Overview of Qualifying Conditions in State Medical ...

Overview of Qualifying Conditions in State Medical Marijuana/Cannabis Programs

(With a Focus on Severe or Chronic Pain as a Qualifying Condition)

Monday June 15, 2015

STATE QUALIFYING CONDITIONS (with focus on pain-related conditions)

Information on state program web site regarding proportion of enrollees who qualified through severe/chronic pain

AZ

Cancer, hepatitis seizures, glaucoma, multiple sclerosis,

71% registered only with

Alzheimer's disease, muscle spasms, HIV/AIDS, or Crohn's

severe/chronic pain; 87%

disease, or "chronic disease or medical condition or its treatment registered with severe/chronic pain

that causes one or more of the following: cachexia or wasting

either alone or with additional

syndrome, severe or chronic pain"

conditions

AK

Cancer, glaucoma, HIV/AIDS, plus "any chronic or debilitating No info regarding frequency of

disease or treatment for such disease, which produces, for a

qualifying conditions on web site

specific patient, one or more of the following, and for which, in

the professional opinion of the patient's physician, such

condition or conditions reasonably may be alleviated by the

medical use of marijuana: severe pain, severe nausea, seizures,

including those characteristic of epilepsy, persistent muscle

spasms, including those that are characteristic of multiple

sclerosis"

CA

AIDS, anorexia, arthritis, cachexia, cancer, chronic pain,

No info regarding frequency of

glaucoma, migraine, persistent muscle spasms (including, but not qualifying conditions on web site

limited to, spasms associated with multiple sclerosis), seizures

(including, but not limited to, seizures associated with epilepsy),

severe nausea, or "any other chronic or persistent medical

symptom that either limits the ability of the person to conduct

one or more major life activities as defined in the Americans

with Disabilities Act of 1990, or, if not alleviated, may cause

serious harm to patient's safety or mental or physical health"

CO

"... the following debilitating medical conditions or a

As of November, 2014: 94% of

debilitating medical condition that produces one of the

enrolled patients qualified with

following: cancer, glaucoma, HIV or AIDS, cachexia, persistent severe pain (These patients might

muscle spasms, seizures, severe nausea, and severe pain."

have had additional qualifying

conditions, as well; there was

double counting of conditions for

patients with multiple qualifying

conditions)

CT

Not included. (Qualifying conditions: cancer, glaucoma,

No info regarding frequency of

HIV/AIDS, Parkinson's disease, multiple sclerosis, damage to qualifying conditions on web site

the nervous tissue of the spinal cord with objective neurological

indication of intractable spasticity, epilepsy, cachexia, wasting

syndrome, Crohn's disease, PTSD).

DE

Cancer, HIV/AIDS, hepatitis C, amyotrophic lateral sclerosis, No info regarding frequency of

and agitation of Alzheimer's disease or the treatment of these

qualifying conditions on web site

conditions. PTSD can qualify as a debilitating medical condition

STATE

Wash DC IL HI ME MD MA

MI

QUALIFYING CONDITIONS (with focus on pain-related conditions)

