Week Three: 1/26-2/1 The Basics: Definitions and Premise of Policy-Making

Since the US policy-making system is not perfect and it is influenced by other factors such as self-interest and interest groups instead of just what is best for the nation’s health, it is understandable why certain things are legal, such as alcohol and cigarettes, when they are known to be harmful for one’s health (Longest, 2010). Also, congressmen and women are re-elected every 2 years to represent their district and they may support certain propositions for their own gains (Longest, 2010).

In 2010, the national Marijuana Policy Project was the driving interest group behind legalizing medical marijuana in Arizona and donated $140,000 to support the campaign (BallotPedia, 2010). There was a lot more money put into the campaign for legalization of medical marijuana than what was spent to oppose Proposition 203. Voters were told that “marijuana is safer than alcohol” and “better than deadly painkillers.” Proposition 203 was passed in 2010 by roughly 4,000 votes, 50.1% of participants voted yes and 49.9% voted no (BallotPedia, 2010). I think that the initial intention to make medical marijuana available for those who really need it is justified. However, recent reports from the Arizona Department of Health (ADH) show that people who don’t need medical marijuana are getting it too. In addition, legalization of medical marijuana seems to be the gateway to propose legalization of marijuana for recreational use. Currently, four states have legalized marijuana for recreational use including Washington, Colorado, Oregon, and Alaska (Keller, 2015).The Marijuana Policy Project is now focusing their efforts on Arizona to make marijuana legal for recreational use. State Representative Mark Cardenas, D-Phoenix, recently introduced the bill that would legalize marijuana for recreational use and generate an estimated $48 million annually from tax revenue (Rau, 2015). This is just one example of how bills are not made in the best interest of the nation’s health and are intended to generate income at the expense of one’s health.

Since legalization of medical marijuana, William Humble, the director of the ADH, states that part of their medical marijuana program is actually recreational (Fischer, 2015). The Arizona Medical Marijuana Act End of the Year Report from the ADH indicates that 71% of patients have a medical marijuana card in Arizona for severe and chronic pain and roughly 2% or less is used for all other conditions, patients ages 18-30 are the ones buying the most marijuana, and the most marijuana was purchased on New Year’s Eve in 2014 (Arizona Department of Health Services, 2014). In addition, the 2014 Arizona Youth Survey reports that about 10% of students are getting marijuana from medical marijuana card holders (Harrison, 2014). Medical marijuana card holders are allowed up to 2.5 ounces of marijuana every 2 weeks, but this amount is actually enough to smoke one joint a day for 4-6 months (Green, 2014). It is possible that patients with medical marijuana cards are distributing their excess marijuana illegally to others.

References

Arizona Department of Health Services. (2014). Arizona Medical Marijuana Act (AMMA) end of year report. Retrieved from http://www.azdhs.gov/medicalmarijuana/documents/reports/2014/arizona-medical-marijuana-end-of-year-report-2014.pdf

BallotPedia. (2010). Arizona medical marijuana question, proposition 203 (2010). Retrieved from http://ballotpedia.org/Arizona_Medical_Marijuana_Question,_Proposition_203_(2010)

Fischer, H. (2015). Report: Arizona patients consumed 10 tons of medical marijuana in 2014. Retrieved from http://azcapitoltimes.com/news/2015/01/15/report-arizona-patients-consumed-10-tons-of-medical-marijuana-in-2014/

Green, J. (2014). How many joints are in an ounce of marijuana? Retrieved from http://www.theweedblog.com/how-many-joints-are-in-an-ounce-of-marijuana/

Harrison, B. (2014). Arizona youth survey. Retrieved from http://azcjc.gov/ACJC.Web/sac/AYSReports/2014/2014%20Arizona%20Youth%20Survey%20State%20Report.pdf

Keller, J. (2015). The map is going to make marijuana legalization advocates very, very happy. Retrieved http://mic.com/articles/109270/this-map-is-going-make-marijuana-legalization-advocates-very-very-happy

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

Rau, A. (2015). Arizona lawmaker proposes legalizing pot. Retrieved from http://www.azcentral.com/story/news/arizona/politics/2015/01/06/arizona-lawmaker-proposes-legalizing-pot/21371767/

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6 thoughts on “Week Three: 1/26-2/1 The Basics: Definitions and Premise of Policy-Making

  1. This is such an important topic! I had never looked into the regulations regarding our ability as NP’s to prescribe cannabis, and was not aware we do not have authority to do this. It has been a concern of mine as a soon to be psychiatric/mental health NP how I will handle legalization of recreational marijuana use if it happens. Marijuana is such a common drug used among those with mental health issues, and at times, it can help to a certain extent, but most times creates more issues with the patients. It is so easy to obtain today, and I have seen many times patient’s claiming that “at least I am using medicinal marijuana” when in fact they don’t have a card themselves. So it goes to show, and it is not so surprising, that those with cards are frequently dispersing their quantity with others. I am curious, however; about the reverse psychology associated with legalizing it. Will there be a matter of stigma that marijuana loses when it is legalized for recreational use?

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  2. Lynn, I am curious about the quantity guidelines in the current legislation. How was the 2.5 oz every 2 weeks guideline determined? Given the myriad ways of using marijuana, might approaches other than smoking require larger quantities of the substance?

    I am also wondering about the New Year’s Eve statistic. Is marijuana an allowable expense for HSA or FSA spending? Is it possible that some percentage of late December marijuana purchases might represent an effort to “use up” those last HSA dollars before they expire at the end of the year?

    You raised an important issue about the relative dearth of evidence related to medical marijuana, and the need to extrapolate meaning from circumstantial evidence. How does this impact the policymaking effort?

