Assignment: Position Paper on Health Policy

Assignment: Addressing Patient Safety and Quality of Care through Policy

NURS 4105: Advocacy through Healthcare Policy

Maria Pribe

Walden University

September 15, 2019

Addressing Patient Safety and Quality of Care through Policy

The legalization of the policy relating to the use of Marijuana in Michigan for adults aged 21 years and older removes criminal and monetary penalties for the possession, use, and supply of the drug for recreational purposes (Todd, 2018). The Michigan Medical Marihuana Act legalized the growth, possession, and use of marijuana. A 21 year and older will be allowed to possess 2.5 ounces of marijuana and grow up to 12 plants in an enclosed area (Michigan Regulation and Taxation of Marihuana Act, Initiated Law 1, 2018). The aim of writing this paper is to address patient safety and quality of care through policy.

Ways that the Policy Addresses Safety, Quality, and its Implications Triple Aim Initiative

Medical cannabis products acquired from dispensaries and state programs follow the specified Michigan requirements of growing, formulation, manufacturing, marketing, and distribution (Thomas & ElSohly, 2016). In the United States (US), there is an increase in errors in the chemical content and inaccuracies in the labeling of products purchased from medical cannabis markets. According to Thomas and ElSohly (2016), an analysis of the tetrahydrocannabinol (THC) content on 75 products from 47 brands indicated that 17% were accurately labeled, 23% had inadequate descriptions, and 60% had an increase in classifications. Additionally, the FDA reported that in the US, firms were marketing cannabidiol-containing drugs that had not been approved thus indicating a decrease in quality control measures. Also, edibles that resemble sugars may increase intoxication or unintentional consumption. Therefore, the risk of overdosing is exacerbated by the absence of appropriate labeling and the lack of an FDA-approved antagonist that reverses the effects of the drug (Thomas & ElSohly, 2016).

States that have legalized the use of marijuana have laws requiring product safety testing for contaminants, pesticides, and cannabinoids before selling (Klieger et al., 2017). Consequently, the labeling rules outline the need to indicate the health risks, the strain of marijuana used, product potency, and proof of contaminant testing. Due to the concerns of accidental ingestions of edibles by children, manufacturers are required to have child-resistant packaging and labeling (Pacula & Smart, 2017).

To address safety and quality, the state of Michigan has regulations that outline the standards of testing, packaging, and labeling of products (Michigan Regulation and Taxation of Marihuana Act, Initiated Law 1, 2018). It is also a requirement that for marihuana-infused products, the maximum level of THC and the amount of marihuana concentrate is specified on the product label. Also, a sample of the product needs to be tested by a marihuana safety compliance facility before distribution (Michigan Regulation and Taxation of Marihuana Act, Initiated Law 1, 2018). Consequently, restrictions have been made on advertising, marketing, and display of marihuana to protect adolescents and children from early exposure to the drug.

The Institute for Healthcare Improvement (IHI) developed a framework that illustrates the efficient approach to optimizing health system performance (The IHI Triple Aim Initiative, n.d.). The objective of IHI Triple Aim is to improve the quality and experience of care offered to the patient, enhance the health of the population, and reduce the per capita cost of accessing health care. Communities that accomplish the Triple Aim have populations with improved health because of designing policies that identify healthcare problems and provide solutions to them.

The medical cannabis programs achieve the objectives of the IHI Triple Aim because the interdisciplinary services of medical cannabis programs improve the patient healthcare experience. Furthermore, medical cannabis was found to be effective in managing cancer and opioid addiction, therefore, it improves the health of the population because patients are offered coordinated care that decreases the illness (The IHI Triple Aim Initiative, n.d.). Additionally, economic benefits have been observed in states with medical cannabis programs such as reduced Medicare Part D spending and increased taxation profits. Hence, a reduction in the per capita cost of care for populations reduces publicly funded health care budgets. Assignment: Position Paper on Health Policy

The Effectiveness of the Policy on Improved Outcomes of Care for Patients

States that have legalized the use of medical marijuana to treat chronic pain have reduced opioid overdose deaths and untreated use disorder (Lucas & Walsh, 2017; Todd, 2018). In states that have legalized medical marijuana, the overdose death rates reduced by 25%. Legal access to marijuana has also caused a reduction in opioids dependence or hospitalization because of abusing the drug by 23% (Todd, 2018). Studies show that patients use marijuana to reduce the use of opioids for mental health and pain-related conditions (Todd, 2018). The increased rate of substitution for prescription drugs among the patients suggests that medical cannabis may be an effective treatment for the conditions (Lucas & Walsh, 2017).

