As the medical cannabis industry in Maryland continues to expand after 14 months of delivering finished medical cannabis products to patients, I have noticed an increasing number of inquiries from medical providers currently issuing medical cannabis recommendations, as well as those interested in participating in the Maryland medical cannabis program. Questions range from “How do I register with the Maryland Medical Cannabis Commission (“MMCC”), to “What qualifying conditions am I allowed to treat under Maryland law?”, to “Can a patient use medical cannabis if they own a firearm?” These are only a few of the significant questions I have received from MMCC-registered and non-registered medical providers alike, demonstrating even greater interest in the program among medical professionals.
Below, I have included a few key questions that medical providers should be prepared to address as part of their medical cannabis practice, although this list is my no means exhaustive. As the “gatekeepers” of medical cannabis, medical providers should expect to receive the following questions from patients and should be prepared to provide patients with a thoughtful and thorough answer.
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1. Driving under the influence of cannabis, even pursuant to a medical cannabis recommendation issued by a registered provider, remains unlawful. Any individual operating a vehicle under the influence of cannabis (who is caught doing so by law enforcement) will be subject to criminal law charges regardless of whether the individual is a medical cannabis cardholder.
2. Medical providers can never prescribing cannabis—this is illegal under federal law. Rather, a medical provider may recommend cannabis for patients suffering from a debilitating medical condition if the medical condition and/or symptoms of the condition may be treated and/or alleviated with the use of cannabis. Regardless of a medical provider’s knowledge and familiarity with medical cannabis, it is important to emphasize the significant uncertainty regarding the efficacy, contraindications, and side effects of various forms of medical cannabis, particularly with respect to the wide range of medical conditions and symptoms that may be treated with medical cannabis pursuant to state law. While a medical provider is certainly permitted to issue a recommendation in the absence of medical certainty as a matter of law, as a matter of medical ethics and professionalism, it is impossible to overstate the importance of managing patient expectations. At the end of the day, medical providers should incorporate the same precautions, warnings, and words of wisdom used to prepare patients undergoing novel treatments and therapies, making sure to disclose all potential drawbacks and the existence of numerous “known-unknowns” regarding the efficacy, contraindications, and pharmacokinetics of the drug.
3. Given the growing popularity of medical cannabis use, it is important for patients and patient caregiver(s) to recognize the state law limitations concerning the possession and commercial distribution of medical cannabis. Even if a patient is in possession of medical cannabis pursuant to a recommendation issued by a medical provider, the patient is prohibited from transferring medical cannabis products to any other individual, even if an individual is also a medical cannabis cardholder. Additionally, any individual who distributes cannabis to another person who is not a medical cannabis cardholder may face additional criminal law penalties for diverting medical cannabis products to the illegal black market. While both actions are illegal under Maryland law, the reality is any individual diverting medical cannabis to the black market is begging for trouble. State regulators take significant steps to prevent diversion to the black market and anyone who sidesteps state law for personal financial gain will likely face steep penalties for failing to abide by the most important rule in medical cannabis states: Preventing black market diversion!
4. Medical cannabis patients in Maryland can be fired for using medical cannabis pursuant to a medical provider’s recommendation, even if the patient is not using medical cannabis at the workplace.
5. Medical cannabis patients who apply to purchase a firearm will need to disclose their status as a medical cannabis cardholder when purchasing a firearm from a federally licensed firearms dealer because federal gun laws require all gun buyers to complete ATF Form 4473 prior to obtaining the firearm. The form asks whether the individual purchasing the firearm is a medical cannabis cardholder and any individual who answers this question in the affirmative will not be able to proceed with the firearm purchase. And in case you’re wondering whether it is possible to lie about your status as a medical cannabis cardholder and get the gun anyway, that is called perjury, aka a federal crime. Anyone who provides inaccurate, misleading, or false information on the form could, if caught, face up to 20 years in prison.
6. Federal law still prohibits medical cannabis patients from transporting any amount of cannabis across state lines, regardless of the stated purpose. This prohibition applies even if both states permit medical, recreational, or both medical and recreational cannabis use, as crossing from one state to another implicates federal law by way of interstate commerce. In other words, the federal government can pursue charges against an individual for violation of federal drug laws, and transporting cannabis from one state to another bordering state constitutes federal drug trafficking under the federal Controlled Substances Act.