MEDICAL MARIJUANA PRESCRIBING GUIDELINESFOR LICENSED PODIATRISTS
The Oklahoma Board of Podiatric Medical Examiners adopts the following guidelines
regarding the recommendation of medical marijuana by podiatric physicians in Oklahoma.
1. Any doctor of podiatric medicine who chooses to recommend medical marijuana must possessa valid Oklahoma podiatric medical license, be in good standing, and cannot have restrictions
on his or her podiatric medical license with the Board of Podiatric Medical Examiners. See 63O.S.Supp.2019, § 427.10(A); OKLA. ADMIN. CODE § 310:681-1-9(a). A podiatric physician
who has not completed his or her first residency may not recommend medical marijuana.
2. Licensed Oklahoma podiatrists should only sign medical marijuana recommendations related
to the care and treatment of ailments, diseased conditions, deformities, or injuries related tothe practice of podiatric medicine as set forth in the Podiatric Medicine Practice Act, 59
O.S.2011, § 135.1.
3. Although Oklahoma law does not require a licensed podiatric physician to obtain aregistration, a licensed Podiatrist may register with the Oklahoma Medical Marijuana Authority(“OMMA”) as a physician to recommend medical marijuana to patients. He or she has theoption to publicly share your registration information or keep certain information private to
the extent allowed by Oklahoma law.
4. A licensed podiatric physician must establish a medical record for the patient and possess abona fide physician-patient relationship.
5. When recommending medical marijuana to a patient, a licensed Podiatrist must properly
evaluate a patient’s medical condition and then prescribe medical marijuana adhering to theaccepted standards that a reasonable prudent physician would follow for recommending orapproving any medication. See 63 O.S.Supp.2019, § 427.10(C).
6. Prior to submitting a Physician Verification Form, a podiatric physician must verify a patient’sidentity with OMMA. See OKLA. ADMIN. CODE § 310:681-1-7.
7. A podiatric physician must complete all required portions of a Physician Recommendation
Form for it to be considered by OMMA.
8. While a podiatric physician may prescribe to adults and minors, two (2) physicians must signa Physician Recommendation Form submitted on behalf of a minor. While the law does not
specify if the physicians must hold the same education credential, it would be a best practiceto have a second podiatric physician to sign off on the Recommendation Form.
9. A podiatric physician’s practice location cannot be collocated at the same physical address as
a dispensary or cultivation center.
10. A medical marijuana recommendation may last for up to two (2) years.
11. A podiatric physician should use his or her reasonable medical judgment to determine whether
a patient’s underlying medical condition warrants at sixty (60) day or two (2) year registration
with OMMA.
12. A podiatric physician may terminate his or her recommendation by notifying the State
Department of Health (“OSDH”) that he or she has determined that the continued use of
medical marijuana by patient no longer meets requirements for possession of a license. See 63
O.S.Supp.2019, § 427.10(E).
a. The recommending podiatric physician will need to comply with OSDH’s requests for
information or documentation for a termination to be processed.
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13. A podiatric physician should not recommend a medical marijuana license if he or she knowsor should know that the license will be abused and the licensee will willfully violate thosesections of law regarding medical marijuana in Title 63 of the Oklahoma State Statutes. See 59
O.S.Supp.2019, § 149.1.
Podiatric Physicians must also follow the Code of Ethics of the American Podiatric Medical
Association. See 59 O.S.2011, § 148(A)(12). Any violation of the Code of Ethics is a violation of thePodiatric Medicine Practice Act. Consequently, podiatric physicians should comply with all provisionsof the Code of Ethics at all times. The following provisions from the Code of Ethics are especiallyrelevant to the recommendation of Medical Marijuana:•Under ME4.41, a podiatric physician cannot cease providing care or being able to provide care
to a patient “without giving the patient sufficient notice and/or the opportunity to seeking
continuing treatment with another health care practitioner.” Consequently, a podiatricphysician may want to consider advising a patient that he or she intends to revoke his or her
recommendation for the patient to have a medical marijuana license to provide the patient an
opportunity to seek a new podiatric physician who may be willing to recommend medical
marijuana.

