(Editor’s note: Following is an open letter to the Big Islsnd chapter of Americans for Safe Access written by Sen. Josh Green about the state’s medical marijuana program.)
Dear ASA Big Island Chapter,
I appreciate your focus on good, comprehensive care for patients.
Hawaii’s Medical Marijuana program historically has been run by the Public Safety Department which placed physicians in a precarious position if they chose to prescribe medical marijuana (MM) for their patients. It was focused on restricting access rather than making it a mainstream program. This was something that almost everyone who participated in the MM program objected to, both patients and physicians alike.
Because the current MM program was considered by many to be controversial and vulnerable to federal interruption or shutdown, due to some providers taking extreme liberties (who do nothing but provide cards for a fee without a genuine patient-physician relationship), it has been difficult if not impossible to move the program forward to begin to consider meaningful changes that would really help patients, such as creating a pilot dispensary program in Hawaii which many of you have advocated for.
Last year I sponsored, fought for and passed legislation to make a critical fundamental change in the program, placing it under the Department of Health. This change was the single most important policy change for all to consider, and passed with 97% of the legislature’s support and was then signed by the governor. This change will over time remove the stigma from prescribing MM, thus encouraging all PCPs to consider prescribing to patients who need it. No restrictions were placed on what disease states warranted getting a MM card and we increased the amounts of MM a patient can have.
The bill also specified that MM cards be processed through primary care physicians. The reason to focus on PCPs was simply to meet the standard of care for management of chronic disease. We were unfortunately seeing physicians fly into Hawaii to do nothing BUT provide MM cards for a fee, even though they didn’t know the patient’s history or care for all of their healthcare needs. Some doctors were hosting parties with a $200 entry fee at the door and then filling out MM cards in exchange for the entrance fee. This undermined your ability to care for your patients properly. Still others were renting a room at luxury hotels and filling out cards to pay for they vacations.
Had we continued on the same path with the 2000 MM law, and the concerns raised above weren’t addressed, it was only a matter of time before we were shut down completely in Hawaii and no patients would have been eligible for MM cards. Many providers were being examined for their pattern of prescription to the exclusion of other care.
Because it has been pointed out that some PCPs in Hawaii MAY STILL not prescribe MM to one of their patients who needs it, I have proposed in this years legislation an expansion to Pain Specialists, Oncologists, Palliative Care Specialists and Ophthalmologists. I reiterate that this means that a simple referral is all that would be necessary for someone with a PCP who chooses not to prescribe MM.
Also, if it is important enough to a patient to have a MM relationship with their PCP above all else, patients may choose one who provides that care.
One of your members (Dr. Berg) expressed a concern that uninsured individuals might not be able to get a MM card, because they don’t have a designated primary care physician, however he is overlooking the national mandate for all citizens to have insurance by 2014 (this year), per the affordable care act. Even in this circumstance an uninsured person could still see a specialist (as listed above) and pay for the visit to be evaluated for a MM card. This is what many people were doing anyway. Presently Hawaii has the lowest uninsured rate of any state except Massachusetts.
Ideally though, everyone will be insured and can see their PCP for a healthcare visit that might include getting MM if they need it, or a referral to meet their needs. This way patients MM use will be integrated into all the rest of the care patients seek and need.
I hope this clarifies your questions about the MM program.
Josh Green MD
Chairman, Senate Health Committee