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Do You Need a New Doctor’s Rec Under Prop 64?

The Medical Cannabis Regulation and Safety Act (MCRSA) and the newly passed Proposition 64 (AUMA) establish new rules and deadlines for doctors and medical cannabis patients.

A valid recommendation letter can be used to obtain the State Medical Cannabis ID card through a local County Health Department. With this card, patients do not pay sales tax on cannabis purchases. Patients will still be responsible for paying the 15% excise tax starting on January 1, 2018 under Prop 64.

Doctors are required follow reasonable practices in examining a patient and making the determination that the patient has a serious medical condition requiring medical cannabis. This means a proper in-person exam, determining whether a serious medical condition exist, and finding that cannabis is necessary for the patient’s condition. Superficial appointments via Skype, phone call, or with a nurse or physician’s assistant who issues a pre-signed recommendation will likely not be valid. The doctor should review medical history and records and examine the patient, before documenting condition and a recommendation that cannabis be used to treat it.

The Boards overseeing medical and osteopathy doctors is tasked with prioritizing cases of abuse with doctors who are issuing recommendation letters to patients inappropriately. The doctor issuing the recommendation must be the patient’s “attending physician,” which has been defined as the doctor in good standing with the licensing boards, who has taken responsibility for an aspect, the medical care, treatment, diagnosis, counseling, or referral of a patient. A doctor can be found liable for:

(1) clearly excessive recommendations (“pot doctors”) or

(2) for repeatedly recommending cannabis to patients without a good faith medical examination and medical reason for recommending cannabis.

Step 1: Patients have until January 1, 2018 to get a doctor’s recommendation that is in compliance with these regulations. That means that any recommendation obtained after 1/1/2017 will be okay, as long as the recommendation is from a licensed attending physician who follows standards in conducting the medical examination.

Step 2: Once an appropriate doctor’s recommendation letter is obtained, the patient should get a State ID card through their county health department. The cost is capped at $100, $50 for MediCal patients, and is good for a year. Only Colusa and Sutter counties do not participate in the State ID Card program.

Step 3: Provide the State ID card to dispensaries to avoid paying retail tax on cannabis purchases. The base rate is 7.5% on the state level, with some cities and counties charging more. Local rates are published here. Dispensaries are responsible for keeping track of evidence that sales are exempt from the sales nad use taxes, and providing that documentation if required.

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