Medical Cannabis
Physician Recommendation for a Patient’s Use of Medical Cannabis
The Darren Wesley “Ato” Hall Compassion Act was passed by the Alabama Legislature in 2021. This law allows qualified Alabama physicians to recommend medical cannabis to patients. Physicians must complete the application process and receive approval from the Alabama Board of Medical Examiners prior to recommending medical cannabis to Alabama patients for specified qualifying medical conditions.
While recommending medical cannabis to patients is not the same as prescribing, many of the same risks for abuse and diversion exist; accordingly, the Board expects physicians to adhere to the same standard of care and discretion as they would for any other treatment utilizing controlled substances. Registered Certifying Physicians are required to strictly adhere to all provisions of the Darren Wesley “Ato” Hall Compassion Act and the Board's Administrative Rule Chapter titled "Physician Recommendation of the Use of Medical Cannabis" when recommending medical cannabis to patients.
- Application for AMCC Permit
- Requirements for Certification and Recommendation of the Use of Medical Cannabis
- FAQs
- Resources
APPLICATION FOR ALABAMA MEDICAL CANNABIS CERTIFICATION (AMCC) PERMIT
Apply online by selecting the Medical Cannabis option from the Applications menu in Licensee Gateway portal.
AMCC Permit Eligibility Requirements
- Hold the following licenses/registrations:
- Active, unrestricted Alabama medical license (no serious discipline in the past five years).
- Active, unrestricted Alabama controlled substances registration (ACSC).
- Active Alabama-specific DEA registration.
- Current registration to query the Alabama Prescription Drug Monitoring Program (PDMP) maintained by the Alabama Department of Public Health.
- Current registration, or immediate intent to register, with the Alabama Medical Cannabis Patient Registry System established and maintained by the Alabama Medical Cannabis Commission.
- Proof of completion of a Board-approved four-hour course related to medical cannabis and a passing grade on an examination.
- A list of all practice locations from which the applicant may certify or recommend a patient for the use of medical cannabis.
- Non-refundable, non-transferable initial application fee of $300.
AMCC Permit Experience Requirements
- Has been in the active practice of medicine or osteopathy for at least three years (excluding internship, residency, fellowship, or other supervised training program); or
- Has actively practiced medicine or osteopathy for at least one year (excluding internship, residency, fellowship, or other supervised training program) and is certified by a specialty board approved by the American Board of Medical Specialties or the American Osteopathic Association Bureau of Osteopathic Specialists.
Prohibitions
Alabama Medical Cannabis Certification (AMCC) Permit holders may NOT:
- Accept remuneration for certifying a patient from anyone but the patient for a fee not to exceed customary charges.
- Accept, solicit, or offer any form of remuneration from or to a dispensary for referring a patient to a specific dispensary.
- Offer a discount or any other item of value to a patient to use a specific registered caregiver or a specific dispensary.
- Hold a direct or indirect economic interest in a licensee (grower, transporter, dispensary, integrated facility) of the Alabama Medical Cannabis Commission (AMCC).
- Serve on the Board of Directors or as an employee of a licensee (grower, transporter, dispensary, integrated facility) of the AMCC.
- Refer patients to a specific caregiver or a specific dispensary.
- Advertise in a dispensary.
- Advertise on a website, in brochures, or other media that generally describes the scope of practice of the physician as a “medical cannabis” or “medical marijuana” physician or doctor, or otherwise advertises the status of a registered certifying physician, other than stating the following: “Dr. ____ is qualified by the State of Alabama to certify patients for medical cannabis use under the Alabama Compassion Act.”
- Be located in the same office space as a dispensary or a dispensing site.
- Certify or recommend, or re-certify or re-recommend a patient for the use of medical cannabis unless both the physician and the patient are physically located in Alabama, and any examination, visit, or other consultation occurs while both parties are physically located in Alabama.
- Recommend cannabis for the treatment of a condition that the physician is not trained to treat with conventional medical treatment.
- Certify or recommend, or recertify or re-recommend, the use of medical cannabis to any patient who is pregnant, breastfeeding, or attempting to conceive.
- Certify or recommend, or recertify or re-recommend, the use of medical cannabis to any patient who has a condition for which cannabis is contraindicated under the current standard of care or by evidence-based research.
