Nevada board ponders doctor roles in pot business

Fourteen years after Nevada made medicinal marijuana legal, the state is wrestling with a host of questions related to the emerging industry.

Nevada gambling regulators decisively declared any involvement with the medical marijuana business to be off limits to those in the casino industry. The State Bar wasn’t so sure and asked for guidance from the Nevada Supreme Court.

Now the board in charge of licensing doctors, policing medical ethics and standards of care is trying to sort through its own list of issues, including determining what role if any physicians should be allowed to play in the business of growing and supplying marijuana.

“It’s a complicated issue,” said Douglas Cooper, executive director of the state Board of Medical Examiners.

While marijuana has seen growing acceptance around the country, it’s still illegal under federal law, and the American Medical Association has not endorsed the use of it for medical purposes.

Medicinal marijuana has been legal in Nevada since 2000, but the only way for patients to get it was to grow it themselves. That all changed last year when state lawmakers approved and Gov. Brian Sandoval signed a law setting up a taxing, regulatory and distribution system for cultivation, testing and processing establishments and dispensaries. Patients are expected to be able to purchase medical marijuana from licensed establishments by early next year.

The number of available licenses is limited and passage of the law has sparked a rush among those hoping to cash in on weed.

Clark County, home to 2 million people and posh resorts on the Las Vegas Strip, received 206 applications from 109 companies hoping to get into the pot business. At least a dozen physicians are among the applicants, including Dr. Rachakonda Prabhu, who serves on the medical examiners board; and Dr. Florence Jameson, a member of the Silver State Health Insurance Exchange board of directors. Others include Drs. Jaswinder Grover and Babuk Ghuman of the Nevada Spine Clinic, and Drs. Nick Spirtos and Geoffrey Hsieh of Women’s Cancer Center of Nevada.

None of the physicians contacted by The Associated Press returned messages or would comment.

The medical board has asked the attorney general’s office for an opinion ahead its meeting June 6-7 in Reno when it will discuss doctors investing in marijuana establishments, Cooper said.

Nevada gambling regulators made it clear — unless federal law is changed, casino operators shouldn’t get involved in pot because it would “tend to reflect discredit” upon the state’s largest industry.

The Nevada Supreme Court, at the urging of the State Bar, amended its conduct rules for lawyers, allowing them to advise clients on medical marijuana issues. But when it comes to involvement by lawyers in the business, the message was a warning — proceed at your own risk. Many are doing just that and seeking licenses.

Physician regulators are grappling with the same quandary on whether doctors can knowingly violate a federal statute.

“We are just beginning to look at aspects of medical marijuana dispensaries, as well as the potential ballot initiative for recreational marijuana use,” said Stacy Woodbury, executive director of the Nevada State Medical Association. “Clearly there is a delicate balance at stake between federal law, Nevada law and the practice of medicine.”

In Nevada, “physicians can’t refer to an establishment they have a financial interest in without full disclosure to the patient,” Cooper said.

In Washington state, a law says a health care professional shall not “hold an economic interest in an enterprise that produces, processes or dispenses cannabis if ... the professional authorizes the medical use of cannabis”

A 2010 Colorado law prohibits doctors from working out of dispensaries, but some medicinal pot shops arranged to have doctors “on call” to authorize medical marijuana. To crack down on the practice, the state health department now requires a doctor to have a “bona fide doctor-patient relationship” and to diagnose a patient in person.

Arizona prohibits physicians who certify patients for medical marijuana from being a principal or board member of a dispensary.

Medical regulators are also perplexed by other questions.

“Let’s say this thing gets rolling,” Cooper said. “Medical patients are being treated. If there is a complaint about the standard of care, we have nowhere to refer. There is no standard of care.”

The American Medical Association wants more studies of marijuana in treating patients with serious conditions and is urging that the drug’s federal status as a Schedule 1 controlled substance be reviewed to allow more research.

But the policy adds, “This should not be viewed as an endorsement of state-based medical cannabis programs ... or that scientific evidence on the therapeutic use of cannabis meets the current standards for a prescription drug product.”