Pubdate: Mon, 10 Sep 2012
Source: Arizona Republic (Phoenix, AZ)
Copyright: 2012 The Arizona Republic
Author: Yvonne Wingett-sanchez


State Seeks to Build Partnerships, Bring in Experts to Boost Efficiency

Arizona health officials will dip into a pot of money generated by 
medical-marijuana fees with the goal to improve the state's 
controversial new program.

The Arizona Department of Health Services will soon spend more than 
$1.2 million to weed out physicians who improperly recommend 
marijuana to patients, help train marijuana-dispensary staff, hire 
private accountants or auditors to examine dispensary financial 
statements, and hire private attorneys to assist the department with 
legal issues arising from the program.

The ADHS will also continue to fund a $200,000 contract with the 
University of Arizona College of Public Health to, in part, review 
published research about the effectiveness of marijuana in treating 
medical conditions.

ADHS Director Will Humble said the new partnerships will help health 
officials keep the program as "medical" as possible.

"I'm trying to hit this from the financial angle, the medical angle, 
the certification angle to try to close as many gaps as I can that 
could result in bad outcomes for patients," he said. "That means 
bringing in expertise that we don't have inhouse."

Voters in 2010 passed a measure to allow people with certain 
debilitating medical conditions, including chronic pain, cancer and 
muscle spasms, to use medical marijuana.

They must receive a recommendation from a licensed physician and 
register with the state, which issues identification cards to 
qualified patients and caregivers. The state has granted about 31,000 
people permission to use medical marijuana.

The state has collected about $9.3 million in fees from cardholders 
and dispensary applicants since last year, when the program began. 
Officials have spent about $2.5 million on staff, its contract with 
the University of Arizona and technology. About $6 million remains in 
the medical-marijuana fund.

One national medical-marijuana expert said she is unaware of any 
other state spending medical-marijuana program fees in such a manner. 
Karen O'Keefe, director of state policies at the Marijuana Policy 
Project in Washington, D.C., criticized how Arizona is paying for the 
training and other programs.

She said patients - many of whom are poor - should not have to 
subsidize state programs to pay for their drugs.

"They're already in a financial hardship, they're already suffering 
from some kind of ailment," she said.

Within the next few weeks and months, Humble said the ADHS will sign 
contracts or agreements with:

The Arizona Board of Pharmacy, to fund a position so that staff can 
more quickly review how many times physicians have accessed the 
board's controlled-substances database, which tracks 
prescription-drug use. State rules require physicians to check the 
database before recommending pot.

In an effort to prevent doctors from encouraging recreational 
marijuana use, health officials each quarter review how many times 
physicians who have written more than 200 recommendations accessed 
the database. Under this new agreement, Humble hopes officials can 
review that information in real time and more quickly pass 
information on to the regulatory boards that license and discipline physicians.

As part of that agreement, health officials will also upgrade 
technology for the pharmacy database so physicians can obtain access 
to the site almost immediately instead of applying through the mail.

The ADHS will spend up to $200,000 on this agreement the first year, 
Humble said, and about $150,000 the second year.

Banner Good Samaritan Poison and Drug Information Center and the 
University of Arizona College of Pharmacy, to train the medical 
directors at future marijuana dispensaries and be available 
round-theclock to offer advice.

Medical directors must train dispensary agents; develop guidelines to 
inform patients about the risks, benefits and side effects of medical 
marijuana; and know how to recognize signs of substance abuse.

"I want there to be a hub resource so the medical directors have some 
consistency with the way they operate," Humble said.

Humble hopes the $700,000 partnership will also help ensure patients 
are properly tracking the amount of marijuana they are ingesting and 
will ensure they are not combining marijuana with alcohol or narcotics.

A yet-to-be-determined auditing or accounting firm, to ensure future 
dispensaries are not profiting off medical-marijuana sales.

The dispensaries must be run as non-profits. State rules offer some 
guidance but provide plenty of wiggle room. Dispensaries must have 
bylaws that include "provisions for the disposition of revenues" and 
provide receipts and a business plan showing the facility is 
operating as a non-profit. There are no limits on compensation for 
dispensary personnel other than that it be "reasonable."

Humble said the behavior of some dispensary applicants suggests 
maintaining true nonprofit status "may not be their primary motive." 
Outside auditors will comb through financial statements to ensure 
dispensaries aren't engaging in a "shell game," where they are 
grossly overpaying staff, board members and lessors and kicking back 
money to dispensary operators.

The state will spend an estimated $100,000 each year on this contract.

Private law firm Sherman and Howard, to represent the state 
Department of Health Services on legal issues. Legal counsel from the 
Attorney General's Office typically represents the ADHS. But as more 
legal issues arise with the medical-marijuana program, Humble wanted 
to hire private attorneys to pick up the extra work so staff 
attorneys can concentrate on traditional publichealth issues.

Rates will range between $450 an hour for partners and $140 an hour 
for legal assistants, according to public records.
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MAP posted-by: Jay Bergstrom