Week Two 1/19-1/25: Impact of Healthcare Policy on Health & The Role of Ethics in Decision Making

Impact of Legalizing Medical Marijuana in Arizona on Health

Health policies are government laws, rules, or regulations that have the power to influence and impact population health and to support the pursuit of health, a basic human right (Longest, 2010). According to the Congressional Research Service (2012), the Drug Enforcement Administration (DEA) regulates the use of controlled substances as defined by the Controlled Substances Act (CSA). Drugs in Schedule I are not accepted for medical use and are illegal to prescribe to the public. Providers registered with the DEA are only authorized to prescribe controlled substances listed in Schedule II-V. Marijuana is listed as a Schedule I drug (Congressional Research Service, 2012). Therefore, providers are not allowed to “prescribe” marijuana, they can only “certify” or “recommend” medical marijuana to qualified patients. Medical Marijuana is also not approved by the Food and Drug Administration. However, researchers interested in performing clinical trials for medical marijuana need to collaborate with the National Institute on Drug Abuse for government-approved marijuana (Food and Drug Administration, 2014).

In Arizona, it is legal for physicians to certify patients for medical marijuana. However, nurse practitioners were not included in the legislative language and cannot certify patients for medical marijuana. According to Mark Adams, author for High Times Magazine (2013), physicians in Arizona are hesitant to recommend medical marijuana. In fact, naturopathic doctors certify the majority of patients for medical marijuana in Arizona. The director of the Arizona Department of Health Services, Will Humble, states that it is possible that patients may be getting certified by “certification mills” instead of talking to their primary care providers about medical marijuana (Adams, 2013).

Medical Marijuana and the role of NPs

Nurse practitioners are capable of diagnosing, managing, and treating medical conditions that medical marijuana is approved for, such as cancer, glaucoma, HIV/AIDS, hepatitis C, amyotrophic lateral sclerosis, Crohn’s disease, agitation of Alzheimer’s disease, post-traumatic stress disorder, or a chronic/debilitating disease or treatment that causes cachexia, severe and chronic pain, severe nausea, seizures including epilepsy, and severe and persistent muscle spasms including multiple sclerosis (Arizona State Legislature, n.d.). It is recommended by the Arizona Board of Nursing to include nurse practitioners into Arizona’s Medical Marijuana Law and to be granted certifying rights (Arizona State Board of Nursing, 2011).

Role of Ethics in Decision Making Regarding NP Certifying Patients for Medical Marijuana

The American Nurses Association supports the ethical obligation of nurses to be advocates for all patients to have access to healthcare, including medical marijuana (American Nurses Association, 2008). An expansion of the law to include nurse practitioners would increase patient access to health care providers that can certify patients for medical marijuana for debilitating medical conditions. Medical marijuana can be the right drug for the right person with in-retractable nausea, vomiting, and pain, wasting disorders, seizures, and other conditions that are refractory to prescription medications and both the provider and the patient can be protected from arrest and persecution under Arizona law.

References

Adams, M. (2013). Arizona cracks down on medical marijuana doctors. Retrieved from http://www.hightimes.com/read/arizona-cracks-down-medical-marijuana-doctors

American Nurses Association. (2008). In support of patients’ safe access to therapeutic marijuana. Retrieved from http://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/ANAPositionStatements/Position-Statements-Alphabetically/In-Support-of-Patients-Safe-Access-to-Therapeutic-Marijuana.pdf

Arizona State Board of Nursing. (2011). Advanced practice committee meeting minutes. Retrieved from https://www.azbn.gov/Documents/meetings/Advanced%20Practice%20Committee/2011/Advanced%20Practice%20Committee%20Meeting.02.11.11.pdf

Arizona State Legislature. (n.d.). Retrieved from http://www.azleg.gov/FormatDocument.asp?inDoc=/ars/36/02801.htm&Title=36&DocType=ARS

Congressional Research Service. (2012). The controlled substances act: Regulatory requirements. Retrieved from http://fas.org/sgp/crs/misc/RL34635.pdf

Food and Drug Administration. (2014). FDA and marijuana: Questions and answers. Retrieved from http://www.fda.gov/NewsEvents/PublicHealthFocus/ucm421168.htm#Q2

Longest, B. (2010). Health policymaking in the United States. (5th ed.). Arlington, VA: Association of University Programs in Health Administration.

