Friday, November 16, 2012

Biggest Fear: Medical Marijuana and Pregnancy

The Republic | Tue Nov 13, 2012 10:29 PM
Arizona pediatricians are concerned that the state’s medical-marijuana law is being used to treat the ailments of pregnant women, potentially harming fetuses.
Members of the Arizona chapter of the American Academy of Pediatrics want to stop the practice and point to one incident in which a mother in labor told hospital officials that she had received a medical-marijuana card during pregnancy and had been using the drug.
The mother later told her baby’s pediatrician, Kara Tiffany, that a physician who was aware of her pregnancy recommended the marijuana. The mother showed the pediatrician her medical-marijuana-certification documents, which indicated that a naturopath made the marijuana recommendation.
“I was appalled,” Tiffany told The Arizona Republic, adding that the mother told her the naturopath researched marijuana use during pregnancy and “thought it would be OK.”
Recommending marijuana to pregnant women appears to be legal under Arizona’s medical-marijuana law, passed by voters in 2010.
The law allows people with certain debilitating medical conditions — such as severe nausea, chronic pain and cancer — to use marijuana. Patients must obtain a recommendation from a physician and register with the state, which issues identification cards to qualified patients and caregivers. Patients can obtain up to 2½ ounces of marijuana every two weeks.
Program rules require physicians to perform a physical exam, a review of a year’s worth of medical records and a review of a state database that tracks certain prescription-drug use. Physicians are not required to ask patients if they are pregnant.
“It’s totally up to their physician,” said Department of Health Services Director Will Humble, who oversees the state’s medical-marijuana program. “If the physician signs off on a series of attestations that we ask for, then, by our rules, that’s a certification for medical marijuana.”
A woman’s decision to use medical marijuana while pregnant, even if she has a card, could affect her parental rights, however.
Depending on the physician and the hospital, state Child Protective Services is contacted if use of certain substances — such as marijuana, alcohol and other drugs — is suspected, said Susan Stephens, medical director for the health plan that covers children in the state’s foster-care program. In those instances, CPS can open an investigation and immediately visit the child in the hospital and the home to assess his or her safety.
No one tracks the number of pregnant women who may have received recommendations for medical marijuana.
Physicians and the lobbyist for the Arizona chapter of the American Academy of Pediatrics said the issue has lit up the organization’s LISTSERV, with other physicians who say they, too, have encountered pregnant women obtaining medical-marijuana recommendations.
The Arizona chapter plans to work with lawmakers to introduce legislation in the coming session that, if approved, would prevent pregnant women from receiving recommendations for marijuana; require physicians who recommend marijuana to ask patients if they are pregnant; and require women to submit to pregnancy tests when seeking recommendations.
Such changes would require approval by a supermajority of the Legislature because it would alter a voter-approved law and a revision of program rules by state health officials.
The group also wants lawmakers to earmark a portion of money raised through the program to pay for developmental testing on the effects of marijuana on babies and breast milk. The effects of marijuana on fetuses are unclear; studies have contradicted each other on the effects, such as low birth weight and memory problems.
“All women need to be informed that the effects of marijuana on a developing baby are not known, and, therefore, it should not be used,” said Sue Braga, executive director of American Academy of Pediatrics’ local chapter. “This is an unintended consequence of this law — I want to believe —and it needs to be corrected.”
Karen O’Keefe, director of state policies at the Marijuana Policy Project in Washington, D.C., said none of the 18 states and Washington, D.C., with medical-marijuana laws explicitly ban pregnant women from obtaining marijuana recommendations.
Andrew Meyers, campaign manager for the organization that got the program on the Arizona ballot, said “it was never intended that pregnant women would access the program.” He said supporters approached the drafting of the law with the idea of trusting physicians to make appropriate medical decisions for patients.
“I cannot imagine that an ethical physician would not consider the well-being of a fetus if a pregnant woman was seeking a medical-marijuana card,” Meyers said. “If this is a serious problem … it’s something that needs to be worked on.”
But Meyers said the best way to approach the issue is through education at the licensing-board level — not through legislation.
Medical regulatory boards are typically at the forefront of such issues. In Colorado, for example, a doctor last year surrendered his medical license after the state’s medical board accused him of failing to meet expected standards of care because he did not perform a physical exam on a patient, review her medical history or ask if she was pregnant before recommending marijuana. At one point, the doctor disputed whether using marijuana during pregnancy was harmful, according to public records.
The Arizona Naturopathic Physicians Medical Board, which regulates naturopaths in Arizona, has not received complaints related to the practice of recommending the drug to pregnant women, Deputy Director Gail Anthony said. Naturopaths, according to a new state report on the program, are the physicians who most often recommend medical marijuana to patients.
The Arizona Medical Board regulates pediatricians, obstetricians, gynecologists and all other medical doctors and has had one case involving a pregnant woman who was recommended medical marijuana as well as prescribed opioids, which are clinically known to be dangerous to fetuses, Executive Director Lisa Wynn said. Ultimately, the doctor was disciplined for prescribing the OxyContin.
“It goes against the standard of care for a doctor to prescribe narcotics to a pregnant woman,” Wynn said. “However, the standard of care for recommending medical marijuana is evolving … as well as voter-driven.”
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