Medical Cannabis: Why Physician Support Hasn’t Kept Pace With Public Approval

Why Doctors Are Not Prescribing Medical Marijuana

With nationwide acceptance for medical cannabis at an all-time high, a remarkable majority of physicians are still unwilling to certify patients. All too often those suffering from severe and chronic conditions are denied certification from their network of treating physicians.

This begs the question – Why do many physicians refrain from exploring medical cannabis as a treatment option? Why do certain hospitals and practice groups explicitly forbid their affiliated physicians from certifying patients? Why haven’t we reached a critical mass of support?

Why Doctors Are Not Prescribing Medical Marijuana

Put simply, three primary issues impede greater physician “buy in.”

Potential Assumption of Risk

Physicians worry that certifying medical cannabis patients poses a risk to their controlled substance license, commonly referred to as a DEA (or Drug Enforcement Agency) number.  Since cannabis is a Schedule I Controlled Substance illegal at the federal level, some assert that certifying patients under a license issued and regulated by a federal agency is problematic. As an added worry, practitioners question whether cannabis certifications will make them more susceptible to an audit, inciting the State Medical Board or Department of Health to possibly become more suspicious of their scope of practice, and consequently, what effect this might have on their relationships with insurance carriers.

Physicians further fear that patients may fail to use cannabis responsibly by driving while intoxicated or improperly storing cannabis product, which can lead to potential diversion or consumption by minors.  Some states have sought to limit and preempt these liability concerns, i.e. through the inclusion of clauses where the physician simply attests that the patient has a qualifying condition and that the potential benefits of using cannabis outweigh the risks. However, this may do little to satisfy those more conservative physicians who hold a general posture of non-engagement in so-called “riskier” or exploratory activities.

Additionally, the permissibility of insurance reimbursements for cannabis-related physician consultations is gray, at best. How can a provider submit a claim for a “consultation visit” whereby a non-FDA approved, illegal drug is recommended? This is complicated by the fact that many patients with serious illnesses who qualify for medical cannabis are insured through government funded programs, such as Medicaid, which are subsidized, in part, by Federal dollars.

Confusion and Unease About the Certification Process

Physicians may be unacquainted with the rules of their State’s program. Confusion exists regarding authorization to certify patients (as in some states a medical cannabis education program may be a prerequisite), submission of a patient’s supplemental health information, and term of care required for a valid “bona fide” patient / physician relationship.  Some physicians hold the apocryphal belief that they cannot legally certify, and patients must go to a specialized “marijuana doctor.”

In many ways, a medical cannabis certification is antithetical to conventional guidelines for prescribing medication. Cannabis certification lacks specificity on dosing, types of products, and methods of administration. For example, a gastroenterologist prescribing corticosteroids to treat Crohn’s disease may issue a 10-day supply  of oral medication and schedule a follow-up appointment to monitor the patient’s progress. Certification of a medical cannabis card, in comparison, typically authorizes the patient a full year of access to flowers for smoking, oils for vaping, edibles for consumption, and topicals for skin application. Physicians’ lack of control over medication specificity prompts unfamiliarity and unease.

Limited and Spotty Information

Empirical evidence of medical cannabis efficacy collected through U.S. based research is limited and spotty due to its federally illegal status. Physicians oftentimes ascertain information about cannabis in an informal and haphazard fashion — such as through patient accounts of black-market consumption, sensationalized investigative journalism or interactions with other health care providers. Though some physicians may choose to do their own research, most are left feeling ill-informed.

This is a stark contrast to the pharmaceutical world, where a veritable cadre of drug reps meticulously carve out practitioners by territory and specialty providing comprehensive education on their product line. These reps cite research studies, highlight product improvements, proffer comparative medication data, and discuss common side effects. They deliver product samples and coupon books to practitioners to stimulate demand for scripts.

In the world of cannabis, licensed dispensaries, processors, and cultivators are start-ups lacking the deep pockets of Big Pharma. Moreover, regulatory limitations on advertising constrain message contents and permitted distribution channels. As one might expect, product samples (distributed by an entity other than a dispensary) are expressly prohibited by law. So, for instance, a doctor cannot offer a patient a gram of Cherry Kush as treatment for his incessant muscle spasms.

In short, this groundswell of doubt towards certifying medical cannabis patients is seeded by liability, informational, and regulatory concerns. Unpacking these objections proves a worthwhile exercise, particularly for legislators crafting cannabis reform.

Six weeks ago, bipartisan Federal representatives came together to establish the first-ever Congressional Cannabis Caucus. It is my hope that the initiatives put forth by this Caucus will provide one avenue for assuaging physicians’ concerns, consequently leading to accretion of support and further advancement of the medical cannabis movement.

Medical Marijuana Photo via Shutterstock

This article, “Medical Cannabis: Why Physician Support Hasn’t Kept Pace With Public Approval” was first published on Small Business Trends

This Top Ranked City for Entrepreneurs Might Surprise You

Top Cities for Entrepreneurs

You don’t need to start your business in a big startup capital like the Silicon Valley or New York City in order to be successful. According to a new list from Entrepreneur and Livability, some of the best cities for entrepreneurs are actually lesser-known towns.

