What Nurses Need to Know About Medical Marijuana in Ohio

Medical marijuana in mortar with prescription. Document is fictitious.

Ohio became the 25th state to legalize medical marijuana when Governor John Kasich signed HB 523 on June 8, 2016. The new law became effective on Tuesday, September 6, 2016 and will allow limited possession and use beginning Thursday, September 8, 2016.

The bill, introduced in mid-April, received intense scrutiny by the members of the General Assembly during the roughly seven weeks it was under consideration. Lawmakers acted relatively quickly in order to avoid having voters decide the issue through a fall ballot initiative that would have added provisions to Ohio’s Constitution (rather than the Revised Code) authorizing the use of medical marijuana. The legislative approach allowed lawmakers to craft the program with limits and safeguards believed to meet the concerns of both proponents and opponents alike. The bill ultimately received bipartisan support in both the Ohio House and Senate. Ohioans for Medical Marijuana announced it was suspending its statewide ballot campaign shortly after passage of what the group described as a “moderately good bill”.

What does the bill do?

Key provisions in the legislation established parameters for producing and using medical marijuana. The Department of Commerce and Board of Pharmacy will jointly administer the program with advice from a 12-member Medical Marijuana Advisory Committee. Committee members are to be appointed by elected officials no later than October 6th with its responsibilities ending as of October 2021. Appointees include the following:

Governor-appointed:

2 practicing physicians, one who supports legalization of medical marijuana and the other who is a member of the state medical board;

2 practicing pharmacists, one who supports legalization of medical marijuana and one who is a member of the state pharmacy board;

1 individual representing the interests of employers;

1 individual representing agriculture interests..

Speaker of the House appointed:

1 person involved in mental health treatment

1 patient

Senate President appointed:

1 person representing the interests of law enforcement

1 caregiver

Minority House leader appointed:

1 labor representative

Minority Senate leader appointed:

1 nurse.

The Department of Commerce will license cultivators, processors and testing laboratories while the pharmacy board will license/certify retail dispensaries, patients, and caregivers. One year or less after the effective date of the bill the board and department must adopt specified rules and the entire program must be operational by September 6, 2018.

Although some proponents have expressed concerns about the slow implementation allowed by the bill, it does create an affirmative defense for patients obtaining medical marijuana from non-Ohio-regulated sources before it is available here. The marijuana must, however, be in a form authorized by HB 523 and consumed in a manner outlined as legal in the state. No home growing is allowed. Authorized forms include marijuana oils, tinctures, plant material, edibles, patches, and vaporization as well as other forms authorized by the pharmacy board.

No smoking is allowed.

One provision that received considerable scrutiny and discussion dealt with the medical conditions that may be treated with medical marijuana. HB 523 lists 21 such conditions and allows the state medical board to add others. The recognized conditions include:

AIDS

Alzheimer’s disease

ALS

Cancer

Chronic traumatic encephalopathy

Crohn’s disease

Epilepsy or other seizure disorder

Fibromyalgia

Glaucoma

Hepatitis C

Inflammatory bowel disease

MS

Chronic and intractable pain

Parkinson’s disease

HIV positive

PTSD

Sickle cell anemia

Spinal cord injury or disorder

Tourette’s syndrome

TBI

Ulcerative colitis.

Operational aspects outlined in the law would require a physician to hold a certificate issued by the medical board in order to prescribe medical marijuana. Physician may not prescribe the drug for family members and must complete two hours of continuing education on its use every two years.

Authorized physicians must submit an application to the pharmacy board to register patents or caregivers qualified to receive a 90-day supply of medical marijuana. The supply may be replenished three times for 90 days each without a physical examination by the physician. The Ohio Automated Rx Reporting System (OARRS) must be reviewed before recommending treatment with medical marijuana.

Only registered patients or caregivers are authorized to use or possess specified paraphernalia or accessories.

Implications for nurses

Only physicians are authorized to prescribe medical marijuana, and they must have special designation from the medical board to do so. Nurses may encounter patients who are using the drug; therefore, it will be important for them to become knowledgeable about its effects, complications, and any unique limitations imposed by Ohio law and rules.

Nursing input into the development of Ohio’s medical marijuana program will come via representation on the state’s Medical Marijuana Advisory Committee. Senator Joe Schiavoni, (D-Youngstown) Minority Leader of the Ohio Senate will be naming a nurse to that committee with the appointment required to be made shortly after the effective date of the bill this fall. If interested in serving on the committee contact ONA for information about the appointment process.

Although not expected to be fully operational until 2018, it will be important for nurses to follow the actions of the advisory committee and the rules proposals as they are submitted. That level of scrutiny will help ensure implementation of the program is consistent with the safeguards nurses believe are essential to patient safety.