when it manifests itself in severe physical suffering, such as severe or chronic pain or severe nausea and vomiting, or otherwise severely impairs the patient's physical ability to carry on the activities of daily living." Also, "A chronic or debilitating disease or medical condition or its treatment that produces one or more of the following: cachexia or wasting syndrome; severe, debilitating pain that has not responded to previously prescribed medication or surgical measures for more than three months or for which other treatment options produced side effects; intractable nausea; seizures; or severe and persistent muscle spasms, including but not limited to those characteristic of multiple sclerosis" Not included. (Qualifying conditions: HIV/AIDS, glaucoma, multiple sclerosis, and cancer. Also, patients receiving the following medical treatments: chemotherapy; the use of azidothymidine or protease inhibitors; or radiotherapy). No broad category of chronic/severe/intractable pain, but several disorders related to pain: rheumatoid arthritis, reflex sympathetic dystrophy (Complex Regional Pain Syndrome Type 1), causalgia (Complex Regional Pain Syndrome Type 2) Cancer, glaucoma, HIV/AIDS or "a chronic or debilitating disease or medical condition or its treatment that produces one or more of the following: cachexia or wasting syndrome; severe pain; severe nausea; seizures, including those characteristic of epilepsy; severe and persistent muscle spasms, including those characteristic of multiple sclerosis" Cancer, glaucoma, HIV/AIDS, hepatitis C, amyotrophic lateral sclerosis, Crohn's disease, agitation of Alzheimer's disease, nailpatella syndrome, or, "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 measures for more than 6 months." Program substantially revised 2014. Under fall 2014 rules qualifying conditions include: "Have a chronic or debilitating disease or medical condition or are receiving treatment for a chronic or debilitating disease or medical condition that causes: cachexia, anorexia, wasting syndrome, severe pain, severe nausea, seizures, or severe or persistent muscle spasms" Patients must have a "debilitating medical condition," defined as cancer, glaucoma, HIV/AIDS, hepatitis C, amyotrophic lateral sclerosis, Crohn's disease, Parkinson's disease, and multiple sclerosis (when such diseases are debilitating)". "Debilitating" is defined as, "causing weakness, cachexia, wasting syndrome, intractable pain, or nausea, or impairing strength or ability, and progressing to such an extent that one or more of a patient's major life activities is substantially limited." "A chronic or debilitating disease or medical condition or its treatment that produces 1 or more of the following: cachexia or wasting syndrome; severe and chronic pain; severe nausea; seizures (including, but not limited to, those characteristic of

Information on state program web site regarding proportion of enrollees who qualified through severe/chronic pain

At some point in 2014 physicians were no longer required to report specific conditions or diagnoses No info regarding frequency of qualifying conditions on web site No info regarding frequency of qualifying conditions on web site

No info regarding frequency of qualifying conditions on web site

No info regarding frequency of qualifying conditions on web site

No info regarding frequency of qualifying conditions on web site

No info regarding frequency of qualifying conditions on web site

STATE MT

NV NH NJ NM

QUALIFYING CONDITIONS (with focus on pain-related conditions)

epilepsy); or severe and persistent muscle spasms (including, but not limited to, those characteristic of multiple sclerosis." In addition to information required for certifying any patient, additional information required for certifying a patient because of chronic pain: attestation that the patient's chronic pain has been objectively proven and attestation from a 2nd physician concurring with the diagnosis of chronic pain. Required for all patients certified: narrative description of the patient's debilitating condition why it is debilitating, and to what extent it is debilitating; medications and procedures used to treat it and statement that these options have not been effective; restrictions to the patient's activities due to use of marijuana; time period for marijuana use (maximum = 1 year) AIDS, cancer, glaucoma, and "a medical condition or treatment for a medical condition that produces, for a specific patient, one or more of the following: cachexia, severe nausea, severe pain, persistent muscle spasms (including, without limitation, spasms caused by MS), and seizures (including, without limitation, seizures caused by epilepsy)" Patients need to have one of the listed medical conditions and one of the listed symptoms, which includes "severe pain if it has not responded to other treatments or if treatments produced serious side effects." The medical conditions: cancer, glaucoma, HIV/AIDS, hepatitis C, ALS, muscular dystrophy, Crohn's disease, Alzheimer's disease, MS, chronic pancreatitis, spinal cord injury/disease, traumatic brain injury, injuries that significantly interfere with daily living" ALS, multiple sclerosis, terminal cancer, muscular dystrophy, inflammatory bowel disease (including Crohn's disease), terminal illness if the physician has determined a prognosis of less than 12 months of life. The following conditions apply, if resistant to, or if the patient is intolerant to, conventional therapy: seizure disorder (including epilepsy), intractable skeletal muscular spasticity, glaucoma. The following conditions apply if severe or chronic pain, severe nausea or vomiting, cachexia or wasting syndrome results from the condition or treatment thereof: HIV/AIDS, cancer. Cancer, glaucoma, multiple sclerosis, epilepsy, spinal cord damage with intractable spasticity, HIV/AIDS, painful peripheral neuropathy, intractable nausea/vomiting, severe anorexia/cachexia, hepatitis C infection currently receiving antiviral treatment, Crohn's disease, PTSD, ALS, severe chronic pain, hospice care, inflammatory autoimmune-mediated arthritis, cervical dystonia, Parkinson's disease, Huntington's disease, ulcerative colitis.

