Arkansas Medical Marijuana Certifications: Higher-Volume Physicians Associated With Less Evidence Of Care Coordination

Patients' access to medical marijuana has dramatically increased despite the lack of Food and Drug Administration approval. In this study, we profiled individuals and the conditions for which they were certified for medical marijuana, and we examined the evidence of coordination with their physicians providing traditional care. Within two years of initiation, medical marijuana was approved for 3.4 percent of Arkansans ages eighteen and older by 12.5 percent of physicians who had an active license in the state. Posttraumatic stress disorder and four pain diagnoses were the most frequent qualifying conditions. We observed care coordination among low-volume certifying physicians, with a majority having both seen and diagnosed the adult with the qualifying conditions. Conversely, seven high-volume certifying physicians, each with more than 1,000 certifications, demonstrated limited contact with those they certified. The Department of Health and Human Services has recommended that marijuana be changed from Schedule I to Schedule III in the Controlled Substances Act, and the Justice Department has submitted a notice of proposed rulemaking to effect this change. Implications include the need to continue research and develop clinical guidelines, notify routine providers of care with potential incorporation of certifications into the health information exchanges, and consider screening for medical marijuana use in clinical settings.