Nancy Onyett, FNP-C

The Perils of Medical Marijuana in Arizona

In November 2010 Arizona voters won by a narrow margin for legalizing medical marijuana. Since then Arizona policymakers with assistance of the pain society wrote the statutes for use of marijuana. In Article 2 , R9-17-201 a patient must have one of the following debilitating conditions diagnosed by a physician to qualify for registration to obtain a medical marijuana card.

1. Cancer

2. HIV

3. Glaucoma

4. AIDS

5. Hepatitis C

6. ALS

7. Crohns disease

8. Alzheimers disease with agitation

9. Cachexia or wasting syndrome from a chronic medical disease

10.Chronic pain from a disease

11. Chronic nausea from a disease

12. Seizures from a chronic disease including those in the form of Epilepsy

13. Severe persistent muscle spasms from a chronic disease characteristic of MS.

14. Lastly, an added disease that is debilitating in ADL's with substantiation that medical marijuana will be of palliative benefit through description of the disease and patient afflictions along with peer reviewed articles for benefit.

The above patient physician relationship must be fully documented with history, physical exam, diagnosis and the reason for medical marijuana in palliative care. At any time, a physician can request a card holder to be revoked from their medical marijuana card based on evidence of diversion, no benefit, and noncompliance.

The irony in medical marijuana; it is still against federal law. Secondly, there are no scientific evidence based medicine guidelines for efficacy in treatment of pain with dosing, effects of marijuana on the pain receptors and benefit vs harm. Therefore, the DEA classifies medical marijuana as a Controlled substance Class I and an illegal substance for medical use based on no scientific evidence. The Federal Prosecutor issued a warning to Arizona State Health Department on May 3,2011 stating cultivators, patients, and caregivers are breaking federal law. http://the420times.com/2011/05/arizona-federal-prosecutor-warns-state-about-medical-marijuana/. In Rhode Island, Maine, Colorado, and California there are documented reports of cultivators and patients prosecuted along with physicians in some states.

The AMA still firmly stands against endorsement for medical marijuana and state regulated marijuana programs. In November 2009, the AMA called for the federal government to ease the restrictions with marijuana for more scientific research. http://www.cbsnews.com/8301-503544_162-5614233-503544.html However, the AMA stands firm in not endorsing it.

The Arizona Pain Society has not endorsed medical marijuana and the Arizona Medical Board policy for Pain Management as endorsed by American Pain Society and the American Academy of Pain Medicine has not endorsed medical marijuana.

How does all the controversy with the boards and laws exist amongst practicing physicians in Arizona. It is easy either they prescribe or they don't. Most of the ones I talked with at the Arizona Pain Society/ Medical Marijuana Conference were against medical marijuana. It is a harm rather than benefit to the public and a drug that can easily be diverted. It will be hard for patients to find a physician in Arizona to prescribe it. Physicians and nurse practitioners adhere to the guidelines with Board of Medicine and the Board of Nursing in prescribing opioids. Those patients who do receive their medical marijuana cards will be reinforced to stay with their physician for pain management due to medical liability with marijuana detection in their urine.

The Medical Marijuana Program is new to Arizona and only passed by a margin of the voters. Most medical professionals and societies for pain management are against it due to the lack of scientific evidence. There isn't a reason to give a patient an addictive substance when pain medications can be manipulated for better pain control. Over the next few years we will watch how the Board of Medicine, and the Arizona Pain Society deals with this issue. I doubt anything will change in policies and guidelines. It is a hard drug to do research for evidenced based medicine.

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Human Growth Hormone

In Age Management medicine, human growth hormone has a place in treatment for conditions of deficiency. In the older adult an IGF1 < 175 accompanied with signs/symptoms of aging are the criteria to treat and improve many of these contitions. In review sign/symptoms of aging include fatigue, decreasing energy, diminishing drive for activity, socialization, memory impairment, poor sleeping, thinning hair, wrinkling, loose skin, centripetal fat deposition, decreasing strength, cardiovascular disease, decreased bone mass, hyperlipidemia, and insulin resistance. Generally, it is the signs and symptoms of aging with age related diseases. The benefits of growth hormone replacement include improved vitality, cardiovascular function, improved lipolysis and helps to reverse the signs/symptoms of aging towards health and vitality.

