Advocates Fight to Expand Criteria for Medical Marijuana


Arizona Cannabis Nurses Association seeks to expand medical marijuana access for chronic conditions, such as post-traumatic stress disorder.

Arizona Cannabis Nurses Association seeks to expand medical marijuana access for chronic conditions, such as post-traumatic stress disorder.

With the addition of adult use medical marijuana dispensaries in various parts of the country, many patients have multiple avenues to access the care they need with the medication they want.

Despite the large volume of patients trying to access care with medical cannabis, opposition still abounds when it comes to expanding the current criteria for accessing care with medical marijuana. Through groups like the Arizona Cannabis Nurses Association (AZCNA), whose mission is to expand the existing criteria to encompass an array of chronic conditions, policymakers are becoming more educated about the potential benefits to treatment with medical cannabis and are beginning to embrace mental disorders as grounds for treatment with medical marijuana.

Heather Manus, RN, founder and president of the AZCNA, has worked tirelessly with a group of fellow nurses to expand the criteria for treatment with medical cannabis to include individuals who suffer from post-traumatic stress disorder (PTSD). As of January 1, 2015, the state of Arizona lists PTSD as a condition that deserves treatment with medical cannabis.

This was the first time a department had ever been ordered to add a condition to a medical marijuana program in the state. But the road to success was not an easy one to navigate. Manus was met with much opposition in her efforts to successfully pass legislation to include PTSD in the medical marijuana program.

Much of the opposition stemmed from the fact there is little research to support medical cannabis as medically beneficial to patients.

“They’re saying there’s not enough research that’s available, and what I would say to that is, you’re right! There’s not a whole lot of research that’s available and there’s a very, very good reason for that,” Manus said. “We’re not really able to conduct research on the benefits of cannabis in the United States. It creates all this controversy just to try and do a study. But if you really do dig and you really do look you see that there’s research going on all over the world on cannabis.”

So digging for facts is exactly what the AZCNA did. Over a two-month period of time, the educational patient advocacy group analyzed 2000 pages of medical literature and created about 150 pages of written text in the form of 8 petitions for different disease processes, including traumatic brain injury, Autism, arthritis, and Parkinson’s disease.

Yet, despite their best efforts to provide meaningful evidence to policymakers about the benefits of medical marijuana for these conditions, many still oppose on the grounds that the research is not sufficient enough.

“They’re actually looking for the study that says a patient with Autism used cannabis and had this amount of results,” Manus explained. “We don’t really have studies like that. We have more broad areas of this in the disease process, this is how cannabis works in the biological pathways in the cannabinoids, and you can put 1 and 1 together to say this makes sense that cannabis would help for this condition.”

That’s exactly the type of logic the AZCNA tried to instill in the courtroom when they presented their case for PTSD to be added to the medical marijuana program. As they went through the processes of the endocannabinoid system and described how the use of marijuana effectively regulates that system and serves as the homeostasis mechanism for the body, a shift began to come over the courtroom and something very important happened: they listened.

“When we got to court we did something very, very important. We didn’t go in there and make a fool; we went in there and educated,” Manus said. “We educated the other side. They were in shock at some of the things that we were saying. They didn’t even understand the studies, or the information, or the real down and dirty stories.”

The AZCNA also had patient advocates present at the courtroom hearing. One of these was a veteran who shared the harrowing story of his battle with suicidal ideation due to his PTSD and the ineffective pharmaceuticals he was taking.

He said that medical marijuana saved his life from suicide, as his insight shook the core of the courtroom. His moving story lead to the ultimate decision that PTSD could be added to the medical marijuana program.

But why does this program need to be expanded to incorporate conditions other than chronic pain? Many of the conditions patients present with allow them to access treatment with medical marijuana because of the chronic pain associated with their condition.

So what importance would expanding the criteria bring?

“One of the things they say in Arizona is that we don’t need to expand [the criteria],” Manus said. “Everybody just qualifies under chronic pain. You don’t need to add anymore conditions because everyone can just go under chronic pain. You’re right. They could do that. But what are we missing? We’re missing an opportunity to collect data on very specific diseases from patients that are choosing to use cannabis therapy.”

That kind of data is exactly the type of research policymakers ask for when dealing with cases for medical marijuana: evidence to support that medical marijuana can benefit certain conditions. In order for that data to be collected, decision-makers will have to include a wide array of conditions in the medical marijuana program, not only in Arizona, but across the country.

While the AZCNA is taking steps in the right direction with their petition to include PTSD, as well as petitions for other chronic conditions, their win with PTSD did not come without stipulation.

“Unlike any other patient on the program, they stated that a PTSD patient would have to prove that they were currently undergoing conventional therapy before they would qualify to get their card for PTSD,” Manus explained.

After a long, tiresome battle with the court systems, Manus and her team almost decided to let the stipulation go. However, when unhappy veterans came to the AZCNA pleading with them to not give up the fight, Manus decided the stipulation needed to be removed.

The AZCNA has appealed the court’s decision and is currently fighting to get the discriminatory language removed.

“You don’t tell a cancer patient that they can’t receive cannabis if they’re not on chemo,” Manus said. “You don’t tell a chronic pain patient that they can’t receive cannabis if they’re not on opiates. So why would you do that to a PTSD patient and say you can’t qualify if you’re not on anti-depressants?”

The AZCNA continues to advocate for patients and educate others about the benefits of medical cannabis. As the only group to succeed in bringing change to the medical marijuana program, they remain hopeful about their mission to further expand the criteria to include other chronic conditions.

“People say all the time that cannabis is a gateway drug, and I say cannabis is a gateway,” Manus said. “Cannabis is a gateway to health. I’ve seen that over and over repeatedly and I know this to be true.”

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