Medical marijuana runs into problems with physician, nursing boards

Despite passing new laws designed to give patients easier access to medical marijuana, state legislators continue to run into bureaucratic obstacles with the various regulatory bodies that oversee medicine in Louisiana.

The legislature’s Medical Marijuana Commission met Friday to address problems with the Louisiana State Board of Medical Examiners and Louisiana State Board of Nursing.

Dr. Vincent Culotta, executive director of the Board of Medical Examiners, surprised lawmakers when he told them his organization still requires doctors to set in-person appointments for patients seeking medical marijuana despite a new law passed this year that was supposed to loosen the rules to allow virtual visits.

The Board of Examiners considers marijuana a Schedule II drug, and the rules for prescribing Schedule II drugs require at least one in-person visit to establish a doctor-patient relationship prior to conducting any telemedicine appointments, Culotta said.

Federal laws classify controlled substances into five categories or schedules. The federal government has long considered marijuana a Schedule I drug, meaning a drug with no currently accepted medical use and a high potential for abuse.

Culotta said Louisiana passed a law a few years ago that classified medical marijuana as a Schedule II drug. Therefore, the board applies its Schedule II prescription rules to medical cannabis, which require in-person visits.

However, lawmakers on the Medical Marijuana Commission seemed unable to recall or find the law Culotta referenced.

Rep. Joe Marino, I-Gretna, who chairs the commission, said the legislature never classified marijuana as Schedule II.

“There’s no requirement that there has to be an in-person visit,” Marino said.

Culotta told the commission that the Board of Medical Examiners can change the rule at the direction of the legislature, but the board currently treats marijuana as a Schedule II drug for purposes of physician “recommendation,” which is the term Louisiana law uses for the prescription of medical marijuana.

Marino pushed back.

“I think we [already] did change it, and we did say that telemedicine — it’s not restricted,” Marino said. “You’re adding something to it that I don’t believe that the legislation intended to do.”

Rep. Travis Johnson, D-Vidalia, said the legislature has worked for several years to expand health care and medical marijuana to rural communities.

“We tried to fix that because we acknowledged how difficult it’s been for some people to have access to medicine,” Johnson said.

Both lawmakers pointed to new legislation that took effect Aug. 1 that they said should have addressed the issue of doctors recommending medical marijuana via telemedicine. A provision in Act 491 states: “Nothing in this Part shall be construed or enforced in any manner that prevents a physician authorized… to recommend therapeutic marijuana from recommending therapeutic marijuana through telemedicine.”

Culotta said the in-person appointment requirement exists to prevent telemedicine clinics from “becoming pill mills.” He said he didn’t understand why the legislature would want to keep marijuana in the Schedule I category because federal law prevents Schedule I drugs from being prescribed at all.

Marino acknowledged the federal restrictions against prescribing Schedule I drugs, but he explained that the legislature specifically wrote the state’s medical marijuana laws using the word “recommend” in place of the word “prescribe” to get around the federal drug schedules.

Culotta said he would consult with the Board of Medical Examiners’ legal team in an effort to clarify the issue.

Another problem the commission addressed was with recently passed legislation to allow nurse practitioners to recommend medical marijuana.

Dr. Karen Lyon, State Board of Nursing executive director, said the term “nurse practitioner” in the legislation was not specific enough because the general public uses it vaguely to refer to any advanced practice nurse who prescribes drugs. It can refer to clinical nurse specialists and certified nurse midwives, she said.

“Everyone collapses all the four rolls of advanced practice into nurse practitioner and uses that term,” Lyon said. “It has become like Coca-Cola used generically for every soda.”

Some of the lawmakers expressed frustration as to why Lyon did not bring up this issue when the bill was being crafted. Lyon said she never thought medical marijuana would apply to nurse practitioners because she always knew it to be a Schedule I drug.

“Everyone knows it’s a scheduled drug,” Marino said. “I mean, again, we’re doing all these gymnastics, I call it, to try to get medicine to people because the federal government won’t take it out of Schedule I, which they should do.”

Lyon said she is working with the State Board of Pharmacy to put a list of nurse practitioners authorized to recommend medical marijuana on its website. Nurse practitioners will have to fill out a form to obtain those privileges from the Board of Nursing, she said. Physicians no longer need special authorization to recommend medical marijuana in Louisiana.