A medical organization is making recommendations for Hawaii’s nascent medical marijuana dispensary system, saying it wants doctors to have a say in the process.

“We feel we have to stand up as a medical society to have a clear voice — for the Department of Health, the state, doctors and patients,” said Dr. Scott Miscovich of the Hawaii Medical Association. “We are trying to talk about best practices and safety, to raise awareness.”

The HMA is a professional organization for medical doctors, resident physicians and medical students.

Among its 14 recommendations are that dispensaries have mandatory “informed consent” forms outlining the risks of marijuana, that there be a “smooth and efficient mechanism” to report adverse effects of the products, and that edible products not resemble candy and cookies so they are less likely to fall into the hands of children.

Glass artist Mark Nowicki sits at his booth O.G. Tubes Hawaii featuring his hand made glass art at he Marijuana Expo. Hawaii Conventioin Center. 19 july 2015. photograph Cory Lum/Civil Beat
Glass artist Mark Nowicki of O.G. Tubes Hawaii displayed his wares at a marijuana expo at the Hawaii Convention Center last July. Cory Lum/Civil Beat

“One of the big concerns as the state’s medical society is, we are going from home-grown to all of a sudden a highly cultivated, genetically enhanced product with high concentrations of THC,” said Miscovich, referring to the active ingredient in marijuana that gets people high. “This is not the pot of the 1960s, ’70s and ’80s. If patients are not used to this level of THC, that is where we start having issues. We are concerned about driving, for example.”

HMA’s recommendations come as the Department of Health prepares to begin accepting applications for marijuana business owners. That process opens Jan. 12.

It also comes as state legislators have raised concerns about the DOH’s implementation of the dispensaries law, including bans on Sunday sales, the use of greenhouses and the sale of rolled marijuana cigarettes, as well as a lack of a definition of a marijuana plant.

Miscovich is co-chair of the HMA’s Commission on Medical Cannabis Education for Physicians and Patients. He is also chair of the state’s Narcotic Policy Steering Committee.

While the HMA did not lobby for or against the medical marijuana dispensaries law, which was signed by Gov. David Ige last July, Miscovich said the HMA will be proposing legislation in the Hawaii Legislature that opens Jan. 20. The intention is to curb the overuse of narcotics, in particular, prescription opioids.

Miscovich said that most medical marijuana cards are issued for pain, which prompted HMA’s concern.

Rep. Della Au Belatti, the Democrat who chairs the House Health Committee, said she welcomes the involvement of the HMA in addressing medical marijuana dispensaries.

“To date, the medical community has been somewhat silent for the last 13 years,” said Belatti, one of the co-authors of the dispensaries legislation and a key figure in its passage. “Understandably, many doctors are hesitant to publicly participate in the program. I think the new legislation and the prospects of dispensaries coming on board, where we can actually regulate the quality of the products and medicine, provides this opportunity.”

Rep. Della Au Belatti and Sen. Roz Baker at a Dec. 28 briefing on medical marijuana dispensaries.
Rep. Della Au Belatti, left, and Sen. Roz Baker at a Dec. 28 briefing on medical marijuana dispensaries. Cory Lum/Civil Beat

Bellati added, “With respect to the HMA’s 14 specific recommendations, I see that they are all very good. Whether these can be put into law or adopted as best practices, we will have to move forward in the legislative session as well as in development of the industry to see how this plays out. But many of the recommendations are already in line with what’s in the legislation.”

Miscovich has visited marijuana dispensaries in Colorado and spoken with authorities there. He gives the Hawaii Legislature and DOH credit for trying to come up with rules and a bid process so quickly after the law was passed. The dispensaries are allowed to open in July.

“That’s quite a challenge,” he said.

Miscovich said Hawaii has an opportunity to be a leader in best practices for medical pot. Key to that is ensuring that there be standardized education at the state level, he said.

“Doctors are not allowed to write a prescription for what patients get,” he noted. “We only write a certification. It is the ‘bud tender’ who will recommend the products. … We feel that every patient who walks into a dispensary, before they purchase a product, that they be required to watch a video and be informed as to what they are purchasing.”

HMA Recommendations:

  1. Insure product purity and quantifiable potency.
  2. Avoid edibles resembling candy, cookies and other child­-oriented food items.
  3. Encourage use of naturally grown products versus extreme potency extractions such as “shatter,” “wax” and “honey oil.”
  4. Where smoking or vaping is the preferred method of delivery, perform regular medical surveillance of pulmonary impact through pulmonary function testing.
  5. Develop mandatory informed consent forms outlining the risks of cannabis use as a prerequisite at dispensing sites. This should include clear warnings that cannabis should not be used when driving motorized vehicles, working around heavy machinery or any other high-­risk environments.
  6. Develop patient education kiosks at all dispensary sites with written materials and video to the satisfaction of DOH, with special warning regarding the risk of edible forms of cannabis.
  7. Insure a smooth and efficient mechanism for reporting adverse effects of locally dispensed cannabis products and preparations.
  8. Require all certifying doctors be members of the HMA, an established Hawaii hospital or other Hawaii authoritative body with peer review oversight.
  9. Support the development of ongoing continuing medical education opportunities for local medical professionals and dispensary personnel on a) preparations and types of cannabis preparation currently available, b) current research findings and publications and c) up-to-date public health impact experience of other states where medical cannabis is legal.
  10. Insure that an ongoing medical relationship with regular follow-up be maintained between certifying physician and patient consistent with best-­practice standards of care.
  11. Dedicate a percentage of gross revenues generated by dispensing to promote education of at ­risk young people on the risks of recreational use and of adults of the dangers of over dosage, operating motor vehicles and other high risk environments while under the influence of cannabis.
  12. Dedicate a percentage of gross revenues generated to promote the reclassification of cannabis from Schedule I to Schedule II allowing more definitive study of both positive and negative effects of its use. The use of these revenues should be under the control of the DOH working in concert with officials of the John A. Burns School of Medicine and the HMA.
  13. Require all cannabis dispensaries participate in the Drug Enforcement Agency prescription drug monitoring program to include type and amount of cannabis dispensed consistent with best practice standards of other local dispensaries and pharmacies.
  14. Advise all medical cannabis­ naïve patients to go “low and slow” with any and all products that exceed 10 percent THC content.

For more information about the DOH medical marijuana program, click here for general information and click here for administrative rules.

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