Changes might be coming for Colorado cannabis physicians and the patients they serve – but at least those docs and their clients will have had a say.

On November 19, the Colorado Medical Board will consider, and likely approve, the final draft of guidelines for medical marijuana physicians that would not only bring medical marijuana recommendations more in line with other medical practices, but could also decrease the pool of 100,000-plus medical marijuana patients in Colorado. The guidelines, written by the Colorado Medical Board's Medical Marijuana Workgroup, call for physicians to further evaluate and follow up with potential patients when recommending medical marijuana.

The initial draft of the new guidelines strongly recommended incorporating mental-health background checks and background checks of family and other medical records, as well as imaging studying and laboratory testing for all patients.

Denver-based medical marijuana physician Dr. Peter Pryor was a vocal opponent of the first draft, which he says had an angry tone regarding marijuana.

"We should remember medical marijuana has existed for fifteen years in Colorado, helping hundreds of thousands of patients. Only since the legalization of recreational marijuana, and the millions of dollars of tax revenue it has created, has medical marijuana come under such scrutiny," he wrote in an open letter.

Pryor wasn't alone in his criticism. After receiving more than 400 comments from medical marijuana physicians, patients and industry stakeholders, the Medical Board redrafted the guidelines and recommended such tests only in pertinent situations.

Two other parts of the draft that drew major disapproval from physicians and patients were the singling out of chronic pain in the "Develop and Maintain Competence" section and suggesting pregnancy tests for any woman of child-bearing age in evaluation recommendations.

"As it relates to treatment for debilitating pain, the physician should specifically develop competence in the area of assessing and treating pain to improve function. Competence necessitates understanding current, evidence-based practices and using other resources and tools related to evaluating patients and recommending marijuana as a therapeutic option," read the draft. Chronic pain was the only condition mentioned in the section. It has since been removed.

The newest version also scaled back on the pregnancy testing suggestion, instead asking physicians to "take into consideration the possibilities of pregnancy and breast-feeding" when evaluating patients. Since the new draft has been posted for the public, Pryor's stance has significantly softened.

“I thought the changes were fair. The input we gave them, they listened to it and made the necessary changes,” Pryor says. “The tone was better this time. I think they did their due diligence.”

Jason Werf, executive director of the Southern Colorado Cannabis Council, participated in stakeholder meetings leading to the creation of the new guidelines draft. He also thought the initial draft's recommendations came off as broad and unenlightened, and didn't want marijuana recommended after an evaluation similar to that for narcotic painkillers.

"We definitely had concerns with the first draft," he says. "Just because guidelines for one medication is considered appropriate doesn't mean it works for another substance."

Although still concerned with the state’s lack of marijuana experience in administrative health positions, Werf sees the guidelines as a positive step overall that provides a protective outline for proficient medical marijuana physicians.

"Anything that works to further clarify what’s happening right now in medical practices is a good thing for protection and a step towards education for the Medical Board on what these physicians do,” he says. “It’s a bridge we have to build.”

The new guidelines were written after the Senate's Caregiver Act was signed into law on May 18; among other things, the bill required the Colorado Medical Board to craft a policy for medical marijuana recommendations. The measure called for creating marijuana recommendations that would be more in line with recommendations for more traditional medications, to limit bogus recommendations and extended plant-counts – which the state had assumed would decrease with recreational legalization. Physicians who fail to follow these guidelines would be referred to the Medical Board, and the result could be an investigation leading to the loss of a medical license.

As of July, there were 113,862 registered patients in the Colorado Medical Marijuana Registry, up from the 111,030 registered patients in January 2014, when recreational sales began.

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