Cannabinoids regulate crucial cell signaling pathways that are involved in its survival, angiogenesis, invasion, and metastasis. A research conducted by Orellana-Serradell et al. (2015) detected the presence of cannabinoid receptors on prostatic cancer and then assessed the effects of the in vitro use of synthetic cannabis analogs. The study established that there is a presence of a dose-dependent inhibitory effect that included an increase in the levels of activated caspase-3 and a decrease of Bcl-2, confirming the activation of apoptosis. The researchers also observed an endocannabinoid-modulated activation of the ERK path-way and a concurrent reduction in the AKT pathway activation. This observation suggests that endocannabinoids may impact the treatment of prostate cancer (Orellana-Serradell, 2015).

Role of the Nurse in Addressing the Quality and Safety Standards within the Policy

In the United States, the federal government classifies cannabis as a schedule 1 controlled substance with increased chances for abuse and no accepted medical value. Nurses are important in providing quality care in the health care system because of their frequent interactions with patients (Mason, Gardner, Outlaw, & O’Grady, 2016). Therefore, nurses may influence practice standards and processes to ensure the quality of care through policy work. Nurses are required to have practical information to effectively care for the increasing number of patients using cannabis through the medical marijuana program and those who self-administer the drug for recreational purposes or treatment of different conditions (National Council of State Boards of Nursing [NCSBN], 2018).

A nurse requires to know the current state of legalization and the jurisdiction of medical and recreational cannabis (NCSBN, 2018). An understanding of the endocannabinoid system, cannabinoid receptors, pharmacology, and the research associated with the medical use of cannabis. Additionally, nurses need to identify the safety considerations for patient use of cannabis to treat the patient without judging their choice of treatment (NCSBN, 2018). These principles provide the nurse with the essential knowledge for providing safety and quality care for the patients using medical or recreational marijuana.

Opinion about the Policy

I support the policy on the legalization of Marijuana in Michigan state for adults 21 years and older because of its therapeutic benefits. Studies show that cannabinoid-based medications are effective in the treatment and management of chronic pain and cancer (Orellana-Serradell, 2015; Lucas & Walsh, 2017). However, nurses lack evidence-based resources when caring for patients who use medical or recreational marijuana because of its classification as a schedule 1 controlled substance (NCSBN, 2018). Assignment: Position Paper on Health Policy

References

Klieger, S. B., Gutman, A., Allen, L., Pacula, R. L., Ibrahim, J. K., & Burris, S. (2017). Mapping medical marijuana: State laws regulating patients, product safety, supply chains and dispensaries. Addiction, 112(12), 2206–2216. doi:10.1111/add.13910

Lucas, P., & Walsh, Z. (2017). Medical cannabis access, use, and substitution for prescription opioids and other substances: A survey of authorized medical cannabis patients. International Journal of Drug Policy, 42, 30–35. doi:10.1016/j.drugpo.2017.01.011

Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2016). Policy & politics in nursing and health care (7th ed.). St. Louis, MO: Elsevier.

Michigan Regulation and Taxation of Marihuana Act, Initiated Law 1 (2018). Retrieved from https://www.legislature.mi.gov/(S(r03jnxzfjaqkfrcvnkpajhxx))/documents/mcl/pdf/mcl-Initiated-Law-1-of-2018.pdf

National Council of State Boards of Nursing (2018). The NCSBN national nursing guidelines for medical marijuana. Journal of Nursing Regulation, 9(2). Retrieved from https://www.ncsbn.org/The_NCSBN_National_Nursing_Guidelines_for_Medical_Marijuana_JNR_July_2018.pdf

Orellana-Serradell, O., Poblete, C. E., Sanchez, C., Castellón, E. A., Gallegos, I., Huidobro, C., . . . Contreras, H. R. (2015). Proapoptotic effect of endocannabinoids in prostate cancer cells. Oncology Reports, 33(4), 1599–1608. doi:10.3892/or.2015.3746

Pacula, R. L., & Smart, R. (2017). Medical marijuana and marijuana legalization. Annual Review of Clinical Psychology, 13(1), 397–419. doi:10.1146/annurev-clinpsy-032816-045128

Institute for Healthcare Improvement. (n.d.). Retrieved from http://www.ihi.org/Engage/Initiatives/TripleAim/Pages/default.aspx

