Health policy

HEALTH POLICY 14

Table of content

Policy description

Problem statement

Literature review summary

Research methodology

Discussion

Study results

Arguments for and against the bill

Impact

Critical appraisal

Relevance in nursing

Conclusion

References

Recently, a proposal to add post-traumatic stress disorder to a listof conditions that qualify PTSD patients to become medical cannabispatient was filed in New Jersey. Assembly members Vincent Mazzeo andLinda Stender sponsored the assembly bill no. 3726. It was introducedto the assembly health and senior services committee on 22ndSeptember 2014 for scrutiny and its currents state is pending. Themove to pass this bill would be in line with science that foundcannabis and its compounds helpful in treating PTSD (thejointblog,2014).

PTSD is a psychological mental condition triggered by a traumaticevent such as rape, assault, physical abuse, emotional torture,neglect, terrorism attacks, childhood abuse combat exposure or anyextreme and life threatening situations. The memories of the painfulevents recur on a patients mind as symptoms like severe anxiety,emotional distress, uncontrollable thoughts of the events,nightmares, flashbacks, physical symptoms and feelings of numbness,detachment leading to self-destructive behavior occur. In extremecases, the patients go into a depression and have suicidal thoughtsor attempts if not treated. Due to the complexity of this medicalcondition, developing a health policy bill that will help PTSDpatients recuperate and get better is crucial.

PTSD is a medical condition that affects 7.7 million peopleaccording to NIH (national Institute of health). It can affect anypopulation including children, adults and the elderly. It does notselect any population with those who have gone through extremelytraumatizing conditions being most vulnerable. The use of medicalmarijuana was found to be a promising target for innovativeintervention strategies through a government-funded study using humantrials. According to thejointblog (2014), the journal ofNeuropsychopharmacology published similar findings on the study oftreating PTSD through cannabinoids. As a result, passing this billinto law will be useful and help the state of New Jersey treat PTSDto qualifying patients.

Policy Description

The bill if enacted by the senate or New Jersey’s general assemblywill offer medical solutions to qualifying PTSD patients. It is anact concerning medical marijuana and amendment of PL 2009, c.307bill. Section 3 of PL 2009 will be amended to read as follows. Theterm bona-fide physician patient relationship implies an ongoingrelationship in which a doctor has an ongoing responsibility forcare, assessment and treatment of debilitating medical condition of apatient. Certification implies a signed statement by a physician.Thus attests to the physician’s authorization for a patient toapply for medical marijuana use. Once passed the act shallimmediately take effect facilitating the treatment of PTSD toqualifying patients.

Problem statement

The rising numbers of PTSD patients is a health issue of concern. Asa result, the need to come up with a health policy or medicalsolution that authorizes medical marijuana for qualifying PTSDpatients is dire. The proven health benefits of marijuana forqualifying PTSD patient my just be the solution to end the list ofdebilitating medical conditions related to PTSD.

Literature review summary

Medical marijuana use has qualifications that patients need to meetbefore being allowed to access the treatment. To qualify for medicalmarijuana for example, PTSD patient’s symptoms would have to beresistant to conventional medical therapy. This therapy combinespsychotherapy with antidepressants and anxiety medications. Forauthorization of medical marijuana, patients would have to meet otherrequirements of the use medical marijuana act of New Jersey. Theserequirements include obtaining certification of the patient’scondition from a physician with whom the patient has a bona-fiderelationship.

Research methodology

The interview method of research best suites this research. Lists ofinterview questions and emails to the senate were written, compiledand filed.

Email sent to the senator

To the Senator,

New Jersey

It with great honor that I am writing to you this email regarding aproposed bill that will transform and improve many lives in NewJersey. I am a healthcare provider from one of the leading hospitalsin New Jersey of which I will not disclose for ethical purposes.Having been in the medical field for one decade has let me see andexperience the pain of many patients especially those suffering frompsychological conditions like PTSD. Many medical conditions resultfrom psychological conditions leaving patients devastated and unableto go on with life normally. However, with the recent proposal oflegalizing medical marijuana many patients will benefit and havetheir psychological conditions treated. Kindly go through the billproposal and give it your support as New Jersey citizens haveeverything to gain through making the bill a law.