•

Under ME5.11, a podiatric physician should respectfully advise patients whether he or she will
recommend medical marijuana or not.

•Under BE1.11, podiatric physicians must ensure that communications to the public are
accurate and do not convey false, untrue, deceptive, or misleading information. As such, apodiatric physician should accurately advise others on all facts related to the recommendationof medical marijuana as a treatment when directing information for public consumption.

•Under BE2.41, a podiatric physician must truthfully disclose actual and potential conflicts ofinterest in the recommendation and/or prescription of services, materials, medicines, andfacilities that may be utilized in the care of a patient. Therefore, a podiatric physician should
disclose any actual or potential conflicts of interest regarding ownership of or financial interest
in any dispensary or other commercial medical marijuana entity in operation in this State.

•Under BE4.11, a podiatric physician has a responsibility to supervise his or her employees
and/or contractors. Accordingly, a podiatric physician should take all necessary steps to ensurethat no employees and/or contractors are signing off on recommendations.

•Under BE4.21, only a podiatric physician should sign a recommendation. Thus, no one on
staff other than the licensed podiatric physician should be signing off on recommendations.
Under no circumstances should the podiatric physician delegate his or her authority for signing
off on a recommendation form.

•Under BE4.31, a podiatric physician has a duty to strive to practice podiatric medicine
consistent with standards of care established within the community. As a matter of practice, a
podiatric physician should only recommend medical marijuana so long as it is standard careand practice to offer medical marijuana under the particular circumstances in the case within
the community that the podiatric physician practices in.
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Medical Marijuana Prescribing Guidelines for Licensed Podiatrists
The State Board of Podiatric Medical Examiners further adopts or adapts the following
guidelines1 published by the Federation of State Medical Boards (“FSMB”) in April 2016:

Podiatric Physician – Patient Relationship2
The health and well-being of patients depends upon a collaborative effort between the physician andthe patient. The relationship between a patient and a podiatric physician is complex and based on themutual understanding of the shared responsibility for the patient’s health care. The podiatricphysician-patient relationship is fundamental to the provision of acceptable medical care. Therefore,
podiatric physicians must have documented that an appropriate podiatric physician-patient
relationship has been established, prior to providing a recommendation, attestation, or authorization
for marijuana to the patient. Consistent with the prevailing standard of care, podiatric physicians
should not recommend, attest, or otherwise authorize marijuana for themselves or family member.

Patient Evaluation3
A documented medical evaluation and collection of relevant clinical history commensurate with thepresentation of the patient must be obtained before a decision is made as to whether to recommend
marijuana for medical use. At minimum, the evaluation should include the patient’s history ofpresent illness, social history, past medical and surgical history, alcohol and substance use history,
family history with emphasis on addiction or mental illness/ psychotic disorders, physical exam,
documentation of therapies with inadequate response, and diagnosis requiring the marijuana
recommendation.

Informed and Shared Decision Making4
The decision to recommend marijuana should be a shared decision between the podiatric physician
and the patient. The podiatric physician should discuss the risks and benefits of the use of marijuanawith the patient. Patients should be advised of the variability and lack of standardization of marijuana
preparations and the effect of marijuana. Patients should be reminded not to drive or operate heavymachinery while under the influence of marijuana. If the patient is a minor or without decision-making
capacity, the podiatric physician should ensure that the patient’s parent, guardian or surrogate isinvolved in the treatment plan and consents to the patient’s use of marijuana.

Treatment Agreement5
A health care professional should document a written treatment plan that includes:•Review of other measures attempted to ease the suffering caused by the terminal or debilitating
medical condition that do not involve the recommendation of marijuana.