Thomas, B. F., & ElSohly, M. A. (2016). The Analytical Chemistry of Cannabis: Quality Assessment, Assurance, and Regulation of Medicinal Marijuana and Cannabinoid Preparations (pp.83–99). St. Louis, MO: Elsevier. http://dx.doi.org/10.1016/B978-0-12-804646-3.00005-9

Todd, T. (2018). The benefits of marijuana legalization and regulation. Berkeley Journal of Criminal Law, 23(1), Article 6. https://doi.org/10.15779/Z38NK3652D

Assignment: The Cost of Health Care

NURS 4105: Advocacy through Healthcare Policy

Name: Maria Pribe

Walden University

Instructor: Dr. Dorothy Roberts

September 8, 2019

The Cost of Health Care

Cannabis is an illicit drug that is frequently cultivated, trafficked, and abused worldwide. According to the world health organization (WHO), the consumption of cannabis has an annual prevalence rate of 2.5% of the global population (Bridgeman & Abazia, 2017). The legalization of the use of medical marijuana has a significant impact on the cost, access, and quality of health care. A study conducted on conditions that medical marijuana is considered an alternative treatment method showed that states with active cannabis policies had fewer drug prescriptions (Bradford & Bradford, 2016). A reduced number of drug prescriptions cause a decrease in Medicare Part D and enrollee spending. Hence, the use of medical marijuana is cost-effective (Lear-Phillips, 2018). The aim of writing this paper is to analyze the impact of financing and budgetary issues associated with the legalization of medical marijuana in Michigan State.

Funding and Annual Costs of Continuing of the Policy for the Last Year

Health care systems may be financed using government funding, taxation, donations, private insurance, and voluntary aid. The state of Michigan created a marihuana regulation fund in the state treasury to fund the legalization of the use of medical cannabis (Michigan Regulation and Taxation of Marihuana Act, Initiated Law 1, 2018). The initial funding of the policy will be appropriated from a general fund, however, proceeds from the fund would be used to repay any amount allocated. According to Wolfram (2016), the medical marijuana industry generates $44.3 million a year based on the current patient population.

Financial and Budgetary Efforts Developed to Contain Costs.

The state of Michigan passed legislation that allows limited sale and purchase of marijuana by individuals with certified licenses. Michigan’s regulatory agency, the Department of Licensing and Regulatory Affairs, has imposed a 10% excise tax on all marijuana sales, minimum levels of insurance for individuals with licenses, and provide for the levy and collection of fines for violations of the act or rules (Wolfram, 2016). These legislations will create a transparent, licensed, and regulated medical marijuana industry in Michigan causing the collection of revenue to be consistent and businesses to operate under established rules, hence, promoting competition. Assignment: Position Paper on Health Policy

Current Cost-Containment Strategies

Public health and safety policies on medical cannabis are modified and changed to adapt to new regulations, restrictions, and penalties (Cornett, 2018). States that have permitted the use of medicinal cannabis have established laws that regulate its sale (Bridgeman & Abazia, 2017). The Michigan Medical Marihuana Act legalized the growth, possession, and use of marijuana to treat debilitating conditions such as neuropathic pain, spasticity in multiple sclerosis, and nausea because of chemotherapy. The law allows Michigan residents to be given permits by the department of licensing and regulatory affairs after a recommendation by a certified doctor. Therefore, a 21 year and older will be allowed to possess 2.5 ounces of marijuana and grow up to 12 plants in an enclosed area (Wolfram, 2016). However, government medical assistance programs and private health insurers do not provide reimbursement of medical cannabis expenses. The schedule 1 classification of cannabis causes hospitals and other care settings that receive Medicare reimbursement or federal grants to consider the potential loss of the funds. The loss of funds may occur if the government penalizes hospitals because of permitting the use of marijuana therapy in their facilities (Bridgeman & Abazia, 2017). In March 2019, Gov. Gretchen Whitmer approved the establishment of the Marijuana Regulatory Agency within the Michigan Department of Licensing and Regulatory Affairs (LARA). The new agency released regulations on the implementation process of the 2018 voter-approved law that legalized marijuana for adults 21 and older (Marijuana Policy Project, 2019). The guidelines outline the role of the agency in promoting the communities’ participation in the cannabis industry. Also, the rules included the provision of licenses that permit the use of cannabis for temporary events. The regulations by LARA provide license renewal fees that are triple-tiered based on the gross weight of products transferred the previous year by the individual, therefore, this will increase the revenue collection (Marijuana Policy Project, 2019). The use of medical marijuana under a strict regulatory framework will allow patients to have increased access to safe medicine. Additionally, the sale and production of the drug through a licensed and accountable system will enhance the growth of the business and promote competition, therefore, impacting the economy of Michigan (Wolfram, 2016).

