Health Policy Topic
Should Nurse Practitioners be able to recommend Medicinal Marijuana to qualified patients?
According to the National Institute of Drug Abuse (2014), marijuana is a drug that is made from dried leaves and parts of a Cannabis sativa plant. It is most commonly known as a street drug. When smoked or ingested, the psychoactive chemical, delta-9-tetrahydrocannabinol (THC), attaches to cannabinoid receptors in the brain and causes alterations in perception and mood, impaired coordination, and difficulty with thinking, learning, memory and problem solving. In adolescents, smoking marijuana may cause permanent impairments in learning, memory, and decreased IQ (National Institute of Drug Abuse, 2014). According to the Institute of Medicine (1999), marijuana smoke can increase the risk of lung cancer, tachycardia, hypertension, myocardial infarction, respiratory infections, and poor pregnancy outcomes. In high doses, it can cause mental confusion, panic reactions and hallucinations. However, there is evidence to support the use of marijuana as a last resort for “debilitating symptoms” such as pain/muscle spasms, nausea, vomiting, anxiety, and decreased appetite (Institute of Medicine, 1999).
Current Legislative Position
According the Arizona Department of Health Services (2012), marijuana is illegal at the federal level and it is classified as a Schedule I substance—having no medical uses and at high risk for abuse. However, at the state level, there are currently 23 states that have legalized medical marijuana including Arizona, Alaska, California, Colorado, Connecticut, Delaware, Hawaii, Illinois, Maine, Maryland, Massachusetts, Michigan, Minnesota, Montana, Nevada, New Hampshire, New Jersey, New Mexico, New York, Oregon, Vermont, Rhode Island, and Washington. Arizona passed the bill on November, 2, 2010 to legalize medical marijuana. According to the Arizona Medical Marijuana Act, only physicians may “certify” or “recommend” medical marijuana to qualified patients. It is illegal to “prescribe” marijuana. Qualified patients are also required to have a Medical Marijuana identification card from the Arizona Department of Health Services. If a qualified patient does not live within 25 miles of a dispensary, they may apply to grow their own marijuana or designate a “caregiver” to grow marijuana for them (Arizona Department of Health Services, 2012).
According to Arizona State Legislature (n.d.), only a “physician” is able to “recommend” medicinal marijuana to “qualified patients.” The Arizona State Legislature (n.d.) defines a physician as a doctor of medicine, a doctor of osteopathic medicine, a naturopathic physician, or a homeopathic physician. Non-physicians may not certify qualified patients for medical marijuana in Arizona. I think that this health policy topic is relevant to nurse practitioners since it is likely that we will have patients asking us about medical marijuana. Nurse practitioners may not want their scope of practice expanded due to the ethical nature of recommending a highly abused drug. However, changing the language of the bill from “physician” to “healthcare provider” will decrease patient barriers to access to care and create provider parity.
Arizona Department of Health Services. (2012). Arizona medical marijuana program: Keeping it medical, the role of the physician. Retrieved from http://www.azdhs.gov/medicalmarijuana/documents/physicians/MMJ_KeepingItMedical_TheRoleofthePhysician.pdf
Arizona State Legislature. (n.d.). Retrieved from http://www.azleg.gov/FormatDocument.asp?inDoc=/ars/36/02801.htm&Title=36&DocType=ARS
Armentano, P. (2005). Marinol vs. natural plant. Retrieved from http://norml.org/component/zoo/category/marinol-vs-natural-cannabis
Institute of Medicine. (1999). Marijuana and medicine: Assessing the science base. Washington, DC: The National Academies Press.
National Institute of Drug Abuse. (2014). Drug facts: Marijuana. Retrieved from http://www.drugabuse.gov/publications/drugfacts/marijuana