Top Cities for Entrepreneurs

Take Brookings, South Dakota, for example, which was ranked at number 25 on the list. The fourth largest city in the state actually has a thriving economy, with one of the lowest unemployment rates in the country. And since it also boasts a low cost of living, that leaves residents with more money to spend on purchases from small businesses.

Entrepreneur and Livability also included input from actual local business owners in their study. According to Trevor Clements, co-founder, Coteau des Prairies Olive Oil Co., “Early on, we were uncertain if we could be successful in a town and region the size of ours. But Brookings is incredibly supportive of local businesses, and the community is quite diverse, much like a slice of a much larger city.”

The Entrepreneur list isn’t all about small, surprising towns. Palo Alto, Calif., was number 19 on the list. But that demonstrates just how much lesser-known communities can actually compete with major markets when it comes to amenities for entrepreneurs.

So if you’re looking to start or relocate your business, you don’t need to only focus on the big names. Smaller communities like Corvallis, Ore., Ames, Iowa and Manhattan, Kan. also made the list.

Many of the towns on the list feature a nearby college or other type of anchor that provides employment and training opportunities for residents. But factors like low unemployment rates and cost of living can also have a major impact for entrepreneurial residents. And those are the things you should look for when considering where to locate your small businesses, instead of just going with the biggest names first.

Brookings, South Dakota Photo via Shutterstock

This article, “This Top Ranked City for Entrepreneurs Might Surprise You” was first published on Small Business Trends

Nearly All U.S. Exporters are Small Businesses (INFOGRAPHIC)

An astonishing 97 percent of all U.S. companies that export products are actually small businesses.

That’s according to new research by SCORE, a nonprofit association for small businesses.

International Export Has Clear Benefits for Small Businesses

Data gathered by SCORE reveals U.S. companies that export grow faster and are nearly 8.5 percent less likely to go out of business than non-exporting ones.

And that’s not the only reason to consider international trade. About 26 percent of companies that trade internationally significantly outperform their market.

Small Business Concerns Regarding International Trade

Despite the obvious benefits of trading internationally, less than one percent of America’s 30 million companies export. That’s probably because they have a few concerns. Data reveals thirty-nine percent say their goods are not exportable and 37 percent don’t know how to start.

A large number of small businesses (63 percent), however, would like to export their goods and services.

Exporting is Easier Than Most Businesses Think

According to SCORE data, becoming an exporter is easier than most businesses might think.

Forty-eight percent of businesses say it took them just a few months before they started exporting. In other words, there’s no reason for small businesses to not consider exporting, especially when the benefits are there for the taking.

For more insights, check out the infographic below.

97 percent of all US exporters are actually small businesses

Infographic: SCORE

This article, “Nearly All U.S. Exporters are Small Businesses (INFOGRAPHIC)” was first published on Small Business Trends

After Failure to Repeal Obamacare, Pence and McMahon Reassure Small Businesses

Pence and McMahon Talk About Small Businesses and the Fight Against Obamacare

After failure by the U.S. House of Representatives to pass a bill that could repeal and replace the Affordable Care Act Friday, Vice President Mike Pence and SBA Administrator Linda McMahon made a stop in West Virginia to reassure small business owners and listen to their concerns.

The pair met with a crowd of small business leaders at Foster Supply, a family-owned business in Charleston, W.V., Hosted by owner Ronald Foster and Delegate Nancy Reagan Foster, the event featured remarks from both Pence and McMahon about small businesses and the fight against Obamacare.

Pence told the event’s attendees, “I truly believe that President Trump is the best friend small business will ever have.” Among the reasons for that sentiment, Pence cited Trump’s family history of business ownership. He also said that the administration is focused on creating an environment with less regulation, fewer tax burdens, free and fair trade and more.

Pence also touted McMahon’s business acumen, explaining her history of building a small company into the worldwide brand WWE.

Small Businesses and the Fight Against Obamacare

Repealing Obamacare has been a major talking point for the Trump administration since the early days of the campaign. And it’s something that small business owners have been following closely.

While Friday’s effort failed to accomplish this goal, Pence and McMahon’s visit to West Virginia mainly showcased the administration’s interest in listening to small business owners when shaping policies going forward.

Mike Pence Photo via Shutterstock

This article, “After Failure to Repeal Obamacare, Pence and McMahon Reassure Small Businesses” was first published on Small Business Trends

Small Business Owners and Buyers Ready for Trump Tax Reforms

Small Businesses Want Tax Reform Plan From Trump

Healthcare reform is an important issue for small business.

That seems unlikely right now, but just as important, according to recent data from BizBuySell, is tax reform.

In a recent poll of 700 small business owners and prospective buyers, healthcare and tax reform were the top two issues mentioned for President Donald Trump to address.

Of the total group responding — owners and perspective buyers — 44 percent said healthcare was the number one issue while 41 percent said tax reform.

