NCPA Executive Update

NCPA Executive Update delivers insights on legislative, regulatory, policy, and industry developments from NCPA CEO B. Douglas Hoey, Pharmacist, MBA, to NCPA members and pharmacy leaders every Friday.

Hashing Out Our Medical Marijuana Opportunity | NCPA Executive Update | August 25, 2017

by NCPA | Aug 25, 2017

Dear Colleague,

Doug Hoey

I was busted for gambling somewhere outside of Reno. It was at a gas station in the middle of nowhere. I couldn’t resist the temptation. Fortunately, the clerk was forgiving and let me go.

It helped that I was only 12 years old and on a family vacation. I was familiar with popping quarters into video games like Space Invaders and Asteroids. I had never seen a slot machine, but it looked like the same kind of flashing-light fun.

That was more than three decades ago, and now gaming is ubiquitous, with casinos, state lotteries, racetracks, riverboats, and other venues in almost every state (though, granted, they still don’t let 12-year-olds play the slots).

Back then, with few exceptions, Nevada and Atlantic City were the only places to roll the dice or pull a handle. There were plenty of people who said (and still do) that legalized gambling was immoral, that it was a tax on those who could least afford it.

Dollar signs of a different kind – state tax revenue – has been a huge driving force in that change. More than $80 billion in gaming revenue has driven a change in attitude, or at least more acceptance.

What does this have to do with community pharmacy, you say? Similar to public opinion about gambling, there has been a radical swing in opinions about legalizing marijuana.

Twenty-eight states have legalized medical marijuana, and eight states and D.C. have legalized its recreational use. As with gambling, economics is one of the big drivers of legalization. Colorado, one of the first states to legalize recreational use, has received more than $500 million in revenue from cannabis sales since pot was legalized in 2014.

And even though public attitudes about the legalization of marijuana have changed radically over the last 20 years – from 25 percent approval in 1995 to 58 percent approval in 2014 – there are still plenty of people opposed to legalization, citing its potential health risks and believing it to be a “gateway drug” to addiction.

Whatever your feelings are about marijuana use – and I certainly have my own personal opinions – more and more states are making it legal, yet community pharmacy is largely on the sidelines.

That may be just fine for many community pharmacists. Or it might not. Marijuana is still scheduled as a C-I – the same as heroin and LSD – meaning the federal government does not recognize it as having an accepted medical treatment use. Yet, eight states have legalized it recreationally. To say that’s inconsistent is an understatement. But in the meantime, other states are considering legalizing the use of marijuana, and pharmacists shouldn’t be bystanders.

In 2010, NCPA’s House of Delegates approved this position on medical marijuana:

    “NCPA supports the dispensing of all controlled and legend medications, including any legal prescriptions for marijuana, through state board-licensed community pharmacies in accordance with applicable laws, rules and regulations.”

Community pharmacies are not bystanders when it comes to being regulated and being held accountable for the use of C-II through C-V’s and all other legend drugs. There are multiple licenses, fees, and standards that community pharmacies have to have and adhere to.

At a time when prescriptions for specialty medications are being steered out of retail and into PBM mail order houses, shouldn’t legalized marijuana go through the medication expert already licensed and practiced in dealing with controlled substances?

Some states have already passed legislation requiring pharmacists be included. Connecticut, for example, requires that a pharmacist be present at the specific dispensary (remember, it’s a C-I so pharmacy options are limited) where the marijuana is dispensed for medical purposes. Arkansas, New York, and Minnesota have also enacted legalization laws in which pharmacists can play a role.

At a time when even medical marijuana remains illegal under federal law, the question, of course, is what role? It’s easy to see pharmacists dispensing medical marijuana, and yet to do so at present would not only violate federal law, but might put in jeopardy a pharmacy owner’s relationships with wholesalers, payers, and others, whose contracts usually include a clause allowing termination in the event the pharmacist violates federal law.

So, three things:

  1. In September, NCPA will release a one-page info sheet to assist our state partners who are grappling with the issue of legalizing medical marijuana. The document will point out issues states should consider as they contemplate a role for pharmacists and will highlight the four states in which pharmacists have a role in medical marijuana dispensing and/or counseling.

  2. NCPA is asking for your opinions on the use of medical marijuana and what role the community pharmacy and pharmacist should play. Take this short (5 minutes or less) survey and tell us what you think. We’ll collect your opinions and report back.

  3. NCPA is also helping you assess what business opportunities and threats currently exist with medical marijuana with the program “Hitting the High Points of Medical Cannabis” at the NCPA Annual Convention in October.

We’re eager to hear what you think.

Doug Hoey

P.S. Executive Update will not be published Friday, Sept. 1. Have a safe and relaxing Labor Day weekend.