Physician Recommendation for a Patient’s Use of Medical Cannabis
The Board of Medical Examiners may not issue Medical Cannabis Certification Permits to physicians until the AMCC has issued at least one license each for a cultivator, a processor, a secure transporter, and a dispensary, or at least one license for an integrated facility. Due to litigation concerning the integrated facility licenses, this process has been delayed. A time period for the issuance of the integrated facility licenses is unknown at this time.
- Application for AMCC Permit
- Requirements for Certification and Recommendation of the Use of Medical Cannabis
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 with the Alabama Medical Cannabis Patient Registry System established and maintained by the Alabama Medical Cannabis Commission (pending).
- 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.
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.
- Certify or recommend 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.
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.
- 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.
- 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 assocated 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 to be included in the AMCC permit holder’s annual report to the Board?
The Board continues to develop the content and process for submitting this report.
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.
- Results of any drug screens and any proscriptive measures taken due to an unsatisfactory screen.
- Documentation of the physician’s performance of a physical examination relevant to the patient’s current medical condition.
- 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 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 home address;
- The AMCC permit holder’s name and Alabama Medical Cannabis Certification Permit number;
- The name of the patient’s 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 forms of medical cannabis recommended;
- The permissible length of duration of the certification, which shall not exceed ninety (90) days;
- 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.