Safe Harbor Qualification

Caring for the Caregiver: Coping as a Medical Marijuana Caregiver

Sometimes, the idea of “care” in its meaning as an emotion seems to be forgotten in the word “caregiver.” We emphasize the caregiver’s responsibilities and duties, while forgetting that they’re acting out of love, not duty. They aren’t just dispensing medications but are motivated by a sincere desire to help a loved one enjoy life to the fullest.

In the world of medical marijuana caregiving, things get even more complicated. In Pennsylvania, the medical marijuana caregiver is a legally defined person, required to navigate a world of unfamiliar processes and adhere to strict legal requirements. Through it all, the medical marijuana caregiver endures the same stresses facing all caregivers.

How does the medical marijuana caregiver manage? It’s a two-part process that requires, first, knowing the law, and second, learning to cope.

Know the law: Medical marijuana caregivers in Pennsylvania[i]

Under Pennsylvania’s Medical Marijuana Program, authorized by Act 16 of 2016, designated caregivers obtain medication for patients who are homebound or for minors under age 18. Since minors cannot apply for their own Medical Marijuana ID cards – the card that allows patients to buy medical cannabis at a Pennsylvania dispensary – this is a critical step for parents and guardians of children with one of the 21 serious medical conditions approved for medical marijuana treatment.

A caregiver must be over 21 years old, or if the patient is under 18, the person designated by a patient for certified medical use (for instance, a 20-year-old spouse). The designated caregiver can be a parent, guardian, spouse, or other person tapped for this crucial role. Patients may have up to two caregivers – a handy provision for busy families. Individual caregivers may have up to five patients each.

To become registered, caregivers must take these steps:

  • Visit the Pennsylvania Department of Health’s Patient and Caregiver Registry and choose the form to fill out – caring for an adult patient, or caring for a minor or person with a disability.
  • Complete a criminal background check through the Pennsylvania State Police. The Department of Health reviews the results to determine “the caregiver’s character, fitness and suitability” for the task. The department can deny a card to applicants convicted within the previous five years of selling or possessing drugs, narcotics or controlled substances. A history of drug abuse or diverting drugs, as revealed by the Prescription Drug Monitoring Program, is also grounds for denial.
  • Complete an authorization form designating the third-party caregiver”, if necessary.
  • Return to the Patient and Caregiver Registry and pay the $50 fee for a medical marijuana card. Fees can be waived or reduced for applicants who document financial hardship.

The address on caregivers’ state IDs (driver’s license or other official state identification) must match their current address exactly. Cards are valid for one year.

The identity and any information in the applications of medical marijuana ID card holders, including caregivers, are confidential and safe from public disclosure.

Rights and responsibilities:[ii]

Medical marijuana ID cards grant holders the right to obtain medical cannabis from licensed dispensaries, but cardholders have responsibilities, too. Under Pennsylvania regulations, they must immediately inform the Department of Health and return the card if:

  • The cardholder’s name or address changes.
  • The patient’s medical practitioner withdraws the medical marijuana certification.
  • The practitioner has been removed from the Pennsylvania practitioner registry.
  • The patient or legal guardian decides to discharge a caregiver.
  • The caregiver decides to stop caregiving.
  • The patient or legal guardian decides to obtain medical treatment from another practitioner.

Cardholders who fail to tell the department about these changes can lose the right to use the card at a dispensary. Lost or damaged cards must be renewed or modified within 10 days, for a $25 fee (as of 2018. Any revisions are posted every January).

The department can revoke cards or suspend cardholders if the practitioner has withdrawn a patient’s certification, the caregiver is no longer providing care, the cardholder is convicted of drug offenses or “intentionally, knowingly or recklessly” violates the medical marijuana law, the cardholder doesn’t visit a dispensary within 60 days of the card’s issuance, or the caregiver is no longer caring for any patients.

Caregivers of patients under age 21 are also advised to seek a Pennsylvania Medical Marijuana Safe Harbor Letter (MMSHL), which allows them to administer medical marijuana to minors, including on school property. Caregiver applicants need a Safe Harbor Physician form, completed Pennsylvania background check, and electronic copy of their caregiver status. Legal guardians need electronic copies of guardianship papers, and spouses need electronic copies of their marriage certificates. Applicants file all the materials with the Department of Health at the MMSHL page.

Caring for the caregiver

What’s the first step in becoming a medical marijuana caregiver? Talk to a trusted physician who can answer your questions. Many doctors have undergone the training required to be listed on the Pennsylvania practitioner registry, and all other physicians with a valid Pennsylvania medical license can take the training in order to be registered.

Through all of this, caregivers need to remember someone else who needs care – themselves. Caregiving is inherently stressful, and all the legal requirements of medical marijuana caregiving add another layer of concern. There’s an important piece of advice that experts offer to first-time users of medical cannabis — “start low and go slow,” which means starting with low dosages and slowly testing the most effective approach.

“Start low and go slow” can be a caregiving strategy, too. The duties and responsibilities can seem overwhelming, but taking a one-day-at-a-time approach and adopting proven coping techniques can ease the road ahead.

First, medical professionals say, watch for the signs of stress. Constant worry and fatigue, too much or too little sleep, weight gain or loss, sadness, frequent headaches or pain, and overuse of alcohol or drugs, including prescription medications, can be signs that caregiving is getting too stressful.

That’s when it’s time to step back and strategize, using these coping tips:

  • Accept help when it’s offered.
  • Remind yourself that no one is superhuman. You can only do one thing at a time.
  • Break big tasks into small goals, and turn down requests that are draining, such as hosting holiday meals.
  • Look into caregiving resources for your loved one’s particular condition, and you just might find community help with transportation, meals, or housekeeping.
  • Join a support group, and stay connected with friends, even if it’s just going for a walk. Medical marijuana support groups are starting to pop up on Facebook and Meetup.
  • Set personal health goals, such as making time for physical activity, eating healthy foods, and drinking plenty of water. If you have trouble sleeping, talk to your doctor, because sleep is essential to staying healthy.
  • Stay up-to-date on vaccinations and screenings. Tell your doctor that you’re a caregiver, and speak up about any concerns or symptoms you’re feeling.[iii]

It all might seem confusing at first, but with patience and an open mind, you can learn to navigate this new world. That’s when stepping up as a medical marijuana caregiver becomes extremely rewarding, especially when a loved one experiences the relief that comes from medical cannabis.

[i] https://www.pa.gov/guides/pennsylvania-medical-marijuana-program/#PatientsandCaregivers

[ii] http://www.health.pa.gov/My%20Health/Diseases%20and%20Conditions/M-P/MedicalMarijuana/Documents/DOH-DRAFT-28-PA-CODE-CH-1191-MM-Patients-and-Caregivers.pdf

[iii] https://www.mayoclinic.org/healthy-lifestyle/stress-management/in-depth/caregiver-stress/art-20044784