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Medical marijuana: The hospital leader's to-do list

April 16, 2019

    As of January 2019, 33 states and Washington, D.C. have legalized recreational or medical marijuana. However, marijuana is still illegal at the federal level and is classified as a Schedule I substance—meaning the federal government has ruled that it has a high potential for abuse and no currently accepted medical use in the United States.

    New resource guide: Marijuana in the health system

    Federal, state marijuana policies create challenges

    This contradiction between state and federal law poses a number of clinical and legal challenges for health systems. Because of its restricted federal status, hospitals that allow marijuana use risk violating federal law, thus exposing themselves to potential penalties and even loss of federal funding. Federal restrictions also limit the availability of information on marijuana's safety and efficacy. To date, researchers have not conducted any large-scale clinical trials on marijuana—in large part because of onerous review processes. The dearth of active studies, coupled with current regulatory barriers, will continue to limit future research findings.

    However, data suggest that Americans are becoming more interested in learning about and using medical marijuana, leading to greater demands for information on its safety, use, and availability. In fact, many health systems report fielding a high volume of medical marijuana-related patient requests after legislation is passed in their states—especially from patients with cancer. According to the American Society of Clinical Oncology's 2018 cancer opinions survey, 58% of patients who have or have had cancer wish they had more information about the benefits of using medical marijuana.

    Despite the legal and clinical ambiguity surrounding marijuana policy and use, health systems should devise a strategy for managing marijuana in their facilities—both as a risk mitigation strategy and as a patient and employee safety mechanism.

    How to develop an effective marijuana policy

    Many organizations choose to codify their marijuana strategy in a formal written policy. More than half of health systems surveyed by the Pharmacy Executive Forum in February 2019 reported having a formal medical marijuana policy. Specifically, 16% of respondents have a policy in place that allows medical marijuana use on campus, and 41% have a policy that does not allow its use.

    Regardless of what your policy covers, it should be created by a multidisciplinary group that includes physician, nursing, pharmacy, legal, and HR representation. Additional contributors might include addiction specialists, pain management clinicians, drug diversion specialists, or psychiatrists. This group should also maintain accountability for policy implementation, enforcement, and continual review.

    Health system leaders can use the following to-do list to help create and implement their organizations' marijuana policy:

    1. Consult with stakeholders across the health system—especially legal and HR—to develop recommendations for updating marijuana and hiring policies;

    2. Create a policy to communicate the system's stance on medical marijuana and ensure providers are prepared to treat patients in accordance with policy;

    3. If applicable, clearly state which formulations of medical marijuana patients are able to use on campus or which ones providers are able to recommend; and

    4. Educate staff on the system's policy and marijuana's medical applications so clinicians are not forced to make educated guesses when designing care plans.

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