Small Businesses Want Tax Reform

While it appears healthcare reform — repealing and replacing Obamacare — may not happen immediately, tax reform appears to be a more achievable goal. And it may be the one that helps small business owners and buyers in the wallet the most.

Of those responding to BizBuySell’s survey, 34 percent said they’ve been financially penalized for an error they’ve made in the country’s complicated tax code.

Trump’s Treasury secretary Steven Mnuchin has promised to lower taxes and simplify the code at the same time.

Obamacare Let Down

Last week proved a setback to repealing Obamacare.

That’s likely to sour a lot of small business owners and buyers. Each group told BizBuySell they wanted to see the healthcare law repealed. The number one reason why was the mandate to purchase a plan or pay a penalty.

Sixty percent of small business owners say they want Obamacare repealed and 51 percent say the mandate is the reason. The same amount of prospective small business buyers want the law repealed, too. And exactly half say the mandate is their biggest issue with Obamacare.

Red Tape

One overarching issue that needs to be addressed by Trump is regulations.

Predictably, 71 percent of owners and 74 percent of buyers say there are too many regulations. A little more than 20 percent believe there are just enough regulations. Less than 5 percent say there are too few.

President Trump Photo via Shutterstock

This article, “Small Business Owners and Buyers Ready for Trump Tax Reforms” was first published on Small Business Trends

Wix Acquires DeviantArt Revealing New Stock Photo Niche

Wix Acquires DeviantArt Revealing New Stock Photo Niche

Israel-based Wix.com (NASDAQ:WIX) recently acquired DeviantArt, an online community for artists, art enthusiasts and designers, for $36 million.

Wix, which helps small business to build and operate websites, will have access to DeviantArt’s over 325 million pieces of original art as well as its more than 40 million registered members.

The Impact as Wix Acquires DeviantArt

DeviantArt will continue with its operations as before and will put investments into building mobile and desktop apps. On the other hand, Wix will provide technology and marketing expertise to the DeviantArt users, helping them to further their reach and increase engagement both on the web and on mobile.

“The DeviantArt community is talented and robust and hungry for additional product expertise,” stated the co-founder and CEO of Wix Avishai Abrahami in a press release. “We understand their passion, share their creative vision and are excited to offer the power of the Wix platform to their millions of artists.”

DeviantArt will on the other hand allow Wix users with a platform to engage with artists and designers from multiple mediums.

“This combined effort with Wix creates new opportunities for innovation never before seen on the internet and an amazing super-charged offering to our community members,” stated co-founder and CEO of DeviantArt Angelo Sotira. “We look forward to being part of the Wix team, and we are humbled by the respect and love they have shown to our community.”

The two companies’ said that they will strive to create an innovative gallery for artists globally that will mix world class creative with “unmatched opportunities for design, display and distribution.”

If all goes as planned, the acquisition might be an alternative to standard stock photo services like Shutterstock and Adobe, and the once boring images on your blog or eBook of a guy with a clipboard might soon be replaced with interesting images of alien vistas or other more artistic renderings.

Image: Small Business Trends

This article, “Wix Acquires DeviantArt Revealing New Stock Photo Niche” was first published on Small Business Trends

Hiscox Launches California Small Business Workers’ Compensation Insurance Offering

Hiscox Launches California Small Business Workers Compensation Insurance Offering

Owners of companies providing professional business services ranging from IT to architecture in California now have the option to purchase state-mandated workers’ compensation insurance through Hiscox (LON:HSX). The international and national small business insurer made the announcement of the new option recently. The new policy covers medical benefits, wages and access to medical professionals for workers who suffer an injury or illness as a result of their employment.

California Labor Code Section 3700 mandates that all employers offer workers’ compensation even if they have only one employee.  The new product will be underwritten by Hiscox Insurance Company Inc in Chicago. A Hiscox Workers’ Compensation Insurance policy is to be sold in a package with another business insurance product covering professional or general liability and/or a business owners’ policy from the company. Presently, the policy is available only in California.

The kind of work-related accidents and illnesses that are included under California workers’ compensation insurance include employee injuries suffered while lifting heavy objects and accidents that occur when a staff member is traveling to a client’s office.

Companies that will be covered under a Hiscox Workers’ Compensation Insurance policy include IT/Technology firms as well as Architects and Engineers and a variety of others offering professional business services.

Although these policies are state-mandated, the annual premiums a firm pays from a private insurance company depend on several factors such as payroll, industry classification and the number of past work-related injuries on record. A Hiscox Workers’ Compensation Insurance policy will offer flexible monthly payment options with no additional fees.

Kevin Kerridge, Executive Vice President of Small Business Insurance at Hiscox USA, explains the company’s focus and future plans in the space.

“One of the key insights behind us launching our US small business operation in 2010 was just how underserved small business owners have been by the insurance industry,” Kerridge told Small Business Trends.  “We’re proud to add another product offering to what we already provide to those customers. We’ve started in California as a first step, and over the next 12 months we’ll selectively expand our geographic footprint in this new product line.”

California Flag Photo via Shutterstock

This article, “Hiscox Launches California Small Business Workers’ Compensation Insurance Offering” was first published on Small Business Trends