Over the past several months, I have had multiple family members, friends, and business associates ask me about the recent DHSS investigations into fraudulent medical cannabis certifications. They ask me how this could happen, what the ramifications will be to our industry, and most importantly, how can we prevent such actions in the future. The honest answer, I tell them, is that while there are certainly ways to improve the safety and security of medical cannabis certification process, not all bad actions can be predicted or prevented, and some level of risk will always remain. The good news is, there are some simple questions patients can ask themselves when selecting a physician or group for medical cannabis certification to ensure that they receive their certification in an ethical, private, and fully legally compliant manner. Even better, the questions apply not just to medical cannabis certifications, but also to any situation when choosing a medical practitioner to provide for your health! To help, here are some examples of questions I would ask myself when choosing a doctor:
Who is the physician with whom you will be meeting? Will you be able to reach this person later if you have questions or need follow-up care? Are they local to Missouri or based out of state? Do they have a regular medical practice with an office where you can be seen in person, or are they only available online?
Since the legalization of medical cannabis in Missouri, there has been an explosion of websites online advertising medical cannabis certification. I personally cringe when I see an ad with the phrase “one of our licensed doctors” in it, because largely that is code for the entity being a profit-driven organization which is likely not physician-run, potentially based out of state, which has frequent turnover of physicians, and is purely driven to maximize the number of certifications provided in a short-term profit-grab. It is in the patient’s best interest, however, to select a physician with demonstrated commitment to the Missouri medical cannabis segment, who is ethical, and who is properly motivated by the goal to care for patients, not just take their money. There are many physicians in our state who run patient-centered professional medical practices which cater to the cannabis community, who understand the legal aspects of medical care such as HIPAA compliance, maintaining appropriate malpractice insurance, proper record keeping with a compliant electronic medical record system, and who are committed to providing health care to the cannabis community, whether through medical certifications or primary health care services.
Is the physician or practice ethical? What is their reputation in the Missouri medical cannabis community?
In medical school, every physician is educated in medical ethics. Ideally, for a medical practice to be considered “ethical,” it must respect all four principles: autonomy, justice, beneficence, and non-maleficence. For the lay person, this comes down to 1) Does the practice or physician allow the patient to make their own informed decision, free of coercion, after educating them about the risks or benefits of a certain course of treatment, 2) Is the care being provided with the intent of benefitting the patient involved, and 3) Is there a risk of harm to the patient or society which should prevent certain therapies being employed? What this means, is that every physician has the ethical obligation to meet directly with the patient, inform the patient of the risks and benefits of a potential therapy, and work together to make an informed, collaborative decision in providing care that is in the patient’s best interests. It also means that a physician “should do no harm,” meaning if a therapy is likely to make a condition worse or otherwise harm a patient, it should not be provided, and the physician should have the courage to withhold such care if ethically indicated. In the field of medical cannabis certifications, this means that at times, patients are denied certifications, not just rubber-stamped through in pursuit of a quick buck.
Is the physician or practice established, will they be around to provide care for years to come? Is the physician experienced or knowledgeable about cannabis?
These are admittedly hard questions to answer right now – we have already seen many groups come and go over just the past year, and there is no recognized medical subspecialty for cannabis medicine. It is becoming clearer, however, that there is a core group of physicians and medical practices dedicated to the Missouri medical cannabis community, practices which are physician-run, Missouri-based, and borne out of regular medical practices that have served their communities for years before expanding into cannabis medicine and medical cannabis certifications. These physicians have joined national organizations, such as the Society of Cannabis Clinicians, actively seek out educational opportunities in cannabis medicine, and employ the considerable experience they already have in dealing with the many certifiable medical conditions, such as chronic pain, with the added tool of medical cannabis.
The take-home message is this: as a patient, your interests are best served by selecting a physician with whom you can discuss your medical condition, review any risks of cannabis therapy, and develop a collaborative relationship for your healthcare moving forward. The risk of fraud is minimized when you know the physician’s name, are able to reliably get in touch with them after certification, and when they are preferably based in Missouri with a track record of providing quality medical care in the community. They should be knowledgeable about cannabis, take the time and be able to answer your questions, be discerning enough to request records when appropriate, and even deny certification if ethically indicated. By selecting a physician committed to serving your healthcare needs in the manner described above, you not only improve your own health, but support the building of a strong, respected Missouri medical cannabis community at large.