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6 thoughts on “Week Two 1/19-1/25: Impact of Healthcare Policy on Health & The Role of Ethics in Decision Making

  1. I think you bring up a very great point that nurse practitioners were not included in the law allowing physicians to write for a patient to receive their marijuana card. As nurse practitioners in the state of Arizona, nurse practitioners are allowed to practice autonomously and do not need to be supervised by a physician (AANP, 2014). With this right being granted to a nurse practitioner they should also be fully capable of prescribing all medications and now that medical marijuana is legal in Arizona so this should be included as well. In many specialties marijuana shows promise of being a well tolerated medication with positive outcomes. Nurse practitioners are at a disadvantage by not being able to have this medication as an option for patients.

    With marijuana being a scheduled I drug, as you stated, it might be difficult for this law to change to allow nurse practitioners to be granted the ability to prescribe it because, unfortunately, nurse practitioners often are granted rights after physicians are. Do you feel that if the classification of the medication was changed it would be easier for NPs to be allowed to prescribe marijuana? Also, there is now a discussion of whether or not recreational marijuana should be allowed in Arizona. Do you think this new push for that will affect the NP scope of practice regarding marijuana at all? If marijuana was made legal for recreational use then the positive benefits of it in the medical world might not be as prominent.

    Reference:
    American Association of Nurse Practitioners. (2014). Interactive nurse practitioner scope of practice guide. Retrieved from http://www.bartonassociates.com/nurse-practitioners/nurse-practitioner-scope-of-practice-laws/.

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    1. Hi Andrea,
      I think that we need to send a letter to an appropriate professional nursing organization or advocacy group such as the American Academy of Nurse Practitioners or the Marijuana Policy Project to write letters to congress to make an amendment to the medical marijuana legislature in Arizona to put in the definition of a nurse practitioner or “healthcare provider” to include other groups such as physician assistants to be able to “recommend” or “certify” patients to legally buy marijuana from dispensaries or from their designated caregiver.
      I haven’t researched too much about the new bill for legalization of marijuana for recreational use in Arizona and it is a very complex issue. I personally do not want recreational use to be legalized. They want it to be regulated like alcohol. How many kids in middle school and high school are already offered to try alcohol or marijuana? I am concerned that if we legalize marijuana for recreational use, people will start to think that it is not a real drug, like how we view alcohol and tobacco. It is a very big decision to make and we should not rush it.

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      1. Lynn,
        I agree with you that legalization will harm those who use it for medical purposes because how many people say alcohol can help with medical problems? Nobody does and marijuana will be in the same class. I also agree fully that adolescents already are offered it way too much and that will only make it worse.

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  2. Lynn – I think this is great that you are addressing this health care policy. Being a nurse on the oncology/BMT floor at Mayo I took care of so many patient that would benefit from using medical marijuana for chemotherapy induced nausea and vomiting. Mayo took a stand where they would not support their patients for the use of medical marijuana for symptom management. I found this to be extremely disappointing for the Mayo medical community and doing their patients a huge disservice. Being trained as RNs and being on the forefront and seeing how nausea and vomiting can effect our patients first hand is even more of a reason why advanced practice nurses should be able to certify patients for medical marijuana use. Most times common antiemetics are not effective for the chemotherapy induced nausea and vomiting and what did work was a benzodiazepine like Ativan which would make patients extremely fatigue and do nothing for appetite. Medical marijuana is effective in nausea and vomiting and increasing appetite. It is interesting to know that ANA does support this health policy.

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  3. I find it interesting that an individual with a medical marijuana card can have marijuana on them during a medical emergency requiring hospitalization (involving police enforcement, like with any emergency), and not have their marijuana seized, but when taken to the hospital, the hospital staff states that they cannot have the “medicine” with them while in the hospital due to federal restrictions, etc. Such a double standard… and you’d think the police would be the authorities with the harsher viewpoint.

    I agree with Lynn’s initiation of submitting a letter to a professional nursing agency; a fantastic and necessary proposal. As one of the professors stated in immersion Friday afternoon, it is up to us (individuals with distinguished backgrounds and credentials) to make a stand for the health care innovation we wish to see occur. I urge you, too, to make this step forward in writing a letter to recommend change.

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