Week Seven 02/23/15-03/01/15: The Affordable Care Act as an Example of Public Policy Implementation

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.


Week Six 2/16-2/22: Public Sector Influence on Healthcare Policy: Efforts to Aid the Uninsured

The public sector is the part of the government, such as the US Department of Health and Human Services (HHS), US Department of Housing and Urban Development (HUD), US Department of Labor (DOL), US Department of Education, US Department of Agriculture, and US Department of Treasury, that tries to provide health care and public services for the poor, underprivileged, uninsured, underinsured, and disabled to decrease health disparities (Welfare Information, n.d.). In the United States, the government tries to provide programs to help people that have low or no income. Welfare programs include Medicaid, Medicare, Women, Infants, and Children (WIC), the Supplemental Nutrition Assistance Program (SNAP), Housing and Urban Development (HUD), Supplemental Security Income (SSI), Temporary Assistance for Needy Families (TANF), tax discounts such as Earned income Tax Credit (EITC), Child Welfare Services, Head Start, and Work Study (Welfare Information, n.d.). Welfare benefits and economic assistance includes food stamps, vocational rehabilitation, unemployment compensation, housing and utility benefits, health care services (medical, prescriptions, dental, vision), alcohol and substance abuse programs, child care assistance, and direct cash payments (Welfare Information, n.d., Kraft & Furlong, 2015). The purpose of welfare is to try to encourage people to move from welfare to work according to the 1996 Personal Responsibility and Work Opportunity Reconciliation Act signed by Bill Clinton (The Center for Media and Democracy, 2011). Poverty is defined as an annual income less than $23,850 for a family of four (Kraft & Furlong, 2015).

Since medical marijuana is not legal under the federal government, insurance does not cover it and it is not tax deductible (Campbell, 2014). However, people who participate in the Food Stamps or SNAP program do get a 50% discount on the cost of a registry identification card and the price is reduced from $150 to $75 for initial and annual renewal cards (Arizona Department of Health, n.d.). There is also no special tax on medical marijuana besides Arizona’s sales tax (Arizona Department of Health, n.d.). Medical marijuana in Arizona typically costs around $280-$400 an ounce out-of-pocket (GivingTree Wellness Center, 2015). A personal interview with Dr. Gina Mecagni (February 8, 2015), Medical Director of The Giving Tree Wellness Center, states that the costs to get a medical marijuana card are too high. Most patients have to pay an extra $150 on top of the state application to get a medical marijuana card to find a Medical Marijuana Evaluator, because most family physicians will not recommend medical marijuana (G. Mecagni, telephone interview, February 8, 2015). These visits usually cost $150 and are not covered by insurance (Hays, 2013).


Arizona Department of Health Services. (n.d.). Qualifying patients. Retrieved from http://www.azdhs.gov/medicalmarijuana/faqs/index.php?pg=qualifying-patients

Campbell, J. (2014). Is medical marijuana tax deductible? Retrieved from http://marijuanapatients.org/medical-marijuana-tax-deductible/

GivingTree Wellness Center. (2015). Phoenix menu: Flowers. Retrieved from http://www.givingtreeaz.com/product-category/phoenix-menu/flowers-phoenix-menu/

Hays, C. (2013). How to get a medical marijuana card in Arizona in 4 easy steps. Retrieved from http://blogs.phoenixnewtimes.com/jackalope/2013/09/get_medical_marijuana_card_arizona_mmj_weed.php

Kraft, M.E., & Furlong, S.R. (2015). Public policy: Politics, analysis, and alternatives (5th ed.). Thousand Oaks, CA: Sage.

The Center for Media and Democracy. (2011). 1996 personal responsibility and work opportunity reconciliation act. Retrieved from http://www.sourcewatch.org/index.php?title=1996_Personal_Responsibility_and_Work_Opportunity_Reconciliation_Act

Welfare Information. (n.d.). What is welfare state? Retrieved from http://www.welfareinfo.org/state/