1 Report of the FSMB Workgroup on Marijuana and Medical Regulation, Model Guidelines for the Recommendation ofMarijuana in Patient Care, FEDERATION OF STATE MEDICAL BOARDS, April 2016.
2 Id. at 6.
3 Id.
4 Id.
5 Id. at 7.

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Medical Marijuana Prescribing Guidelines for Licensed Podiatrists
••
•

••
•

Advice about other options for managing the terminal or debilitating medical condition.
Determination that the patient with a terminal or debilitating medical condition may benefit
from the recommendation of marijuana.
Advice about the potential risks of the medical use of marijuana to include:o The variability of quality and concentration of marijuana;o The risk of cannabis use disorder;o Exacerbation of psychotic disorders and adverse cognitive effects for children andyoung adults;o Adverse events, exacerbation of psychotic disorder, adverse cognitive effects forchildren and young adults, and other risks, including falls or fractures;
o Use of marijuana during pregnancy or breast feeding;o The need to safeguard all marijuana and marijuana-infused products from children andpets or domestic animals; ando The need to notify the patient that the marijuana is for the patient’s use only and themarijuana should not be donated or otherwise supplied to another individual.
Additional diagnostic evaluations or other planned treatments.
A specific duration for the marijuana authorization for a period no longer than twelve months.
A specific ongoing treatment plan as medically appropriate.

Qualifying Conditions6
At this time, there is a paucity of evidence for the efficacy of marijuana in treating certain medicalconditions. Recommending marijuana for certain medical conditions is at the professional discretionof the podiatric physician. The indication, appropriateness, and safety of the recommendation
should be evaluated in accordance with current standards of practice and in compliance with state
laws, rules and regulations, which specify qualifying conditions7 for which a patient may qualify formarijuana. However, Oklahoma law explicitly does not require physicians to document any
qualifying condition. See 63 O.S.Supp.2019, § 420(M). Specifying a medical condition on a Patient
Recommendation Form may be probative that a recommending podiatric physician isrecommending medical marijuana in accordance with accepted standards that a reasonable prudent
physician would follow for recommending or approving any medication.

Ongoing Monitoring and Adapting Treatment Plan8
A podiatric physician recommending marijuana should register with the appropriate oversight agency
and provide the registry with information each time he or she issues a recommendation. The podiatricphysician should regularly assess the patient’s response to the use of marijuana and overall health andlevel of function. This assessment should include the efficacy of the treatment to the patient, the goalsof the treatment, and the progress of those goals.

6 Id. at 7.

7 Oklahoma does not require any qualifying conditions. Instead, the podiatric physician should make his or her
recommendations according to accepted standards a reasonable and prudent physician would follow whenrecommending or approving any medication. See 63 O.S.Supp.2019, § 420(M).
8 Report, at 7.

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Consultation and Referral9
A patient who has a history of substance use disorder or a co-occurring mental health disorder may
require specialized assessment and treatment. The podiatric physician should seek a consultation
with, or refer the patient to, a pain management, psychiatric, addiction or mental health specialist, asneeded.

Medical Records10
The podiatric physician should keep accurate and complete medical records. Information that should
appear in the medical record includes, but is not necessarily limited to the following:
••
•
•
•
•
•

The patient’s medical history, including a review of prior medical records as appropriate;
Results of the physical examination, patient evaluation, diagnostic, therapeutic, and laboratory
results;
Other treatments and prescribed medications;
Authorization, attestation or recommendation for marijuana, to include date, expiration, andany additional information required by state statute;
Instructions to the patient, including discussions of risks and benefits, side effects and variableeffects;
Results of ongoing assessment and monitoring of patient’s response to the use of marijuana;
A copy of the signed Treatment Agreement, including instructions on safekeeping andinstructions on not sharing.

More Information
Podiatric physicians can consult directly with OMMA about any questions that they may have. OMMA
can be contacted by phone at 405-522-6662 or by email at OMMAphysicians@ok.gov.
Guidelines adopted on April 7, 2020..

9 Id. at 7

10 Id. at 8.

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