palliative benefit from the medical use of marijuana to treat or alleviate the patient’s debilitating medical condition or symptoms associated with the debilitating medical condition.

11. 11 Physician Must have DEA license Certification must be made “only” in the course of a bonafide physician-relationship after the physician has completed a full assessment of the qualifying patient’s medical history BOLIM and Osteopathic Board will expect compliance with Rule Chapter 11.

12. 12 Physician Licensing boards can not discipline a physician for simply participating with the new law, but can discipline a licensee for failing to properly evaluate or treat a patient’s medical condition or otherwise violating the applicable standard of care

13. 13 Protections for Physician State law provides that a physician can not be arrested, prosecuted or disciplined in any way “solely for providing written certifications or for otherwise stating that a patient is likely to receive therapeutic benefit from the medicinal use of marijuana”. Attorney General Eric Holder’s statement on behalf of the Obama administration.

14. 14 Risks for Physicians Standard malpractice risks if meaningful informed consent is not achieved Failure to review potential side effects, interaction with other medication, etc. Can’t ensure appropriate dosage or purity of product Reversal of federal position Becoming “the pot doc”

15. 15 Options for Physicians Participate in the program, preparing medical certificates for those patients who may qualify Just say no Role of MMA

16. 16 Additional Aspects of the Law Special provisions for minors Establishment of licensed dispensaries Registry and identification cards for registered patients, registered caregivers, and officers, board members and employees of dispensaries

17. 17 Issues Unresolved by L.D. 1811 Deleting any medical conditions from the list Centralized growing facility

18. 18 Proposed Rules (HHS) Proposed rules follow the initiated law and amendment and fill in any gaps. Thirty-seven terms defined Section 4.5 amplifies requirements of physician’s written certification Specifies regulatory requirements of dispensaries and registry identification cards

19. 19 Issues Will the number of physicians willing to participate be sufficient to meet patient demand? How many dispensaries (limit of 8) will be licensed, given the proposed $15,000 annual fee? How many eligible patients will seek a medical certificate at $100 per certificate?

20. 20 Questions? Gordon H. Smith, Esq. Executive Vice President Maine Medical Association gsmith@mainemed.com www.mainemed.com