Medical marijuana program still months from start-up despite July 1 effective date

MORGANTOWN, W.Va. — West Virginia’s medical cannabis program officially takes effect July 1. But patients and caregivers shouldn’t expect to be receiving their physician certification or program ID cards anytime soon, according to the Department of Health and Human Resources.

Though the program was enacted in 2017, two pieces of legislation crucial to get the program rolling were just passed this, the most recent in late May. At this point, the state and medical practitioners aren’t ready to roll.

Meanwhile, the U.S. House of Representatives passed legislation this week that may make it easier for states to operate their programs.

DHHR spokeswoman Allison Adler explained where the state stands at this point. “In most states, it has taken several years (often three to five) to get medical cannabis programs up and running. It requires program staffing and development, rules implementation, industry buildout (building licensed, in-state growing facilities, processing facilities, dispensaries, laboratories, etc.), registration of certifying providers, registration of patients, etc. Advance work undertaken by DHHR should somewhat shorten this time in West Virginia.”

The two recent pieces of legislation addressed flaws in the original program’s design.

HB 2538, passed in early March and signed into law in late March, addressed the banking problem. Because medical cannabis money is still federally illegal, the bank holding the state’s checking account, BB&T, won’t handle cannabis money. So the bill created the Medical Cannabis Program Fund to receive license fees, penalties and taxes associated with the program; and the Treasurer’s Medical Cannabis Fund to receive all oversight and compliance fees charged to the financial institution chosen to handle the program fund.

The second problem was the lack of vertical integration for growers, processors and dispensers. Federal tax law makes it essentially impossible for businesses to operate profitably without being able to operate as a single company. So SB 1037, passed and signed into law in May, during the early part of the ongoing special session, took care of that, along with a number of other problems in the original legislation.

Adler said, “If all goes smoothly, DHHR’s Office of Medical Cannabis estimates it being two to three years from a fix to the financing issue before patients with a qualifying medical condition can procure quality-tested medical cannabis in West Virginia.”

In the meantime, terminally ill cancer patients will be able to take advantage of reciprocity agreements with other states in order to receive medical cannabis. Other patients will have to wait.

The Dominion Post asked WVU Medicine and Mon Health about their preparations for the program: about registering doctors willing to participate, about registering and certifying patients.

WVU Medicine spokeswoman Angela Knopf said, “WVU Medicine is having ongoing and multidisciplinary discussions and group meetings about all the details related to medical marijuana. … It will likely be up to the individual doctor to decide if he or she wants to register to certify patients, regardless of specialty.”

WVU Medicine, she said, is still developing procedures for integrating patients receiving medical marijuana from inside and outside the system.

Patients familiar with treatment at WVU Medicine facilities know that often a medical school resident or fellow will see them in clinic before the attending physician steps in. Knopf said residents and fellows will not be able to certify patients; that will be up to the attending physician.

For patients in the hospital, she said, “Whether doctors and patients discuss the use of medical marijuana is entirely up to them.”

Mon Health referred The Dominion Post to two physicians with expertise in this area who could not be reached in time for this report.

At Mon Health, Dr. Gregory Nelcamp, senior vice president for clinical affairs, said their plan is to follow their bylaws and treat medical cannabis as they would any other new therapeutic option.

Committees will meet to review the program and get an understanding of the state law. They will identify appropriate medical indications and appropriate privileging criteria for practitioners, and interested physicians will then be eligible to apply.

Their thoughts and decision-making, he said, will focus on the question of “What’s good medicine.” That means quality, peer-reviewed, evidence-based medicine.

Asked about which kinds of physicians might be eligible to certify patients, Nelcamp noted that the law lists 15 serious medical conditions that can be treated under the program. It’s a wide variety that includes cancer, Parkinson’s, multiple sclerosis, epilepsy, neuropathies, PTSD, severe chronic or intractable pain of neuropathic origin and terminal illness.

That means, he said, that a wide variety of practitioners might believe medical cannabis could be a valuable adjunct to their practice.

And again, that goes back to evidence-based medicine, he said. For what diseases are cannabis, in all its medicinal forms, shown to change patient outcomes.

“We’re interested in just being good doctors.” And doing what’s right for the patient.

Echoing what Adler said about the lengthy timeline to roll out the program, Nelcamp said he’s not aware that the state has made any effort to contact the medical community to begin registering and training physicians to participate. He’s sure the state will provide guidance, as this is a work in progress.

House of Representatives

The House is working on the2020 Commerce, Justice, Science, and Related Agencies Appropriations Act, which remains unfinished at this point.

Among the amendments to the bill was a bipartisan offering by Reps. Earl Blumenauer, D-Ore., Tom McClintock, R-Calif., and Delegate Eleanor Holmes Norton, D-D.C.

The amendment would prohibit the Department of Justice from interfering with state cannabis programs and was adopted 267-165.

All three of West Virginia’s representatives voted no on the amendment.

David McKinley represents the 1st District, which includes the area from Wheeling to Clarksburg. Asked about his vote, spokeswoman Amanda Hyman said, “Attorney General Barr has already stated a hands-off policy toward states on this issue, so the amendment is unnecessary.”

Carol Miller represents the 3rd District, spanning the southern portion of the state. In 2017, as a member of the state House of Delegates, she was part of the 76-24 majority supporting SB 386, which created the medical cannabis program.

The Dominion Post asked her about her vote in the amendment in the context of her prior vote, but her office did not respond to voice and email messages.

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