- A registered certifying physician is prohibited from utilizing any form of telemedicine when certifying or recommending, or recertifying or re-recommending a patient for the use of medical cannabis, or when conducting any examination associated therewith.
AMCC Permit Holders
- Must diagnose the patient with at least one qualifying medical condition or confirm that the patient has been medically diagnosed by a physician with at least one qualifying medical condition.
- Must establish a bona fide physician-patient relationship with the patient in an in-person visit. There is an expectation that the physician will provide care to the patient on an ongoing basis.
- Must conduct a physical examination while physically present in the same room as the patient and obtain a full assessment of the patient’s medical history.
- Any certification or recommendation, or recertification or re-recommendation of a patient for the use of medical cannabis must also occur with the registered certifying physician and the qualified patient physically present in the same room.
- Shall create and maintain a medical record that complies with Board rules.
- Determine from the patient registry whether the patient has an active registration for the use of medical cannabis.
- Submit to the patient registry the electronic certification or recommendation for treatment with medical cannabis.
- Must be available to provide follow-up care and treatment to the patient who is certified or recommended treatment with medical cannabis, including physical examinations relevant to the patient’s condition.
- May keep the records required for the certification or recommendation of medical cannabis with the patient’s other medical records and shall retained them for at least seven years.
- Must submit an annual report describing the AMCC permit holder’s observations regarding the effectiveness of medical cannabis in treating patients.
Dosage Limitations of Medical Cannabis
- Medical cannabis with a potency greater than three percent (3%) tetrahydrocannabinol may not be recommended to any minor for any qualifying condition.
- The Alabama Medical Cannabis Commission will establish the maximum daily dosages for each qualifying medical condition. Certain maximums may be increased if the physician determines it is medically appropriate (not to exceed 75 mg of delta-9-tetrahydrocannabinol) or the patient has been diagnosed with a terminal illness. The AMCC permit holder shall notify the patient that the patient’s driver’s license will be suspended.
Does the advertising restriction apply to a notification to patients and/or other physicians that a clinic intends to offer certification and recommendation for the use of medical cannabis to patients?
No. The restricted advertising is on a website, in brochures, or in other media.
What are the qualifying medical conditions for a recommendation for the use of medical cannabis?
The qualifying medical conditions are established by statute and are the following:
- Autism Spectrum Disorder (ASD).
- Cancer-related cachexia, nausea or vomiting, weight loss, or chronic pain.
- Crohn's Disease.
- Depression.
- Epilepsy or a condition causing seizures.
- HIV/AIDS-related nausea or weight loss.
- Panic disorder.
- Parkinson's disease.
- Persistent nausea that is not significantly responsive to traditional treatment, except for nausea related to pregnancy, cannabis-induced cyclical vomiting syndrome, or cannabinoid hyperemesis syndrome.
- Post Traumatic Stress Disorder (PTSD).
- Sickle Cell Anemia.
- Spasticity associated with a motor neuron disease, including Amyotrophic Lateral Sclerosis.
- Spasticity associated with Multiple Sclerosis or a spinal cord injury.
- A terminal illness.
- Tourette's Syndrome.
- A condition causing chronic or intractable pain in which conventional therapeutic intervention and appropriate therapy is contraindicated or has proved ineffective.
Will telemedicine visits with the patient meet the requirements for recommending the use and dosage of medical cannabis?
No. A registered certifying physician is prohibited from utilizing any form of telemedicine in certifying or recommending, or recertifying or re-recommending a patient for the use of medical cannabis or in conducting any examination associated therewith. A physical examination with the registered certifying physician physically present in the same room as the patient is required before certifying or recommending a dosage of medical cannabis for a patient or re-certifying or re-recommending a dosage for a patient. Additionally, the law states that the registered certifying physician and the patient must be physically located in Alabama, and any examination, visit, or other consultation must occur while both parties are physically located in Alabama. Furthermore, the law specifies that the physician must establish a bona fide physician-patient relationship with the patient for the provision of medical services in an in-person visit.
What is required in the patient's medical record/informed consent?
- Patient’s name and date or dates of office visits or treatments.
- Description of patient’s qualifying medical condition.
