With medical marijuana expected to boom into a $100 million-a-year business in Arkansas within a year or two, medical clinics specializing in marijuana certifications are cropping up to handle the rush.
And some of their “risk free” advertisements have raised concerns that patients may be getting certifications with too little scrutiny.
The Arkansas State Medical Board “has expressed concerns regarding the need for a physician [treating medicinal cannabis patients] to properly establish a patient-physician relationship and maintain patient records pursuant to Board Rules,” the board’s lawyer, Kevin O’Dwyer, told Arkansas Business.
But David Couch, architect of the state’s new medical marijuana industry, doesn’t think the Medical Board can do much. “I don’t see how the board can add anything,” the Little Rock lawyer said. “The only prohibition I know is that in the Amendment it says if you own a dispensary you cannot write prescriptions.”
The untracked role of physicians is an outlier in Arkansas’ tightly controlled legal cannabis process, which now serves more than 33,000 people diagnosed with one or more of 18 qualifying conditions. The 2016 constitutional amendment legalizing medicinal use, which Couch wrote and which won over 53% of voters, lays out the process in full, he said.
In a state that monitors each marijuana seedling and tracks every bud sold at dispensaries, no count exists on cannabis practitioners and no data is kept on what percentage of certifications they’re denying.
Arkansas is not alone among the 20 medicinal cannabis states in taking a hands-off approach, but nearly half those states apply at least some extra hurdles to prescribers.
Florida requires a two-hour training course and a state exam for cannabis doctors. New Jersey, which also tracks prescribers, recently suspended a license after a doctor was accused of giving prescriptions to patients he didn’t treat.
Here, “any medical doctor or doctor of osteopathy who is licensed to practice in Arkansas and has a current DEA number can complete a certification,” said Meg Mirivel, director of health communications for the Arkansas Department of Health. “ADH does not keep a list of doctors who are completing certifications.”
Some 7,100 physicians and osteopaths practice in Arkansas, according to 2019 numbers from the Kaiser Family Foundation. With no special training or licensing, cannabis doctors face only normal Medical Board scrutiny. Taking doctor-patient confidentiality and health privacy laws into account, that is appropriate, Couch said.
Dr. Brian Nichol, a pain management specialist with a North Little Rock clinic, agrees. “Should there be special requirements for doctors to certify patients? I really don’t think so,” Nichol said. “When a state has a list of qualifying conditions, that simplifies things. I’ve seen some of the websites for clinics advertising cannabis certification, and they ask patients to show up with medical records.”
Nearly $30 million in cannabis was sold from the retail program’s inception in May through December, and 20 of 32 authorized dispensaries have yet to open. Market forecasts see 80,000-100,000 Arkansans getting cards by 2025.
The Arkansas Cannabis Industry Association website lists two dozen doctors offering consultations, including some with several locations.
AR Cannabis Clinic, founded by Dr. David Nguyen of Little Rock just 11 months ago, now has a dozen sites across Arkansas.
‘100% Risk Free’
Nguyen’s clinics are booking patients in Texarkana, Little Rock, North Little Rock, Fayetteville, Bentonville, Fort Smith, Hot Springs, Clinton and Jonesboro. Clinics will open soon in West Memphis, Pine Bluff and El Dorado, according to the company’s website, ARCannabisClinic.com.
The clinics charge $50 per certification exam, and patients don’t pay if they aren’t approved.
“We are rapidly expanding,” said the site, which calls AR Cannabis “THE statewide leader in Arkansas Medical Marijuana Card Certifications.”
Nguyen, the clinics’ founder and chief physician, did not respond to several messages seeking comment, but he told the Texarkana Gazette last year that experience in emergency medicine had convinced him that cannabis is a necessary alternative for pain treatment. “I’ve seen the faces of opioid addiction … I saw the problem, and I saw that medical marijuana was an alternative,” he told the Gazette’s Karl Richter.
His clinics do not certify pregnant women or minors.
O’Dwyer, the Medical Board attorney, said it works from complaints, like many state oversight panels. As of Thursday, he hadn’t responded to a question on whether any complaints related to cannabis.
“Any situation, I suppose, has the potential for abuse,” he said. “As for qualifying a patient, the Board would look at the patient records to determine what the physician reviewed in order to diagnose or confirm an existing diagnosis … They are doing what they have always done, diagnosing a particular patient with a particular ailment.”
Qualifying conditions here include cancer, Alzheimer’s, severe arthritis and PTSD, but the list also contains more open-ended conditions like persistent nausea or intractable pain.
“I suppose anyone could complain of nausea or pain, but there would need to be something more than just a patient’s statement as to any diagnosis,” O’Dwyer said.
Nichol, who charges a $200 fee, spends 45 minutes to an hour with patients seeking cannabis, looking for individual approaches. “I’ve been doing this for a while, working on getting patients to use cannabis properly,” he said.
Cannabis is relatively safe, he said. “Look at its safety profile; it has a vanishingly low toxicity, as far as the potential for poisoning people.”
The American Medical Association is more cautious.
In an August statement applauding a federal advisory on harmful effects of marijuana on pregnancy, Association Pre-sident Patrice A. Harris spoke against legalization without study. “The AMA believes that scientifically valid and well-controlled clinical trials conducted under federal investigational new drug applications are necessary to assess the safety and effectiveness of all new drugs, including potential cannabis and cannabinoid products.”
She noted, however, that marijuana’s continued status as a forbidden federal Schedule 1 narcotic makes FDA-style testing impossible. “In states that have already legalized cannabis, the AMA urges jurisdictions to take steps to regulate the product effectively,” Harris said.
In Arkansas, physicians certify that they have completed an in-person assessment, that the patient has a qualifying condition, and that the doctor is licensed to practice in the state. No further certification or training is required, though the Health Department may confirm the physician’s signature and qualifications. Consultations are subject to the federal Health Insurance Portability & Accountability Act, which keeps records private, the state notes.
The Health Department oversees medical aspects of the cannabis program, but operational rules are enforced by the Alcoholic Beverage Control Division of the Department of Finance & Administration.
“I’m sure there are people out to game the system, trying to obtain cards for non-legitimate reasons, but I can’t say I’ve seen any people like that in my practice,” Nichols said.
“Most of our patients are in the over-50 group with established and diagnosed conditions. The qualifying conditions limit who can have access.”
Still, Nichol believes that doctors “should be able to recommend cannabis for whatever they think it may help, not just for what politicians have decided is the appropriate thing.”
For NLR Doctor, a Budding Tech Opportunity
Dr. Brian Nichol, a North Little Rock doctor now seeing medical cannabis patients, is pursuing marijuana education as a tech startup opportunity. “I’m in business with an Apple developer and a research person to come up with an artificial intelligence system for cannabis education to market to the state’s dispensaries,” he told Arkansas Business last week.
Cathie Hiegel, a researcher who used medical marijuana in a remarkable recovery from a severe stroke, reached out to Nichol after reading about his practice, he said. Together they formed Cannabis Expert Training LLC, teaming up with Donna Mooney, a developer once aligned with Bespoke Health Media of Little Rock, to devise a program that’s drawn interest from a half-dozen dispensary companies in Arkansas, the doctor said.
“Instead of walking up to the budtender and asking, patients can consult a database of all the knowledge and research we’ve accumulated,” he said. “Patients will enter their demographic data, diagnoses, other medications that they take, and that gets run through an AI algorithm matching it with strains available at the dispensary that are most appropriate.”