{"id":42302,"date":"2022-02-07T20:16:37","date_gmt":"2022-02-08T03:16:37","guid":{"rendered":"https:\/\/dh.durangoherald.com\/tj\/effort-to-crack-down-on-cannabis-concentrates-spooks-some-doctors\/"},"modified":"2022-02-08T03:16:37","modified_gmt":"2022-02-08T03:16:37","slug":"effort-to-crack-down-on-cannabis-concentrates-spooks-some-doctors","status":"publish","type":"post","link":"https:\/\/dh.durangoherald.com\/tj\/effort-to-crack-down-on-cannabis-concentrates-spooks-some-doctors\/","title":{"rendered":"Effort to crack down on cannabis concentrates spooks some doctors"},"content":{"rendered":"\n

\"Jessica
Jessica Hogan, owner of Vibrant Health Clinic, stands outside the office during one of their final days in the space. After 12 years of serving the Colorado Springs community, the medical cannabis clinic closed its doors at the end of January. (Parker Seibold for The Colorado Sun)<\/span>cca<\/span><\/figcaption><\/figure>\n<\/p>

A new Colorado law aimed at keeping young people from buying and reselling highly potent THC concentrate has sparked concerns from doctors who recommend medical cannabis about how the new provisions could jeopardize their ability to practice medicine.<\/p>\n

The law, which has some doctors saying they have stopped working with medical cannabis patients altogether, requires that patients obtain written \u201ccertifications\u201d from doctors in order to access marijuana concentrates over a new daily limit. Doctors must include new information on those forms like a patient\u2019s address, maximum THC potency level, dosage, directions for use and a daily authorized quantity.<\/p>\n

Previously in Colorado, doctors would recommend cannabis rather than prescribe it, in keeping with a 9th U.S. Circuit Court of Appeals ruling that protects a doctor\u2019s right to \u201crecommend\u201d and discuss the health benefits of cannabis as part of a doctor-patient relationship.<\/p>\n

But the new requirements for concentrates in House Bill 1317, which was approved by the Legislature last year, are more akin to writing a prescription for cannabis, which remains illegal under federal law, said Dr. Laura Lasater. Doctors must maintain an active certification with the Drug Enforcement Agency to practice medicine.<\/p>\n

\u201cCannabis is still considered a Schedule I drug,\u201d said Lasater, who left her job at a medical cannabis clinic in Denver in protest over the new rules. \u201cI could lose my DEA license by trying to write the specifications (the state) is now requiring.\u201d<\/p>\n

Schedule I drugs are defined by the federal government as having no accepted medical use and include heroin, LSD and peyote.<\/p>\n

Doctors have also cited provisions under the state\u2019s Medical Practices Act that prohibit them from \u201cadministering, dispensing or prescribing any habit-forming drug or any controlled substance.\u201d<\/p>\n

It is unknown how many doctors have decided to stop working with cannabis patients. There are 25,857 physicians currently licensed to practice medicine in Colorado. By comparison, just 326 providers \u2013 which can include dentists, advanced nurse practitioners and physician assistants \u2013 wrote recommendations for cannabis patients last year.<\/p>\n

At least one clinic has closed amid concerns over the new law.<\/p>\n

Vibrant Health, a Colorado Springs clinic that saw 2,000 patients a year, shuttered at the end of January after two of its three doctors said they were no longer comfortable working with medical cannabis patients.<\/p>\n

\u201cWe don\u2019t know for sure what could happen, but we just weren\u2019t comfortable with the prescriptive nature of the new physician forms,\u201d said Jessica Hogan, owner of Vibrant Health and a longtime cannabis advocate in Colorado. \u201cThere are other clinics that are definitely staying open that we are referring (patients) to, that are willing to risk this to see how it pans out.\u201d<\/p>\n

Other clinics are seeing doctors resign.<\/p>\n

A physician for Cohen Medical Centers, a clinic in Denver, resigned at the end of 2021, citing the implementation of the law in a letter to the Colorado Attorney General\u2019s Office. Another who worked in communities including Aspen, Rifle and Glenwood Springs is taking a sabbatical, citing the increase in coronavirus cases and the new law.<\/p>\n