Health Outcomes of Financing the Policy and the Role of the Nurse in the Workplace

In the United States (US), approximately 3.1 million individuals use marijuana daily (Wilkinson, Yarnell, Radhakrishnan, Ball, & D’Souza, 2016). Thirty states in the US have legalized the use of cannabis for medicinal and recreational purposes. However, the legalization of marijuana for medical use occurs by popular vote and this differs from the approval of medications by the U.S. Food and Drug Administration (FDA) that requires an intensified standard of evidence for both efficacy and safety (Wilkinson et al., 2016). Financing the use of medical marijuana will provide the state the ability to regulate its use causing safer use of cannabis. Consequently, there will be a decline in the prevalence of marijuana use among individuals (Wilkinson et al., 2016). However, the presence of operating medical marijuana dispensaries in certain municipalities may cause an increase in the use of the drug. Shih (2019) noted that young adults living near medical marijuana dispensaries had an increased rate of using the drug and this exposes them to the risk of developing mental and physical health problems.

The use of prescription opioids for patients with chronic pain may lead to an overdose. A research conducted on states having medical cannabis laws established that there was a reduced annual rate of opioid overdose and death by 24.8% (Cornett, 2018). Hence, an increase in the prescription of medical cannabis for health conditions such as cancer and chronic pain may reduce Medicare spending and private insurance costs (Lear-Phillips, 2018).

The role of a health care practitioner is to advocate for the patients’ rights and needs (Lear-Phillips, 2018). Medical marijuana applies to the future roles of nurses because they may encounter a patient with a prescription of the drug. It is the responsibility of the practitioner to ensure a patient acquires quality care in their institution. Therefore, the role of the nurse is critical in the provision of care because a provider may advise them to administer medical marijuana to patients with chronic pain before a therapy session (Lear-Philips, 2018). Additionally, the nurse is required to counsel the patient about safety to avoid developing health outcomes such as addiction to the drug. Assignment: Position Paper on Health Policy

References

Bradford, A. C., & Bradford, W. D. (2016). Medical marijuana laws reduce prescription medication use in Medicare part D. Health Affairs, 35(7), 1230-1236. doi:10.1377/hlthaff.2015.1661

Bridgeman, M. B., & Abazia, D. T. (2017). Medicinal cannabis: History, pharmacology, and implications for the acute care setting. Pharmacy and Therapeutics, 42(3), 180-188. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312634/

Cornett, L. N. (2018). Legalization of medical cannabis and potential implications for healthcare delivery in the United States. Kentucky Journal of Undergraduate Scholarship, 2(1), Article 2. Retrieved from https://pdfs.semanticscholar.org/d398/14ec2f6c8dca93ca50468c21b78ab2049415.pdf

Lear-Phillips, J. T. (2018). Medical marijuana and the healthcare system. Kentucky Journal of Undergraduate Scholarship, 2(1), Article 4. Retrieved from https://pdfs.semanticscholar.org/d0cd/bb93fa304207554ff46bb4559911d623b807.pdf

Marijuana Policy Project. (2019). Marijuana regulatory agency publishes emergency rules to implement legalization. Retrieved from https://www.mpp.org/states/michigan/

Michigan Regulation and Taxation of Marihuana Act, Initiated Law 1 (2018). Retrieved from https://www.legislature.mi.gov/(S(r03jnxzfjaqkfrcvnkpajhxx))/documents/mcl/pdf/mcl-Initiated-Law-1-of-2018.pdf

Shih, R. A. (2019). Young adults who live near medical marijuana dispensaries use marijuana more often, have more-positive views. Retrieved from https://www.rand.org/news/press/2019/06/17.html

Wilkinson, S. T., Yarnell, S., Radhakrishnan, R., Ball, S. A., & D’Souza, D. C. (2016). Marijuana legalization: Impact on physicians and public health. Annual Review of Medicine, 67(1), 453–466. doi:10.1146/annurev-med-050214-013454

Wolfram, G. (2016). The economic impact of a strong regulatory framework for medical marijuana in Michigan. Retrieved from http://www.mml.org/pdf/resources/Economic%20Report_Gary%20Wolfram.pdf