Nurses group seeks more approved uses for medical pot

Members of the Arizona Cannabis Nurses Association are petitioning the Department of Health Services to add those conditions and four more to the list of what qualifies people to use the drug. The voter-approved Arizona Medical Marijuana Act requires the agency to consider the requests.

To date, all other efforts have failed — with one notable exception for post-traumatic stress disorder. And that approval came only after the petition was denied and the case wound up in court.

What may make the outcome different this time around is that the nurses group has apparently figured out exactly what the law requires. Most significantly, a medical condition can be added only if there are peer-reviewed studies that have been published in medical journals.

Attorney Ken Sobel, who represents the nurses, has provided such references in each of the eight new petitions submitted. But it remains to be seen whether these studies prove acceptable to Cara Christ, who took over as state health chief earlier this year.

Sobel acknowledged these are not the same kind of studies the Food and Drug Administration requires before approving new drugs.

Those involve not just large numbers of people, but are double-blind studies, meaning neither the researcher nor the patient knows who is getting the real drug and who is getting a placebo.

But he insisted that doesn’t matter — at least as far as Arizona law goes.

“The first prong is that we have articles published in peer-reviewed scientific journals that show that people suffering those conditions have a benefit from cannabis,” Sobel said. “Requiring an FDA-like standard … was never under the Arizona Medical Marijuana Act.”

He insists that “plant medicines” are not subject to the same standards. Beyond that, Sobel said federal officials have refused to approve full-blown research projects on the benefits of marijuana, making such studies unavailable.

Christ would not comment about the petitions — or what she intends to demand as proof.

The 2010 voter-approved law lists specific medical conditions for which doctors may recommend the drug. With that recommendation and a state-issued card, a patient can purchase up to 2½ ounces every two weeks.

So far, close to 80,000 Arizonans have qualified as patients.

On the list are things like glaucoma and AIDS. But most of the state-issued marijuana-user cards have been under the category of having any chronic or debilitating condition that leads to severe and chronic pain.

An aide to Christ said she will contract with the Mel and Enid Zuckerman College of Public Health at the University of Arizona to review all available studies to determine if there is sufficient evidence to suggest that marijuana is helpful in treating the ailment itself, or at least the symptoms. That will also include taking a closer look at the studies Sobel cited to determine if they’re scientifically significant.

That could prove a closer call. For example, a petition to add rheumatoid arthritis mentions a study about the use of Sativex, a commercial form of marijuana.

Sobel says the study found a “significant analgesic effect” following treatment, with disease activity “significantly suppressed.” But even there, researchers concluded the differences are small and variable across the population, showing the need for more detailed investigation.

In the case of Huntington’s disease, caused by nerve breakdown in the brain, Sobel said there is no known cure.

Instead, he said, the issue is managing the disease for the comfort of the patient, including anti-depressants and medications to control anxiety and seizures. But he said these have their own side effects, along with the possibility of overdose.

“Medical marijuana, on the other hand, does not carry with it many of these negative side effects, yet may help to reduce tension and anxiety as well as help reduce nausea, restlessness or insomnia,” he wrote in the petition. “In addition, there is no reported overdose in the 5,000-year history of man’s use of cannabis, and the addiction rate is less than caffeine.”

The petitions have gotten the attention of Maricopa County Attorney Bill Montgomery, who opposed the 2010 measure.

Montgomery said his focus remains on killing a proposed 2016 ballot measure to allow the recreational use of marijuana.

“But I can say, ‘I told you so.’ Back in 2010 there was more than one discussion that the Arizona Medical Marijuana Act system could become a de facto recreational system,” he said, basing his statement not only on the ability to get the drug for chronic pain but the ability to add more conditions later.

“Maybe we’ll also see presbyopia added, too?” he quipped, a reference to being farsighted.

Under the rules, Christ has until the end of October to determine if there’s enough evidence to even schedule a legally required public hearing.

The addition of PTSD to the list was not easy, with Will Humble, Christ’s predecessor, rejecting the application after concluding there was not enough medical evidence.

But Maricopa County Superior Court Judge Thomas Shedden said Humble was wrong to base his ruling solely on the lack of scientific peer-reviewed studies.

The judge said the health chief should also have considered the testimony of doctors and nurses who said the drug has helped their patients.

Before there was an appeal, Humble changed his mind after finding there is at least one study showing the drug can be helpful in treating the symptoms of PTSD. He said that — combined with some anecdotal evidence — provides what he needs under Arizona law to allow a doctor with a qualifying patient to recommend the drug.