Medical Marijuana Use: Prescribers, Patricia Hughes, SVP, RM OneBeacon ...

Slide 1

Up in Smoke? Medical Marijuana Use: Prescribers,

Patients and Personnel

Patricia Hughes, SVP, RM OneBeacon HealthCare Group

?2015 : OneBeacon Insurance Group LLC

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Slide 2

Disclaimer

Information is provided for general informational purposes only and does not constitute legal, risk management, or other advice. Viewers should consult their own counsel or other advisors for such advice. OneBeacon Insurance Group, and its parents and affiliates ("OneBeacon"), and consultants, contractors, and vendors of OneBeacon assume no responsibility or liability for the discovery or elimination of risk that possibly could cause accidents, injuries, or damages. Compliance with any strategies or opportunities for improvement provided does not assure elimination of risk or the satisfaction of requirements of applicable law. Copyright OneBeacon Insurance Group. All Rights Reserved.

?2015 : OneBeacon Insurance Group LLC

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Backdrop: Medical Cannabis (Marijuana)

? As of 11/15: 23 states, DC, Guam allow for comprehensive public medical marijuana and cannabis programs (MA, CT, VT, RI,NH, ME; some include minors; ); 17 states allow use of "low THC, high cannabidiol (CBD)" products for medical reasons in limited situations (some only for epilepsy in children)

? MA: 105 CMR 725.000: IMPLEMENTATION OF AN ACT FOR THE HUMANITARIAN MEDICAL USE OF MARIJUANA

? MA: 18,476 patients have gotten certification/registered ? As of July 2015: 88 doctor's offices in MA authorized to approve

medical marijuana for patients.

?2015 : OneBeacon Insurance Group LLC

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Backdrop: Medical Cannabis (Marijuana)

? Recognized physician 1st Amendment right to professional-client ? speech. (Conant v. Walters) ? Still a Schedule 1 drug under the Controlled Substances Act and

therefore cannot be prescribed. FDA will re-evaluate Schedule 1 status ? DEA considers it : to have highest potential for abuse w/ no currently accepted medical use. ? So, dispensing, possessing, selling, purchasing, or prescribing and use still violates federal laws.

?2015 : OneBeacon Insurance Group LLC

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Slide 5

Our Unscientific Survey

? 12 respondents; from MA ? 1 tert care hosp; 3 comm hosps; 3 MD practices; 1 UC; 1 Occ

Health; 1 inpt rehab ? 2 have certifiers (MDs only, as authorized under MA

regulations); 7 "no" ? 2 (yes) response to "there was an org decision to allow

participation as certifiers" ? 0 responses to : All authorized providers...must provide

confirmation of PL insurance coverage for this activity.

?2015 : OneBeacon Insurance Group LLC

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Narrative Comment

"Our physician leaders voted in this and agreed that a policy indicating that the group as a whole would not prescribe would be appropriate. They believe that if a patient has an illness that would benefit from medical marijuana a specialist would be involved in their care and that specialist would need to manage the medical marijuana along with other treatments. We are comprised of 18 primary care offices, 3 OB|GYN offices, a neuro/spine office and a GI practice. I have only encountered one physician who is not happy about the policy."

?2015 : OneBeacon Insurance Group LLC

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Slide 7

The reasons by the organization (or providers) for not allowing or participating include:

Answer

Response

%

concerns about legal/regulatory 6

75%

liability (state and/or federal)

have been advised by legal

3

38%

counsel, insurance carriers or

other not to participate

simply not interested in

2

25%

participating

lack of clear professional liability 1

13%

coverage for this practice

lack of knowledge about medical 1

13%

cannabis

potential impact on government 0

0%

funding

don't want to take time, effort to 0

0%

meet state requirements

other

0

0%

Slide 8

Patients/residents/clients in my healthcare facility are allowed to continue the use of their authorized MM while receiving care on site

Answer

Response

%

Yes, inpatient

0

0%

No

4

50%

Yes, outpatient

4

50%

Slide 9

There are specific policies and procedures that addresses patient use of medical marijuana while an inpatient and/or while receiving treatment/procedure in the ambulatory setting.

Answer

Response

%

Yes; *1 will "store"

3

38%

No

5

63%

Total

8

100%

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Slide 10

The policy addresses adults and minors.

Answer

Response

%

No

3

50%

Yes, adults and minors 2

33%

Yes, Adults only

1

17%

Yes, Minors only

0

0%

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There is specific language regarding employee use of medical marijuana in human resources policies.

Answer

Response

%

Yes

2

33%

No

4

67%

Total

6

100%

Slide 12

Organizational human resources policy language regarding

medical marijuana use by employees addresses:

Answer

Response

%

Impairment on the job

3

100%

Termination

2

67%

Mandated employee training on 2

67%

applicable policies and

procedures

Drug testing requirements and 2

67%

procedures

" Zero tolerance"/drug free

2

67%

workplace

Exceptions to safety sensitive

1

33%

roles

Use of medical marijuana

1

33%

None of the above

0

0%

Other

0

0%

Use of medical marijuana outside 0

0%

of work time/the workplace

"Safety-sensitive " roles

0

0%

Sb

b

0

0%

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Slide 13

Provider Risk Exposures

?2015 : OneBeacon Insurance Group LLC

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Slide 14

Provider Risks

? State/local laws, regulations & required processes. ? State reciprocity for

MM

? Federal DEA license: requirements: "no prescribing, administration, dispensing of

Schedule 1 drugs for medical use." Includes VA physicians, FQHC.

? Medicaid-Medicare reimbursement billing compliance (False Claims Act

liability; "compliance with all state & federal law")

? Some national associations support, others lukewarm, some opposed ? Employer/entity/practice permission to participate ? Being a "marijuana doc"/ no "bona fide" patient relationship (exam &

review of med recs)..."WE'ED like to be your doctor!"

?2015 : OneBeacon Insurance Group LLC

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Slide 15

Provider Risks

? Knowledge and clinical training on the medical and legal aspects (MA=2 hrs.

CME)

? Concerns about contents, dosage, type; growing/cultivation safety concerns ? Lack of follow up and monitoring. ? Drug testing ? "Certifying" vs "prescribing"; "referral", recommendations for

dosage ? Informed consent: risks of MM; side effects, drug interactions and effects on

preexisting conditions. Safety in the home. DOCUMENT

? Scientific evidence and "Standards of care"? ? Negligence/malpractice theories of liability ? Professional liability insurance coverage (individual, group, entity) :

"non-FDA approved" ?excluded ?required

?2015 : OneBeacon Insurance Group LLC

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