Every day, patients around America use cannabis to treat everything from glaucoma to chronic pain to nausea from chemotherapy treatments. Yet even in places like California, which pioneered legal medical marijuana in 1996 and passed adult-use cannabis in 2016, hospital policy has not caught up with the law and cannabis remains officially barred from hospital premises across the country. The reason why should sound familiar: federal prohibition.
Hospitals in the United States are subject to federal regulations, and could stand to lose funding and the ability to serve patients if they break the federal law, even with something like a state-legal medication.
This conflict between state and federal law on cannabis use in hospitals has very real consequences. One woman, Jessica Assaf, wrote on Healthcare in America in January 2018 about the experience of watching her partner’s father die of colon cancer at Memorial Sloan Kettering Cancer Center in New York City.
“After two years of failed chemotherapy and radiation, this prominent New York City lawyer weighed 130 pounds and could no longer talk nor move,” she wrote. “Though this patient had a medical recommendation for cannabis use in New York and vaporized THC and CBD daily to manage his pain, he could not use his medicine while he was stuck in the hospital. Instead, he was administered fentanyl.”
The medical marijuana movement, in fact, has a history of pushing for cannabis use in hospitals. The legendary activist known as Brownie Mary brought the issue into the international spotlight after she was arrested for bringing pot brownies to people dying of HIV/AIDS in San Francisco’s hospitals in the 1980s. Forty years later, it might be legal for millions to purchase medical marijuana — but using it in hospitals remains as prohibited as ever.
California Pioneering the Fight for Cannabis Use in Hospitals
The first sign of progress in allowing cannabis use in hospitals came in September 2016, just north of San Francisco. In a 2-0 vote, with three members abstaining, the board of California’s Marin Healthcare District voted in favor of a resolution to study allowing patient cannabis use at Marin General Hospital, in the town of Greenbrae. A series of public forums were to be held to discuss the proposal.
However, in the three years since, the study has not been conducted and has effectively stalled.
The resolution was originally introduced by retired emergency room physician Dr. Larry Bedard, who had served on the California Medical Association cannabis task force that led to the association recommending legalization in 2011.
“We ought to be on the cutting edge for our patients, allowing them to openly and appropriately use medicinal cannabis,” Bedard told San Francisco’s KPIX at the time of the Marin resolution.
Speaking at the board meeting in support of the resolution was Lynnette Shaw, who opened the first licensed medical marijuana dispensary in Marin County back in 1997. She told KPIX she had been sneaking pot brownies into Marin General for 20 years, and that most doctors there were perfectly aware of the practice.
“This is something they know about,” said Shaw. “I think it’s time for Marin General to step up, because this is a revolution for better health… For goodness sake, help the patients! Save lives!”
However, Shaw’s comments apparently didn’t get through. In the three years since the Marin Healthcare District voted to study the issue, little has come of it. Reached for comment in Marin County by Cannabis Now, Bedard says the resolution has seen no progress.
“The hospital administrators basically said ‘C’mon Larry, it’s a Schedule I drug, the Trump administration would take away our Medicare provider number and we’d have to close,” Bedard tells us.
He points out that any hospital that handles Medicare patients — predominantly people with the federal health insurance for those over 65 — must be certified by the federal Department of Health & Human Services. And while there is a small push to get Medicare to cover medical marijuana, there are few prospects for this happening under the current White House administration.
An attempted remedy at the state level in California has also failed. Last year, Senate Bill 305, the “Compassionate Access to Medical Cannabis Act,” unanimously passed both chambers of California’s Legislature. It would have prohibited healthcare facilities from interfering with a terminally ill patient’s use of medical cannabis. It was also dubbed “Ryan’s Law,” after Ryan James Bartell, a San Diego native who had died of pancreatic cancer in April 2018. But in October, it was “begrudgingly” vetoed by Gov. Gavin Newsom.
“This bill would create significant conflicts between federal and state laws that cannot be taken lightly,” Newsom wrote in a veto statement, noting that “health facilities certified to receive payment from the from the federal Center for Medicare and Medicaid Services must comply with all federal laws.”
But his statement also took aim at those federal laws. “It is inconceivable that the federal government continues to regard cannabis as having no medicinal value,” Newsom wrote, adding that this “ludicrous stance puts patients and those who care for them in an unconscionable position.”