- Documented assessment of the patient’s medical history including prescription history, history of substance use disorder, review of available diagnostic test results, prior treatment and the patient’s response to treatment, and current medications, including all controlled substances.
- Documented review that shows conventional medical treatment or therapy has been attempted.
- Documented drug screen for the presence of controlled substances
- No certification of recommendation for the use of medical cannabis may be made for any patient who has a positive drug screen for any illicit or controlled substances for which they are not prescribed, excluding cannabis.
- Documentation of the physician’s performance of a physical examination relevant to the patient’s current medical condition.
- A negative pregnancy test result on any patient capable of conception with the results of the pregnancy test maintained in the medical record.
- The physician’s diagnosis of the qualifying medical condition or confirmation of the diagnosis by another qualified physician. Records relied upon to confirm the diagnosis shall be maintained by the registered certifying physician.
- If the AMCC permit holder diagnoses or confirms the diagnosis of a qualifying medical condition, the following actions must be documented in the medical record:
- Development of a treatment plan.
- Review of the patient’s controlled drug prescription history for the preceding 24 months.
- Discussion with the patient regarding any indicators of possible abuse or diversion reflected on the PDMP report.
- Explanation of the risks and benefits of treatment with medical cannabis.
- The registered qualified patient’s voluntary and informed written consent (see Resources below for sample informed consent), which a registered caregiver must also review and sign in the presence of the registered certifying physician, if applicable, including, at a minimum:
- Federal and state classification of cannabis as a Schedule I controlled substance.
- The approval and oversight status of cannabis by the Food and Drug Administration.
- The current state of research on the efficacy of cannabis to treat the qualifying medical condition or conditions.
- The potential for addiction.
- The potential effect that cannabis may have on coordination, motor skills, and cognition, a warning against operating heavy machinery or motor vehicle or engaging in activities that require alertness or quick responses.
- The potential side effects of cannabis use.
- The risks, benefits, and drug interactions of cannabis.
- That the use of medical cannabis could result in termination from employment without recourse and that costs may not be covered by insurance or government programs.
- That the patient’s de-identified health information contained in the patient’s medical record, physician certification, and patient registry may be used for research purposes or to monitor compliance with the law.
- That a certification or recommendation by an AMCC permit holder does not constitute a prescription for medical cannabis.
- Whether the patient requires the use of a registered caregiver to assist in the use or administration of medical cannabis. If the patient requires or utilizes a registered caregiver, the physician must document the name of the registered caregiver designated by the patient or the patient’s legal representative.
What information must be submitted to the Medical Cannabis Commission registry?
- The registered qualified patient’s full legal name, date of birth, and social security number;
- The AMCC permit holder’s name and Alabama Medical Cannabis Certification Permit number;
- The full legal name, date of birth, and social security number of the patient’s registered parent or legal guardian and/or registered caregiver, if applicable;
- A description of the qualifying medical condition(s) and whether the qualifying condition is a terminal illness (life expectancy of six (6) months or less);
- The daily dosage of medical cannabis being recommended, not to exceed the limitations set by the AMCC;
- The type or permissible form(s) of medical cannabis recommended;
- The permissible length of duration of the certification, which shall not exceed 30 days for a patient capable of conception or 90 days for all other patients;
- Statements and affirmations as follows:
- A bona fide physician-patient relationship exists between the AMCC permit holder and the registered qualified patient;
- The registered qualified patient has been diagnosed with at least one qualifying medical condition by either the AMCC permit holder or another qualified physician;
- The AMCC permit holder confirmed that attempted conventional medical treatments or therapies have failed to result in successful outcomes, or that the use of medical cannabis is the standard of care for the patient’s qualifying medical condition;
- A report of controlled substances prescribed to the registered qualified patient has been reviewed; and
- The patient has been informed of the risks and benefits of medical cannabis as it pertains to the patient’s qualifying medical condition and medical history.
What is the Food & Drug Administration's role in regulating cannabis and cannabis-derived products?
How often will patients need to be seen to receive a recertification?
In order to reactivate a patient's certification in the patient registry, the physician must see the patient and affirm that the patient still has a qualifying condition and that the use of medical cannabis is still recommended. Whether this is before or after the expiration of the initial certification does not matter, but if there is a lapse in certification, the patient will be unable to obtain any medical cannabis from a dispensary until recertification.