Growth hormone is titrated in slowly via injection daily for optimal range per blood work. Blood levels fluctuate throughout the day and requires blood work to be done at different times for safety in dosing. This is a critical aspect in compliance on the patient's part to contribute to their health. The blood work is evaluated and dosing adjustments are made for optimal IGF1 ranges. Growth hormone is safe, there is not a study in the literature that negates it; although, it is one of the most feared and under known of hormones. The only contraindication to growth hormone is cancer. One reason why patients are screened with history and physical exam along with blood work and advanced testing for risk factors before being administered growth hormone. Patients must keep up with their current mandatory testing and screening for cancer yearly including, PSA, prostate exam, mammogram, and pap smear. Colonoscopy is a must baseline and as recommended by gastroenterology for frequency in follow up colonoscopies.

Anyone over 50 years old who has been on hormone supplementation and still feeling signs/symptoms after six months of therapy are candidates for growth hormone if their IGF1 is < 175 and determined by their health care provider. Growth hormone is a healing hormone often used in burns and trauma. It is elective in age management medicine, because it is not medically necessary therefore insurance does not cover it. If it wasn't so costly, more elderly patients would be using it.

Side effects associated with growth hormone administration include edema, insulin sensitivities, and carpal tunnel syndrome. These side effects are easily corrected with dosing adjustments from the provider. What is important to know is growth hormone does not cause cancer but if someone has a cancer and takes growth hormone then the cancer will grow. Again, that is why careful screening, with history and physical, lab work and advanced testing is critical to health and safety before growth hormone administration. Elderly patients who are interested in growth hormone must see an age management provider.

 

 

Disclaimer: Patients are to be under the care of a physician or nurse practitioner trained in Age Management Medicine for safety and improvement in health and well being.

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Chronic Disease: Acquired or Genetic

More than one-third of the American population is chronically ill. That doesn’t factor in the idea that you can be 80 percent not well before the first symptoms of disease manifest. Even if you have no outward signs of disease, you may still be heading into a downward spiral that will cause chronic disease later in life. It may take twenty years for enough tumor cells to show up on an x-ray or mammogram. At the time of the diagnosis, you’re at the end stage of a healing crisis, not the beginning. Your arteries could be 90 percent occluded before you experience the first symptoms of angina or some other condition. It might take forty years for an occlusion to get that bad. You’re told it was caught early, when, in actuality, you got it at the end. So, we’ve got possibly another 100 million people walking around who are processing disease that is not yet diagnosed. Then we have another 50 million people who have the early stages of disease. These are our youth.

Most of what we call aging is simply the presence of disease – chronic, seemingly ubiquitous disease that makes us age with such apparent time-dependent consistency that we accept it universally as “simply getting older.” Estimates suggest that up to 90 percent of adult illness is due to the degenerative processes of aging. Despite commonly held beliefs that aging is mostly out of our control, inherited genetics accounts for less than 30 percent of all aging effects, and the importance of genetic inheritance matters less and less the older your calendar age. By the age eighty,behavioral choices account almost entirely for a person’s overall health and longevity.

More than 65 percent of annual American deaths are attributable to heart disease, cancer, and stroke. These three diseases,degenerative diseases of aging, consume more than fifty percent of the U.S.health-care budget. Moreover, health care costs are increasing at double-digit rates each year. The trouble is we have little to show for it. Any improvements in the incidence of heart disease have been because of lifestyle improvements, not medical ones. The same is for cancer.

Prevention is the only vehicle that will account for change. If we really want to make an impact on health care in this country and throughout the world, the focus must be on preventing the degenerative diseases of aging. Instead of micro-managing disease, we should focus on macro-managing wellness. Ninety percent of first heart attacks result from preventable lifestyle choices. The same is true of type II diabetes. The overwhelming majority of cancers are avoidable. These diseases along with many others, such as Alzheimer's disease, are not a component of natural aging. Rather, they are a form of pathological aging that results from a lifetime of unhealthy choices. If we can slow the physiologic processes of aging we can alleviate more than 50 percent of all disease overnight. We can alter this dreadful course by preventing, delaying, or reversing the diseases associated with aging.

Only a small percentage of the American population is truly healthy. And it is no accident that they are healthy. They work at it. So when will you change? You are most likely to change when you lose it all, when you realize one day that you’ve made the wrong choices. Think of how many times you changed because you lost everything. Breaking old habits takes courage. It begins with mindfulness – attention and intention. You can make the mindful decisions to make the changes in your life to grow younger, not older, with each passing day.

[Adapted from Gary Null’s
Ultimate Anti-Aging Program. Gary Null,
PhD. Broadway Books, 1999]