Thank you,

Yours faithfully, concerned healthcare provider

Question list

a. I understand that you areworking on Bill No. 3726entitled use of medical marijuana for PTSD.Could you tell me your role thus far in the process? Yesb.I see that this Bill has been on the table for __2months__months, when do you expect this legislation to go forward? SoonWhat is the next step?Approval from congressc.Who are the proponents of this Bill? Healthcare givers and relatives or friends of people suffering from PTSD .What is the majorimpetus to getting this Bill passed? PTSDmedical benefit.What arethe major barriers to getting this Bill passed? Pasttarnished image of marijuanad.You might want to interject that as a healthcare provider you feelstrongly about as ahealthcare provider I feel that this bill will be successful.how do you feel about this? Itwill help improve PTSD conditions which contribute to many challengesfor patients and care givers.e.Will my interest in contacting him/her make a difference on hisdecision-making related to this Bill and why. No.If the bill is authentic, it will be approved.f.What can be done to make this Bill go further or stop it from beingpassed? Nothingg.Is the bill likely to be passed? Yes

Responses

a. Our role as the senate is toweigh the bill and find its validity and on finding good reasonsapprove or reject it.

b. The bill was tabled sinceSeptember 22ndthis year and we expect it to go for legislation soon. Itslegislation may not be difficult as there exists a similar billconcerning medical marijuana PL 2009, C.307 that is also beingamended.

c. The proponents of this bill areto start with its sponsor’s assemblyman Vincent Mazzeo and assemblywoman Linda Stender as well as health practitioners and relatives ofpeople suffering from PTSD medical conditions. The major impetus togetting this bill passed is its medical benefits. For years, cannabishas been associated to drug abuse and negative effects leading tocriminal behavior. Its past records of an abused drug pose as athreat to getting the bill passed. A possibility for marijuana tohave medical benefits due to its tainted image was unimaginable. Thecontroversy behind the use of medical marijuana to treat PTSD makesthe bill more exciting.

d. Healthcare providers areconcerned for PTSD patients especially when dealing with a drug likemarijuana. Healthcare providers want to give their patients the bestand the thought of using an illegal drug like marijuana does notsound right. Marijuana is still not legalized in some states. Thefact that it has been labeled and is associated with criminalbehavior makes it impossible for healthcare providers to believe thatit will treat patients appropriately. However, to confirm thevalidity and qualifications of cannabis for PTSD medical conditions,it has been tested and proven to work. Several researches using humantrials have shown positive results as other studies published similarconclusions that found cannabinoids to treat PTSD. The positiveresults have reassured healthcare providers that patients will besafe using this drug to treat PTSD.

e. The interest in contacting thesenate does not make any difference on the decision that they willmake regarding this bill. If the bill proves its authenticity andpotential benefits to the department of health, the senate will votefor its approval.

f. Nothing much can be done to makethe bill go further as it has all the relevant facts stated. If it isgenuine, its facts and past researches will speak for it. The medicalbenefits it is also likely to offer cannot be measured with anythingelse. Approving the bill is the only way to go.

g. The chances of the bill beingapproved are higher than rejection. To start with, a similar bill waspassed in 2009 and thus this one seems to be more of an amendmentthan a new bill. With 7.7 million people suffering from PTSD, a direneed for medical intervention at all costs has to be taken.

Discussion to date of the proposed bill

To date, the proposed bill has evoked numerous discussions.Marijuana has for years been termed as a drug that influences vicesand bad behaviors especially amongst the youth. Crime behavior andlaw breaking youths admit to abusing marijuana at some point in theirlives. This has significantly ruined the image of marijuana, which islisted as one of the drugs commonly abused and sold in the blackmarket. Marijuana is banned and illegal in some states with its usersfacing serious criminal charges. Due to such reasons, the proposal ofa bill that proposes medical marijuana for qualifying patients withPTSD is questionable. There are many reasons why healthcare providersand relatives of PTSD patients feel concerned about using medicalmarijuana bearing in mind that it is not just any other medical drugor prescription. To date the bill has raised many questions but withits proven validity through medical researches on humans, seems to begaining momentum. So far as a proposed bill nothing much has beendone. It was just introduced on 22nd September this yearand referred to the assembly health and senior services committee.

