Every time a state passes a resolution to legalize medical cannabis, lawmakers are left wringing their fingers as they are forced to sit down and draw up the rules. A common concern is the risk of medical cannabis card mills popping up all over their respective states. To borrow a phrase from Francis Pharcellus Church, yes Virginia, medical cannabis card mills are real.
The KevinMD website published a fantastic article discussing card mills back in 2021. It is a very good read. The author followed up with a second article a short time later, an article in which she relayed a personal experience with a patient who was possibly saved from improper treatment by avoiding a card mill.
Unfortunately, state-legal medical cannabis has opened the door to a cottage industry of card mills operating for the sole purpose of helping people get their medical cannabis cards as easily as possible.
Card Mill Basics
The medical cannabis card mill has been likened to the pill mills that facilitated our current opioid crisis. Card mills are medical offices staffed by licensed providers with state authority to recommend medical cannabis. They typically allot 15-20 minutes per patient.
A patient comes in, discusses their symptoms with the medical provider, and then leaves it to the provider to decide whether or not a medical cannabis recommendation is forthcoming. This would be just fine if the medical provider knew each patient and had a sufficient understanding of each one’s medical history. But that is not the case.
Oftentimes, card mill doctors and their patients are complete strangers when they first meet in the exam room. Doctors ask a list of cursory questions to make sure they comply with the law. But 15-20 minutes is hardly enough time to delve into what is going on to ensure that medical cannabis is the most appropriate treatment.
Combatting the Card Mill Phenomenon
States have enjoyed different levels of success combating the card mill phenomenon. According to the operators of the Utahmarijuana.org website, Utah lawmakers originally attacked the problem by limiting the number of patients qualified medical providers (QMPs) could recommend medical cannabis for. That number was six hundred.
By limiting a QMP office to just six hundred patients, lawmakers took away the financial incentive to establish card mills. They have since loosened the restrictions, allowing QMP patient levels to match 1.5% of the total number of medical cannabis card holders in the state. At this point, QMPs can have just over 1,000 patients.
Other states have tried different strategies to prevent card mill proliferation. But the very fact that they need to fight against it tells us something very revealing about the medical cannabis industry: it’s not always about patient health despite claims to the contrary.
A Missing Test
The previously mentioned author of the KevinMD articles was dealing with a patient she had never met before. In addition, the patient scheduled her appointment at the last minute. To her credit, the doctor resisted the temptation to recommend cannabis even after spending 30 minutes with the patient. Instead, she took time at the end of her day to go through the patient’s medical records. She even called the patient’s GP the following day.
Interestingly, she discovered that one of the critical tests needed to determine what was going on with the patient had never been conducted. She ordered that test rather than recommending medical cannabis and sending the patient on her way. In other words, she did what a card mill would never do. For better or worse, that is the reality of the card mill phenomenon.
