Should Medical Cannabis Pharmacists Review Every Transaction?

The thirty-six states that allow medical cannabis use control their programs with a wide variety regulations. For example, many states require medical cannabis dispensaries to have at least one certified pharmacist on staff. The pharmacist is there to consult with patients regarding the most appropriate products and delivery methods. But should pharmacists do more?

Utah legislators approved changes to their medical cannabis program earlier this year (2021). One change requires medical cannabis pharmacists to review every transaction before patients walk out the door. Should other states adopt the same regulation? There is no right or wrong answer, but you can make a compelling case that Utah did the right thing.

New Medical Cannabis Prescriptions

Despite some states being incredibly careful to use language that includes terms like ‘pharmacy’ and ‘prescription’, there really is no such thing as a medical cannabis prescription. Cannabis is a Schedule I controlled substance under federal law. Therefore, doctors cannot prescribe it; all they can do is recommend it.

The lack of a legitimate prescription creates a conundrum for doctors, pharmacists, and patients alike. In many cases, patients consult with a medical cannabis pharmacist on their first visit to a dispensary. After that, they are really on their own unless they actively make an effort to consult with the pharmacist on subsequent visits.

This creates a situation in which patients are left to figure out for themselves what works and what doesn’t. Even with a doctor’s recommendation and the availability of a consulting pharmacist, patients often self-medicate for all intents and purposes.

The impetus behind requiring pharmacist review of all transactions is to stop this from happening. Forcing patients to consult with pharmacists on every visit would give pharmacists a greater role in determining product, delivery method, and dosage.

Increasing Doctor Participation

There is another reason for requiring pharmacy review, according to Salt Lake City’s Beehive Farmacy. They say that mandatory pharmacist review opens the door to getting more doctors involved without requiring special certification.

In states without mandatory pharmacist review, doctors have to undergo additional training in order to be certified to recommend medical cannabis. There are plenty of doctors who just aren’t interested in doing so. They do not want the liability that comes with recommending a controlled substance they cannot prescribe.

It has been suggested that allowing doctors to recommend medical cannabis without being certified is a starting point to getting more of them involved. Allowing them to recommend while trusting pharmacists to handle the actual prescription portion could push some over the finish line.

 Someone Needs to Review Transactions

Regardless of who reviews transactions, it only makes sense that someone should be required to do it. If a doctor is not interested in writing a detailed prescription in the same way they would for any other drug, then the pharmacist should be handling that portion. Otherwise, we are allowing patients to self-medicate. They can do that on the street. They do not need legally recognized medical cannabis to do so.

It is interesting to note that we don’t treat any other prescription drug this way. Patients are not allowed to choose their own opioid dosage. They do not get to determine for themselves which antibiotics they want to take, or the dosage and frequency with which they want to take them. So why are things so fast and loose with medical cannabis?

Some state legislatures seem to grasp the problem. Perhaps the need for greater control is what prompted Utah lawmakers to require pharmacist review. If cannabis truly is a drug with medical purposes, forcing pharmacist review is a step in the right direction.

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