Recently, the Delaware House of Representatives, following ideas from Washington D.C., passed a law to do two things:  (1) remove the list of qualifying conditions from their medical cannabis laws, and (2) allow people over the age of 65 to “self-certify” that they need marijuana for medical purposes.

At the Association of Cannabinoid Specialists (ACS), the medical cannabis treatment experts, we think the bill does not demand sufficient professionalism from clinicians, and that self-certification is misguided.

Qualifying Conditions Must Go Away, But…

The removal of the list of qualifying conditions is actually something we have supported since our inception.  We believe that clinicians should be able to prescribe cannabis or cannabinoids for whatever purpose is supported by human clinical trials.  In most states, the list is driven by politics, not science. 

For example, nearly every state has Glaucoma on the list, despite it being malpractice to use cannabis for this disease as cannabis is vastly inferior to conventional medications for this illness and puts patients’ vision at risk.

Why, then, is the removal of qualifying conditions deficient in the case of Delaware?  The Delaware bill is for the expansion of the cannabis industry.  It does nothing to safeguard patients or to facilitate the ability of clinicians to provide appropriate care to patients.

If Delaware were serious about patient care they would have included more specific provisions for clinicians to make exact prescriptions for patients while also directing Boards of Licensure to enforce basic standards of care like Informed Consent and close follow up.

Self-Certifying Is Recreational Sales in All but Name

More ridiculous is the idea of self-certifying.  This bypasses knowledgeable medical guidance entirely.  The role of medical care is to be sure that the patient knows the risks and benefits, and is advised on the best practices that help mitigate the risks. 

In essence, clinicians work to see that their patients use the least amount necessary (of any medicine) to experience benefit and to avoid problems that arise from excessive use. Whereas, of course, the industry would like people to use as much as possible.

Further, rules like self-certifying normalize the idea that cannabis isn’t real medicine and that people should just McGyver their way along until it all blows up in their faces.  Have we learned nothing from the Opioid Crisis?  Can we not see a looming Cannabinoid Crisis?  Guidance from clinicians would help prevent this, if those clinicians are held to account for providing actual care to patients. 

While misuse is clearly visible among young people, it is not limited to them. The fastest growing segment of Americans using cannabis is the over 65 crowd and it’s also the segment in which cannabis use disorder is growing the fastest.  Overall, this is because people are not getting the guidance that protects them. 

Further, older people have other health problems too.  The interplay between their various health problems and their often extensive medication lists is crucial to how safe and effective cannabis can be for them.

The Libertarian argument that people should be able to make up their own minds is flawed.  It assumes that people have access to accurate information about their health, about the risks and benefits of cannabis (including drug interactions), and have the depth of understanding to reasonably interpret that information. 

This is what healthcare is all about.  Practitioners are there, having spent countless years studying and accruing experience, to help patients understand their options and the risks, benefits, and best practices to mitigate those risks.  The cannabis industry wants to bypass this knowledge because it limits their sales. 

If Delaware Wants to Lead, Lead in the Right Direction

So, is Delaware on the right track?  Mostly no.  If they were serious about patient care they would be eliminating qualifying conditions while reinforcing professional responsibility to clinicians for their recommendations and outcomes.  They would reject any idea that allows patients to bypass medical care as this puts patients at risk in favor of increased sales for the industry. 

We call upon Delaware and other states (as well as the federal government) to get serious about regulating cannabis medicine in accordance with our knowledge of what makes patients healthier and safer.