In 1996, California voters approved the Compassionate Use Act (Proposition 215), which allowed Californians access to cannabis for medical purposes, and prohibited punitive action against physicians for making cannabis recommendations. SB 420 (Vasconcellos, Chapter 875, Statutes of 2003), the Medical Marijuana Program Act, included issuance of identification cards for qualified patients, and allowed patients and their primary caregivers to collectively or cooperatively cultivate cannabis for medical purposes.
- In 2015, SB 643 (McGuire, Chapter 719), related to physicians recommending medical cannabis, was signed into law. This law includes, in the Medical Board of California’s (Board) priorities, cases that allege a physician has recommended cannabis to patients for medical purposes without a good faith prior examination and medical reason. This law also specifies that physicians recommending cannabis to a patient for a medical purpose without an appropriate prior examination and a medical indication, constitutes unprofessional conduct. The law prohibits a physician from recommending cannabis to a patient unless that physician is the patient’s attending physician, as defined by subdivision (a) of section 11362.7 of the Health and Safety Code (HSC). The HSC defines an “attending physician” as an individual who possesses a license in good standing to practice medicine or osteopathy issued by the Board or the Osteopathic Medical Board of California and who has taken responsibility for an aspect of the medical care, treatment, diagnosis, counseling, or referral of a patient. The law requires a physician to conduct a medical examination of that patient before recording in the patient's medical record the physician's assessment of whether the patient has a serious medical condition and whether the medical use of cannabis is appropriate.
This law subjects physicians recommending cannabis to the definition of “financial interest” in Business and Professions Code section (BPC) 650.01 and does not allow a physician to accept, solicit, or offer any form of remuneration from or to a licensed dispenser, producer, or processor of cannabis products in which the licensee or his or her immediate family has a financial interest. This law does not allow a cannabis clinic or dispensary to directly or indirectly employ physicians to provide cannabis recommendations, a violation would constitute unprofessional conduct. This law does not allow a person to distribute any form of advertising for physician recommendations for medical cannabis unless the advertisement contains a notice to consumers, as specified.
This law required the Board to consult with the California Marijuana Research Program, known as the Center for Medicinal Cannabis Research (CMCR) on developing and adopting medical guidelines for the appropriate administration and use of cannabis. The Board consulted with CMCR and adopted Guidelines for the Recommendation of Cannabis for Medical Purposes on October 27, 2017 and revised those guidelines on April 20, 2018. These Guidelines were developed to assist physicians who choose to recommend cannabis for medical purposes to their patients. These Guidelines are not intended to mandate the standard of care and deviations from these Guidelines may occur and may be appropriate depending upon the unique needs of individual patients.
- AB 710 (Wood, Chapter 62, Statutes of 2018) changed the law to allow a physician, pharmacist, or other authorized healing arts licensee acting within his or her scope of practice, to prescribe, furnish, or dispense cannabidiol, if it is excluded from Schedule 1 of the federal Controlled Substances Act (Act) and placed on a schedule other than Schedule I, or if a product composed of cannabidiol is approved by the federal Food and Drug Administration (FDA) and either placed on a schedule of the Act other than Schedule I or is exempted from the Act. This law specifies that if a physician, pharmacist, or other authorized healing arts licensee prescribes, furnishes, or dispenses cannabidiol in accordance with federal law, they shall be deemed to be in compliance with state law.
The Board often receives inquiries from physicians regarding the personal use of cannabis by physicians for medicinal or recreational purposes.
- The Board does not have a policy regarding a physician’s use of cannabis for medicinal and/or recreational purposes, but views the use of cannabis like it does the use of other controlled substances and alcohol. The Board must follow the law, which states if a physician is impaired, the Board can take disciplinary action.
- The law prohibits physicians from using drugs or alcohol to the extent or in such a manner as to be dangerous to themselves or to any other person, and from being impaired while practicing medicine, whether they are using cannabis for medical purposes or for recreational use. BPC sections 822 and 2239 authorize the Board to take action against a physician who is impaired, and BPC section 2234 authorizes the Board to take action for unprofessional conduct. The Board will take appropriate action against any physician who has violated the Medical Practice Act.
- If a physician is convicted for a cannabis-related crime, be it a misdemeanor or felony, the Board would adhere to its mission of consumer protection and treat the conviction as is it does any crime committed by physicians. The Board would look into the circumstances surrounding the conviction and take the appropriate action to protect the public. Moreover, the Board is alerted when a physician is arrested, including for driving under the influence, and the Board would look into the circumstances leading to the arrest and take appropriate action for public protection.
- The Board investigates all complaints it receives regarding a physician who may be impaired (including from cannabis use – medical or recreational). The Board must determine if a physician is impaired, which may require an evaluation pursuant to BPC section 820. If it is determined through the investigative process that it would be dangerous to allow the physician to continue practicing, the Board can also petition for an Interim Suspension Order preventing the physician from practicing medicine pending resolution of the disciplinary matter.