Information on state program web site regarding proportion of enrollees who qualified through severe/chronic pain

As of December, 2014: approximately 65% certified for "severe chronic pain" and another 11% certified for painful peripheral neuropathy and 8% for CNS disorder resulting in chronic, painful spasticity or muscle spasms. Unclear if double counting was done

No info regarding frequency of qualifying conditions on web site

Registration has not yet begun

As of December, 2013, approximately 36% of active patients qualified with "severe or chronic pain" (These patients might have had additional qualifying conditions, as well; there was double counting of conditions for patients with multiple qualifying conditions)

As of May 20, 2015, approximately 26% of active patients qualified with chronic pain and 4% with painful peripheral neuropathy and 1% with inflammatory autoimmunemediated arthritis (46% qualified with PTSD). These patients might have had additional qualifying conditions, as well; there was double counting of conditions for patients with multiple qualifying conditions

STATE QUALIFYING CONDITIONS (with focus on pain-related conditions)

NY

Patients must be "diagnosed with a specific severe, debilitating

or life-threatening condition that is accompanied by an

associated or complicated condition. The law identified the

following severe, debilitating or life-threatening conditions:

cancer, HIV infection or AIDS, amyotrophic lateral sclerosis,

Parkinson's disease, multiple sclerosis, spinal cord injury with

spasticity, epilepsy, inflammatory bowel disease, neuropathy,

and Huntington's disease. The associated or complicating

conditions are cachexia or wasting syndrome, severe or chronic

pain, severe nausea, seizures, or severe or persistent muscle

spasms."

Information on state program web site regarding proportion of enrollees who qualified through severe/chronic pain Registration has not yet begun

OR

"A medical condition or treatment for a medical condition that As of April 21, 2015,

produces for a specific patient one or more of the following:

approximately 93% of enrolled

cachexia, severe pain severe nausea, seizures (including, but not patients qualified with severe pain

limited to, seizures caused by epilepsy), persistent muscle

(might have additional qualifying

spasms (including, but not limited to, spasms caused by multiple conditions, as well)

sclerosis)"

RI

Cancer, glaucoma, HIV/AIDS, hepatitis C, or "a chronic or

In 2012 approximately 44% of

debilitating disease or medical condition or its treatment that

enrolled patients qualified with

produces one or more of the following: cachexia or wasting

severe, debilitating chronic pain.

syndrome; severe, debilitating chronic pain (specify); severe

These patients might have had

nausea; seizures (including, but not limited to, those

additional qualifying conditions,

characteristic of epilepsy); severe muscle spasms (including but as well; there was double counting

not limited to those characteristic of multiple sclerosis; or

of conditions for patients with

agitation related to Alzheimer's disease."

multiple qualifying conditions

VT

"A) Cancer, multiple sclerosis, positive status for HIV, AIDS, or No info regarding frequency of

the treatment of these conditions, if the disease or the treatment qualifying conditions on web site

results in severe, persistent, and intractable symptoms; or, B) a

disease, medical condition, or its treatment that is chronic,

debilitating, and produces severe, persistent, and one or more of

the following intractable symptoms: cachexia or wasting

syndrome; severe pain; severe nausea; or seizures."

WA

"(a) Cancer, HIV, multiple sclerosis, epilepsy or other seizure

No info regarding frequency of

disorder; or spasticity disorders; or (b) intractable pain, limited qualifying conditions on web site

for the purpose of this chapter to mean pain unrelieved by

standard medical treatments and medications; or (c) glaucoma,

either acute or chronic, limited for the purpose of this chapter to

mean increased intraocular pressure unrelieved by standard

medications; or (d) Crohn's disease with debilitating symptoms

unrelieved by standard treatments or medications; or (e) hepatitis

C with debilitating nausea or intractable pain unrelieved by

standard treatments or medications; or (f) diseases, including

anorexia, which result in nausea, vomiting, wasting, appetite

loss, cramping, seizures, muscle spasms, or spasticity when these

symptoms are unrelieved by standard treatments or medications;

or (g) chronic renal failure requiring hemodialysis. (PTSD and

traumatic brain injury will be added effective July 24, 2015)."

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