From what we have read from Kingdon (2011), we learned that the Affordable Care Act (ACA) had to be very strategically done. President Clinton tried to initiate a total health care reform in 1993. However this did not go over well, because there are many interest groups and stakeholders that need and want to be involved when planning a total health care reform. Also, there are many chances to veto a bill in this political culture and the bill has to go through every stage in the voting process. Furthermore, we have learned that when there is a problem and it involves policy and politics, then a window of opportunity opens to where it will be very likely that a bill will pass. This moment has to be acted on or else it may not be addressed again for a very long time (Kingdon, 2011).
The Arizona Medical Marijuana Act passed in 2010 and there is a debate going on now about legalizing marijuana for recreational use. I think that our window of opportunity is still there if nurse practitioners want to be included in the legislative language to certify patients for medical marijuana. The problem is that most physicians will not risk their licenses to certify patients for a federally illegal substance and there is not enough research out there on marijuana to be confident enough to recommend marijuana for therapeutic use (G. Mecagni, telephone interview, February 8, 2015 ). In addition, most patient’s providers are nurse practitioners and we aren’t legalized to certify patients for medical marijuana. Therefore, most patients have to go to certification mills to get certified. Unfortunately the certification mill probably doesn’t know the patient very well. This creates an environment where it is easier to get marijuana and receive protection under the law for substance abuse. If nurse practitioners were included in the legislative language, then we could help regulate medical marijuana more safely and efficiently, as well as decrease the stigma surrounding marijuana as a “dangerous drug.” According to Dr. Mecagni (February 8, 2015), an expert in the field of medical marijuana, the safety profile of marijuana is not as bad as some of our legal prescription drugs. Dr. Mecagni supports that it is not our place to assume that any patient is a drug seeker, but to use our prudent medical judgment to assist patients with finding a therapeutic regimen that works for them, especially if behavioral or other pharmaceuticals have not worked very well for them. Marijuana may be more effective for their condition considering the safety and side effect profile (G. Mecagni, telephone interview, February 8, 2015). For those of you who do not wish to recommend medical marijuana to patients, I want to assure you that in Arizona, physicians reserve the right to not participate in the Arizona Medical Marijuana Program and I believe this right will also be extended to nurse practitioners if we are legally allowed to certify patients for medical marijuana (Arizona Department of Health Services, n.d.).
If we were to initiate an amendment to the law, I believe that our best bet would probably be to contact the Marijuana Policy Project interest group to get in touch with a representative for our state. In this case, it would be Andrew Meyers. We would need to file for a petition with the Arizona Secretary of the State and get 225,962 signatures or 15% of the votes for the most recent gubernatorial election for the Arizona governor to make it onto the ballot (Ballotpedia, n.d.). I believe this would work, because this is how Prop 203 was passed in the first place. Otherwise, Andrew Meyers would probably have to work with a representative in the House or the Senate that is interested in making medical marijuana more readily available to patients such as Arizona House of Representatives, Mark Cardenas. Then we could make our case, however, there is a greater likelihood of it being vetoed. I believe this could work, because it is an incremental change/amendment.
Lastly, I think that nurse practitioners should still be able to certify patients for medical marijuana even if marijuana become legalized for recreational use. Patients still need to be supervised under the guidance and direction of their primary care provider when using marijuana for therapeutic uses. I don’t think that marijuana should be legalized recreationally, because as a health care provider, we are in it to help people, and I do not support the use of marijuana for fun in exchange for increased health risks and tax revenue.
Arizona Department of Health Services. (n.d.) FAQs: QP15: Is a licensed physician required to write medical marijuana certifications to a patient who has a chronic or debilitating condition? Retrieved from http://www.azdhs.gov/medicalmarijuana/faqs/index.php?pg=qualifying-patients
BallotPedia. (n.d.). Laws governing the initiative process. Retrieved from http://ballotpedia.org/Laws_governing_the_initiative_process_in_Arizona
Kingdon, J. (2011). Agendas, alternative, and public policies (2nd ed.). Glenview, IL: Pearson Education.