Where is the list of certifying physicians located?
Click here to be taken to the ALBME License Lookup page.
To see a current list of Certifying Physicians, select 'AMCP' from the 'License Type' selection box and click the blue Search button.
Any physicians with an Alabama Medical Cannabis Permit will show in the list, as well as the permit's status, and other information.
Which patients are required to complete a pregnancy test?
All biological females are requried to complete a pregnancy test.
A registered certifying physician shall obtain a negative pregnancy test result on any patient capable of conception.
Definitions:
540-X-25-.02(18) PATIENT CAPABLE OF CONCEPTION. A patient possessing female reproductive organs who is between eleven (11) and fifty (50) years of age, excluding any patient who the registered certifying physician has confirmed to have had a hysterectomy or tubal ligation.
What type of pregnancy test is acceptable?
Lab-based pregnancy tests are acceptable.
Must the pregnancy test be ordered or performed by the certifying physician?
Yes, the pregnancy test must be ordered or performed by the certifying physician.
How should pregnancy test results be submitted?
Lab results should be uploaded into the patient's chart.
In regard to pregnancy testing, is there a required timeframe relative to the certification date?
One week. Lab based pregnany tests should be conducted every 30 days.
Are drug tests required for all patients or only in specific situations?
Drug tests are required for all patients.
What type of drug test is acceptable, and must it be lab-based?
All drug tests must be lab based.
How should drug test results be documented and submitted?
Lab results should be uploaded into the patient's chart.
In regard to drug testing, is there a required window relative to certification?
One week.
Are there any exceptions to Admin. Rule 540-X-25-.09 (14) as it relates to telemedicine?
All patient certifications and re-certifications must occur in conjunction with an in-person examination conducted by the certifying physician. There are no exceptions to this requirement and telemedicine cannot be utilized in the context of medical cannabis certifications.
Are physicians permitted to utilize digital administrative tools - such as online contact forms and appointment scheduling software - to manage the practice, provided the tool is used strictly for booking or inquiries?
The Board is not aware of any provisions in the medical cannabis regulations that would prohibit the use of practice management tools for functions such as appointment scheduling or patient communications.
Can third-party practice management suites be utilized for the medical cannabis practice, provided that virtual meetings are disabled or do not utilize the virtual/video-chat features, thereby ensuring all clinical encounters remain in person?
The Board is not aware of any provisions in the medical cannabis regulations that would prohibit the use of third party software suites as a tool for medical cannabis practice.
Telemedicine is not permitted for the purpose of certifying or re-certifying recommendations and the use of a software suite would not obviate the requirement to fully input information into the Patient Registry.
Is there a required submission process or specific documentation that must be provided to the AMCC/ABME to demonstrate the third-party business software and office protocols satisfy compliance standards?
This information is not required to be submitted to the Board. It is the physician's responsibility to ensure that any tools utilized in their medical cannabis practice are compliant with all laws and regulations. The Board is happy to answer questions and provide guidance when requested.
Regarding patients with severe limited mobility, is there any current or anticipated discussion regarding the potential for telehealth exceptions in the future?
The Board is not aware of any ongoing discussions related to modifying the in-person requirement.
AMCC currently has a mechanism in place, for Alabama cannabis processors, to upload and submit marketing materials, articles, and related requests directly through the AMCC Portal. Why doesn't the physician have this option?
The Board does not have any process in place for reviewing marketing materials. The Code of Alabama specifically limits physician "advertising" to the following statement", "Dr. ____________ is qualified by the State of Alabama to certify patients for medical cannabis use under the Alabama Compassion Act."
Anything beyond the statement above would be a violation of Alabama law. This applies to websites, signage, and any other marketing/advertising materials. The Board does not have any discretion regarding advertising/marketing.
RESOURCES
Board Rules on Physician Recommendation of the Use of Medical Cannabis
Required Informed Consent Form
Alabama Medical Cannabis Commission
FDA Regulation of Cannabis and Cannabis-Derived Products, Including Cannabidiol (CBD)
MedWatch: The FDA Safety Information and Adverse Event Reporting Program
SAMSHA Brief Counseling for Marijuana Dependence Manual
SAMSHA-Using Motivational Interviewing in Substance Use Disorder Treatment