Letters — About The Medical Marijuana Program

(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

8 replies
  1. Ken
    Ken says:

    With all due respect, I think the good Senator should take a cue from his colleague Sanjay Gupta:


    A few special quotes:

    “I am not backing down on medical marijuana; I am doubling down.”

    “More remarkable, many doctors and scientists, worried about being ostracized for even discussing the potential of marijuana, called me confidentially to share their own stories of the drug and the benefit it has provided to their patients. I will honor my promise not to name them, but I hope this next documentary will enable a more open discussion and advance science in the process.”

    “Marijuana is classified as a Schedule I substance, defined as “the most dangerous” drugs “with no currently accepted medical use.””

    “Neither of those statements has ever been factual. Even many of the most ardent critics of medical marijuana don’t agree with the Schedule I classification, knowing how it’s impeded the ability to conduct needed research on the plant.”

    Too bad he declined being the Surgeon General.

  2. Kit
    Kit says:

    As we sit here mulling over the merits of this bill, Rev. Roger Christie sits in extra-judicial Federal Detention, kept away from family and friends – and for what?

    I will state again what has been said many times before, a conspiracy undoubtedly exists between the Judge in this case and the federal prosecutors assigned to his case. Why they seek to punish him, in ways that appear inhumane if not downright illegal, is not known.

    I call upon the Judge to honor his oath and immediately stop this unwarranted ‘special agreement’ with prosecutors for the persecution of this gentle man.

  3. Kelly
    Kelly says:

    @punated – please address issues instead of proffering personal putdowns.
    For example; there is nothing in the new legislation that would make it legal and easier to obtain cannabis for qualified patient/consumers. We don’t need the promise of some future ‘pilot program’. We need safe access. Now.
    Dozens of programs, elsewhere, are in place and functioning well. Going to my PCP, who won’t ‘recommend’, then going to a palliative Dr. is going to cost more than going to the cannabis ‘specialist’ in the first place.
    Dr. Josh Green, in my opinion, needs to refocus from professional disapproval of the perfectly fine Dr. certifiers, to promoting legislation permitting safe and secure and legal access to cannabis.
    I agree with DR. Josh Green that this needs to be normalized, but the PCP initiative is going to restrict, much less legalize access.
    All of this would be moot if we simply legalize cannabis.
    Why not?

  4. punated
    punated says:

    Kelly, try to become more literate. My comment was about Josh Green’s legislative actions.

    He has mucked up the medical marijuana program to make it even worse than it was before. Have you even read his latest medical marijuana bill? He says the solution for a PCP is to allow specialists to become PCP, after he was the one that made PCP the only way to get a prescription with last year’s legislation. Now, he says, let highly paid, extremely limited doctor specialists write prescriptions. Right, like a orthopedic surgeon or oncologist or brain surgeon would have any interest in writing medical cannabis prescriptions. Try reading his legislation first before commenting ignorantly.

  5. Kit
    Kit says:

    PCP’s on the Big Island are already so overscheduled with patients on a daily basis, it’s almost laughable that this bill add yet another bureaucratic burden to overstressed staff.

    I’m not saying it is true in this case, but sometimes I think certain bills are introduced to make it impossible to administer; hence, no progress even though it is overwhelmingly supported by the people.

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