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DPH slows medical marijuana fixes, infuriating patients

Elizabeth Earl/Peninsula Clarion via Associated Press

By Dan Adams Globe Staff 

Governor Charlie Baker’s administration has frozen an effort to expand the availability of medical marijuana, infuriating advocates who say the long-pending regulatory changes — which include allowing more medical professionals to prescribe and administer the drug — would help tens of thousands of sick patients.

The proposed revisions to the state’s medical marijuana rules were unveiled in September 2016 by the Massachusetts Department of Public Health, in response to a directive by Baker that state agencies review and streamline their regulations. The agency has already held public hearings and published draft versions of the new rules, which last year it called “common-sense reforms.”

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The suggested changes include permitting certified nurse practitioners, who have advanced degrees and prescribing authority for other medicines, to also prescribe medical marijuana. Employees of nursing homes, hospice centers, and other medical facilities would also be allowed to administer it to patients.

Additionally, medical dispensaries under the revised regulations would be allowed to post their prices online, helping patients comparison shop, and could grow cannabis from clippings instead of seeds, boosting yields, lowering prices, and ensuring marijuana strains stay consistent over multiple harvests.

But health officials have declined to implement the measures. Instead, the department said it will defer to the new Cannabis Control Commission, which was created under the 2016 voter-approved recreational marijuana initiative and is expected to absorb the medical marijuana program late next year.

A DPH spokeswoman said the agency still supports the new rules, but that health officials need to talk through the changes with the cannabis commission. A meeting between the agencies is tentatively scheduled for Oct. 18.

“Given that the authority of regulating the medical use of marijuana will be shifting to the Cannabis Control Commission,” said spokeswoman Ann Scales, “we believe that moving forward with our regulatory process should be a shared decision with the Commission.”

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The delay is the second this year; health officials previously waited out the state Legislature’s revisions to the recreational marijuana law, which were completed in July.

Advocates are decrying DPH’s inaction, insisting the health department has always had — and still has — full authority to implement the improvements. Even the chairman and acting executive director of the cannabis commission, Steve Hoffman, said there is no reason for DPH to wait for his agency.

“I really hope that while we’re doing our job in terms of building and regulating a recreational marijuana industry, [and] until we take medical marijuana over, nothing slows down what DPH has committed to do,” Hoffman said.

“DPH is running this,” Hoffman added, referring to the changes to medical marijuana.

Advocates for medical marijuana patients said the delay is exactly the sort of problem they feared when the Legislature combined oversight of the medical and recreational industries.

“Medical marijuana patients are being told to wait and take a back seat by the Department of Public Health while the adult-use [recreational] industry gets priority,” said Michael Latulippe, development director of the Massachusetts Patient Advocacy Alliance.

Latulippe and other advocates said allowing certified nurse practitioners to prescribe the drug could significantly lower the cost of the initial medical appointment, which can run to nearly $200 in out-of-pocket costs as marijuana consultations are not covered by health insurance.

It would also make it easier for patients to find prescribers in parts of the state where physicians who recommend marijuana are few and far between.

“There are so many patients who would benefit from marijuana but can’t access it because there aren’t enough physicians who are willing to prescribe it,” said Barbara Shea Tracy, a nurse practitioner who provides in-home care to severely ill and dying patients in Western Mass.

Tracy said gaining the ability to prescribe marijuana — in particular, nonpsychoactive preparations — would give her a powerful tool to better treat patients’ symptoms.

“I’ve had patients who obtained [marijuana] other ways, and it helped them sleep, reduced their pain and anxiety — all around, it’s much more effective than a narcotic,” such as an opiate painkiller.

DPH’s failure to implement the new rules, Tracy added, “is just causing patients more pain, especially people in hospice who can’t wait.”

Similarly, letting employees at nursing facilities and similar institutions administer the drug would make it far easier for the elderly or very ill to use marijuana as medicine. Currently, patients at such facilities who want marijuana must hire a “personal caregiver,” or draft a family member or friend to serve as one, and have that person licensed by the state.

Advocates are also hoping that DPH will streamline the cumbersome patient registration process, which in addition to requiring a physician’s recommendation necessitates filling out an online form and waiting two or three weeks for a DPH card to arrive in the mail.

Medical dispensaries, too, want the regulatory changes implemented quickly. Current regulations require them to plant each new cannabis crop from seeds, which can lead to significant variability in the potency and yields of plants. Growers strongly prefer using clippings from a marijuana plant with known characteristics, which makes cultivation cheaper and faster, and produces a more consistent final product.

Dispensaries also want to be allowed to post their prices on their websites, which is currently forbidden under a rule meant to discourage aggressive advertising of the drug, but which has frustrated patients trying to comparison shop.

Norton Arbelaez of New England Treatment Access, which runs medical dispensaries in Brookline and Northampton, said the changes are “ripe for action, and have the solid support of existing operators and many stakeholders.”

The main groups representing doctors and nurses in the state did not weigh in on the proposed changes. But the Massachusetts Health & Hospital Association opposed allowing medical facilities to register their employees as caregivers, saying it put them at risk of losing their licenses because marijuana is still illegal at the federal level.

DPH’s stewardship of medical marijuana has been checkered. Its rollout of the program in 2014 was hobbled by missteps, including conflicts of interest and the department’s hiring of highly paid contractors who failed to detect unqualified applicants for dispensary licenses.


Dan Adams can be reached at daniel.adams@globe.com.