    HMR

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    1. Hi Dr. Ross,

      Every state has its own possession limit and ranges from 1 oz to 24 oz and from 2 weeks to 60 days (Medical Marijuana Pros and Cons, 2015). For example, in Massachusetts, a patient may possess up to 10 ounces of marijuana every 60 days. A police officer states that this amount is enough for 300-400 joints of marijuana (Eagan, 2014). However, advocates state that 10 ounces will cover all methods of administration for all ailments (Handy, 2014). In California, there was a court case that could not set limits on medical marijuana possession, because it was considered an unconstitutional amendment after voters approved The Compassionate Use Act (Dorman, 2010). There is also not that much evidence out there on how much marijuana is needed for smoking verses eating. It is difficult to regulate marijuana and the dosage, because every crop varies in potency and there are many different strains of marijuana (Dorm, 2013). In addition, marijuana is not covered by HSA or FSA because these accounts are regulated by the IRS and marijuana is illegal under federal law (Caron, 2010; Wells, 2010). The Arizona Revised Statues Section 36-2814 states that, “Nothing in this chapter requires a government medical assistance program or private health insurer to reimburse a person for costs associated with the medical use of marijuana” (KEYTLaw, 2010). Lastly, strategies and interventions can be developed based on trend extrapolation. Trend extrapolation is used in policy-making to predict the future state of society based on historical and current policy problems or trends (Longest, 2010).

      References
      Caron, P. (2010). You can’t buy medical marijuana with pre-tax dollars from your HAS. Retrieved from http://taxprof.typepad.com/taxprof_blog/2010/08/you-cant-buy-medical-marijuana-.html
      Dorm, D. (2013). Understanding different cannabis strains. Retrieved from http://www.medicaljane.com/2013/12/03/learn-how-different-strains-of-cannabis-affect-you/
      Dorman, G. (2010). Medical marijuana possession has no limits. Retrieved from http://www.criminaldefenseduilawyer.com/medical-marijuana/medical-marijuana-possession-has-no-limits/
      Eagan, J. (2014). Concerns grow over Massachusetts medical marijuana limits. Retrieved from http://medicalmarijuana.procon.org/view.resource.php?resourceID=000881
      Handy, N. (2014). Marijuana possession limits under debate in MA. Retrieved from http://www.golocalworcester.com/news/marijuana-possession-limits-under-debate-in-ma
      KEYTLaw. (2010). ARS 36-2814. Retrieved from http://www.keytlaw.com/arizonamedicalmarijuanalaw/the-mmd-law/ars-%c2%a7-36-2814/
      Longest, B. (2010). Health policymaking in the United States. (5th ed.). Arlington, VA: Association of University Programs in Health Administration.
      Medical Marijuana Pros and Cons. (2015). 23 legal medical marijuana states and DC. Retrieved from http://medicalmarijuana.procon.org/view.resource.php?resourceID=000881
      Wells, J. (2010). Should your HAS pay for pot? Retrieved from http://www.cnbc.com/id/37087121#

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  3. Hello Lynn. Your post this week reiterated points that I have thought in my own mind. As a future Nurse Practitioner (NP), I am honestly relieved that we are not permitted to prescribe medical marijuana, as there is still more research that needs to be done to support or refute its therapeutic effectiveness. Yet, this is not fair to NPs who are lobbying for independent practice, as this limits their scope of practice. In Arizona, cigarettes are taxed at $2.00 per 20 pack (Arizona Department of Revenue, 2013). In Colorado, there is a 15% tax on recreational marijuana, but the tax rate on medical marijuana is one-third of that (Henchman, 2014). The cigarette tax is used by policy makers to discourage their use, yet policy makers are fine with profiting off marijuana use on the backs of their citizens. Delta9-tetrahydrocannabinol (THC) has been linked to impaired cerebellar function along with a host of other adverse effects (Stella, 2013). As a family member of my permanently disabled sister, who sustained her injury while under the influence of marijuana and alcohol, policy makers are failing to see how their attention to gaining revenue with marijuana has permanent ill effects on the health of the general population. However, we should not ignore the research that has supported the therapeutic effects of some components of marijuana. Cannabidiol (CBD) has shown very promising effects in treating epilepsy (Welty, Luebke, & Gidal, 2014). Therefore, some medical marijuana use is beneficial. This topic is ever-evolving and very interesting and though-provoking. I look forward to reading your future posts.

    References

    Arizona Department of Revenue (2013). Tobacco tax. Retrieved from http://www.azdor.gov/Portals/0/Brochure/541.pdf

    Henchman, J. (2014). Taxign marijuana: The Washington and Colorado experience. Retrieved from http://taxfoundation.org/article/taxing-marijuana-washington-and-colorado-experience

    Stella, N. (2013). Chronic THC intake modifies fundamental cerebellar functions. The Journal of Clinical Investigation, 123(8): 3208–3210. doi: 10.1172/JCI70226

    Welty, T.E., Luebke, A., & Gidal, B.E. (2014). Cannabidiol: Promise and pitfalls. Epilepsy Currents, 14(5): 250–252. doi: 10.5698/1535-7597-14.5.250

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  4. Lynn – You make some great points and have done a lot of recent research on this topic. However it seems like in this blog you are advocating for a health policy that goes against legalizing marijuana. In your prior blog I thought you were advocating that NPs would have the authority to prescribe medical marijuana. Are you worried that this would not be needed if they legalize marijuana in Arizona? I guess you have to make a decision on how much energy you should put into advocating your initial health policy if they will just end up legalizing marijuana anyway.

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