Medical Cannabis: Key Components of Utah’s Program Presented by Steve Ipsen, RN, MSN Center for Medical Cannabis Utah Department of Health HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
PROGRAM PURPOSE Working with trained medical professionals, qualified patients will receive a recommendation for quality-controlled cannabis products from a licensed pharmacist in a medicinal dosage form. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
TRANSITION PHASE Transition Phase: Dec 3, 2018 – Dec 31, 2020 Individuals are not guilty of use or possession of medical cannabis under Utah law if, at the time of the arrest: • the individual has been diagnosed with a qualifying condition and had a pre-existing provider-patient relationship with a Utah-licensed APRN, physician, or physician assistant who believed that the individual’s illness could benefit from the use in question; and • the medical cannabis was in a medicinal dosage form in a quantity not to exceed specified limits. *Medical cannabis cards and qualified medical provider registration are not required during this transition period. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
UTAH MEDICAL CANNABIS ACT SYSTEM HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
UTAH MEDICAL CANNABIS ACT Utah Department of Agriculture and Food • Cultivation • Processing • Lab Testing HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
QUALIFYING CONDITIONS Pain lasting longer than two weeks Post Traumatic Stress Disorder (PTSD) if it is not adequately managed by a which is treated by a licensed mental non-opioid or physical intervention health therapist and has been after at least two treatment diagnosed by either the VA or through attempts an evaluation by a doctoral level HIV or AIDS psychiatrist, psychologist, LCSW, or Alzheimer’s Disease APRN Amytrophic Lateral Sclerosis (ALS) Autism Cancer Terminal illness with less than 6 Cachexia months to live Persistent nausea under certain A condition resulting in the patient conditions receiving hospice care Crohn’s Disease / Ulcerative Colitis A rare condition or disease that affects Epilepsy / debilitating seizures less than 200,000 individuals in the US Multiple Sclerosis (MS) or and is not adequately managed by a persistent muscle spasms non-opioid or physical intervention. Individuals who do not have a “qualifying condition” may submit a petition to the Compassionate Use Board (CUB) for review with help from their QMP. All patients under age 21, regardless of their medical condition, must have their application approved by the CUB. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
COMPASSIONATE USE BOARD Board members appointed by the Executive Director of the Utah Department of Health and confirmed by the Utah State Senate for 4 year terms Comprised of 7 physicians including at least 2 pediatricians Board members to be board certified in at least one of the following: neurology, pain medicine and pain management, medical oncology, psychiatry, infectious disease, internal medicine, pediatrics, or gastroenterology. First meeting expected to be in Fall 2019 Meetings expected to be monthly at beginning of program, possibly more frequent Petitions must be reviewed and approval or denial determined within 90 days of electronic submittal Board is required to submit an annual report to the Health and Human Services Interim Committee HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
QUALIFIED MEDICAL PROVIDERS • Must be a Utah licensed physician, physician assistant or APRN with a controlled substance license • Must complete at least 4 hours of education in medical cannabis during every two year renewal cycle • May recommend cannabis treatment to no more than 175 patients at the same time. QMPs who are board certified in anesthesiology, • For complete information about qualified gastroenterology, neurology, oncology, pain, medical provider requirements, see Utah hospice and palliative medicine, physical medicine Code 26-61a-106. and rehabilitation, rheumatology, or psychiatry may recommend to no more than 300 patients. • May only recommend medical cannabis With approval from DOPL, QMPs may recommend treatment to a patient in the course of a up to 600 patients at one time. physician-patient relationship after they • have completed and documented in the Cannot advertise they recommend cannabis for patient’s medical record a thorough treatment, but may communicate on a website: a assessment of the patient’s condition and green cross; a list of qualifying conditions they medical history based on the appropriate treat; or a scientific study regarding medical standard of care for the patient’s condition. cannabis use. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
QUALIFIED MEDICAL PROVIDERS • When a QMP recommends medical cannabis to a patient, they may choose to recommend it without specifying a dosage type and dosage amount. • If a QMP recommends but does NOT specify dosage type and amount, they are required to submit to the electronic verification system (EVS): o an evaluation of the qualifying condition underlying the recommendation; o a description of prior treatment attempts with cannabis and cannabis products; and o the patient's current medication list. For complete information about qualified medical provider requirements, see Utah Code 26-61a-106. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
QUALIFIED MEDICAL PROVIDERS If a QMP recommends without specifying a dosage type and/or amount, the dosage type and/or amount will be determined by the pharmacy medical provider (pharmacist or physician registered by UDOH) at the cardholder’s chosen medical cannabis pharmacy. When making this determination, the pharmacy medical provider (PMP) must: • review pertinent medical records, including the qualified medical provider documentation submitted to the EVS; and • after completing the review and consulting with the recommending QMP as needed, determine the best course of treatment through consultation with the cardholder regarding: o the individual’s qualifying condition For complete information about qualified underlying the recommendation from the medical provider requirements, see Utah Code qualified medical provider; 26-61a-106. o indications for available treatments; o dosing parameters; and o potential adverse reactions. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
MEDICINAL DOSAGE FORMS Tablet Cube Capsule Resin or wax under Concentrated oil certain conditions Liquid suspension Unprocessed Topical preparation cannabis flower in a Transdermal blister pack preparation No edibles, such as brownies, or unprocessed flower outside of the blister pack. For complete information about legal dosage forms, see Utah Code 26-61a-102 (29). No smoking of cannabis. HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
MEDICINAL DOSAGE FORMS HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
MEDICINAL DOSAGE FORMS HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
PROHIBITED FORMS HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
PROHIBITED FORMS HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
DISPENSING LIMITATIONS A medical cannabis cardholder whose primary residence is less than 100 miles from the nearest medical cannabis pharmacy or local health department, in any one 12-day period, may purchase no more than the lesser of: • an amount sufficient to provide 14 days of treatment on the dosing parameters that the relevant QMP recommends; or • 56 grams by weight of unprocessed cannabis that is in a medicinal dosage form; or For complete information about medical cannabis • Cannabis in medicinal dosage form pharmacy requirements, see that contains, in total, greater than Utah Code 26-61a-502. 10 grams of total composite THC . HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
DISPENSING LIMITATIONS A medical cannabis cardholder whose primary residence is more than 100 miles from the nearest medical cannabis pharmacy or local health department, in any one 28-day period, may purchase no more than the lesser of: • an amount sufficient to provide 30 days of treatment on the dosing parameters that the relevant QMP recommends; or • 113 grams by weight of unprocessed cannabis that is in a medicinal dosage form; or For complete information about medical cannabis • Cannabis in medicinal dosage form pharmacy requirements, see that contains, in total, greater than Utah Code 26-61a-502. 20 grams of total composite THC . HEALTHIEST PEOPLE | OPTIMIZE MEDICAID | A GREAT ORGANIZATION
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