Study results

Several study results on human trials have proven that cannaboidsmay serve as a promising target for innovative interventionstrategies of PTSD. According to Hareetz (2014),the findings of astudy conducted at Haifa university on rats revealed that marijuanamay be effective in treating PTSD symptoms. The study findingssuggested that connectivity with the brain fear circuit after atraumatic experience and the administration of cannaboids preventsthe change from happening. According to this study, understanding thebrain basis and trauma association to receptors and emotionalprocessing is crucial. The positive effects of cannabis on PTSD thussupports the necessity to perform research and examine ways ofpreventing the development of PTSD.

Dr. Mechoulam identified the psychoactive compound (THC) inmarijuana. The Israeli scientist also later discovered the brainsendocannabinoid, endogenous neurotransmitter. In his study, hediscovered anectodal evidence on the use of therapeutic cannabis toimprove the quality of life for PTSD patients and their relatives.Cannabis THC treats PTSD through providing symptomological relief.According to Mechoulam, oral cannabis produces stable blood levels. Aresearch conducted on veterans who failed to show improved results onusing approved treatment showed positive results.

Argument for and against bill

Arguments for the bill state that given the chance, theauthorization of the medical marijuana for qualifying PTSD patientscould be what physicians have been looking for. With millions ofpeople suffering from PTSD, what better solution that medicalmarijuana. It has been tested and proved valid. PTSD is a conditionthat incapacitates people subjecting them to a life of fear.Following that, they are unable to be productive and go on with lifenormally. This lowers the economic stability of a state and decreasesthe capacity of work. Most people who suffer from PTSD were formerveterans and their inability to continue serving their states due toPTSD is a loss to the entire nation. With medical marijuana, suchveterans can get cured and continue with their mission of protectingthe state. Since the treatment will only be issued to qualifiedpatients there is also a minimal risk of administering the drug topatients who are not suffering from PTSD greatly reducing any medicalerrors.

The cons of this bill are largely associated to marijuana’s pastrecords and reports. With its association to crime and illegal use,law enforcers and care providers find it difficult to believe that itcan be useful for medical purposes. Creating awareness andestablishing trust for medical marijuana to be successful isimperative. People need to know that it can also be used for medicalpurposes and inform others about its medical purposes. The lawenforcers also need to work hard in ensuring that marijuana is notmisused or abused. This will be possible if they arrest those abusingit and employ strict rules against misuse of the herb. It will alsoreduce the misconceptions and negative attitude people have againstmarijuana.

Health status, access to care, health disparities and costeffectiveness of the policy addressed (impact)

According to this bill, a patient who is qualified for medicalmarijuana must be suffering PTSD having been diagnosed by a qualifiedphysician with a certification from the physician too. Requirementsof the New Jersey compassionate use and medical marijuana should bemet as well. The patient would have to be resistant to conventionalmedical therapy to qualify for medical marijuana. The treatmentgenerally combines psychotherapy anti anxiety medications andantidepressants. According to legiscan (2014) debilitating medicalcondition implies to conditions such as PTSD, epilepsy, intractableskeletal muscular spasticity or glaucoma. It also means conditionslike severe chronic pain, cachexia, severe nausea or vomiting,wasting syndrome from the treatment condition, positive status forHIV, cancer, terminal illness if a determined prognosis of less than12 months is given by the physician or any other medical conditionapproved by the regulation department. Access to care for suchpatients will be possible if the bill passes.