\"Jessica
Jessica Hogan helps a patient retrieve medical records and a referral to another medical cannabis clinic at Vibrant Health Clinic on Thursday, Feb. 3. (Parker Seibold for The Colorado Sun)<\/span>cca<\/span><\/figcaption><\/figure>\n<\/p>

The state does not have current numbers for registered medical professionals who can write certifications. It may take months for data to reflect how many providers have stopped working with cannabis patients.<\/p>\n

While many medical cannabis groups were strongly opposed to House Bill 1317, the measure passed the Colorado Legislature with broad bipartisan support and was signed into law by Gov. Jared Polis.<\/p>\n

The law is aimed at limiting illicit youth access to highly potent THC products, such as cannabis wax or shatter, which are heated into vapor and inhaled.<\/p>\n

\"Colorado
Colorado State House Speaker Alec Garnett (D-2nd Dist.) is pictured among COVID-19 protective screens on House members\u2019 desks during the first day of Colorado\u2019s 73rd legislative session at the Colorado State Capitol in Denver on Jan. 13, 2021. (Andy Colwell\/Special to The Colorado Sun)<\/span>cca<\/span><\/figcaption><\/figure>\n<\/p>

The legislation was pushed by parent groups concerned about teens or young adults obtaining medical marijuana cards to buy cannabis concentrates and then illegally reselling them to underage buyers. Some young people have reported experiencing anxiety, psychosis or other negative health effects after using high-THC products.<\/p>\n

The judicial system could weigh in on the concerns from providers as part of an ongoing lawsuit, filed in July by Benjamin Wann, a 19-year-old medical marijuana patient with epilepsy, seeking to block the law from going into effect based on arguments that it violates state constitutional protections for medical marijuana patients.<\/p>\n

A hearing to consider the legal action has not been scheduled.<\/p>\n

House Speaker Alec Garnett, a Denver Democrat and one of the prime sponsors of House Bill 1317, declined to comment in detail on the concerns of physicians, citing the lawsuit.<\/p>\n

\u201cThe law just took effect, and I haven\u2019t heard these concerns,\u201d Garnett said. \u201cThat said, we always evaluate legislation after it\u2019s implemented, and we will do the same with this one. I\u2019m monitoring this issue closely.\u201d<\/p>\n

Concerns about patient access<\/div>\n

The changes have also sparked concerns that patient access to medical cannabis may suffer, especially for people living in rural areas, if the number of doctors willing to work in the field declines.<\/p>\n

There were more than 64,000 Coloradans with active medical marijuana registrations as of December, according to state data.<\/p>\n

The number of medical providers willing to work with medical cannabis patients is low because cannabis is still illegal under federal law, said Martha Montemayor, director of Cannabis Clinicians Colorado, a professional group that lobbied against the law and is backing the lawsuit challenging it.<\/p>\n

Many insurance companies or health networks do not allow doctors to write cannabis recommendations, and malpractice insurance companies may refuse to insure a doctor or increase their premiums if they write recommendations, she said.<\/p>\n

The law imposes new limits on how much concentrated THC products patients and recreational customers can buy. To enforce that cap, it requires the tracking of daily purchases made at medical dispensaries.<\/p>\n

People aged 18 to 20 who are applying for a medical card for the first time, and all minors, must now see two providers from separate practices in order to obtain a medical marijuana card. People who already had a valid card prior to this year can keep their current cards.<\/p>\n

Many doctors are continuing to write certifications that allow patients to receive a medical marijuana card. If a patient needs marijuana concentrates that exceed the daily purchase limit of 8 grams, they must get a separate approval from a doctor under the new law through a form that some doctors won\u2019t sign.<\/p>\n

Montemayor, who also owns clinics in different parts of the state, said this impacts patients with cancer, epilepsy and other conditions who use concentrated cannabis products and may want to stock up for several days or a month.<\/p>\n

\u201cThe people who are really affected are not the people who live in Denver, Colorado Springs and Fort Collins. It\u2019s people who live in places like Gunnison and Rifle,\u201d Montemayor said. \u201cGunnison County is recreational only, it\u2019s an hour and a half drive (to see a doctor).\u201d<\/p>\n

Autumn Brooks, a Clear Creek County resident who testified against House Bill 1317, is worried that a decrease in cannabis doctors will make it harder for people like her to get an appointment and drive up appointment and product costs. In 2020, Brooks\u2019 13-year-old son Raven began taking concentrated medical marijuana products to help his autism spectrum disorder after trying several pharmaceutical drugs.<\/p>\n

