Oregon issues doctor guidelines on medical marijuana

Physicians should provide medical marijuana patients a level of care that, at minimum, includes a full evaluation, treatment and follow-up plan, with documentation in the patient’s medical record, when recommending the drug’s use, according to a new Oregon Health Authority report.

A report presented this month to the Oregon Legislature, HB 4014 Clinical Guidelines Work Group: Guidelines for Attending Physicians When Recommending the Medical Use of Marijuana, provides recommendations to physicians on appropriate care of a patient diagnosed with one or more debilitating conditions for which the physician is recommending the medical use of marijuana.

Qualifying debilitating conditions include cancer; glaucoma; a degenerative or pervasive neurological condition; positive HIV or AIDS status; or a side effect related to treating these conditions. Also qualifying are a medical condition or treatment for a condition that produces cachexia; severe pain; severe nausea; seizures; persistent muscle spasms; or post-traumatic stress disorder.

The Clinical Guidelines Work Group, created when the Legislature passed House Bill 4014 in 2016, developed the guidelines with the principles that physicians who recommend medical marijuana to a patient engage in the practice of medicine and do so within the context of a bona-fide physician-patient relationship.

“What this report is saying is that patients for whom medical use of marijuana is recommended deserve the same minimum level of care as those prescribed any medication to treat a debilitating condition,” said Andre Ourso, manager of the Oregon Medical Marijuana Program at the OHA Public Health Division.

The work group consisted of 10 allopathic and osteopathic physicians and a patient advocate, as well as Ourso and state health officer Katrina Hedberg, MD, as ex-officio members.

Patient evaluation includes obtaining a comprehensive medical history, and performing a complete physical examination appropriate to the patient’s debilitating medical condition and medical history, the report states. The physician should develop a written treatment plan, including documentation of informed consent, and discuss risks and benefits. The physician should follow up with the treatment plan, conduct ongoing evaluation and treatment, and properly maintain and document health records.

The report also notes that the work group “strongly opposes the smoking of marijuana as a means of therapeutic delivery” because of harms associated with inhaling any kind of smoke, and that several other delivery options are available that pose less risk to patient health.

“Marijuana smoke, like smoke from a cigarette or a wood-burning stove, contains particulate matter, much of which is potentially bad for the lungs, so we do not recommend a patient consume marijuana by smoking it,” Hedberg said.

In addition, physicians should advise patients to consume the lowest possible amount of marijuana to achieve discussed treatment goals, according to the guidelines. They also recommend physicians consider the potential negative health effects of using marijuana while also using opioids, and it refers physicians to Oregon’s Opioid Prescribing Guidelines.

Direct link to the report: http://public.health.oregon.gov/PreventionWellness/marijuana/Documents/OHA-9262-Attending-Physician-Guidelines.pdf