Karen Nitkin

Date: 05/11/2018

A new Johns Hopkins Medicine policy prohibits patients from possessing or using medical marijuana at its facilities, unless the patients are part of a clinical trial approved by the institutional review board.  

The policy, which went into effect April 1, clarifies Johns Hopkins Medicine rules for medical marijuana, which is legal in Maryland, Washington, D.C., and Florida, but is classified under federal law as a Schedule I drug with no accepted medical use.

Medical marijuana became legal in Maryland in 2015; the first dispensaries opened in late 2017. 

“This policy came about because Maryland passed the medical marijuana law, and most of our entities are in Maryland,” says Peter Hill, senior vice president of medical affairs for the Johns Hopkins Health System and vice president of medical affairs at The Johns Hopkins Hospital.

“We knew patients would be interested in interacting with our providers to obtain medical marijuana, and we knew we needed an institutionwide policy for patients who want to use medical marijuana in a hospital setting,” Hill says.

Leaders from across Johns Hopkins worked together for about a year to create the policy, he says, taking into consideration the ethical, legal and scientific ramifications of allowing medical marijuana in Johns Hopkins facilities. 

Medical marijuana is not dispensed through prescriptions. Doctors must register with the state or district’s cannabis commission to certify patients for medical marijuana use to combat conditions including pain, seizures, glaucoma, anorexia and nausea.

Johns Hopkins physicians may register to become medical marijuana providers if they choose, Hill says. However, some departments and Johns Hopkins organizations, including Johns Hopkins Community Physicians, ask that no clinicians do so. “Individual groups can make their own determination, based on their interpretation of the relevant literature,” says Hill.

Under the new policy, patients may not possess or use medical marijuana at the facilities of these organizations: The Johns Hopkins Hospital, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Howard County General Hospital, Suburban Hospital, Suburban Outpatient Surgery Center, Sibley Memorial Hospital, Johns Hopkins Community Physicians, Johns Hopkins Regional Physicians and Ophthalmology Associates.

If patients enter those facilities with medical marijuana, they must be instructed to remove it, and they are advised of other medications they can use instead during their hospital stay.  

If patients with medical marijuana are unconscious or incapacitated, the drug must be kept with the patient’s personal belongings until the patient or family members can remove it. The new guidance also requires that staff at each participating organization learn the policy.

“Marijuana is still illegal federally,” says Hill. “If we violate federal law by possessing or dispensing it, we could risk legal action, including withholding of federal funds. We felt that risk was too high to the organization and to our staff.”

Additionally, the science is not yet persuasive that medical marijuana is better than legal alternatives, such as ibuprofen for pain or anticonvulsant medications for seizures, says Hill. “Many physicians are just not convinced based on the current research,” he says.

Johns Hopkins All Children’s Hospital, in St. Petersburg, Florida, is in the process of formulating its own medical marijuana policy, which will likely be similar to the Johns Hopkins Medicine one, says Michelle Smith, intensive care unit physician and co-chair of the Pharmacy and Therapeutics Committee at All Children’s.

She says some families believe it helps patients who are suffering from seizures. The goal, Smith says, is to have conversations with families about alternatives to medical marijuana use, and to recommend outpatient use if that’s the best option for the patient.

One priority will be talking to parents about alternatives to medical marijuana that can be used while hospitalized, particularly for children with refractory seizure disorders or cancer. “We want to establish expectations in the outpatient setting, before a potential hospital admission,” Smith said. The policy, with any updates, can be found here.