After a few months on cannabis, Brooks said her son, who struggles with self-harm and aggression, was catching up in school and was no longer disrupting class with outbursts.<\/p>\n

\u201cIt helped him become social,\u201d she said. \u201cHe went from having no friends to being invited to stuff, and his bullies don\u2019t mess with him anymore.\u201d<\/p>\n

The local dispensaries in Clear Creek County carry both recreational and medical marijuana products, but the stock is often geared toward recreational consumers with limited selection for patients.<\/p>\n

She typically drove to Denver and Colorado Springs to stock up. The daily purchase limits on concentrated products mean she can no longer do that, Brooks said. After the bill passed, she decided to transition Raven off of cannabis to avoid changing his medication during the school year. Some behavioral issues have returned.<\/p>\n

\u201cI\u2019ve called a couple providers; they aren\u2019t taking anyone else,\u201d Brooks said. \u201cIt\u2019s kind of futile.\u201d<\/p>\n

The courts could weigh in<\/div>\n

The family of Benjamin Wann, a 19-year-old medical cannabis patient who uses cannabis-derived products to control his severe epilepsy, filed a lawsuit in July challenging the law\u2019s constitutionality.<\/p>\n

Two doctors, Sharon Montes and David Gray, later joined the legal action.<\/p>\n

The Colorado Attorney General\u2019s Office, which is representing the state in the lawsuit, and Gov. Jared Polis both declined to comment on concerns from physicians, citing the ongoing litigation.<\/p>\n

In a court filing, the state argued the new requirements for physician certifications are fully within the bounds of Amendment 20, the constitutional amendment approved by voters in 2000 that enshrined protections for medical marijuana in state law.<\/p>\n

The state also argued Wann, Montes and Gray haven\u2019t provided any evidence of a \u201ccredible threat of enforcement\u201d against doctors by the federal government.<\/p>\n

Steve Kotecki, a spokesman for the DEA, said the agency had not revoked any certifications in January as a result of the law and that the agency \u201cdoes not review individual states\u2019 marijuana policies or comment on state legislation.\u201d<\/p>\n

Lee Rasizer, a spokesperson for the state Medical Board, which oversees licensing and discipline, said the board \u201chas no implementation authority and is unaware of any provisions that would violate the Medical Practice Act.\u201d<\/p>\n

Meanwhile, members of the Colorado Board of Health have raised concerns.<\/p>\n

At a Dec. 15 meeting, members approved emergency regulations to codify the new law, but said they were voting reluctantly given the concerns from doctors.<\/p>\n

\u201cI know it\u2019s a legal question, but it seems like we\u2019re creating two conflicting regulations, potentially,\u201d said Tom Butts, a member of the board who also serves on the board of the National Environmental Health Association.<\/p>\n

\"A
A sign announcing Vibrant Health Clinic\u2019s closure due to HB-1317 hangs in the window. (The Colorado Sun)<\/span>cca<\/span><\/figcaption><\/figure>\n<\/p>

Doctors serving medical marijuana patients have, until now, been loosely regulated. Hogan, the owner of Vibrant Health, said she agrees there should be more rules for providers. Her clinic asked for medical records and screened patients before they were booked for an appointment. But practices by other clinics \u201cruined it for the rest of us,\u201d she said.<\/p>\n

One of Hogan\u2019s doctors, however, says she hopes the law will reduce the profit motive for bad actors in the industry. Dr. Margaret Gedde, who now lives out of state and cannot write certifications, still sees cannabis patients from Colorado for telemedicine consultations. Though she is unable to write certifications, Gedde said she would feel comfortable doing so under the new law.<\/p>\n

\u201cWhen I look at the extra information requested, to me it\u2019s still not a prescription, it\u2019s not even close,\u201d Gedde said.<\/p>\n

Montemayor is hoping for a resolution through the courts, but that could take months or years to resolve. Her doctors won\u2019t be writing certifications for concentrates in the meantime.<\/p>\n

\u201cWe are not doing the new certification form until a lawyer says it\u2019s OK,\u201d Montemayor said.<\/p>\n

The Colorado Sun is a reader-supported, nonpartisan news organization dedicated to covering Colorado issues. To learn more, go to coloradosun.com<\/em><\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

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