Medical Marijuana: Coming to a Hospital Near You

As hospital pharmacists, we have all faced the scenario where we receive an order for patients to use their own medication. The particular drug is not on the hospital's formulary, and there really isn't a reasonable therapeutic substitute, so the order comes through and you verify the medication per your hospital's policy and procedure.

Let's take this a step further. Say, for example, you are working in a hospital that happens to be located in 1 of the 23 states that have approved (on some level) the use of marijuana for medical purposes, or even better, 1 of the 2 states that has legalized marijuana for recreational use.

The order that you have just received is for the patient to use his or her own medical marijuana. The physician has gone so far as to document how often and how much the patient may use. The order describes a medical marijuana butter that the patient spreads on a cracker and eats every 4 to 6 hours as needed for pain, nausea, or anxiety.

Upon receiving the order, you perform a quick chart review and realize that the patient has some type of chronic painful condition and the current hospital admission is to help get the patient's pain back under control. Now, what do you do and how do you respond?

On the 1 hand, the patient does have a "prescription" for the medical marijuana, and it was ordered by the physician. This particular state you are practicing in recognizes medical marijuana, and the patient has been using this particular product for quite some time. Is it unreasonable to take a look at the product, verify the substance, and approve it for use within the facility?

On the other hand, marijuana is considered a "Schedule I" drug by the Drug Enforcement Administration (DEA). Handling and administering a Schedule I substance in a pharmacy or hospital without some sort of approved protocol or study is defined as a federal offense. The pharmacy's DEA license may be put at risk, as well as the hospital's federal Medicare reimbursement, not to mention the licenses of the pharmacists who work at the facility.

This scenario is not to promote or negate the use of medical marijuana. As a pharmacist, you need to be prepared for situations so that when they arise, you will be ready to work through the issue at hand.

You may or may not have already worked through this particular scenario. If you haven't, be prepared, because I guarantee you will sometime in the near future.