Thursday, July 5, 2012

July Is Pivot Point For Scope Of AMMA Impact

The Arizona Medical Marijuana Act (AMMA) as adopted by the voters contained a limited universe of debilitating medical conditions that patients had to have to become Qualified Patients (QP)  legally authorized to possess and use cannabis. That universe included eight specific diseases and five symptoms that could be caused by any chronic disease or condition or the treatment of any of them.  Arizoneout detailed the specifics in a June 6, 2011 post.

But that universe was not static, as the AMMA itself requires a process where the citizens can petition the Arizona Department of Health Services (ADHS) to add new debilitating medical conditions for which medical pot use could be authorized.  ARS § 36-2801.01  The law requires ADHS to set rules for the consideration of such requests, and to act on them within 180 days.

The rules ADHS created allow it to designate a very short window in which ADHS will accept petitions in January and July of each year.  The first such window was open for five days at the end of January 2012, and ADHS received a number of petitions during that window. 

Per ADHS rule, the petition had to include: 
  1. evidence that the medical condition impairs the ability of the individual to accomplish activities of daily living;
  2. evidence that marijuana provides a therapeutic or palliative benefit for the condition; and
  3. whether conventional medical treatments provide a benefit for the medical condition.
Petitioners also had to submit supporting data from peer-reviewed scientific journals.

ADHS' medical review team made a preliminary decision that four of the petitions had enough evidentiary support to warrant a full hearing.  ADHS accepted on-line public comments, and conducted a public hearing on those four petitions on May 25, 2012.  The decision is due by the end of July.

Of the original debilitating conditions in the AMMA − the ones we have been operating with for more than a year − the one the overwhelming majority of QPs cite in their applications is chronic pain.  That condition, which is extremely subjective and, some would say, easily faked, has been cited by nearly 89% of the nearly 31,000 applications ADHS has received so far.  The next most prevalent condition is muscle spasms, at nearly 14%, and nausea, at just over 10% of applicants.  Like chronic pain, muscle spasms and nausea are largely self-reported and subjective.  In other words, a recreational user could fake it easily enough, especially with the help of a cooperative physician.

The four conditions currently under consideration arguably fall in the same category as chronic pain, muscle spasms, and nausea.  The pending petitions seek to add post-traumatic stress disorder, depression, migraines, and generalized anxiety disorder to the list of eligible debilitating medical conditions.

ADHS has assembled a lot of information and public comments on these four conditions, including research ADHS commissioned from the University of Arizona College of Public Health,  all of which is available on its website.  Between now and the announcement of the decision on the four petitions, Arizoneout will be reviewing the collected materials and offering tidbits of particular interest to employers.

ADHS Director Will Humble is quite firm that the decision will be based on the medical evidence.  "I want to make sure I'm basing my decision on good science, and Iʼm really looking at the full weight of the evidence," he told the Arizona Republic.

Humble has no illusions, however, that the ADHS decision on the petitions will go down without challenge.  No, being the litigation veteran he has become since passage of the AMMA in November 2010, he probably expects to be sued no matter what ADHS decides.  The AMMA itself authorizes judicial review of decisions on petitions to add debilitating medical conditions.
July also likely will bring another round of petitions, and some probably will propose the same four conditions now under ADHS review, if more scientific evidence has become available in the last six months.  ADHS will accept such petitions for five days from July 23 to 27.  Just part of the AMMA's never-ending, ever-expanding mechanism for making marijuana available for medical use.

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