Section 2 of the New Jersey controlled dangerous substance actdefines Marijuana and medical marijuana. Here health disparities aredescribed as alternative treatment is defined as an organizationapproved by the department for activities qualifying patients withusable marijuana and related issues according to the acts provisions.Medical use of marijuana is the acquisition, possession andtransportation of marijuana by a registered qualifying patient as theact authorizes. A physician is a licensed person to practicemedicine, medical treatment and surgery with whom the patient has abona-fide relationship. The physician is a primary care giver in ahospice responsible for ongoing treatment of the patient’sdebilitating medical condition as long as the ongoing treatment isnot limited to provision of a patient’s authorization to usemedical marijuana and consultation solely for that purpose. A primarycare giver is a term used to define a resident who is at least 18years old, has agreed to help with registered qualifying patient’smedical marijuana use and is not the qualifying patient’sphysician. The primary caregiver has never been convicted ofpossession or sale of controlled and dangerous substance, hasregistered with the department pursuant of section 4 of this act andsatisfied criminal history record background checks, has beendesignated as the primary caregiver for a qualifying patient. Aqualifying patient means a resident of the state provided withcertification by a physician pursuant to a bona-fide physicianpatient relationship. Usable marijuana means the flowers, driedleaves or any mixture thereof excluding seeds, stems roots and thestalk of the plant according to (PL2012, c.17, s.9). The impact ofthe health bill has been discussed in the pros and cons above. Thebill aims at improving the health policy in New Jersey and creatingroom for medical intervention for PTSD conditions.

Critical appraisal of the bill as compared to the US policy healthcare system

America’s attitude towards marijuana in the recent years has beenshifting slowly but surely. There was a time that no debate aboutsuch a drug would be raised but today polls indicate that a majorityof people in the US actually support legalizing it. In 2012,Washington and Colorado legalized marijuana. So far, more thaneighteen states have legalized marijuana and 23 states have passedlaws in support of medical marijuana. The benefits of medicalmarijuana are numerous and no wonder decriminalizing it comes soeasily in many states. For legislatures that have been slow tosupport the drug, advocates have taken action to push for vote ballotmeasures. This month alone three states will decide whether tolegalize marijuana. Others will decide whether to legalize medicalmarijuana programs soon.

This bill differs from recreational reasons that parts of US haveused to legalize marijuana. It supports US policy of health care andseeks to come up with suitable medical interventions for a conditionthat is affecting millions of Americans. If passed it will bebeneficial for many states and help solve a medical crisis that hascontinually been a challenge. It will also serve as an eye opener forother drugs to be tested and proven if they have medical benefits ornot.

Relevance in nursing or advance nursing practice

The relevance of this bill in nursing is massive. It is not only acure to medical challenges that nurses have dealt with for decadesbut also comes at a time when alarming situations are causingincreased PTSD cases. There thus is a need for advance nursingpractice to embrace and work with medical marijuana once it isapproved as a solution to treating qualifying PTSD patients.

Conclusion

Authorizing medical marijuana for PTSD patients who qualify has morepros than cons. Post traumatic stress disorder has been defines as amedical mental condition triggered by past traumatic experiences. Itssymptoms include anxiety, fear, emotional distress, nightmares,hallucinations leading to engaging in serious self-destructivebehavior or suicide. As a result of its extreme effects PTSD,incapacitates those affected leaving them to a life that isunproductive. With PTSD, it is impossible to deal with life issues orlive a normal life as one is always afraid of the past traumaticexperiences and feels detached to other people. Treating PTSD iscrucial for health departments and the entire state as large. Severalresearches on marijuana have shown that the drug has elements thatcan be useful in treating PTSD. Due to its medical benefits, VincentMazzeo and Linda Stender sponsored the bill to authorize medicalmarijuana for qualifying PTSD patients. With is many health benefitsin treating PTSD, the medical marijuana bill may go through approvalsuccessfully. Other states have already passed such medical programsinto laws in the US.

References

Hareetz, L. (2014). Study: Marijuana could be effective intreating PTSD, research on rats at Haifa university, science andmedicine, Cheshvan, 8 5775.

Legiscan (2014). Assembly no. 3726, State of New Jersey 216thlegislature, retrieved from http://www.njleg.state.nj.us/2014/Bills/A4000/3726_I1.HTM

Mechoulam, R. (2010). Veterans for medical Cannabis access,assuring we leave no soldier behind, fromhttp://veteransformedicalmarijuana.org/content/general-use-cannabis-ptsd- symptoms

Thejointblog.(2014). New Jersey: Bill filed to add PTSD asqualifying medical cannabis condition, news word press fromhttp://thejointblog.com/new-jersey-bill-filed-add-ptsd-q ualifying-medical-cannabis-condition/