Why “Recommendation” is Inadequate

Since the inception of medical cannabis legalization in California in 1996, physicians have only been able to write a “recommendation”.  This was intended, at that time, to keep the practitioners out of trouble with the government by providing only a document stating that the benefits likely outweighed the risks. 

While that may have been a necessary strategy at that time, it violates one of the profession’s highest standards – informed consent.  The doctrine of informed consent requires physicians to obtain consent for treatment while providing the patient with adequate information and guidance to make the decision. 

Practitioners must be educated adequately to guide that decision making process. Further, they must take responsibility for the advice given, and as a result, give explicit and specific advice.  Anything less than this is malpractice.  This includes the “recommending” model.

In a paper published in 2001 in the Medical Science Monitor: International Medical Journal of Experimental and Clinical Research entitled “Medical marijuana: Medical necessity versus political agenda” the authors describe the history of cannabis and the key dilemma facing physicians:

The argument can be framed by the ethical principles of autonomy and beneficence. Patients have the right to expect full disclosure and discussion of all available treatment options from their physicians. Denying a patient knowledge of and access to a therapy that relieves pain and suffering, especially when the patient has a terminal disease, violates the basic duty of a physician. 

One of the basic tools practitioners have for giving explicit and specific advice is the prescription.

A prescription specifies clearly the medication, route of administration, dose, frequency, and an amount to be sold.  This satisfies the need for specific and explicit advice.  It also communicates to the seller (pharmacy or dispensary) all of these specifics – and legally binds the seller to sell only that medication in accordance with the specifics.  This overrides the sales motive that would otherwise promote that seller to make unwarranted claims about the medication or to suggest unhealthy use patterns or the purchase of additional products. 

Ultimately, a prescription assures that practitioners stand behind their advice, that patients get what they need with clear instructions, and that sellers do not derail the treatment plan for their own financial goals. 

ACS is committed to advancing these principles and we call upon both health care providers and regulators to design national and state laws, regulations, and processes that will allow physicians to properly prescribe cannabis medicine for the betterment of their patients.