You likely know that medical cannabis becomes legal in Kentucky in January. What you may not know is that registration for physicians and advanced practice registered nurses (“practitioners”) who want to become medical cannabis practitioners (“MCPs”) began in July when the state opened the Medical Cannabis Practitioner Registration Portal (the “Registry”). The multi-step registration process to be an MCP will take time to complete, and practitioners who want to begin treating patients with medical cannabis in January should start that process soon.
STEP 1: Complete Medical Cannabis Continuing Education Hours.
To register as an MCP, a practitioner must first complete six hours of continuing medical education in (a) diagnosing “qualifying medical conditions” for medical cannabis treatment; (b) treating those qualifying conditions with medical cannabis, (c) the pharmacological characteristics of medicinal cannabis and possible drug interactions; and (d) indications of cannabis use disorder. Proof of completion of the six hours must be submitted with the practitioner’s MCP application.
STEP 2: Apply for Licensure Board MCP Authorization.
The State Medical Cannabis Program has delegated MCP authorization to the Kentucky Boards of Medical Licensure (KBML) and Nursing (KBN). Both boards are accepting applications for MCP authorization and have issued regulations establishing the professional standards for medical cannabis which detail the MCP authorization requirements for their respective licensees. Links to the regulations and each board’s MCP application are available on the practitioner webpage of the program website along with the link to the registry.
Physician and APRN eligibility requirements for MCP authorization are very similar, but not identical. In addition to the obvious need to have an active, unrestricted license in good standing with the KBML or KBN, they include:
- Having current DEA and KASPER registrations. APRN registration certifications must be on file with the KBN;
- No history of disciplinary action or license or permit denial or restriction imposed by any licensing entity in any jurisdiction or by the DEA in connection with inappropriate prescribing or other misconduct involving a controlled substance or other dangerous drug.
- No ownership or investment interest in or compensation agreement with a Kentucky licensed medical cannabis cultivator, dispensary, processor, producer, or safety compliance facility.
Exhaustive descriptions of all MCP eligibility and application requirements can be found in each board’s MCP regulations. The application review process described in the regulations is similar to the medical credentialing process, and it could take a month or longer for the KBML or KBN to review an application, and issue an authorization, a denial, or request more information.
Once granted, MCP authorizations are good for one year and must be renewed before they expire. During that time, the MCP will need to complete three more hours of medical cannabis CME to apply for renewal. Timing for authorization renewals will coincide with each board’s annual license renewal schedule.
STEP 3: Register with the Medical Cannabis Program.
Once a practitioner receives their MCP authorization, they must register as an MCP
on the registration portal to file written certifications for patients to obtain medical cannabis.
STEP 4: Follow the KBML/KBN Professional Standards of Care Procedures to Certify Patients for Medical Cannabis.
The KBML and KBN professional standards for written certifications for medical cannabis include all the following. The MCP must.
- Establish a “bona fide practitioner-patient relationship” with the patient in person;
- Document a comprehensive patient medical and psychiatric history, history of drug use and medication review in the patient’s medical record;
- Perform a physical examination related to the patient’s medical condition, diagnose the patient with a “qualifying medical condition” (per KRS 218B.010); and
- Obtain the patient’s signed informed consent, a KASPER report for the previous 12 months, a pregnancy test for female patients of child bearing potential and age, and a drug screen for patients with a history or evidence of substance abuse.
STEP 5: Determine the Appropriate Form, Dosage and Supply Limit to Recommend in the Written Certification.
Written certifications should follow program supply limits for a daily supply, uninterrupted 10-day supply, and uninterrupted 30-day supply which are published in 915 KAR 2:020. For example, the daily supply limit a dispensary can dispense to a patient with a Medical Cannabis Program ID card is 3.75 grams of raw plant material, 1 gram of concentrate, or 130 milligrams of delta-9 THC infused into an edible, pill, capsule, oil, liquid, or tincture. An MCP can recommend greater than a 30-day supply if “they reasonably believe” and certify that a 30-day supply will be insufficient to give the patient uninterrupted relief. The regulation also establishes a four-step “potency equivalent formula” for determining the amount of raw plant material equivalent to the potency of a medical cannabis product.
STEP 6: Issue the Written Certification.
An MCP issuing an initial written certification to a patient is required to do it during an in-person exam. Certifications are only valid for 60 days. Subsequent certifications can be issued via telehealth. The MCP must record the certification online on the registry within 24 hours of issuing it. Certifications can be renewed before (but not after) they expire for three additional 60-day periods. After that, the MCP must perform an in-person or telehealth exam of the patient before issuing and recording a new certification.
Patients must have a registry ID card to get medical cannabis from a dispensary. The program will issue ID cards to patients who file a notarized application, meet eligibility criteria and have a current initial written certification from an MCP on the registry. The program website states that MCPs may begin recording certifications on the registry on December 1, 2024. However, the website also says ID card applications will not be accepted before January 1. For this reason, filing a certification on the registry too early in December may not be practical if there is a chance the certification will expire before a patient is able to file a notarized ID card application.
The program regulations establishing the written certification and ID card application procedures are not yet final and may be further revised after the program gets underway. It suffices to say the program is a work in progress and will likely be modified to some extent once officials have had the opportunity to evaluate how well those procedures work to accomplish their intended purpose.