Doctors Weigh In
Clearly, the stakes in this question are high due to the illegality of cannabis at the federal level. While 11 states have legalized adult-use cannabis and 33 states have legalized medicinal marijuana, the feds still hold significant sway over hospital policy.
First, as already noted, hospitals must be accredited through the federal Center for Medicare & Medicaid Services and “could be found to be in violation, lose federal funding, and face penalties” if they allow even state-legal cannabis use, according to a 2017 article in the peer-reviewed journal Hospital Pharmacy.
Second, clinicians are also prohibited from prescribing or providing cannabis in a hospital because it is not approved by the U.S. Food and Drug Administration.
“Yet, hospitals in more states are asked to create cannabis policies as voters decriminalize cannabis for medical use,” the authors Laura Borgelt and Kari Franson wrote in that same article. “There is no recognized supplier of medicinal cannabis, so hospitals are often asked to allow patients to bring in their own supply for their own use.”
But in a Kafkaesque twist, hospitals then risk running afoul of a guideline established by the Joint Commission, the national body that sets standards for medical facilities. Joint Commission Standard MM.03.01.05 states: “The hospital informs the prescriber and patient if the medication brought into the hospital by patients, their families, or licensed independent practitioners is not permitted.”
Borgelt and Franson note that some hospitals have considered that “cannabis policies that could adequately address this standard” and allow cannabis on its premises if it informs everyone involved that the cannabis is “not permitted.”
“But several questions remain,” the authors write. “For example, how is the product identified, how does the institution verify its integrity, and how is a federally illegal drug ‘permitted’?”
However, some doctors have taken a more laissez-faire approach to the issue of allowing cannabis in hospitals.
“I think there’s a legal question and an ethical question,” Dr. Benjamin Caplan, founder of the CED Clinic and a representative of the group Doctors for Cannabis Regulation, told Patient Safety Monitor Journal in 2019. “In order for doctors to best manage illnesses carefully, and to the best of our abilities, we must know as much as we can [about] what a patient is taking. But it’s very common for patients to sneak cannabis in back rooms or under the radar, which is really unfortunate for everyone. I think the hospital perspective should be embracing what patients find helpful.”
Emphasizing the ethical dimension, Caplan added: “To have cases where patients are having seizures in a hospital and they can’t get the medicine that they want (and find helpful) as an outpatient is a real cultural disconnect for the medical establishment. I think the solution is for people to not sneak around; the solution is for hospitals to open their arms to patients who find a medication helpful.”
Veterans Lack Access to Cannabis in VA Hospitals
The question of whether or not it’s allowed to use cannabis in a hospital is a particular concern for military veterans — many of whom use cannabis to treat PTSD, yet are more directly dependent on the federal government for their healthcare. The U.S. Department of Veterans Affairs has remained largely intransigent on the question of medical cannabis, despite growing pressure.
“Moving to make cannabis available through VA hospitals or other go-to sources of care is difficult,” the VA website notes. “Doctors at VA facilities aren’t just prohibited from prescribing marijuana: The drug is still listed as ‘Schedule I,’ so these health care professionals can’t even speak about it with their patients.”
Needless to say, if the VA won’t allow its doctors to prescribe cannabis, it’s certainly not allowing its patients to use cannabis on the premises of VA hospitals.
The Mayo Clinic & the Potential for Change
The most significant opening for allowing cannabis in hospitals appears to come from the Mayo Clinic, the national network of medical treatment and research facilities. The Mayo Clinic website recognizes that “medical cannabis has possible benefit for several conditions.”
It notes that three states — Arizona, Florida and Minnesota — have adopted some form of the “Right to Try Act,” allowing access to “investigational” treatments, potentially including cannabis, for people with life-threatening conditions who have exhausted approved treatment options.
In one of those states, the Mayo Clinic allows on-premises use: “Minnesota residents with a supply of medical cannabis from the Minnesota Medical Cannabis program may continue use during their Mayo Clinic visit or hospital admission.”
However, the Mayo Clinic is in a unique position as a not-for-profit organization with national renown and standing as a top research institute. While the Mayo Clinic receives a significant amount of federal funding and has a Medicare number, it appears willing to take the risk with the federal government. If other hospitals will follow remains to be seen.
TELL US, do you think patients should be allowed to use cannabis in the hospital?