According to Arizona Legislative Council (2003), health policy formation goes through three phases in the legislative process: formulation, implementation, and evaluation. The policy formulation phase includes drafting a bill in proper form and getting a legislator to sponsor your bill from either the House or the Senate. The bill is assigned a number and goes through the First Reading. The Speaker/President assigns the bill to the appropriate Standing Committee. The Standing Committee reviews the bill (e.g. holds hearings, expert testimonies, and statements) and makes amendments. The Rules Committee, composed of attorneys, makes sure that the bill is constitutional before it goes to the Whole House for the Second Reading. The Whole House is a floor debate and it is opened to the public. If the bill clears by the majority of a voice vote, then it is given to the Legislative Counsel for engrossing before the Third Reading. There are no more debates or amendments in the Third Reading and a formal vote is counted. If it passes, then the Speaker/President signs it and it goes to the other House/Senate to go through the whole process all over again. If the bill passes without amendments, then it goes to the Governor. If it has amendments, then it goes to the Conference Committee (with members from both the House and the Senate) so that both the House and the Senate can work together to agree on the amendments before passing it on to the Governor to sign. If the Governor does not sign the bill in 5 days, then it automatically becomes a law/statue or if the Governor vetos the bill, then the House and Senate may override the veto by two thirds vote (Arizona Legislative Council, 2003). Citizens may also petition for an “initiated state statute” so that the public can vote on the proposition or measure (BallotPedia, n.d.).

Once a statue has been passed, there is a 90 day period before the “general effective date” (Arizona Legislative Council, 2003). The 90 day period is to allow an opportunity for a veto referendum (BallotPedia, 2003). Next is the implementation phase where the statute or law is put into action through regulatory mechanisms by the state (Abood, 2007). In this case, the Arizona Department of Health Services (AZDHS) was put in charge to develop the policies, rules, and regulations for the Arizona Medical Marijuana Program.

The evaluation and modification phase is when policies are re-evaluated and may be amended, usually in an incremental fashion (Abood, 2007). The AZDHS usually holds an annual rulemaking review. Medical Marijuana was on the 2015 Regulatory Agenda to review Articles 1-3. However, the AZDHS is currently not conducting any rulemaking activities this year due to a rulemaking moratorium established by the Governor, Doug Ducey (Arizona Department of Health Services, 2015).

A personal interview with Dr. Gina Mecagni (February 8, 2015), an ER physician and Medical Director of several medical marijuana dispensaries in Arizona, states that if she could change anything about the Medical Marijuana Program, it would be allow dispensaries to be present in more populated areas. Pharmacies are not allowed to sell medical marijuana because they are regulated by the DEA (Morran, 2014). Therefore, patients have to travel to a remote, unpopulated, industrial area to pick up their medicine. Dr. Mecagni (February 8, 2015) points out the perpetuating stigma surrounding medical marijuana as patients with legitimate medical conditions have to pick up their medications in an undesirable area surrounded by barb wire, junk yards, and security dogs.

Lastly, if we wanted to change the legislative language in the Arizona Medical Marijuana Act (ARS 36-2801) to include nurse practitioners, we would have to go through the legislative process again and there would only be two ways. One would be if the state legislature votes for the amendment to be placed on the ballot, called a “legislatively-referred constitutional amendment” or if there is a petition to include this initiative on the ballot called an “initiated constitutional amendment” (BallotPedia, n.d.).


Abood, S. (2007). Influencing health care in the legislative arena. Retrieved from http://www.medscape.com/viewarticle/553404_3 

Arizona Department of Health Services. (2015). Office of administrative counsel and rules. Retrieved from http://www.azdhs.gov/ops/oacr/rules/index.htm

Arizona Legislative Council. (2003). Arizona legislative manual: Legislative procedure. Retrieved from http://www.azleg.state.az.us/alisPDFs/council/legman2003.pdf 

BallotPedia. (n.d.). Laws governing the initiative process. Retrieved from http://ballotpedia.org/Laws_governing_the_initiative_process_in_Arizona 

Morran, C. (2014). Why can’t you get medical marijuana at CVS or Walgreens? Reviewed from http://consumerist.com/2014/05/13/why-cant-you-get-medical-marijuana-at-cvs-or-walgreens/

Week Four 02/02 – 02/08: The Role of Institutions and Actors in Developing Healthcare Policies

There are many people involved in the development of health policy. Anyone who is affected by health policy is likely involved in health policy (Longest, 2010). According to Longest (2010), laws are vague and it takes many people to interpret and develop the rules and regulations, and involves judges, attorneys, and police forces to uphold the law and its original intent. Many modifications are made to the law as loopholes are discovered (Longest, 2010).

