The Current State of Medical...
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Transcript of The Current State of Medical...
The Current State of Medical Marijuana
(Anne) Kate Eby, MN, APRN, ONC, FNP-C
The Current State of Medical Marijuana
• Two distinct debates
– Need to be clear about which one we’re discussing and (possibly) supporting
• Why do APRNs need to be familiar with medical marijuana?
DEA schedules for controlled substances
• Drugs in schedule I have no accepted medical use and may not be prescribed, administered, or dispensed for medical use
• Drugs in schedules II-V have some accepted medical use and may be prescribed, administered, or dispensed for medical use
Schedule I
• No currently accepted medical use, lack of accepted safety for use under medical supervision, high potential for abuse
• Examples:– Heroin
– LSD
– Peyote
– Ecstasy
– Marijuana
The 1999 IOM Report – Does it support medical marijuana?
• According to the DEA, it does not:– “The Institute of Medicine conducted a
comprehensive study in 1999 to assess the potential health benefits of marijuana and its constituent cannabinoids. The study concluded that smoking marijuana is not recommended for the treatment of any disease condition. In addition, there are more effective medications currently available. For those reasons, the Institute of Medicine concluded that there is little future in smoked marijuana as a medically approved medication”
The 1999 IOM Report – Does it support medical marijuana?
• Is that all it says about smoked marijuana? – “Until a nonsmoked rapid-onset cannabinoid drug
delivery system becomes available, we acknowledge that there is no clear alternative for people suffering from chronic conditions that might be relieved by smoking marijuana, such as pain or AIDS wasting”
– They make very clear and strict recommendations for the use of smoked marijuana… which the current use does not follow.
The 1999 IOM Report – Does it support medical marijuana?
• “For patients such as those with AIDS or who are undergoing chemotherapy and who suffer simultaneously from severe pain, scientific studies support medical use of marijuana for treatment in the United States”
• “Dependence among marijuana users is relatively rare and dependence appears to be less severe than dependence on other drugs”
The Disconnect between the schedule and the evidence
• A schedule I drug has no currently accepted medical use, lack of accepted safety for use under medical supervision, high potential for abuse
• “For patients such as those with AIDS or who are undergoing chemotherapy and who suffer simultaneously from severe pain, scientific studies support medical use of marijuana for treatment in the United States”
• “Dependence among marijuana users is relatively rare and dependence appears to be less severe than dependence on other drugs”
What do our professional organizations say?
• They overwhelmingly support access to medical marijuana and/or further study into the benefits of medical marijuana
American Nurses Association
• The American Nurses Association supports: – “The education of registered nurses and other
health care practitioners regarding appropriate evidence-based therapeutic use of marijuana including those non-smoked forms of delta-9-tetrahydrocannabinol (THC) that have proven to be therapeutically efficacious”
– “Protection from criminal or civil penalties for patients using medical marijuana as permitted under state laws”
American Nurses Association
• The American Nurses Association supports:
– “Exemption from criminal prosecution; civil liability; or professional sanctioning, such as loss of licensure or credentialing, for health care practitioners who prescribe, dispense or administer medical marijuana in accordance with state law”
– “Reclassification of marijuana’s status from a Schedule I controlled substance into a less restrictive category”
– “Confirmation of the therapeutic efficacy of medical marijuana”
American College of Physicians
• “ACP supports programs and funding for rigorous scientific evaluation of the potential therapeutic benefits of medical marijuana and the publication of such findings”
• “ACP encourages the use of nonsmoked forms of THC that have proven therapeutic value”
• “ACP supports the current process for obtaining federal research-grade cannabis”
American College of Physicians
• “ACP urges an evidence-based review of marijuana's status as a Schedule I controlled substance to determine whether it should be reclassified to a different schedule. This review should consider the scientific findings regarding marijuana's safety and efficacy in some clinical conditions as well as evidence on the health risks associated with marijuana consumption, particularly in its crude smoked form”
