Louisiana continues to develop its medical marijuana capabilities. In the past few years, it has phased in different types of products and eligible medical conditions since the program’s inception. On January 1, 2022, Louisiana took a huge step by giving patients the option to use smokable marijuana to treat eligible medical conditions. Based on the evolution of the medical marijuana program, industry observers were correct to expect even more changes this past legislative session. The new cannabis laws, all effective August 1, 2022, focused on the expansion of approved marijuana pharmacies, increased access, and improved affordability for medical marijuana patients. A summary of the new laws is as follows:
- Act 473 (House Bill 629) by Rep. Marcus Bryant, D-New Iberia, limits law enforcement from using marijuana odor as a pretext for searching someone’s home without a warrant
- Act 651 (House Bill 988) by Rep. Mandie Landry, D-New Orleans, prevents state workers from being discriminated against based solely on a positive drug test for marijuana if they are medical marijuana patients
- Act 499 (House Bill 775) by Rep. Cedric Glover, D-Shreveport, legalizes equipment or devices used for the inhalation of marijuana for state-registered medical marijuana patients
- Act 438 (House bill 135) by Rep. Joseph Marino, I-Gretna, authorizes the dispensing of medical marijuana to non-Louisiana patients who participate in another state's medical marijuana program
- Act 439 (House Bill 137) by Rep. Joseph Marino, I-Gretna, provides immunity from criminal prosecution to qualifying non-Louisiana medical cannabis patients
- Act 478 (House Bill 234) by Rep. Laurie Schlegel, R-Metairie, makes it illegal for a driver or passengers in a motor vehicle to smoke or vape any form of marijuana
Medical Marijuana Pharmacies
Act 491 (House Bill 697) by Republican Speaker Pro Tem Tanner Magee of Houma was the most comprehensive piece of legislation. It keeps the current number of medical marijuana pharmacies but directs the Louisiana Board of Pharmacy (LBP) to issue the 10th permit to the New Orleans region. It allows the current medical marijuana pharmacies to open satellite dispensaries within their regions when their patient count hits certain thresholds. Finally, the bill does not prevent a physician from recommending medical marijuana by means of telemedicine appointments.
As a reminder, each permit was allotted to an entity to operate in one of the Louisiana Department of Health’s nine administrative regions. Expansion under Act 491 (2022) shall occur in two ways. First, it directs the LBP to issue the 10th marijuana pharmacy permit to an entity in the administrative region that includes Jefferson, Orleans, Plaquemines and St. Bernard parishes. Second, it allows current marijuana pharmacy permit holders to open up to two satellite locations depending on the number of active, qualified patients identified in the prescription monitoring program in their region. In addition, the legislation shifts regulation of the state's medical marijuana program from the Louisiana Department of Agriculture to the Louisiana Department of Health.
Nurse Practitioners and Medical Psychologists May Now Recommend Marijuana
Act 444 (House Bill 190) by Rep. Travis Johnson, D-Vidalia, adds nurse practitioners to those medical professionals who can recommend medical cannabis use. They introduce the term “authorized clinicians,” which as defined in Act 444 (2022) include:
- Physicians licensed by and in good standing with the Louisiana State Board of Medical Examiners to practice medicine in this state;
- Nurse practitioners licensed by and in good standing with the Louisiana State Board of Nursing to practice advanced practice registered nursing in this state and who have prescriptive authority conferred by the Louisiana State Board of Nursing; or
- Medical psychologists licensed by and in good standing with the Louisiana State Board of Medical Examiners to practice medical psychology in Louisiana.
Authorized clinicians may recommend marijuana in any form as permitted by the LBP and for treatment of a patient clinically diagnosed as suffering from a debilitating medical condition found in La. Rev. Stat. §1046. Any condition not otherwise specified could be considered debilitating if the authorized clinician, in his or her clinical opinion, considers it debilitating to an individual patient and is qualified through his or her medical education and training to treat the condition.
No authorized clinician shall recommend medical marijuana for the treatment of any condition associated with autism spectrum disorder for a patient who is under the age of 18 unless the clinician complies with the provisions of La. Rev. Stat. §40:1046 and consults with a pediatric subspecialist. A pediatric subspecialist is an individual licensed to practice medicine in any state in the United States who provides care to patients with autism spectrum disorder.
Adverse Events Reporting System
Adverse events from patients using medical marijuana may be reported through the Adverse Events Reporting System developed by the Louisiana State Board of Medical Examiners in collaboration with various universities and medical centers within the state. The electronic data collection system is maintained in a secure environment to ensure that health information is protected. Patients, family members, authorized clinicians who recommend marijuana and other providers may report in the system.
Professional Practice Standards
Under the rule, marijuana pharmacies are permitted to accept recommendations (sometimes referred to as an opinion, referral or request) for a marijuana product when the recommendation is issued directly by an authorized clinician. The authorized clinician must also have an unrestricted state controlled substance license with therapeutic marijuana privileges, which can be requested from the LBP. Pharmacists will accept recommendations made by electronic prescription, or, alternatively, by facsimile bearing a handwritten or digital signature of the physician. The recommendation cannot come from the patient or a third-party other than the entity transmitting the request.
Because recommendations for marijuana do not operate in the same way as prescriptions for other controlled substances, the LBP, by rulemaking, allows marijuana pharmacies to transfer unexpired requests for marijuana products to another marijuana pharmacy when requested by the patient or their caregiver.
CDS License with Therapeutic Marijuana Privileges
Physicians interested in recommending therapeutic marijuana can apply for a Controlled Dangerous Substance (CDS) license on the LBP website. Schedule I privileges are not automatically granted. Physicians already holding a CDS license but who have not yet obtained Schedule I privileges for therapeutic marijuana must send a written request to the LBP office to modify their Schedule I privileges to include therapeutic marijuana. Send written requests via email to email@example.com or via fax to 225.925.6499.
The LBP staff will confirm with the Louisiana State Board of Medical Examiners that the physician’s license is active and unrestricted and then make the requested change for Schedule I, which will read “Limited to Therapeutic Marijuana.” There is no fee for this service. All of the CDS licenses are verifiable on the LBP website and include all of the different schedules authorized. While the verification can be printed and accessed without charge, physicians wishing to order a duplicate copy of the license reflecting the change should use the LBP product order form to purchase one.
Nurse practitioners seeking to recommend medical marijuana can contact the Louisiana State Board of Nursing at the advanced practice inbox address: firstname.lastname@example.org.
Like other states, Louisiana permits physicians to recommend marijuana to patients under specific conditions. Louisiana has also added limited liability protections to physicians and facilities. While these protections can offer state protections, the federal Controlled Substance Act has not lifted the illegality of marijuana. Thus, the prescribing of marijuana to patients for therapeutic use is illegal under federal law and a corresponding charge of manufacturing, distributing, dispensing, or possessing with the intent to manufacture, distribute or dispense a Schedule I controlled dangerous substance is still possible in the future.
For more information about cannabis and its effect on the endogenous cannabinoid system, including studies indicating the correlation between cannabis use for the treatment of medical conditions and pertinent risk mitigation strategies for hospitals and healthcare providers, access the online learning course "Medical Marijuana Issues in Louisiana: An Overview." LAMMICO insureds have complimentary access to this course via our subsidiary risk management education company, Medical Interactive Community. Log in as a Member at lammico.com and go to Online Education & Webinars in the drop-down menu under your name.