In Arizona, there are many actors involved in the marijuana debate including voters, citizens of Arizona, medical marijuana patients, their caregivers, dispensary owners, members of associations and organizations, advocates and anti-marijuana advocates, healthcare professionals, health researchers, interest groups, law-makers, judges, police officers, the governor and attorney general, the DEA, Arizona Department of Health Services, etc. There are so many, we will only be mentioning a few key players that are involved and a few loopholes that have been discovered.

Andrew Meyers is the spokesperson from the Marijuana Policy Project and the executive director of the Arizona Dispensary Association. He helped legalize medical marijuana in 2010 and was involved in the drafting of the law. He currently is working on getting legalization of marijuana for recreational use to be on the Arizona’s 2016 ballot (Stern, 2014).

Bill Montgomery is the Maricopa County Attorney and his job is to provide “legal representation for the County government on behalf of the people of Maricopa County, to provide a safe and well-governed community (Maricopa County Attorney’s Office, n.d.).” He is involved in reinforcing health policy. He has been known for prosecuting medical marijuana cardholders for narcotic possession if they have “edibles” that contain concentrates of marijuana, such as elixirs, oils, and butters that he states are not covered under Arizona law (Stern, 2013). Arizona’s Marijuana law (n.d.) states that “usable marijuana” is defined as “the dried flowers of the marijuana plant and any mixture or preparation thereof.” However, since a judge ruling in March 2014, extracts and edibles are now allowed to be sold in marijuana dispensaries (KJZZ News, 2014).

Will Humble is the director of the Arizona Department of Health Services and implements the law by drafting the rules and regulations of the Medical Marijuana Program. Recently Fischer from the Arizona Capitol Times (2014), reported that the Arizona Cannabis Nurses Association (AZCNA) petitioned for PTSD be added as a qualifying condition for medical marijuana. Initially, Will Humble did not want to add PTSD to the list of qualifying conditions since there was not enough evidence to indicate that marijuana helped treat symptoms of PTSD. However, Judge Thomas Shedden ruled in favor of the AZCNA and stated that Humble should listen to the anecdotal evidence presented by the medical community. Since January 1, 2015, PTSD is now a qualifying condition and patients with PTSD can be certified for medical marijuana (Fischer, 2014).

Lastly, according to Stern from Phoenix New Times (2012), Allan Sobol is one of many dispensary owners in Arizona and an operator of a “cannabis club” or “compassion club.” He also holds classes for people interested in starting their own medical marijuana dispensary. A cannabis club is a place where patients can share medical marijuana with other patients. Participants may pay a cover charge as much as $75 and inside they receive “free” marijuana or are asked for “donations” as much as $400 an ounce. Sobol states that his cannabis club is legal because the Arizona Medical Marijuana Act states that certified caregivers can be compensated for growing marijuana for their patients (Stern, 2012). Cannabis clubs are technically not illegal yet, but there have been many raids and arrests to make sure that people are not buying marijuana and that everyone there has a marijuana card.


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

Fischer, H. (2014). Health director: Arizonans may soon use medical marijuana legally for PTSD. Retrieved from http://azcapitoltimes.com/news/2014/07/09/health-director-approves-marijuana-for-veterans-and-others-with-ptsd/

KJZZ News. (2014). Health director considering patient education for edible medical marijuana. Retrieved from http://kjzz.org/content/33039/health-director-considering-patient-education-edible-medical-marijuana

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

Maricopa County Attorney’s Office. (n.d.). Retrieved from http://www.maricopacountyattorney.org/about-us/

Stern, R. (2012). Allan Sobol: Arizona’s medical-pot martyr? Retrieved from http://www.phoenixnewtimes.com/2012-08-16/news/allan-sobol-arizona-s-medical-pot-martyr/full/

Stern, R. (2013). Bill Montgomery is prosecuting a medical-pot patient for one piece of THC-infused candy. Retrieved from http://www.phoenixnewtimes.com/2013-11-07/news/bill-montgomery-is-prosecuting-a-medical-pot-patient-for-one-piece-of-thc-infused-candy/full/

Stern, R. (2014). Arizona marijuana-legalization campaign for 2016 ballot measure becomes officical http://blogs.phoenixnewtimes.com/valleyfever/2014/09/arizona_marijuana_legalization_campaign_for_2016_ballot_measure_becomes_off.php

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.


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/

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.


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.

Week One 1/12-1/18: Intro to the Health Policy Topic

Health Policy Topic

Should Nurse Practitioners be able to recommend Medicinal Marijuana to qualified patients?

Marijuana 101

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).

Topic Relevancy

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