The Logic Behind Limiting Recommendations for Medical Cannabis

In states where medical cannabis has been decriminalized, doctors are still not authorized to write prescriptions. Instead, they make medical cannabis recommendations. Some states limit the volume of recommendations a single doctor can make. Utah is one such state.

The operators of the Zion Medicinal medical cannabis pharmacy in Cedar City say that state lawmakers recently amended the rules so as to increase the number of recommendations a Utah medical provider can make. A doctor, advanced practice nurse, or orthopedist with prescribing authority in the state can now recommend cannabis to a total number of patients equaling 1.5% of the active cannabis card holders on state rolls. As of April 2024, that equates to 1,252 patients.

Here is the million-dollar question: what is the logic behind limiting medical cannabis recommendations? Why not just allow medical providers to work with as many patients as possible? It boils down to what lawmakers often refer to as ‘card mills’.

State Issued Medical Cannabis Cards

Utah is not unlike many other states in requiring patients to obtain medical cannabis cards in order to legally use cannabis as a medicine. Without some sort of mechanism in place, there is no way to determine legal consumption. In effect, medical cannabis cards act as state licenses to purchase, possess, and consume cannabis.

A medical cannabis card takes the place of a traditional prescription at the pharmacy. Rather than a Utah patient taking a prescription to be filled, he visits Zion Medicinal with his medical card. Zion staff confirm that his card is valid before filling his order. It’s a nice little system that guarantees only approved patients have access to medical cannabis.

How does this relate to limiting doctor recommendations? It’s pretty simple. Patients can only obtain medical cannabis cards after visiting with a medical provider who confirms the patient’s condition and eligibility for medical cannabis. The medical provider also affirms his or her belief that medical cannabis is an appropriate way to treat the patient.

Fears About Card Mills

Utah lawmakers were fearful about card mills popping up all over the Beehive State when their medical cannabis program was first implemented. Limiting doctor recommendations was a way to prevent card mills from opening. At least that was the theory.

So why raise the limits? Originally, medical providers in Utah could recommend cannabis to a total of 600 patients – in a best-case scenario. Most recommended to far fewer. However, it became apparent to lawmakers that the 600-patient limit was not high enough. There simply weren’t enough medical providers to meet demand.

Tying recommendation limits to the total number of active card holders solves the problem. It guarantees that there are enough medical providers to meet demand. But the lawmakers did not stop there. They also implemented the limited medical provider (LMP) program. It allows any medical professional with prescribing authority to recommend cannabis for to up to 15 patients without being certified by the state.

Keeping Matters Under Control

At the end of the day, it’s all about keeping matters under control. States like Utah do not want to see their medical cannabis programs evolve into a modern wild west. They put regulations in place to make sure of it. Limiting the number of recommendations a medical provider can make is just one option within the regulatory framework.

Is utilizing the option a smart move? That probably depends on who you ask. Until state and federal cannabis laws are in agreement, the states need to do their best to manage things. Recommendation limits are one way to do that.

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