Patients who want marijuana won't have to have visited their doctor four times during the past year to get the necessary recommendation.
State Health Director Will Humble said Monday he scrapped that requirement from the rules he first proposed in December for Arizona's medical marijuana laws approved by voters. Instead, a patient would be able to get a recommendation with a single visit.
But Humble denied that change will make it easier for those who want marijuana solely for recreational purposes to get the drug.
Instead, he said the state will depend more on doctors to screen out would-be abusers - with his agency looking over doctors' shoulders to keep them in line.
Humble also said his agency will initially license only one dispensary in each of the state's 126 "community health analysis areas." He said that will prevent dispensaries from concentrating in the same highly populated areas.
He also said would-be patients should be able to get the necessary written recommendation that allows them to purchase marijuana on April 14. But with dispensaries not set to be running until this summer, the first patients will have to grow their own drugs.
That right, however, will expire for most patients after the first year once shops are available. Only those living at least 25 miles from a dispensary will continue to be able to cultivate marijuana legally.
The voter-approved measure allows people with certain medical conditions to obtain a doctor's written certification to purchase up to 2 1/2 ounces of marijuana every two weeks.
It also says a recommendation can be issued only after a "full assessment" of the patient's medical history and condition. And it requires there be a "bona fide physician-patient relationship."
But the law doesn't define what that is, leaving the task to Humble.
"What we're really doing is going for a ‘medical marijuana' program," he said. Humble said programs in other states are "mostly recreational," as shown by the age of the patients getting the recommendations and the frequent diagnosis of "chronic pain."
"Our objective is to get this right, up front, and ensure that the folks getting the certification have a true debilitating medical condition, that they've had a full assessment, that their physician has done a good job at really diagnosing that problem," Humble said.
While eliminating the four-visit requirement, Humble said there still are written guidelines before a doctor can write a recommendation.
For example, a doctor will have to certify he or she has conducted a personal exam of the patient appropriate to the symptoms and the diagnosed medical condition. The doctor also will have to review medical records for the last year as well as records of how the patient has responded to "conventional medications and medical therapies" before recommending marijuana.
And doctors will need to avow they are willing to be responsible for monitoring the patient for the coming year. But Laura Nelson, the department's chief medical officer, conceded nothing in the rules requires a patient to come back.
There are potential loopholes.
That list of conditions for which a doctor may recommend marijuana contains a catch-all for any chronic or debilitating condition or a treatment that results in "severe and chronic pain."
"The challenge there is how you measure that," Nelson said.
She said there was some thought about adding requirements, like having the doctor review X-rays or MRI scans. Instead, she said her agency plans to monitor the documents doctors must submit each time they write a recommendation to see if any are playing fast and loose with the rules.
"There's not a lot of individuals in their 20s and 30s that have debilitating chronic pain," she said, likely triggering a closer look. And Humble said any doctor writing a lot of recommendations - a figure he put at more than 100 a year - is going to come under scrutiny.
The rules, though, do not limit the amount individuals can buy. Humble said once someone has a doctor's recommendation, he or she can purchase the maximum allowable 2 1/2 ounces every two weeks - more than four pounds a year - without further justification, though the excess cannot legally be sold or given away to others.
As to the doctors, Humble said his agency has no discipline authority. Instead, his staffers inform regulatory boards who can suspend or revoke a license to practice if there is evidence a physician is writing too many recommendations in questionable circumstances.
Lisa Wynn, executive director of the Arizona Medical Board said her agency sees marijuana as "one more tool that doctors will have to help alleviate suffering for their patients."