American College of Physicians
• “ACP strongly supports exemption from federal criminal prosecution; civil liability; or professional sanctioning, such as loss of licensure or credentialing, for physicians who prescribe or dispense medical marijuana in accordance with state law. Similarly, ACP strongly urges protection from criminal or civil penalties for patients who use medical marijuana as permitted under state laws”
American Public Health Association
• “Encourages research of the therapeutic properties of various cannabinoids and combinations of cannabinoids”
• “Encourages research on alternative methods of administration to decrease the harmful effects related to smoking”
• “Urges the Administration and Congress to move expeditiously to make cannabis available as a legal medicine where shown to be safe and effective, and to immediately allow access to therapeutic cannabis through the Investigational New Drug program”
American Medical Association
• “Our American Medical Association (AMA) calls for further adequate and well-controlled studies of marijuana and related cannabinoidsin patients who have serious conditions for which preclinical, anecdotal, or controlled evidence suggests possible efficacy and the application of such results to the understanding and treatment of disease”
American Medical Association
• “Our AMA urges that marijuana’s status as a federal Schedule I controlled substance be reviewed with the goal of facilitating the conduct of clinical research and development of cannabinoid-based medicines, and alternate delivery methods. This should not be viewed as an endorsement of state-based medical cannabis programs, the legalization of marijuana, or that scientific evidence on the therapeutic use of cannabis meets the current standards for a prescription drug product”
American Medical Association
• “Our AMA urges the National Institutes of Health (NIH) to implement administrative procedures to facilitate grant applications and the conduct of well-designed clinical research into the medical utility of marijuana…”
• “Our AMA believes that effective patient care requires the free and unfettered exchange of information on treatment alternatives and that discussion of these alternatives between physicians and patients should not subject either party to criminal sanctions”
Where does everyone agree?
• Cannabis has the potential to be beneficial for patients suffering from severe pain and/or severe chronic illness
• Marijuana should be reclassified from a schedule I substance to a less restrictive schedule to allow for further study of its therapeutic benefits
How does a drug get rescheduled?
• Petition the DEA
• Through the legislative or executive branch
• United States Attorney General could reschedule administratively
– The Attorney general may rule to “remove any drug or other substance from the schedules if he finds that the drug or other substance does not meet the requirements for inclusion in any schedule”
References
• American College of Physicians. Supporting Research into the Therapeutic Role of Marijuana. Philadelphia: American College of Physicians; 2008: Position Paper. (Available from American College of Physicians, 190 N. Independence Mall West, Philadelphia, PA 19106.)
• American Medical Association. (2009). Report 3 of the Council on Science and Public Health. Retrieved from: http://www.ama-assn.org/ama1/pub/upload/mm/443/csaph-report3-i09.pdf
• American Nurses Association. (2008). In support of patients’ safe access to therapeutic marijuana. Retrieved from: http://www.nursingworld.org/MainMenuCategories/EthicsStandards/Ethics-Position-Statements/In-Support-of-Patients-Safe-Access-to-Therapeutic-Marijuana.aspx
References
• American Public Health Association. (1995). The American Public Health Association’s endorsement on medical marijuana.
• Drug Enforcement Administration. (2010). Controlled substances Act. Retrieved from: http://uscode.house.gov/download/pls/21C13.txt
• Drug Enforcement Administration. (2006). Practitioner’s manual: An informational outline of the controlled substances act. Retrieved from: http://www.deadiversion.usdoj.gov/pubs/manuals/pract/pract_manual012508.pdf
• Institute of Medicine. (1999). Marijuana and medicine: Assessing the science base. Full text available free at: http://books.nap.edu/openbook.php?record_id=6376&page=R1#
References
• Institute of Medicine. (1999). Marijuana and medicine: Assessing the science base. Full text available free at: http://books.nap.edu/openbook.php?record_id=6376&page=R1#
• Wikipedia. (2011). Removal of cannabis from Schedule I of the Controlled Substances Act. Retrieved from: http://en.wikipedia.org/wiki/Removal_of_cannabis_from_Schedule_I_of_the_Controlled_Substances_Act#Process
